National Healthcare Quality and Disparities Report
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- Adverse Drug Events (ADE) (1)
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- Neurological Disorders (2)
- Newborns/Infants (1)
- Nursing (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (2)
- Prevention (2)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (3)
- (-) Risk (21)
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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 21 of 21 Research Studies DisplayedEvans NJ, Arakkal AT, Cavanaugh JE
The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: a population-based cohort study.
This study’s objective was to estimate the incidence, duration and risk factors for diagnostic delays associated with pertussis. The authors used longitudinal retrospective insurance claims from the Marketscan Commercial Claims and Encounters, Medicare Supplemental (2001-2020), and Multi-State Medicaid (2014-2018) databases. They estimated the number of visits with pertussis-related symptoms before diagnosis beyond that expected in the absence of diagnostic delays, including the number of visits representing a delay, the number of missed diagnostic opportunities per patient, and the duration of delays. They identified 20,828 patients meeting inclusion criteria. On average, delay duration was 12 days, and patients had almost 2 missed opportunities prior to diagnosis. The duration of delays increased considerably with age from an average of 5.6 days for patients aged less than 2 years to 13.8 days for patients aged ≥18 years. Factors associated with increased risk of delays included recent prescriptions for antibiotics not effective against pertussis, emergency department visits, and telehealth visits.
AHRQ-funded; HS027375.
Citation: Evans NJ, Arakkal AT, Cavanaugh JE .
The incidence, duration, risk factors, and age-based variation of missed opportunities to diagnose pertussis: a population-based cohort study.
Infect Control Hosp Epidemiol 2023 Oct; 44(10):1629-36. doi: 10.1017/ice.2023.31..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality
Miller AC, Koeneman SH, Arakkal AT
Incidence, duration, and risk factors associated with missed opportunities to diagnose herpes simplex encephalitis: a population-based longitudinal study.
This retrospective cohort study determined the frequency and duration of diagnostic delays for herpes simplex encephalitis (HSE) that are associated with increased morbidity and mortality. Data from the IBM Marketscan Databases from 2001-2017 was used. The authors estimated the number of visits with HSE-related symptoms before diagnosis that would be expected to occur in the absence of delays and compared this estimate to the observed pattern of visits. Then a simulation-based approach was used to compute the number of visits representing a delay. They identified 2667 patients diagnosed with HSE and estimated 45.9% of patients experienced at least 1 missed opportunity, with 21.9% of patients having delays lasting >7 days. Risk factors for delays included being seen only in the emergency department, age 65 or older, or a history of sinusitis or schizophrenia.
AHRQ-funded; HS027375.
Citation: Miller AC, Koeneman SH, Arakkal AT .
Incidence, duration, and risk factors associated with missed opportunities to diagnose herpes simplex encephalitis: a population-based longitudinal study.
Open Forum Infect Dis 2021 Sep;8(9):ofab400. doi: 10.1093/ofid/ofab400..
Keywords: Infectious Diseases, Neurological Disorders, Diagnostic Safety and Quality, Risk
Shipe ME, Haddad DN, Deppen SA
Modeling the impact of delaying the diagnosis of non-small cell lung cancer during COVID-19
The novel coronavirus (COVID-19) pandemic has led surgical societies to recommend delaying diagnosis and treatment of suspected lung cancer for lesions less than 2 cm. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. Delaying diagnosis can lead to disease progression, but the impact of this delay on mortality is unknown. In this study, the investigators sought to model immediate versus delayed surgical resection in a suspicious lung nodule less than 2 cm.
AHRQ-funded; HS026122.
Citation: Shipe ME, Haddad DN, Deppen SA .
Modeling the impact of delaying the diagnosis of non-small cell lung cancer during COVID-19
Ann Thorac Surg 2021 Jul;112(1):248-54. doi: 10.1016/j.athoracsur.2020.08.025..
Keywords: COVID-19, Cancer: Lung Cancer, Cancer, Diagnostic Safety and Quality, Case Study, Risk
Reddy P, Mencin A, Lebwohl B
Risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients.
