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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
51 to 75 of 914 Research Studies DisplayedTallman JE, Wallis CJD, Zhao Z
Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer.
The purpose of this study was to assess the relationship between prostate volume (PV) and baseline urinary function with treatment choice and post-treatment urinary function among men with localized prostate cancer. The researchers identified 1,647 patients from CEASAR, a multicenter population-based, prospective cohort study of men with localized prostate cancer. The primary study outcomes were treatment choice and health-related quality of life (HRQOL) assessed at pre-specified intervals up to 5 years. The study found that median baseline PV was 36 mL (IQR 27-48), and baseline urinary irritative/obstructive domain score was 87 (IQR 75-100). The study did not find any observed clinically meaningful relationship between PV and treatment choice or post-treatment urinary function. In participants with poor baseline urinary function, treatment with radiation or surgery was related with statistically and clinically significant improvement in urinary function at 6 months which endured through 5 years.
AHRQ-funded; HS019356; HS022640.
Citation: Tallman JE, Wallis CJD, Zhao Z .
Prostate volume, baseline urinary function, and their association with treatment choice and post-treatment urinary function in men treated for localized prostate cancer.
Prostate Cancer Prostatic Dis 2023 Dec; 26(4):787-94. doi: 10.1038/s41391-022-00627-1..
Keywords: Cancer: Prostate Cancer, Cancer, Men's Health
Taylor LN, Wilson BM, Singh M
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
The goal of this survey study was to determine if providing nursing home (NH) clinicians with syndromic antibiograms improves antibiotic treatment urinary tract infections (UTIs). The researchers concluded providing the NH clinicians with urinary antibiograms is associated with selection of active and optimal antibiotics when empirically treating UTIs under simulated conditions.
AHRQ-funded; HS027820.
Citation: Taylor LN, Wilson BM, Singh M .
Syndromic antibiograms and nursing home clinicians' antibiotic choices for urinary tract infections.
JAMA Netw Open 2023 Dec; 6(12):e2349544. doi: 10.1001/jamanetworkopen.2023.49544..
Keywords: Nursing Homes, Antibiotics, Medication, Urinary Tract Infection (UTI)
Watnick S, Blake PG, Mehrotra R
System-level strategies to improve home dialysis: policy levers and quality initiatives.
This article discusses trends in home dialysis use, reviews the evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discusses policy and advocacy efforts that continue to shape the care of US patients, and compares with experiences in other countries. The authors conclude by discussing future directions for quality and advocacy efforts.
AHRQ-funded; HS028684.
Citation: Watnick S, Blake PG, Mehrotra R .
System-level strategies to improve home dialysis: policy levers and quality initiatives.
Clin J Am Soc Nephrol 2023 Dec; 18(12):1616-25. doi: 10.2215/cjn.0000000000000299..
Keywords: Home Healthcare, Kidney Disease and Health, Policy, Quality Improvement, Quality of Care
Fabius CD, Okoye SM, Wu MMJ
The role of place in person- and family-oriented long-term services and supports.
The authors developed a conceptual framework to identify environmental domains contributing to the use, care quality, and care experiences of long-term services and supports (LTSS). They found that LTSS-relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Measures of neighborhood social and economic deprivation were highly associated with adverse consequences due to unmet care needs. Measures of health care and social services delivery environment were inversely associated with participation restrictions in valued activities. The authors concluded that greater attention should be given to strengthening state- and community-based policies and practices that support aging in place.
AHRQ-funded; HS000029.
Citation: Fabius CD, Okoye SM, Wu MMJ .
The role of place in person- and family-oriented long-term services and supports.
Milbank Q 2023 Dec; 101(4):1076-138. doi: 10.1111/1468-0009.12664..
Keywords: Long-Term Care, Elderly, Disabilities
Bingham CA, Harris JG, Qui T
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
The objective of this study was to describe the selection, development, and implementation of quality measures for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome quality measures and a committee of rheumatologists and data analysts developed operational definitions. Initial measures were clinical inactive disease, low pain score, and optimal physical functioning; the revised set included additional measures of disease activity, data quality, and a balancing measure. The authors concluded that PR-COIN's set of JIA quality measures is the first comprehensive set used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.
AHRQ-funded; HS021114.
Citation: Bingham CA, Harris JG, Qui T .
