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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 932 Research Studies DisplayedSolberg LI, Ziegenfuss JY, Rivard RL
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
Drupal date: Fall, 2023
The goal of this study was to test the feasibility of collecting qualitative patient-preferred goals and its feasibility as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement. The study found that joint replacement patients who responded to quantitative PROMS were willing to report on their other preferred outcomes.
The goal of this study was to test the feasibility of collecting qualitative patient-preferred goals and its feasibility as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement. The study found that joint replacement patients who responded to quantitative PROMS were willing to report on their other preferred outcomes.
AHRQ-funded; HS025618.
Citation: Solberg LI, Ziegenfuss JY, Rivard RL .
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
J Patient Cent Res Rev 2023 Fall; 10(4):210-18. doi: 10.17294/2330-0698.2017..
Keywords: Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Al Hussein Al Awamlh B, Wallis CJD, Penson DF
Functional outcomes after localized prostate cancer treatment.
The objective of this observational cohort study was to compare rates of adverse functional outcomes between specific treatments for localized prostate cancer. Researchers used data from five U.S. Surveillance, Epidemiology, and End Results Program registries. Participants were patients treated for localized prostate cancer in 2011-2012. The results indicated that radical prostatectomy was associated with worse urinary incontinence, but not with worse sexual function, at 10-year followup when compared with radiotherapy or surveillance. Among patients with unfavorable-prognosis disease, external beam radiotherapy with androgen deprivation therapy was associated with worse bowel and hormone function at 10-year followup compared with radical prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: Al Hussein Al Awamlh B, Wallis CJD, Penson DF .
Functional outcomes after localized prostate cancer treatment.
JAMA 2024 Jan 23; 331(4):302-17. doi: 10.1001/jama.2023.26491.
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Keywords: Cancer: Prostate Cancer, Cancer, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Feltner C, Wallace IF, Nowell SW
Screening for speech and language delay and disorders in children 5 years or younger: evidence report and systematic review for the US Preventive Services Task Force.
This evidence report and systematic review reviewed the evidence on screening for speech and language delay or disorders in children 5 years or younger to inform the US Preventive Services Task Force. This literature review looked at English-language studies of screening test accuracy, trials or cohort studies comparing screening vs no screening; randomized clinical trials (RCTs) of interventions. Main outcomes and measures were screening test accuracy, speech and language outcomes, school performance, function, quality of life, and harms. A total of 38 studies in 41 articles were included (N = 9006). There were 21 studies (n = 7489) that assessed the accuracy of 23 different screening tools that varied with regard to whether they were designed to be completed by parents vs trained examiners, and to screen for global (any) language problems vs specific skills (e.g., expressive language). Three studies assessing parent-reported tools for expressive language skills had consistently high sensitivity (range, 88%-93%) and specificity (range, 88%-85%). Other screening tools had widely varying accuracy. Seventeen RCTs (n = 1517) evaluated interventions for speech and language delay or disorders. There were no RCTs included on the harms of interventions.
AHRQ-funded; 75Q80120D00006.
Citation: Feltner C, Wallace IF, Nowell SW .
Screening for speech and language delay and disorders in children 5 years or younger: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2024 Jan 23; 331(4):335-51. doi: 10.1001/jama.2023.24647..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Screening, Prevention, Evidence-Based Practice
Cantor AG, Jungbauer RM, Skelly AC
Respectful maternity care : a systematic review.
The purpose of this systematic review was to collect information on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving pregnant and postpartum maternal and infant health outcomes, and strategies for implementation. Frameworks for RMC were found to be well described but varied in definition. Evidence was lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome. Tools to measure RMC demonstrated consistency but lacked a gold standard; the authors conclude that further evaluation was needed before implementation in U.S. settings.
AHRQ-funded; 75Q80120D00006
Citation: Cantor AG, Jungbauer RM, Skelly AC .
Respectful maternity care : a systematic review.
Ann Intern Med 2024 Jan; 177(1):50-64. doi: 10.7326/m23-2676..
Keywords: Maternal Care, Women, Patient-Centered Outcomes Research, Evidence-Based Practice
Peaker B, Dooley C B, Peaker B, Dooley C C
AHRQ Author: Peaker B
Screening for syphilis in nonpregnant adolescents and adults.