Suboptimal bowel cleansing is common in children and can impact diagnostic and therapeutic outcomes. In this retrospective study, the investigators aimed to identify risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients. The investigators concluded that Medicaid status and English as a second language were risk factors. They highlighted distinct associations from those reported in the adult literature including failure to thrive and younger age.
AHRQ-funded; HS026121.
Citation: Reddy P, Mencin A, Lebwohl B .
Risk factors for suboptimal bowel preparation for colonoscopy in pediatric patients.
J Pediatr Gastroenterol Nutr 2021 Jul;73(1):e1-e6. doi: 10.1097/mpg.0000000000003114..
Keywords: Children/Adolescents, Colonoscopy, Risk, Diagnostic Safety and Quality
Michelson KA, Neuman MI, Pruitt CM
Height of fever and invasive bacterial infection.
This study evaluated the association of higher fevers with invasive bacterial infection (IBI) among febrile infants ≤60 days of age. Maximum temperatures of febrile infants with IBI were compared to infants without IBI. The median temperature was higher for infants with IBI (38.8°C) compared to those without IBI (38.4°C). Temperatures ranges of 39°C-39.4°C and 39.5°C-39.9°C were associated with a higher likelihood of IBI, although 30.4% of febrile infants with IBI had maximum temperatures <38.5°C.
AHRQ-funded; HS026006; HS026503.
Citation: Michelson KA, Neuman MI, Pruitt CM .
Height of fever and invasive bacterial infection.
Arch Dis Child 2021 Jun;106(6):594-96. doi: 10.1136/archdischild-2019-318548..
Keywords: Newborns/Infants, Infectious Diseases, Diagnostic Safety and Quality, Risk
Enayati M, Sir M, Zhang X
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
This study’s objective will be to identify variables associated with diagnostic errors in emergency departments using large-scale EHR data and machine learning techniques. It will use trigger algorithms with electronic health record (EHR) data repositories to generate a large data set of records that are labeled trigger-positive or trigger-negative, depending on if they meet certain criteria. This study will be conducted by 2 academic medical centers with affiliated community hospitals.
AHRQ-funded; HS027363; HS026622.
Citation: Enayati M, Sir M, Zhang X .
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
JMIR Res Protoc 2021 Jun 14;10(6):e24642. doi: 10.2196/24642..
Keywords: Emergency Department, Diagnostic Safety and Quality, Patient Safety, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Cifra CL, Westlund E, Ten Eyck P
An estimate of missed pediatric sepsis in the emergency department.
AHRQ-funded; HS025753.
Citation: Cifra CL, Westlund E, Ten Eyck P .
An estimate of missed pediatric sepsis in the emergency department.
Diagnosis 2021;8(2):193-98. doi: 10.1515/dx-2020-0023..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Risk
Huda A, Castaño A, Niyogi A
A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy.
Transthyretin amyloid cardiomyopathy, an often-unrecognized cause of heart failure, is now treatable with a transthyretin stabilizer. It is therefore important to identify at-risk patients who can undergo targeted testing for earlier diagnosis and treatment, prior to the development of irreversible heart failure. In this study, the investigators showed that a random forest machine learning model could identify potential wild-type transthyretin amyloid cardiomyopathy using medical claims data.
AHRQ-funded; HS026385.
Citation: Huda A, Castaño A, Niyogi A .
A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy.
Nat Commun 2021 May 11;12(1):2725. doi: 10.1038/s41467-021-22876-9..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Neurological Disorders, Diagnostic Safety and Quality, Risk
Miller AC, Arakkal AT, Koeneman S
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
Missed opportunities to diagnose tuberculosis are costly to patients and society. In this retrospective cohort study, the investigators (1) estimated the frequency and duration of diagnostic delays among patients with active pulmonary tuberculosis and (2) determined the risk factors for experiencing a diagnostic delay. The investigators found that many patients with tuberculosis experience multiple missed diagnostic opportunities prior to diagnosis.