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
Arthritis Care Res 2023 Dec; 75(12):2442-52. doi: 10.1002/acr.25168.
Keywords: Children/Adolescents, Arthritis, Quality Measures, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Anton NE, Cha JS, Hernandez E
Utilizing eye tracking to assess medical student non-technical performance during scenario-based simulation: results of a pilot study.
The purpose of this study was to determine if eye tracking (ET) metrics are associated with non-technical skills (NTS) performance. Participants wore a mobile ET system and participated in two patient care simulations in which they managed a deteriorating patient. Preliminary data suggests that visual attention on the patient was negatively associated with NTS and may indicate poor comprehension of the patient's status due to heightened cognitive load. The authors concluded that researchers and educators should consider using ET in future work to evaluate and provide feedback on their NTS.
AHRQ-funded; HS028026.
Citation: Anton NE, Cha JS, Hernandez E .
Utilizing eye tracking to assess medical student non-technical performance during scenario-based simulation: results of a pilot study.
Global Surg Educ 2023 Dec; 2(1). doi: 10.1007/s44186-023-00127-3.
Keywords: Simulation
Chase BA, Pocica S, Frigerio R
Mortality risk factors in newly diagnosed diabetic cardiac autonomic neuropathy.
To inform the design of interventions to reduce mortality in cardiac autonomic neuropathy (CAN) patients with diabetes, researchers explored genetic variants,
clinical attributes, and autonomic testing findings present to assess possible associations with increased mortality. They reviewed the electronic medical records of patients with advanced disease at the time when CAN was diagnosed. Some clinical characteristics, as well as sex, race, ethnicity, and incidence of type 1 or type 2 diabetes mellitus were found to be similar in both survivors and non-survivors; clinical and autonomic testing characteristics were often similarly advanced in survivors and non-survivors. The researchers concluded that their analysis provided context by estimating hazard ratios relative to when CAN is objectively diagnosed and indicated that not all risk factors confer equal mortality risk. Their findings may inform both the development of guidelines for prevention and the design of larger studies to evaluate CAN mortality risk factors.
clinical attributes, and autonomic testing findings present to assess possible associations with increased mortality. They reviewed the electronic medical records of patients with advanced disease at the time when CAN was diagnosed. Some clinical characteristics, as well as sex, race, ethnicity, and incidence of type 1 or type 2 diabetes mellitus were found to be similar in both survivors and non-survivors; clinical and autonomic testing characteristics were often similarly advanced in survivors and non-survivors. The researchers concluded that their analysis provided context by estimating hazard ratios relative to when CAN is objectively diagnosed and indicated that not all risk factors confer equal mortality risk. Their findings may inform both the development of guidelines for prevention and the design of larger studies to evaluate CAN mortality risk factors.
AHRQ-funded; HS024057.
Citation: Chase BA, Pocica S, Frigerio R .
Mortality risk factors in newly diagnosed diabetic cardiac autonomic neuropathy.
Clin Auton Res 2023 Dec; 33(6):903-07. doi: 10.1007/s10286-023-00975-5.
Keywords: Mortality, Risk, Diabetes
Hasegawa S, Livorsi DJ, Perencevich EN S, Livorsi DJ, Perencevich EN
Diagnostic accuracy of hospital antibiograms in predicting the risk of antimicrobial resistance in enterobacteriaceae isolates: a nationwide multicenter evaluation at the Veterans Health Administration.
This study examined the effectiveness of an antibiogram to predict antimicrobial resistance (AMR) at the patient-level for Escherichia coli and Klebsiella spp. The authors retrospectively generated hospital antibiograms for the nationwide Veterans Health Administration (VHA) facilities from 2000 to 2019 using all clinical culture specimens positive for E. coli and Klebsiella spp., then assessed the diagnostic accuracy of an antibiogram to predict resistance for isolates in the following calendar year using logistic regression models and predefined 5-step interpretation thresholds. At 127 VHA facilities, the discrimination abilities of hospital-level antibiograms in predicting individual patient AMR were mostly poor, with the areas under the receiver operating curve at 0.686 and 0.715 for ceftriaxone, 0.637 and 0.675 for fluoroquinolones, and 0.576 and 0.624 for trimethoprim-sulfamethoxazole, respectively.
AHRQ-funded; HS027472.
Citation: Hasegawa S, Livorsi DJ, Perencevich EN S, Livorsi DJ, Perencevich EN .