This case study described a 42-year-old male presenting at the clinic with low back pain that had been radiating down his right leg for one week. Case study questions related to the USPSTF recommendation on Screening for Syphilis in Nonpregnant Adolescents and Adults addressed why this patient was at increased risk, whether screening should take place, and why the USPSTF does not recommend screening for all people.
AHRQ-authored.
Citation: Peaker B, Dooley C B, Peaker B, Dooley C C .
Screening for syphilis in nonpregnant adolescents and adults.
Am Fam Physician 2024 Jan; 109(1):79-80..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Evidence-Based Practice, Sexual Health, Children/Adolescents
Timbie JW, Reynolds KA, Evans EL
AHRQ Author: Cohen JW
Advancing data capacity for economic outcomes in patient-centered outcomes research: challenges and opportunities.
The HHS Office of the Assistant Secretary for Planning and Evaluation convened a symposium that brought together patients, researchers, federal agency representatives, and other stakeholders to discuss research on the collection, linkage, and analysis of economic outcomes data for patient-centered outcomes research (PCOR) studies. The purpose of this paper was to synthesize the information gathered in the symposium to guide efforts to build data capacity. The authors then emphasize preliminary opportunities to expand the availability and use of relevant, high-quality economic outcomes data as part of evidence generation in patient-centered outcomes research. Across panel discussions, 4 overarching themes arose to guide efforts to build data capacity for PCOR studies with economic outcomes: 1) Measurement and data collection for economic outcomes should enable a comprehensive, person-centered, and longitudinal understanding of health and other impacts; 2) Research data on economic outcomes should be high quality, accessible, timely, interoperable, and linkable. 3) Collaborative partnerships across stakeholder groups are essential for aligning, advancing, and sustaining efforts to improve the measurement and use of economic outcomes in PCOR; and 5) Economic outcomes in PCOR studies should be defined, collected, and analyzed in ways that advance health equity. With those factors in mind, the researchers explored opportunities to build data capacity for economic outcomes in patient-centered outcomes research in 4 domains: measurement, data collection, data linkage, and data access and use. Within each domain the researchers emphasize opportunities for meaningful, impactful improvements.
AHRQ-authored.
Citation: Timbie JW, Reynolds KA, Evans EL .
Advancing data capacity for economic outcomes in patient-centered outcomes research: challenges and opportunities.
Med Care 2023 Dec; 61(12 Suppl 2):s161-s65. doi: 10.1097/mlr.0000000000001901..
Keywords: Patient-Centered Outcomes Research, Evidence-Based Practice, Patient-Centered Healthcare
Tracer H, Lorei NC
AHRQ Author: Tracer H
Preexposure prophylaxis to prevent acquisition of HIV.
This case study described a 28-year-old woman presented to a community health clinic for sexually transmitted infection (STI) testing. Case study questions related to the USPSTF recommendation on Preexposure Prophylaxis (PrEP) to prevent acquisition of HIV, guidelines for candidacy for PrEP, guidelines for the use of PrEP for the primary prevention of HIV in adults.
AHRQ-authored.
Citation: Tracer H, Lorei NC .
Preexposure prophylaxis to prevent acquisition of HIV.
Am Fam Physician 2023 Dec; 108(6):617-18..
Keywords: U.S. Preventive Services Task Force (USPSTF), Human Immunodeficiency Virus (HIV), Prevention, Evidence-Based Practice
Hammack-Aviran C, Fair AM, Aldrich M
Integrating participants as partners in research governance and operations: an approach from the All of Us Research Program Engagement Core.
This paper examined the efforts to engage participants as partners in governance of large-scale research programs, in this case the NIH-sponsored All of Us Research Program, a precision medicine research initiative which intends to enroll at least one million participants. Over a 3-year period, the Consortium Members were surveyed to assess their readiness for participant engagement. During that period, all items on the survey increased, indicating higher readiness. Of the 291 respondents to the 2021 survey, there was almost unanimous agreement by respondents that participant perspectives are essential (100%), participants understand enough to contribute meaningfully (94%) and participants should be involved in setting goals (96%). There was less agreement that participants should have an equal voice in Working Groups (75%), Steering Committee (69%) and Executive Committee (63%).
AHRQ-funded; HS026122.
Citation: Hammack-Aviran C, Fair AM, Aldrich M .
Integrating participants as partners in research governance and operations: an approach from the All of Us Research Program Engagement Core.
BMJ Open 2023 Nov 27; 13(11):e068100. doi: 10.1136/bmjopen-2022-068100..
