National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (3)
- Cancer (13)
- Cancer: Breast Cancer (10)
- Cancer: Colorectal Cancer (2)
- Children/Adolescents (3)
- Chronic Conditions (1)
- Colonoscopy (1)
- Communication (1)
- Comparative Effectiveness (1)
- Diabetes (1)
- (-) Diagnostic Safety and Quality (22)
- Digestive Disease and Health (1)
- Education: Patient and Caregiver (1)
- Elderly (1)
- Electronic Health Records (EHRs) (2)
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- Evidence-Based Practice (1)
- Healthcare Costs (1)
- Health Information Technology (HIT) (2)
- Health Promotion (1)
- Human Immunodeficiency Virus (HIV) (4)
- Imaging (9)
- Infectious Diseases (2)
- Medical Errors (2)
- Medication (1)
- Medication: Safety (1)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient Safety (1)
- Pregnancy (1)
- (-) Prevention (22)
- Primary Care (1)
- Provider Performance (2)
- Quality Improvement (2)
- Quality of Care (1)
- Racial and Ethnic Minorities (2)
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- Screening (13)
- Social Stigma (1)
- Treatments (1)
- Urban Health (1)
- Women (11)
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 22 of 22 Research Studies DisplayedHo TH, Bissell MCS, Lee CI
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
The purpose of this study was to establish a prioritization method for immediate interpretation of screening mammograms and potential diagnostic assessment. A cohort based on the population, comprising screening mammograms conducted from 2012 to 2020 at 126 radiology centers from 7 Breast Cancer Surveillance Consortium registries, was examined. Classification trees were used to identify combinations of clinical history (age, BI-RADS density, time elapsed since the previous mammogram, history of false-positive recall or biopsy outcome), screening technique (digital mammography, digital breast tomosynthesis), and facility features (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 classified as high and ≥16/100 as very high. The efficiency ratio was calculated as the percentage of recalls divided by the percentage of mammograms. The research cohort consisted of 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The study found that the primary predictor of recall was the time interval since the last mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening method. Recall rates were extremely high for baseline mammograms and high for women with ≥5 years since their previous mammogram. The 9.2% of mammograms in subgroups with very high and high recall rates represented 19.2% of recalls, yielding an efficiency ratio of 2.1 compared to a random strategy. Including women under 50 with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Findings incorporating facility-level characteristics were analogous.
AHRQ-funded; HS018366
Citation: Ho TH, Bissell MCS, Lee CI .
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
J Am Coll Radiol 2023 Mar;20(3):299-310. doi: 10.1016/j.jacr.2022.09.030.
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Diagnostic Safety and Quality
Michelson KA, Reeves SD, Grubenhoff JA
Clinical features and preventability of delayed diagnosis of pediatric appendicitis.
In this case-control study, researchers sought to determine clinical features associated with delayed diagnosis of pediatric appendicitis, to assess the frequency of preventable delay, and to compare delay outcomes. They found that delayed appendicitis was associated with initially milder symptoms but worse outcomes. Their findings suggest that a majority of delayed diagnoses were at least possibly preventable and that many of the studied patients did not undergo indicated imaging, suggesting an opportunity to prevent delayed diagnosis of appendicitis in some children.
AHRQ-funded; HS026503.
Citation: Michelson KA, Reeves SD, Grubenhoff JA .
Clinical features and preventability of delayed diagnosis of pediatric appendicitis.
JAMA Netw Open 2021 Aug;4(8):e2122248. doi: 10.1001/jamanetworkopen.2021.22248..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Prevention
Rauscher GH, Murphy AM, Qiu Q
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
The authors examined the trade-offs for higher recall rates in terms of biopsy recommendations and cancer detection in mammography in a single large health care organization. 2D analog, 2D digital, and 3D digital mammography screenings among women 40-79 years old with cancer follow-up were examined. They found that the results of their investigation were in contrast to those of a recent study suggesting appropriateness of higher recall rates. They concluded that optimal cancer detection appeared to be in the recall rate range of 7-9% for both 2D digital mammography and 3D tomosynthesis.
AHRQ-funded; HS018366.
Citation: Rauscher GH, Murphy AM, Qiu Q .
The "sweet spot" revisited: optimal recall rates for cancer detection with 2D and 3D digital screening mammography in the Metro Chicago Breast Cancer Registry.