Diagnostic accuracy of hospital antibiograms in predicting the risk of antimicrobial resistance in enterobacteriaceae isolates: a nationwide multicenter evaluation at the Veterans Health Administration.
Clin Infect Dis 2023 Nov 30; 77(11):1492-500. doi: 10.1093/cid/ciad467..
Keywords: Diagnostic Safety and Quality, Hospitals
Pak TR, Young J, McKenna CS
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Important studies indicate that every hour of sepsis that elapses until antibiotics are administered increases mortality. The researchers of this study found determined that analyses in the influential studies often adjusted for limited covariates, included patients with long delays until antibiotic administration, combined sepsis and septic shock, and used linear models presuming each hour of delay has equal impact on the sepsis and the patient. The purpose of this study was to assess the effect of the analytic decisions on the relationships between time-to-antibiotics and mortality. The researchers retrospectively identified 104,248 adults admitted from 2015-2022 to five hospitals with suspected infection. The patients included 25,990 with suspected septic shock and 23,619 with sepsis without shock. The study found that changing covariates, maximum time-to-antibiotics, and severity stratification altered the magnitude, direction, and significance of observed relationships between time-to-antibiotics and mortality. In a fully adjusted model of patients treated within 6 hours, every hour related with higher mortality for septic shock, but not sepsis without shock or suspected infection alone. Modeling every hour independently confirmed that every hour delay was related with greater mortality for septic shock, but only delays of greater than 6 hours were related with greater mortality for sepsis without shock.
AHRQ-funded; HS027170.
Citation: Pak TR, Young J, McKenna CS .
Risk of misleading conclusions in observational studies of time-to-antibiotics and mortality in suspected sepsis.
Clin Infect Dis 2023 Nov 30; 77(11):1534-43. doi: 10.1093/cid/ciad450..
Keywords: Antibiotics, Medication, Sepsis, Mortality, Quality of Care
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
Steiner MJ, Hall M, Sutton AG
Pediatric hospitalization trends at children's and general hospitals, 2000-2019.
The purpose of this study was to examine whether pediatric inpatient care has been redistributed from general hospitals into children’s hospitals (CHs). The researchers utilized the AHRQ Kids’ Inpatient Database (KID) to identify inpatient nonbirth discharges for children younger than 18 years from 2000 to 2019. The study included 14.758,391 discharges and found that annual inpatient discharges decreased by 26.5% from 2000 to 2019, while the percentage of total national discharges from CHs increased significantly, from 58.9% in 2000 to 81.8% in 2019. Discharges from freestanding CHs increased from 19.3% to 34.2%, those at non-freestanding CHs increased from 39.6% to 47.6%, and percentage of discharges from non-CHs decreased from 41.1%. An increase in inter-facility transfer (IFT) accompanied the changes in the distribution of pediatric discharges. In 2000, 6.1% of total discharges were transferred from one facility to another before discharge; in 2019, 18.8% experienced an IFT. Of children experiencing an IFT in 2019, 88.0% were transferred to a CH.
AHRQ-funded; HS028683.
Citation: Steiner MJ, Hall M, Sutton AG .
Pediatric hospitalization trends at children's and general hospitals, 2000-2019.
JAMA 2023 Nov 21; 330(19):1906-08. doi: 10.1001/jama.2023.19268..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospitals
Vest JR, Hinrichs RJ, Hosler H
How legal problems are conceptualized and measured in healthcare settings: a systematic review.
The purpose of this study was to answer the question, “How has the concept of patients' "legal problems" been operationalized in healthcare settings?” via a systematic review of the peer-reviewed English-language health literature following the PRISMA guidelines. The researchers reviewed 58 studies reporting a total of 82 different measurements of legal problems. The study found that 56.8% of measures included a single concept (e.g., incarcerated only). The remainder of the measures included two or more concepts within a single reported measure (e.g., incarcerations and arrests). The concept of incarceration or being imprisoned was the most frequently appearing concept. The average of the reported legal problems was 26%. The researchers concluded from the literature that legal concepts are operationalize differently and are quite common among patients.
AHRQ-funded; HS028636.
Citation: Vest JR, Hinrichs RJ, Hosler H .
How legal problems are conceptualized and measured in healthcare settings: a systematic review.
Health Justice 2023 Nov 18; 11(1):48. doi: 10.1186/s40352-023-00246-5..