Keywords: Research Methodologies, Evidence-Based Practice
Chou R, Selph SS, Bougatsos C
Screening, referral, behavioral counseling, and preventive interventions for oral health in adults: a systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic evidence review on the effectiveness of primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force. The main outcomes were dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy. Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies with a total 3,300 participants were included. There were no trials that evaluated primary care counseling or dental referral. There was very limited evidence on screening accuracy, silver diamine fluoride, xylitol; and harms were very limited, although serious harms were not reported. One small study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity and high specificity for periodontal disease and with variable sensitivity and high specificity for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 and specificity of 0.74 for periodontal disease. For preventive interventions there were no studies that evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was found to be insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials). There were no trials that evaluated primary care-administered preventive interventions.
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Selph SS, Bougatsos C .
Screening, referral, behavioral counseling, and preventive interventions for oral health in adults: a systematic review for the US Preventive Services Task Force.
JAMA 2023 Nov 14; 330(18):1780-90. doi: 10.1001/jama.2023.20685..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Dental and Oral Health, Prevention, Evidence-Based Practice, Guidelines
McPheeters M, O'Connor EA, Riley S
Pharmacotherapy for alcohol use disorder: a systematic review and meta-analysis.
Researchers conducted a literature review and analysis to compare efficacy of therapies for alcohol use disorder. Their findings supported the use of oral naltrexone at 50 mg/d and acamprosate as first-line pharmacotherapies in conjunction with psychosocial interventions for treating alcohol use disorder.
AHRQ-funded; 75Q80120D00007.
Citation: McPheeters M, O'Connor EA, Riley S .
Pharmacotherapy for alcohol use disorder: a systematic review and meta-analysis.
JAMA 2023 Nov 7; 330(17):1653-65. doi: 10.1001/jama.2023.19761..
Keywords: Medication, Alcohol Use, Evidence-Based Practice, Patient-Centered Outcomes Research
Chou R, Bougatsos C, Griffin J
Screening, referral, behavioral counseling, and preventive interventions for oral health in children and adolescents aged 5 to 17 years: a systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic evidence review on the effectiveness of primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force. The main outcomes were dental caries, morbidity, functional status, quality of life, harms; and diagnostic test accuracy. Three systematic reviews with a total of 20,684 participants were included along with 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study with a total of 15,026 participants. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 at outcomes closest to 3 years (4 trials; n = 1525); fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 at 1 to 4.5 years (5 trials; n = 3902); and resin-based sealants were associated with decreased risk of carious first molars at 48 to 54 months (4 trials; n = 440). There were no trials that evaluated primary care counseling or dental referral. There was very limited evidence on screening accuracy, silver diamine fluoride, xylitol; and harms were very limited, although serious harms were not reported.
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Bougatsos C, Griffin J .
Screening, referral, behavioral counseling, and preventive interventions for oral health in children and adolescents aged 5 to 17 years: a systematic review for the US Preventive Services Task Force.
JAMA 2023 Nov 7; 330(17):1674-86. doi: 10.1001/jama.2023.20435..
Keywords: Children/Adolescents, Dental and Oral Health, Screening, Prevention, Evidence-Based Practice, U.S. Preventive Services Task Force (USPSTF), Guidelines
Mahenthiran AK, Logan CD, Janczewski LM
Evaluation of nationwide trends in nodal sampling guideline adherence for gastric cancer: 2005-2017.
This study’s purpose was to evaluate trends in program-level disparities in adherence to gastric cancer nodal sampling guidelines. The cohort included 55,421 patients who underwent resection of gastric cancer from 2005 to 2017 identified in the National Cancer Database. Of that total 27,201 (49.1%) of patients met adherence criteria for lymph node sampling. Academic hospitals treated 44.4% of the total cohort. Overall, lymph node sampling criteria were met in 59.2% of patients treated at high-volume academic programs and 37.0% of patients treated at low-volume nonacademic programs. Adherence rates improved overall from 2005 to 2017 for both low-volume nonacademic programs (27.8% in 2005 to 50.1% in 2017) and high-volume academic programs (46.0% in 2005 to 69.8% in 2017).
AHRQ-funded; HS026385.
Citation: Mahenthiran AK, Logan CD, Janczewski LM .
Evaluation of nationwide trends in nodal sampling guideline adherence for gastric cancer: 2005-2017.
J Surg Res 2023 Nov; 291:514-26. doi: 10.1016/j.jss.2023.07.011..