AHRQ-funded; HS027375.
Citation: Miller AC, Arakkal AT, Koeneman S .
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
BMJ Open 2021 Feb 18;11(2):e045605. doi: 10.1136/bmjopen-2020-045605..
Keywords: Respiratory Conditions, Diagnostic Safety and Quality, Risk
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
Stone CA, Stollings JL, Lindsell CJ
Risk-stratified management to remove low-risk penicillin allergy labels in the ICU.
Patients admitted to a medical ICU (MICU) often have chronic illnesses or altered immunity, increasing their need for immediate antibiotic use. In this study, the investigators sought to determine whether MICU patients with low-risk penicillin allergy history could be challenged directly with amoxicillin to have their allergy label safely removed during an acute inpatient stay.
Citation: Stone CA, Stollings JL, Lindsell CJ .
Risk-stratified management to remove low-risk penicillin allergy labels in the ICU.
Am J Respir Crit Care Med 2020 Jun 15;201(12):1572-75. doi: 10.1164/rccm.202001-0089LE..
Keywords: Intensive Care Unit (ICU), Antibiotics, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Risk, Diagnostic Safety and Quality
Gandhi TK, Singh H
Reducing the risk of diagnostic error in the COVID-19 era.
This perspective article discusses anticipated diagnoses errors for positive or negative COVID-19 results. The errors are classified using user-friendly nomenclature. Mitigation strategies are discussed including technology for cognitive support, optimized workflow and communication, people-focused interventions, organizational strategies, and state/federal policies and regulations.
AHRQ-funded; HS027363.
Citation: Gandhi TK, Singh H .
Reducing the risk of diagnostic error in the COVID-19 era.
J Hosp Med 2020 Jun;15(6):363-66. doi: 10.12788/jhm.3461..
Keywords: Diagnostic Safety and Quality, Risk, Medical Errors, COVID-19
Levy AE, Shah NR, Matheny ME
Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: implications for natural language processing tools.
The authors investigated whether Natural Language Processing (NLP) tools could potentially help estimate myocardial perfusion imaging (MPI) risk. Subjects were VA patients who underwent stress MPI and coronary angiography 2009-11; stress test reports were randomly selected for analysis. The authors found that post-test ischemic risk was determinable but rarely reported in this sample of stress MPI reports. They conclude that this supports the potential use of NLP to help clarify risk and recommend further study of NLP in this context.
AHRQ-funded; HS022998.
Citation: Levy AE, Shah NR, Matheny ME .
Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: implications for natural language processing tools.
J Nucl Cardiol 2019 Dec;26(6):1878-85. doi: 10.1007/s12350-018-1275-y..
Keywords: Imaging, Risk, Clinical Decision Support (CDS), Health Information Technology (HIT), Diagnostic Safety and Quality, Cardiovascular Conditions, Heart Disease and Health
Mills J, Thomas A
AHRQ Author: Mills J
Risk assessment for cardiovascular disease with nontraditional risk factors.
This case study considers a 46-year-old Asian American woman who is concerned about risk of cardiovascular disease because of her new, less active working conditions. She has no personal history of hypertension or hypercholesterolemia, but does have a family history. The case study questions are based on USPSTF recommendations for nontraditional cardiovascular risk factors for CVD in asymptomatic adults.
AHRQ-authored.
Citation: Mills J, Thomas A .
Risk assessment for cardiovascular disease with nontraditional risk factors.
Am Fam Physician 2019 Jan 15;99(2):123-24.
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Keywords: Cardiovascular Conditions, Case Study, Diagnostic Safety and Quality, Risk, U.S. Preventive Services Task Force (USPSTF)
Koziatek CA, Simon E, Horwitz LI
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
The objective of this study was to measure the performance of automated, structured data-only versions of the Wells and revised Geneva risk scores in emergency department encounters during which a computed tomography pulmonary angiography was ordered. The hypothesis was that such an automated method would classify a patient's pulmonary embolism risk with high accuracy compared to manual chart review.