AJR Am J Roentgenol 2021 Apr;216(4):894-902. doi: 10.2214/ajr.19.22429.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Rodriguez PJ, Roberts DA, Meisner J
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Dual HIV and syphilis testing might help to prevent mother-to-child transmission (MTCT) of HIV and syphilis through increased case detection and treatment. In this study, the investigators aimed to model and assess the cost-effectiveness of dual testing during antenatal care in four countries with varying HIV and syphilis prevalence. The authors concluded that incorporating dual rapid diagnostic tests in antenatal care could be cost-saving across countries with varying HIV prevalence.
AHRQ-funded; HS013853.
Citation: Rodriguez PJ, Roberts DA, Meisner J .
Cost-effectiveness of dual maternal HIV and syphilis testing strategies in high and low HIV prevalence countries: a modelling study.
Lancet Glob Health 2021 Jan;9(1):e61-e71. doi: 10.1016/s2214-109x(20)30395-8..
Keywords: Human Immunodeficiency Virus (HIV), Infectious Diseases, Prevention, Pregnancy, Women, Diagnostic Safety and Quality, Healthcare Costs
Iribarren S, Lentz C, Sheinfil AZ
Using an HIV self-test kit to test a partner: attitudes and preferences among high-risk populations.
Researchers explored attitudes and preferences among HIV-negative men who have sex with men and HIV-negative transgender women using an HIV self-testing (HIVST) kit to test partners. They found that most preferred gum swab over fingerprick tests, but would prefer a blood test if it gave results for other sexually transmitted infections (STIs). They concluded that efforts to improve HIVST uptake should focus on incorporating testing for other STIs, reducing test kit size, and reducing cost.
AHRQ-funded; HS026383.
Citation: Iribarren S, Lentz C, Sheinfil AZ .
Using an HIV self-test kit to test a partner: attitudes and preferences among high-risk populations.
AIDS Behav 2020 Nov;24(11):3232-43. doi: 10.1007/s10461-020-02885-3..
Keywords: Human Immunodeficiency Virus (HIV), Diagnostic Safety and Quality, Infectious Diseases, Prevention
Shah SC, Itzkowitz SH
Reappraising risk factors for inflammatory bowel disease-associated neoplasia: implications for colonoscopic surveillance in IBD.
One of the most feared complications of inflammatory bowel disease [IBD]-associated colitis is colorectal cancer. An opportunity for early detection is being missed in a group that is overlooked as high-risk, as a substantial proportion of colorectal cancers are being diagnosed in individuals with colonic IBD who have disease duration shorter than when guidelines recommend surveillance initiation. In this study, the investigators discuss a viewpoint that supports a paradigm shift that will ideally result in a more effective and higher-value colorectal cancer prevention approach in IBD.
AHRQ-funded; HS026395.
Citation: Shah SC, Itzkowitz SH .
Reappraising risk factors for inflammatory bowel disease-associated neoplasia: implications for colonoscopic surveillance in IBD.
J Crohns Colitis 2020 Sep 7;14(8):1172-77. doi: 10.1093/ecco-jcc/jjaa040..
Keywords: Digestive Disease and Health, Risk, Cancer: Colorectal Cancer, Cancer, Colonoscopy, Prevention, Diagnostic Safety and Quality, Screening
Koller KR, Day GE, Hiratsuka VY
Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: a call for prediabetes screening, diagnosis, and referral for intervention.
This study estimated incidence of diabetes (DM) and pre-DM relative to DM risk factors among relatively healthy Alaska Native and American Indian (AN) adults living in urban south-central Alaska. Results showed that, controlling for age and sex, obesity, abdominal adiposity, pre-DM, and metabolic syndrome independently increased DM risk. Recommendations included advising health care providers of AN populations to seize the opportunity to screen, refer, and treat individuals with pre-DM and other modifiable DM risk factors prior to DM diagnosis in order to alter the epidemiologic course of disease progression in this urban AN population.
AHRQ-funded; HS000084.
Citation: Koller KR, Day GE, Hiratsuka VY .
Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: a call for prediabetes screening, diagnosis, and referral for intervention.
Diabetes Res Clin Pract 2020 Sep;167:108357. doi: 10.1016/j.diabres.2020.108357..