Keywords: Cancer, Guidelines, Evidence-Based Practice
Ross SM, Wang A, Anthony L
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
The purpose of this study was to research the effects of interventions for blood pressure in small- and medium-sized practices. The researchers utilized retrospective analysis on data from Healthy Hearts in the Heartland (H3), a research program conducted in 2016-2018 as part of the Agency for Healthcare Research and Quality's EvidenceNOW initiative, to examine the impact of implementing more interventions for BP control in these settings. The study included 38 H3 practices which met inclusion criteria and researchers assigned each practice to an implementer group (high or low) based on the number of interventions implemented. Practices in the high-implementer group implemented an average of 2.2 additional interventions relative to the low-implementer group. Groups were compared on two measures of BP control: (1) mean percentage of hypertensive patients with a most recent BP below 140/90, and (2) mean systolic and diastolic BP of hypertensive patients. In the first measure, practices in the high-implementer group had better improvement between baseline and the end of the study. Among the 10,150 patients included in the second measure, reductions in mean SBP and DBP were better for the high-implementer group.
AHRQ-funded; HS000078; HS000084; HS023921.
Citation: Ross SM, Wang A, Anthony L .
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
J Hum Hypertens 2023 Nov; 37(11):1007-14. doi: 10.1038/s41371-023-00813-1..
Keywords: Blood Pressure, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Practice Improvement
Lovero KL, Kemp CG, Wagenaar BH
Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review.
The authors conducted a systematic literature review on the use of Expert Recommendations for Implementing Change (ERIC) project strategies for health intervention implementation in low- and middle-income countries (LMICs) in order to identify gaps and to inform future research. The results indicated that ERIC usage in LMICs is rapidly growing, but its application has not been consistently used to test strategy effectiveness. The authors recommended that future LMICs research test strategies need to be better specified, so they may be compared across contexts and their impact on outcomes evaluated.
AHRQ-funded; HS025632.
Citation: Lovero KL, Kemp CG, Wagenaar BH .
Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review.
Implement Sci 2023 Oct 30; 18(1):56. doi: 10.1186/s13012-023-01310-2..
Keywords: Implementation, Evidence-Based Practice
Kim B, Cruden G, Crable EL
A structured approach to applying systems analysis methods for examining implementation mechanisms.
This article delineated a structured approach to applying systems analysis methods to examining implementation mechanisms. This approach included steps for selecting, tailoring, and evaluating an implementation strategy. The authors illustrated the approach by using an example case, then discussed the strengths and limitations of this approach, when each step might be appropriate. They suggested work that might extend systems analysis methods to the implementation mechanisms research.
AHRQ-funded; HS025632.
Citation: Kim B, Cruden G, Crable EL .
A structured approach to applying systems analysis methods for examining implementation mechanisms.
Implement Sci Commun 2023 Oct 19; 4(1):127. doi: 10.1186/s43058-023-00504-5..
Keywords: Implementation, Evidence-Based Practice, Health Systems
Tyler A, Jolles M
Methodological progress note: implementation science contributions to healthcare research and practice.
Existing research reflects that specific populations such as senior citizens, minorities, and rural Americans have proportionally less access to telehealth when compared to the average American. The purpose of this study was to explore specific strategies for overcoming barriers to telehealth access through an evaluation of data collected by a medical student-run telehealth education program. During the study period the researchers contacted 47 patients by telephone through the GET (Geriatric Education On Telehealth) Access Program. The study found 4 main themes during the discussions with patients, including: completion of registration steps, familiarity with accessing and using video conferencing software, attainment of proxy access for parents of a pediatric patient, and resolution of miscellaneous technical queries.
AHRQ-funded; HS026512.
Citation: Tyler A, Jolles M .
Methodological progress note: implementation science contributions to healthcare research and practice.
J Hosp Med 2023 Oct; 18(10):920-25. doi: 10.1002/jhm.13147..
Keywords: Implementation, Health Services Research (HSR), Evidence-Based Practice
Krefman AE, Ciolino Jd, Kan AK
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
The objective of the Healthy Hearts for Michigan (HH4M) study is to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts. This three-year research program evaluates rural and medically underserved primary care practices’ ability to implement the quality improvement model and tests whether the model improves blood pressure control and tobacco use screening and cessation. Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M. HH4M is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery.
AHRQ-funded; HS027954.
Citation: Krefman AE, Ciolino Jd, Kan AK .