AHRQ-funded; HS024376.
Citation: Koziatek CA, Simon E, Horwitz LI .
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
Acad Emerg Med 2018 Sep;25(9):1053-61. doi: 10.1111/acem.13442..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality, Emergency Department, Imaging, Guidelines
Bowen ME, Xuan L, Lingvay I
Performance of a random glucose case-finding strategy to detect undiagnosed diabetes.
This study describes a case-finding approach using non-diagnostic random glucose values to identify individuals in need of diabetes testing and compares its performance to current screening guidelines. Using random glucose >/=100 mg/dL to identify individuals in need of diabetes, it determined that screening is highly sensitive and specific, performing better than current screening guidelines. Case-finding strategies informed by random glucose data may improve diabetes detection.
AHRQ-funded; HS022418.
Citation: Bowen ME, Xuan L, Lingvay I .
Performance of a random glucose case-finding strategy to detect undiagnosed diabetes.
Am J Prev Med 2017 Jun;52(6):710-16. doi: 10.1016/j.amepre.2017.01.023.
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Keywords: Diabetes, Diagnostic Safety and Quality, Risk, Screening
Bhattacharjee P, Churpek MM, Snyder A
Detecting sepsis: are two opinions better than one?
Researchers conducted a study to characterize the agreement between different providers' suspicion of infection and the correlation with patient outcomes using prospective data from a general medicine ward. They concluded that provider disagreement regarding suspected infection is common, with RNs suspecting infection more often, suggesting that a collaborative model for sepsis detection may improve timing and accuracy.
AHRQ-funded; HS000078.
Citation: Bhattacharjee P, Churpek MM, Snyder A .
Detecting sepsis: are two opinions better than one?
J Hosp Med 2017 Apr;12(4):256-58. doi: 10.12788/jhm.2721.
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Keywords: Diagnostic Safety and Quality, Nursing, Risk, Sepsis
Okafor N, Payne VL, Chathampally Y
Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine.
The researchers analysed incidents reported by ED physicians to determine disease conditions, contributory factors and patient harm associated with ED-related diagnostic errors. Among the 209 incidents, they identified 214 diagnostic errors associated with 65 unique diseases/conditions. Most diagnostic errors in ED appeared to relate to common disease conditions.
AHRQ-funded; HS017586; HS022087.
Citation: Okafor N, Payne VL, Chathampally Y .
Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine.
Emerg Med J 2016 Apr;33(4):245-52. doi: 10.1136/emermed-2014-204604.
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Keywords: Diagnostic Safety and Quality, Emergency Department, Medical Errors, Risk, Patient Safety
Abdelsattar ZM, Wong SL, Regenbogen SE
Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.
The researchers investigated the national treatment patterns and outcomes of patients younger than 50 with colorectal cancer (CRC). They found that patients with CRC diagnosed at age <50 years are more likely to present with advanced-stage disease. However, they receive more aggressive therapy and achieve longer disease-specific survival, despite the greater percentage of patients with advanced-stage disease.
AHRQ-funded; HS000053; HS020937.
Citation: Abdelsattar ZM, Wong SL, Regenbogen SE .
Colorectal cancer outcomes and treatment patterns in patients too young for average-risk screening.
Cancer 2016 Mar 15;122(6):929-34. doi: 10.1002/cncr.29716.
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Keywords: Cancer: Colorectal Cancer, Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Risk, Screening
Boehme AK, Rawal PV, Lyerly MJ
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
The researchers compared several scoring systems among patients receiving systemic and endovascular treatments. They concluded that their study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.
AHRQ-funded; HS013852.
Citation: Boehme AK, Rawal PV, Lyerly MJ .
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
J Stroke Cerebrovasc Dis 2014 Sep;23(8):2001-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.003.
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Keywords: Shared Decision Making, Diagnostic Safety and Quality, Risk, Stroke