Keywords: Policy
Frank M, Loh R, Everhart R
No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system.
This retrospective cohort study of persons released from correctional facilities examined healthcare utilization by merging records from Denver Health (DH), an urban safety-net healthcare system, and the Colorado Department of Corrections (CDOC), for people released from January 1 to June 30, 2021. The study population was either 1) released to the Denver metro area (Denver and its five neighboring counties); or (2 assigned to the DH Regional Accountable Entity; or (3 assigned to the DH medical home based on Colorado Department of Healthcare Policy and Financing attribution methods. From January to June 2021 3242 people were released from CDOC and 2848 were included in the data exchange. 905 individuals of the total 2848 were released to the Denver metro area or attributed to DH. In the study population over three-fourths (78.1%) had a chronic medical or psychological condition. Within the first 6 months of release, 31.1% utilized any health service, 24.5% utilized at least one outpatient service, and 17.1% utilized outpatient services two or more times. Within the first 30 days of release 10.1% utilized outpatient services.
AHRQ-funded; HS027389.
Citation: Frank M, Loh R, Everhart R .
No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system.
Health Justice 2023 Nov 18; 11(1):49. doi: 10.1186/s40352-023-00248-3..
Keywords: Access to Care, Vulnerable Populations, Urban Health, Rural/Inner-City Residents
Liebschutz JM, Subramaniam GA, Stone R
Subthreshold Opioid Use Disorder Prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.
This article described the Subthreshold Opioid Use Disorder Prevention (STOP) Trial, a cluster randomized controlled trial designed to study the efficacy of the STOP intervention to reduce risky opioid use and to prevent progression to moderate/severe opioid use disorder (OUD) in adult primary care patients with subthreshold OUD. The STOP intervention consisted of a nurse care manager providing patient-participant education and primary care provider support, brief advice delivered to patient participants about health risks of opioid misuse, and up to six sessions of telephone health coaching to motivate and support behavioral change. The authors concluded that the STOP Trial offers a potential blueprint for feasible and effective improvement of outcomes for adult subthreshold OUD patients.
AHRQ-funded; HS026120.
Citation: Liebschutz JM, Subramaniam GA, Stone R .
Subthreshold Opioid Use Disorder Prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.
Addict Sci Clin Pract 2023 Nov 18; 18(1):70. doi: 10.1186/s13722-023-00424-8..
Keywords: Opioids, Substance Abuse, Behavioral Health, Prevention
Goldberg DG, Owens-Jasey C, Haghighat S
Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment.
This study focused on gaining a comprehensive understanding of perspectives from research participants and research team members on the value of implementation strategies and factors that influenced the AHRQ-funded EvidenceNOW initiative in Virginia. The goal of EvidenceNOW’s Advancing Heart Health in Primary Care initiative is to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. In 2018, the authors conducted 25 focus groups with clinicians and staff at participating practices, including 80 physicians, advanced practice clinicians, practice managers, and other practice staff. They also conducted face-to-face and telephone interviews with 22 research team members, including lead investigators, practice facilitators, physician expert consultants, and evaluators. They used the integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework in their qualitative data analysis and organization of themes. Implementation strategies that were valued by both practice representatives and research team members included the kick-off event, on-site practice facilitation, and interaction with physician expert consults. Day-to-day activities often overwhelmed clinicians and staff, which hindered their ability to fully participate in the EvidenceNOW initiative.
AHRQ-funded; HS023913.
Citation: Goldberg DG, Owens-Jasey C, Haghighat S .
Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment.
BMC Prim Care 2023 Nov 17; 24(1):242. doi: 10.1186/s12875-023-02200-8..
Keywords: Quality Improvement, Primary Care, Quality of Care, Implementation
Armstrong M, Groner JI, Samora J
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
This retrospective chart review study’s goal was to determine the reduction in prescribed opioid pain dosage units to pediatric patients experiencing acute pain and to assess patient satisfaction with pain control 90-day post discharge following the 2017 Ohio opioid prescribing cap law. The cohort included 960 pediatric (age 0-18 years) burn injury and knee arthroscopy patients treated between August 1, 2015-August 31, 2019. In addition, legal guardians prospectively completed a survey for a convenience sample of 50 patients. From pre-law to post-law, there was a significant decrease within the burn and knee cohorts in the median days (1.7 to 1.0 and 5.0 to 3.8, respectively) and median total morphine milligram equivalents (MMEs) prescribed (15.0 to 2.5 and 150.0 to 90.0, respectively). Results from the prospective survey showed that more than half of participants were satisfied (72% burn and 68% knee) with their pain control and felt they received the right amount of medication (84% burn and 56% knee).
AHRQ-funded; HS029183.
Citation: Armstrong M, Groner JI, Samora J .
Impact of opioid law on prescriptions and satisfaction of pediatric burn and orthopedic patients: an epidemiologic study.
PLoS One 2023 Nov 16; 18(11):e0294279. doi: 10.1371/journal.pone.0294279..
Keywords: Children/Adolescents, Opioids, Policy, Medication
Hails KA, Wellen BC, Simoni M
Parents' preferences for primary care-based behavioral services and the COVID-19 pandemic: a mixed method study.
This mixed method study examined how family factors impacted parents' attitudes toward integrated behavioral health (IBH) in pediatric primary care during the COVID-19 pandemic. The authors hypothesized that COVID-19 impact would predict family functioning challenges, and that pre-existing familial contextual factors would predict parents' interest in IBH modalities. A survey was completed by parents of children ages 1.5-5 years (N = 301) from five primary care clinics with measures assessing familial contextual factors (income, race and ethnicity, and parents' childhood adversity), COVID-19 impact on family relationships and wellbeing, family functioning (child behavior, parenting self-efficacy, and parent psychological functioning), and parents' preferences for behavioral support in primary care. A subsample of 23 parents completed qualitative interviews to provide deeper insights into quantitative relationships. The higher the COVID-19 impact, the more it was significantly associated with worse parent mental health and child behavior problems, as well as lower interest in IBH virtual support options. Lower SES and racial and/or ethnic minority parents both indicated greater interest in IBH modalities compared to higher SES and White parents, respectively. Qualitative interviews conducted found that pandemic stressors led to increases in parents’ desire for behavioral support from pediatricians, with parents sharing perspectives on the nature of support they desired, including proactive communication from providers and variety and flexibility in the behavioral supports offered.
AHRQ-funded; HS022981.
Citation: Hails KA, Wellen BC, Simoni M .
Parents' preferences for primary care-based behavioral services and the COVID-19 pandemic: a mixed method study.
J Pediatr Psychol 2023 Nov 16; 48(11):879-92. doi: 10.1093/jpepsy/jsad034..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Primary Care
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
MacMartin M, Zeng A, Chelen J
'The burden of wanting to make it right': thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA.
The objective of this study was to examine the experience of healthcare professionals who created policies for crisis standards of care. Researchers conducted semistructured interviews with healthcare professionals involved in institutional planning for resource shortages in the setting of the COVID-19 pandemic, specifically regarding the allocation of ventilators in the event of a shortage. One overarching theme developed: planning for resource shortages imposed a psychological burden on many planners. Four subthemes that influenced that burden were also identified. The researchers concluded that improved leadership strategies and cross-institutional collaboration can reduce the psychological burden of planning and can facilitate the update of plans in anticipation of future shortages.
AHRQ-funded; HS024075.
Citation: MacMartin M, Zeng A, Chelen J .
'The burden of wanting to make it right': thematic analysis of semistructured interviews to explore experiences of planning for crisis standards of care and ventilator allocation during the COVID-19 pandemic in the USA.
BMJ Open 2023 Nov 9; 13(11):e076674. doi: 10.1136/bmjopen-2023-076674..
Keywords: COVID-19, Public Health, Policy
Miller LG, McKinnell JA, Singh RD
Decolonization in nursing homes to prevent infection and hospitalization.
Researchers conducted a cluster-randomized trial of universal decolonization as compared with routine-care bathing in nursing homes. Data were obtained from 28 nursing homes. The results indicated that universal decolonization with chlorhexidine and nasal iodophor led to a significantly lower risk of transfer to a hospital due to infection than routine care.
AHRQ-funded; HS024286.
Citation: Miller LG, McKinnell JA, Singh RD .
Decolonization in nursing homes to prevent infection and hospitalization.
N Engl J Med 2023 Nov 9; 389(19):1766-77. doi: 10.1056/NEJMoa2215254..
Keywords: Nursing Homes, Long-Term Care, Healthcare-Associated Infections (HAIs)
Salwei ME, Ancker JS, Weinger MB
The decision aid is the easy part: workflow challenges of shared decision making in cancer care.
The authors indicate that widespread use of shared decision making (SDM) in clinical care has been limited even though both the National Academy of Medicine and the American Society of Clinical Oncology recommend SDM methods to improve patient-centered care. The purpose of this commentary is to explore 3 workflow-related barriers to SDM, and to discuss human factors engineering and demonstrate its potential value to decision aid design through a decision-making case study.
AHRQ-funded; HS026395.
Citation: Salwei ME, Ancker JS, Weinger MB .
The decision aid is the easy part: workflow challenges of shared decision making in cancer care.
J Natl Cancer Inst 2023 Nov 8; 115(11):1271-77. doi: 10.1093/jnci/djad133..
Keywords: Shared Decision Making, Cancer, Patient-Centered Healthcare
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
Miller MJ, Miller MJ, Pak SS, Keller DR SS, Keller DR
Physical therapist telehealth delivery at 1 year into COVID-19.
This study’s purpose was to examine telehealth physical therapy utilization 1 year into the COVID-19 pandemic and identify factors that influence physical therapists' delivery of telehealth in an urban academic medical center. Data was extracted from electronic medical records from March 22 to May 15, 2021. The proportion of physical therapy sessions delivered via telehealth were identified, and patient characteristics were compared by telehealth volume (0 vs ≥1 session, 1 vs >1 session). Telehealth was used for 3793 of 8038 (47.2%) physical therapist sessions, and 1028 unique patients had at least 2 physical therapist sessions (without telehealth: 6.6%, telehealth once: 39.1%, telehealth more than once: 54.3%). Patients who did not use telehealth were older, non-English speaking, had non-commercial insurance, and had at least 1 chronic health condition. Patients who used telehealth more than once had a neurologic diagnosis and lived farther from the treating clinic. Factors that influenced telehealth delivery were physical therapist clinical skills and knowledge, technical proficiency, telehealth-specific interpersonal skills, and cognitive flexibility. External factors outside of the physical therapist that influenced telehealth delivery included the environment, patient equipment and technology proficiency, physical therapist equipment, clinic factors, and patient and referring provider perspectives.
AHRQ-funded; HS026379.
Citation: Miller MJ, Miller MJ, Pak SS, Keller DR SS, Keller DR .
Physical therapist telehealth delivery at 1 year into COVID-19.
Phys Ther 2022 Nov 6; 102(11). doi: 10.1093/ptj/pzac121..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT)
Cifra CL, Custer JW, Smith CM
Prevalence and characteristics of diagnostic error in pediatric critical care: a multicenter study.
This study’s objective was to determine the prevalence and characteristics of diagnostic errors and identify factors associated with error in patients admitted to the PICU. This multicenter cohort study used structured medical record review by trained clinicians using the Revised Safer Dx instrument to identify diagnostic error (defined as missed opportunities in diagnosis). The cohort included 882 randomly selected patients 0-18 years old who were nonelectively admitted to participating PICUs. Of these admissions, 13 (1.5%) had a diagnostic error up to 7 days after PICU admission, with infections (46%) and respiratory conditions (23%) being the most missed diagnoses. One diagnostic error caused a prolonged hospital stay. Common missed diagnostic opportunities included failure to consider the diagnosis despite a suggestive history and failure to broaden diagnostic testing, both at 69%. Unadjusted analysis identified more diagnostic errors in patients with atypical presentations (23.1% vs 3.6%), neurologic chief complaints (46.2% vs 18.8%), admitting intensivists greater than or equal to 45 years old (92.3% vs 65.1%), admitting intensivists with more service weeks/year (mean 12.8 vs 10.9 weeks), and diagnostic uncertainty on admission (77% vs 25.1%). Generalized linear mixed models determined that atypical presentation (odds ratio [OR] 4.58) and diagnostic uncertainty on admission (OR 9.67) were significantly associated with diagnostic error.
AHRQ-funded; HS026965.
Citation: Cifra CL, Custer JW, Smith CM .
Prevalence and characteristics of diagnostic error in pediatric critical care: a multicenter study.
Crit Care Med 2023 Nov; 51(11):1492-501. doi: 10.1097/ccm.0000000000005942..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Critical Care, Intensive Care Unit (ICU), Medical Errors, Patient Safety