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
Contemp Clin Trials Commun 2023 Oct; 35:101199. doi: 10.1016/j.conctc.2023.101199..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care
Krouse RS, Anderson GL, Arnold KB
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
The purpose of this study was to compare surgical versus non-surgical management with the goal of determining the optimal approach for managing malignant bowel obstruction. From May 11, 2015, to April 27, 2020, 221 patients were enrolled, with 199 evaluable participants. The study found no variation between surgery and non-surgery for the primary outcome of good days: mean 42·6 days in the randomized surgery group, 43·9 days (29·5) in the randomized non-surgery group, 54·8 days (27·0) in the patient choice surgery group, and 52·7 days (30·7) in the patient choice non-surgery group. During their initial hospital stay, six participants died, five due to cancer progression and one due to malignant bowel obstruction treatment complications The most common grade 3-4 malignant bowel obstruction treatment complication was anemia.
AHRQ-funded; HS021491.
Citation: Krouse RS, Anderson GL, Arnold KB .
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
Lancet Gastroenterol Hepatol 2023 Oct; 8(10):908-18. doi: 10.1016/s2468-1253(23)00191-7..
Keywords: Cancer, Surgery, Treatments, Comparative Effectiveness, Evidence-Based Practice
Henderson JT, Webber EM, Thomas RG
Screening for hypertensive disorders of pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to conduct a systematic review to update the evidence on the effectiveness of screening for hypertensive disorders of pregnancy with the purpose of informing the U.S. Preventive Services Task Force. The main outcome was Morbidity or mortality, with measures of health-related quality of life. The review included 6 fair-quality studies comparing changes in prenatal screening practices with routine screening at in-person office visits (usual care). This systematic review did not find evidence that any alternate screening strategies for hypertensive disorders of pregnancy had increased effectiveness over routine blood pressure measurement at in-person prenatal visits. No harms of the different screening strategies were identified.
AHRQ-funded; 75Q80120D00004.
Citation: Henderson JT, Webber EM, Thomas RG .
Screening for hypertensive disorders of pregnancy: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Sep 19; 330(11):1083-91. doi: 10.1001/jama.2023.4934..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Screening, Prevention, Evidence-Based Practice, Guidelines, Maternal Care, Women
McHugh M, Heinrich J, Philbin S
Declining participation in primary care quality improvement research: a qualitative study.
This qualitative study’s aim was to identify factors leading primary care practices to decline participation in quality initiative (QI) projects, and strategies to improve the feasibility and attractiveness of QI projects in the future. The authors contacted 109 representatives of practices that had declined participation in 1 of 4 AHRQ-funded EvidenceNOW projects. The representatives were invited to either participate in a 15-minute interview or complete a 5-question questionnaire. Representatives from 31 practices responded. Reasons for declining included staff turnover, staffing shortages, and general time constraints, exacerbated by the pandemic, preventing participation in the QI projects. Secondary reasons included challenges with electronic health records, an expectation of greater financial compensation for participation, and confidence in the practices' current care practices. Tying participation to value-based programs and offering greater compensation were identified as strategies to facilitate recruitment. However, none of the respondents’ recommendations addressed the primary issues of staffing challenges and time constraints.
AHRQ-funded; HS027954.
Citation: McHugh M, Heinrich J, Philbin S .
Declining participation in primary care quality improvement research: a qualitative study.
Ann Fam Med 2023 Sep-Oct; 21(5):388-94. doi: 10.1370/afm.3007..
Keywords: Quality Improvement, Primary Care, Quality of Care, Practice Improvement, Organizational Change, Evidence-Based Practice
Saldanha IJ, Adam GP, Kanaan G
Delivery strategies for postpartum care: a systematic review and meta-analysis.
This systematic review examined the effects of postpartum health care-delivery strategies on health care utilization and maternal outcomes. The authors searched medical databases from inception to November 16, 2022. They found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). The review found that for general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (moderate strength of evidence). Low strength of evidence was found for location of breastfeeding affecting hospitalization, other unplanned care utilization, or mental health symptoms. Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3-6 months but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months but not exclusive breastfeeding (all moderate strength of evidence). Moderate strength of evidence was found for the association of use and nonuse of information technology for breastfeeding care with comparable rates of breastfeeding. Moderate strength of evidence was found for the association of testing reminders for screening or preventive care and greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A1c testing.