Keywords: Diabetes, Racial and Ethnic Minorities, Urban Health, Risk, Prevention, Screening, Diagnostic Safety and Quality, Chronic Conditions
Sprague BL, Miglioretti DL, Lee CI
New mammography screening performance metrics based on the entire screening episode.
Established mammography screening performance metrics use the initial screening mammography assessment because they were developed for radiologist performance auditing, yet these metrics are frequently used to inform health policy and screening decision making. The authors developed new performance metrics based on the final assessment that consider the entire screening episode, including diagnostic workup. They concluded that established screening performance metrics underestimated the interval cancer rate of a mammography screening episode, particularly for women with dense breasts or an elevated breast cancer risk.
AHRQ-funded; HS018366.
Citation: Sprague BL, Miglioretti DL, Lee CI .
New mammography screening performance metrics based on the entire screening episode.
Cancer 2020 Jul 15;126(14):3289-96. doi: 10.1002/cncr.32939..
Keywords: Screening, Diagnostic Safety and Quality, Cancer: Breast Cancer, Cancer, Prevention, Women, Provider Performance, Imaging
Sprague BL, Coley RY, Kerlikowske K
Assessment of radiologist performance in breast cancer screening using digital breast tomosynthesis vs digital mammography.
Many US radiologists have screening mammography recall rates above the expert-recommended threshold of 12%. The influence of digital breast tomosynthesis (DBT) on the distribution of radiologist recall rates is uncertain. The objective of this study was to evaluate radiologists' recall and cancer detection rates before and after beginning interpretation of DBT examinations.
AHRQ-funded; HS018366.
Citation: Sprague BL, Coley RY, Kerlikowske K .
Assessment of radiologist performance in breast cancer screening using digital breast tomosynthesis vs digital mammography.
JAMA Netw Open 2020 Mar 2;3(3):e201759. doi: 10.1001/jamanetworkopen.2020.1759..
Keywords: Cancer: Breast Cancer, Cancer, Diagnostic Safety and Quality, Imaging, Screening, Women, Prevention, Provider Performance
Murphy CC, Sen A, Watson B
A systematic review of repeat fecal occult blood tests for colorectal cancer screening.
This systematic review examined the prevalence of repeat fecal occult blood tests (FOBT) for colorectal cancer screening. MEDLINE, Embase, and the Cochrane Library were searched for studies published from 1997 to 2017 and reported repeat FOBT over 2 and more screening rounds. Thirty-five articles (n=27) were identified which measured repeat FOBT as 1) proportion of Round 1 participants completing repeat FOBT in Round 2; 2) proportion completing two, consecutive FOBTs; or 3) proportion completing 3 or more rounds. The number of participants completing Round 1 ranged from 24.6% to 89.6%. Those who completed Round 2 ranged from 16.4% to 80%; and completion of 3 or more rounds ranged from 0.8% to 64.1%. Repeat FOBT was higher in mailed outreach than opportunistic screening.
AHRQ-funded; HS022418.
Citation: Murphy CC, Sen A, Watson B .
A systematic review of repeat fecal occult blood tests for colorectal cancer screening.
Cancer Epidemiol Biomarkers Prev 2020 Feb;29(2):278-87. doi: 10.1158/1055-9965.Epi-19-0775..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Diagnostic Safety and Quality, Prevention, Patient Adherence/Compliance, Patient-Centered Outcomes Research, Evidence-Based Practice
Giess CS, Wang A, Ip IK
Patient, radiologist, and examination characteristics affecting screening mammography recall rates in a large academic practice.
This retrospective study examined patient, radiologist and examination characteristics affecting screening mammography recall rates. This study used 61,198 examinations from an academic center and two outpatient centers from October 1, 2012 to May 31, 2015. Radiologists’ risk aversion, stress from uncertainty, and malpractice concerns and cancer detection rates were derived from the survey. Their annual screening volumes, clinical experience, and concentration in breast imaging was calculated. About 9.3% of screening examinations were recalled. There was no association found with radiologists’ risk aversion, stress from uncertainty, malpractice concerns and cancer detection rates and high recall rates. The most variation was found with radiologists’ annual reading volume and experience.
AHRQ-funded; HS24722.
Citation: Giess CS, Wang A, Ip IK .
Patient, radiologist, and examination characteristics affecting screening mammography recall rates in a large academic practice.
J Am Coll Radiol 2019 Apr;16(4 Pt A):411-18. doi: 10.1016/j.jacr.2018.06.016..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Imaging, Prevention, Screening, Women
Bundy DG, Singh H, Stein RE
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
This paper discusses the results of Project RedDE, which was a virtual collaborative quality improvement study to reduce diagnostic errors in pediatric primary care practices. Forty-three practices were initially recruited, with a total of 31 practices left at the end due to practice dropout and two participating practices merging. This study was a randomized controlled trial targeting three common diagnostic errors (missed diagnoses of adolescent depression, abnormal blood pressure, and lack of followup for abnormal laboratory results). Contamination across study groups was a recurring problem, but risk mitigations were used. Electronic health records contributed to teams’ success.
AHRQ-funded; HS203608.
Citation: Bundy DG, Singh H, Stein RE .
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
Clin Trials 2019 Apr;16(2):154-64. doi: 10.1177/1740774518820522..
Keywords: Adverse Events, Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Prevention, Primary Care, Quality of Care, Quality Improvement
Payan DD, Florez KR, Bogart LM
Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.
This study explored implementation of an HIV sermon as part of a multi-component intervention in three churches (Latino Catholic, Latino Pentecostal, and African American Baptist) in high HIV prevalence areas of Los Angeles County, California. The investigators found large variation in fidelity to communicating key HIV messages from the sermon guide. They concluded that structured training of clergy may be necessary to implement the more theoretically driven stigma reduction cues included in the sermon guide.
AHRQ-funded; HS000046.
Citation: Payan DD, Florez KR, Bogart LM .
Promoting health from the pulpit: a process evaluation of HIV sermons to reduce HIV stigma and promote testing in African American and Latino churches.
Health Commun 2019 Jan;34(1):11-20. doi: 10.1080/10410236.2017.1384352..
Keywords: Human Immunodeficiency Virus (HIV), Social Stigma, Racial and Ethnic Minorities, Diagnostic Safety and Quality, Health Promotion, Education: Patient and Caregiver, Communication, Prevention
Bates DW, Singh H
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
This paper comments on the progress made in improving patient safety since the 1999 report from The Institute of Medicine titled “To Err is Human” was published. This landmark report highlighted problem areas, and since then there has been a number of effective interventions to prevent hospital-acquired infections and improve medication safety. Additional areas for improvement have also been identified in the past two decades, including outpatient care, diagnostic, errors and the use of health information technology. The authors believe that electronic data developments can help increase patient safety even further.
AHRQ-funded; HS022087; HS017820.
Citation: Bates DW, Singh H .
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
Health Aff 2018 Nov;37(11):1736-43. doi: 10.1377/hlthaff.2018.0738..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Prevention
Haukoos JS, Lyons MS, Rothman RE
The evolving landscape of HIV screening in the emergency department.
This article is a summary of two studies that appear in the same edition of the journal. The two studies describe the value of using targeted vs. non-targeted screening for HIV in emergency departments (EDs). New diagnosis rates were relatively small, which suggested that the use of targeted screening may be need to be refined more in terms of selection criteria.
AHRQ-funded; HS021749.
Citation: Haukoos JS, Lyons MS, Rothman RE .
The evolving landscape of HIV screening in the emergency department.
Ann Emerg Med 2018 Jul;72(1):54-56. doi: 10.1016/j.annemergmed.2018.01.041..
Keywords: Diagnostic Safety and Quality, Emergency Department, Human Immunodeficiency Virus (HIV), Prevention, Screening
Dabbous F, Dolecek TA, Friedewald SM
Performance characteristics of digital vs film screen mammography in community practice.
In this study, the investigators examined performance characteristics of digital vs film screen mammography in community practice by comparing the performance characteristics of 297 629 full field digital (FFDM) and 416 791 screen film mammograms (SFM). In their study, modest gains in performance were achieved with the introduction of FFDM as a replacement for SFM, in a large health care organization.
AHRQ-funded; HS018366.
Citation: Dabbous F, Dolecek TA, Friedewald SM .
Performance characteristics of digital vs film screen mammography in community practice.
Breast J 2018 May;24(3):369-72. doi: 10.1111/tbj.12942..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Comparative Effectiveness, Diagnostic Safety and Quality
Murphy DR, Meyer AND, Vaghani V
Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care.
Because of the unique clinical, logistic, and legal aspects of mammography, this study was conducted to evaluate the effectiveness of a trigger to flag delayed follow-up on mammography. The investigators found that care delays appeared to continue despite federal laws requiring patient notification of mammographic results within 30 days. They suggest that clinical application of mammography-related triggers could help detect these delays.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer AND, Vaghani V .
Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care.
J Am Coll Radiol 2018 Feb;15(2):287-95. doi: 10.1016/j.jacr.2017.10.001..
Keywords: Cancer: Breast Cancer, Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging, Diagnostic Safety and Quality, Prevention, Women
Dabbous FM, Dolecek TA, Berbaum ML
Impact of a false-positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis.
Researchers sought to examine the impact of a false positive (FP) screening mammogram on the subsequent screening mammography behavior. They found that experiencing a FP mammogram increases the risk of late stage at diagnosis compared with prior true negative (TN) mammogram Also, women with a FP mammogram were more likely to delay their subsequent screening compared with women with a TN mammogram.
AHRQ-funded; HS018366.
Citation: Dabbous FM, Dolecek TA, Berbaum ML .
Impact of a false-positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis.
Cancer Epidemiol Biomarkers Prev 2017 Mar;26(3):397-403. doi: 10.1158/1055-9965.epi-16-0524.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Farbman KS, Michelson KA
Anaphylaxis in children.
Anaphylaxis is a serious allergic reaction that can be life threatening. The authors reviewed the most recent evidence regarding the diagnosis, treatment, monitoring, and prevention of anaphylaxis in children. It concluded that epinephrine remains the mainstay of anaphylaxis treatment, and adjuvant medications should not be used in its place.
AHRQ-funded; HS000063.
Citation: Farbman KS, Michelson KA .
Anaphylaxis in children.
Curr Opin Pediatr 2016 Mar 8;28(3):294-7. doi: 10.1097/mop.0000000000000340..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Prevention, Treatments
Nelson HD, O'Meara ES, Kerlikowske K
Factors associated with rates of false-positive and false-negative results from digital mammography screening: an analysis of registry data.
The researchers sought to determine factors associated with false-positive and false-negative digital mammography results, additional imaging, and biopsies among a general population of women screened for breast cancer. They found that false-positive mammography results and additional imaging are common, particularly for younger women and those with risk factors, whereas biopsies occur less often. Rates of false-negative results are low.
AHRQ-funded; 290201200015I.
Citation: Nelson HD, O'Meara ES, Kerlikowske K .
Factors associated with rates of false-positive and false-negative results from digital mammography screening: an analysis of registry data.
Ann Intern Med 2016 Feb 16;164(4):226-35. doi: 10.7326/m15-0971.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Diagnostic Safety and Quality, Women, Screening, Prevention
Vyas A, Madhavan S, Sambamoorthi U
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
The objective of this study is to determine the association between persistence with mammography screening and stage at breast cancer (BC) diagnosis among elderly women. It found that, as compared to women who were not persistent with mammography screening, women who were persistent with mammography screening were significantly more likely to be diagnosed at earlier stages of BC.
AHRQ-funded; HS018622.
Citation: Vyas A, Madhavan S, Sambamoorthi U .
Association between persistence with mammography screening and stage at diagnosis among elderly women diagnosed with breast cancer.
Breast Cancer Res Treat 2014 Dec;148(3):645-54. doi: 10.1007/s10549-014-3204-3..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Elderly, Prevention, Screening, Women
Young RS, Gobel BH, Schumacher M
Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.
The authors aimed to improve the early identification of clinically deteriorating hematology-oncology patients in order to prevent the development of critical illness and to facilitate timely intensive care unit (ICU) transfers. They used a protocol employing the Modified Early Warning Score and found that implementation of this protocol reduced codes and preventable codes without an associated increase in ICU transfers.
AHRQ-funded; HS000078.
Citation: Young RS, Gobel BH, Schumacher M .
Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.
Am J Med Qual 2014 Nov-Dec;29(6):530-7. doi: 10.1177/1062860613508305.
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Keywords: Adverse Events, Cancer, Diagnostic Safety and Quality, Prevention, Quality Improvement