AHRQ-funded; 75Q80120D00001; 75Q80121F32007.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Delivery strategies for postpartum care: a systematic review and meta-analysis.
Obstet Gynecol 2023 Sep 1; 142(3):529-42. doi: 10.1097/aog.0000000000005293..
Keywords: Maternal Care, Women, Healthcare Delivery, Evidence-Based Practice, Patient-Centered Outcomes Research
Chou R, Spencer H, Bougatsos C
Preexposure prophylaxis for the prevention of HIV: updated evidence report and systematic review for the US Preventive Services Task Force.
This article updates research used in the 2019 US Preventive Services Task Force final recommendation on use of oral preexposure prophylaxis (PrEP) to prevent HIV in adults at increased risk. The summary includes newer PrEP regimens that were not available for the 2019 final recommendation. A literature review was conducted that included randomized clinical trials of PrEP vs placebo or no PrEP or newer vs older PrEP regimens and diagnostic accuracy studies of instruments for predicting incident HIV infection. Thirty-two studies were included in the review (20 randomized clinical trials [n = 36,543] and 12 studies of diagnostic accuracy [n = 5,544,500]). Eleven trials in the 2019 review found oral PrEP associated with decreased HIV infection risk vs placebo or no PrEP. One new trial (n = 5335) found oral tenofovir alafenamide/emtricitabine (TAF/FTC) to be noninferior to tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in men who have sex with men. Two new trials found long-acting injectable cabotegravir associated with decreased risk of HIV infection vs oral TDF/FTC in cisgender men who have sex with men and transgender women [n = 4490] and RR, 0.11 in cisgender women [n = 3178]). Discrimination of instruments for predicting incident HIV infection was found to be moderate in men who have sex with men (5 studies; n = 25,488) and moderate to high in general populations of persons without HIV (2 studies; n = 5,477,291).
AHRQ-funded; 75Q80120D00006.
Citation: Chou R, Spencer H, Bougatsos C .
Preexposure prophylaxis for the prevention of HIV: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2023 Aug 22; 330(8):746-63. doi: 10.1001/jama.2023.9865..
Keywords: U.S. Preventive Services Task Force (USPSTF), Human Immunodeficiency Virus (HIV), Prevention, Medication, Evidence-Based Practice
Tugwell P, Welch V, Magwood O
AHRQ Author: Chang C
Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses.
The objectives of this protocol were to: Identify, map, and synthesize findings related to engagement in evidence syntheses; Explore how engagement in evidence synthesis promotes health equity; Develop equity-oriented guidance on methods for conducting, evaluating, and reporting engagement. The authors intended to use their findings to develop draft guidance checklists and assess agreement with each item through an international survey. The guidance checklists will be co-produced and after being finalized at a consensus meeting, an international team will develop guidance for collaborators and partner engagement. The authors concluded that incorporating partnership values and expectations may result in better uptake, potentially reducing health inequities.
AHRQ-authored.
Citation: Tugwell P, Welch V, Magwood O .
Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses.
Syst Rev 2023 Aug 2; 12(1):134. doi: 10.1186/s13643-023-02279-1..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Healthcare Delivery
Jones EK, Ninkovic I, Bahr M
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures.
This study’s objective to investigate if a traumatic rib fracture clinical decision support system (CDSS) reduced hospital length of stay (LOS), 90-day and 1-year mortality, unplanned ICU transfer, and the need for mechanical ventilation. The CDSS included an admission evidence-based (EB) order set and a pain-inspiratory-cough (PIC) score early warning system (EWS). The CDSS was implemented at 9 US trauma centers, with 3,279 patients meeting inclusion criteria. Hospital LOS pre vs post-intervention was unchanged but unplanned transfer to the ICU was reduced, as was 1-year mortality. Provider utilization was associated with significantly reduced LOS. The EWS triggered on 34.4% of patients; however, it was not associated with a significant reduction in hospital LOS.
AHRQ-funded; HS026379.
Citation: Jones EK, Ninkovic I, Bahr M .
A novel, evidence-based, comprehensive clinical decision support system improves outcomes for patients with traumatic rib fractures.
J Trauma Acute Care Surg 2023 Aug 1; 95(2):161-71. doi: 10.1097/ta.0000000000003866..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Evidence-Based Practice, Injuries and Wounds, Trauma
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
AHRQ-funded; HS027804.
Citation: Krishnan JA, Margellos-Anast H, Kumar R .
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities