National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Antibiotics (1)
- Back Health and Pain (1)
- Behavioral Health (1)
- Cancer (3)
- Cancer: Breast Cancer (1)
- Cancer: Lung Cancer (1)
- Critical Care (1)
- Dementia (3)
- Depression (1)
- Diabetes (1)
- (-) Diagnostic Safety and Quality (19)
- Disparities (2)
- (-) Elderly (19)
- Evidence-Based Practice (2)
- Guidelines (1)
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- Imaging (4)
- Intensive Care Unit (ICU) (1)
- Lifestyle Changes (1)
- Long-Term Care (2)
- Medicare (4)
- Neurological Disorders (4)
- Nursing Homes (3)
- Outcomes (1)
- Palliative Care (1)
- Patient-Centered Outcomes Research (2)
- Patient Self-Management (1)
- Pneumonia (1)
- Prevention (1)
- Primary Care (1)
- Screening (1)
- Sepsis (1)
- Sleep Problems (1)
- Social Determinants of Health (1)
- Urinary Tract Infection (UTI) (1)
- Women (1)
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 19 of 19 Research Studies DisplayedWretman CJ, Boynton MH, Preisser JS
Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: a discrete choice experiment.
The purpose of this study was to address the overdiagnosis of UTIs in nursing home residents as a significant public health threat by exploring which patient-level information was related with the overdiagnosis. The study found that the results of urinalyses and lower urinary tract status were most related with the overdiagnosis of UTIs.
AHRQ-funded; HS024519.
Citation: Wretman CJ, Boynton MH, Preisser JS .
Patient-level information underlying overdiagnosis of urinary tract infections in nursing homes: a discrete choice experiment.
Infect Control Hosp Epidemiol 2023 Jul; 44(7):1151-54. doi: 10.1017/ice.2022.171..
Keywords: Urinary Tract Infection (UTI), Nursing Homes, Long-Term Care, Diagnostic Safety and Quality, Elderly
Hua CL, Thomas KS, Bunker J
Changes in the agreement between the Minimum Data Set and hospital Medicare claims measures of dementia.
The objective of this study was to examine the agreement between a clinical Minimum Data Set measure of dementia and a diagnosis of dementia documented on a hospital claim across three points in time. A second objective was to examine the extent to which the agreement varied by age, sex, and race/ethnicity. Findings showed that hospital claims for patients aged 66–75 were less likely to be accurate than those for other age groups and suggests that physicians do not always look for signs of dementia in younger adults. Additionally, Asian patients were less likely to have a diagnosis of dementia documented during hospitalization, which could be related to language barriers between patients and clinicians.
AHRQ-funded; HS000011.
Citation: Hua CL, Thomas KS, Bunker J .
Changes in the agreement between the Minimum Data Set and hospital Medicare claims measures of dementia.
J Am Geriatr Soc 2021 Sep;69(9):2672-75. doi: 10.1111/jgs.17201..
Keywords: Elderly, Dementia, Neurological Disorders, Diagnostic Safety and Quality, Medicare
Ricci KB, Oslock WM, Ingraham AM
Importance of radiologists in optimizing outcomes for older Americans with acute abdomen.
Patients presenting with acute abdominal pain often undergo a computed tomography (CT) scan as part of their diagnostic workup. The authors of this study investigated the relationship between availability, timeliness, and interpretation of CT imaging and outcomes for life-threatening intra-abdominal diseases or "acute abdomen," in older Americans. The investigators concluded that delays obtaining results were associated with adverse outcomes in older patients with acute abdomen.
AHRQ-funded; HS022694.
Citation: Ricci KB, Oslock WM, Ingraham AM .
Importance of radiologists in optimizing outcomes for older Americans with acute abdomen.
J Surg Res 2021 May;261:361-68. doi: 10.1016/j.jss.2020.12.022..
Keywords: Elderly, Imaging, Diagnostic Safety and Quality
Ganguli I, Lupo C, Mainor AJ
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
This observational cohort study looked at the prevalence and cost of care cascades after routine tests considered low value in fee-for-service Medicare patients from January 2013 through March 2015 who had gone for an annual wellness visit (AWV). Among the 75,275 AWV recipients identified, 18.6% received at least 1 low-value test including an ECG, urinalysis, or thyrotropin tests. Patients who were younger, White, and lived in urban, high-income areas were most likely to receive those tests. The cost-cascade was considered notable but of modest cost.
AHRQ-funded; HS023812.
Citation: Ganguli I, Lupo C, Mainor AJ .
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
JAMA Netw Open 2020 Dec;3(12):e2029891. doi: 10.1001/jamanetworkopen.2020.29891..
Keywords: Elderly, Medicare, Healthcare Costs, Diagnostic Safety and Quality
Bolstad CJ, Moak R, Brown CJ
Neighborhood disadvantage is associated with depressive symptoms but not depression diagnosis in older adults.
This study tested how neighborhood disadvantage (ND) relates to depressive symptomology and diagnosis to assess for neighborhood disparities in mental health care cross-sectionally. Using data from the University of Alabama at Birmingham Study of Aging, the investigators found living in the high and mid-ND tertiles to be associated with depressive symptomology, yet ND had no significant relation to depression diagnosis. They concluded that older adults living in high and mid-disadvantaged neighborhoods may be more likely to experience depressive symptomology but not receive a diagnosis, indicating a possible disparity in mental health care.
AHRQ-funded; HS013852.
Citation: Bolstad CJ, Moak R, Brown CJ .
Neighborhood disadvantage is associated with depressive symptoms but not depression diagnosis in older adults.
Int J Environ Res Public Health 2020 Aug 8;17(16). doi: 10.3390/ijerph17165745..
Keywords: Elderly, Depression, Behavioral Health, Diagnostic Safety and Quality, Disparities, Social Determinants of Health
Fink HA, Linskens EJ, Silverman PC
Accuracy of biomarker testing for neuropathologically defined Alzheimer disease in older adults with dementia
This study is a systematic review of biomarker and test accuracy for identification of Alzheimer Disease (AD) in older adults. Studies with low or medium risk of bias were analyzed, and two reviewers rated risk of bias. Fifteen brain imaging studies and 9 cerebrospinal fluid (CSF) studies met analysis criteria and were included. The meta-analysis found that in methodologically heterogeneous studies of uncertain applicability to typical clinical settings, the biomarkers amyloid PET, 18F-FDG proton emission tomography (PET), and magnetic resonance imaging (MRI) were highly sensitive for neuropathologic AD. Single studies suggested that adding amyloid PET, 18F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation.
AHRQ-funded; 290201500008I.
Citation: Fink HA, Linskens EJ, Silverman PC .
Accuracy of biomarker testing for neuropathologically defined Alzheimer disease in older adults with dementia
Ann Intern Med 2020 May 19;172(10):669-77. doi: 10.7326/m19-3888..
Keywords: Elderly, Dementia, Neurological Disorders, Imaging, Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Evidence-Based Practice
Hemmy LS, Linskens EJ, Silverman PC
Brief cognitive tests for distinguishing clinical Alzheimer-type dementia from mild cognitive impairment or normal cognition in older adults with suspected cognitive impairment.
Researchers summarized evidence on accuracy and harms of brief cognitive tests for clinical Alzheimer-type dementia (CATD) in older adults with suspected cognitive impairment. They encountered the following limitations: small studies, few test metrics being evaluated by multiple studies, and few studies directly comparing different tests, scores, cut points, or test combinations. They concluded that many brief, single cognitive tests accurately distinguish CATD from normal cognition in older adults but are less accurate in distinguishing mild CATD from normal cognition or CATD from mild cognitive impairment.
AHRQ-funded; 290201500008I.
Citation: Hemmy LS, Linskens EJ, Silverman PC .
Brief cognitive tests for distinguishing clinical Alzheimer-type dementia from mild cognitive impairment or normal cognition in older adults with suspected cognitive impairment.
Ann Intern Med 2020 May 19;172(10):678-87. doi: 10.7326/m19-3889..
Keywords: Dementia, Neurological Disorders, Diagnostic Safety and Quality, Elderly, Evidence-Based Practice, Patient-Centered Outcomes Research
Haymart MR, Banerjee M, Reyes-Gastelum D
Adverse Events, Health Status, Provider: Clinician, Provider: Nurse, Provider: Physician, Surgery
This study used Surveillance, Epidemiology, and End Results (SEER) data to analyze thyroid cancer incidence in adults aged 65 years or older. Data was analyzed in the SEER-Medicare database from 2002 and 2013. Thyroid ultrasound use as initial imaging increased in all types of thyroid cancer, which increased the diagnosis of low-risk thyroid cancer. It was associated with female and comorbidities. Researchers believe that there is greater thyroid ultrasound use which results in increased diagnosis.
AHRQ-funded; HS024512.
Citation: Haymart MR, Banerjee M, Reyes-Gastelum D .
Adverse Events, Health Status, Provider: Clinician, Provider: Nurse, Provider: Physician, Surgery
J Clin Endocrinol Metab 2019 Mar;104(3):785-92. doi: 10.1210/jc.2018-01933..
Keywords: Cancer, Diagnostic Safety and Quality, Elderly, Imaging
Albrecht JS, Wickwire EM, Vadlamani A
Trends in insomnia diagnosis and treatment among Medicare beneficiaries, 2006-2013.
In this study, the investigators examined trends in insomnia diagnosis and treatment among Medicare beneficiaries over an eight-year period. In this large national analysis of Medicare beneficiaries, prevalence of physician-assigned insomnia diagnoses was low but increased over time. Prevalence of insomnia medication use was up to four-times higher than insomnia diagnoses and remained steady over time.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Wickwire EM, Vadlamani A .
Trends in insomnia diagnosis and treatment among Medicare beneficiaries, 2006-2013.
Am J Geriatr Psychiatry 2019 Mar;27(3):301-09. doi: 10.1016/j.jagp.2018.10.017..
Keywords: Diagnostic Safety and Quality, Elderly, Medicare, Sleep Problems
Dombrowsky A, Borg B, Xie R
Why is hyperparathyroidism underdiagnosed and undertreated in older adults?
The purpose of this study was to determine why older patients with hyperparathyroidism were not appropriately diagnosed and referred for parathyroidectomy. They reviewed charts for a random sample of 25 patients aged 75 and older who had hyperparathyroidism and were referred for surgical evaluation, and 25 who were not referred. The investigators concluded that substantial gaps existed in processes for diagnosis and referral of patients with hyperparathyroidism that led to underdiagnosis and undertreatment.
AHRQ-funded; HS023009.
Citation: Dombrowsky A, Borg B, Xie R .
Why is hyperparathyroidism underdiagnosed and undertreated in older adults?
Clin Med Insights Endocrinol Diabetes 2018 Dec 12;11:1179551418815916. doi: 10.1177/1179551418815916..
Keywords: Diagnostic Safety and Quality, Elderly
Mian HS, Wildes TM, Fiala MA
Development of a Medicare health outcomes survey deficit-accumulation frailty index and its application to older patients with newly diagnosed multiple myeloma.
JCO Clinical Cancer Informatics 2018; 2):1-13. doi: 10.1200/cci.18.00043.
This study’s objective was to develop a frailty index for older patients and apply it to a subset of patients newly diagnosed with multiple myeloma. The study used the Rockwood Accumulation of Deficits approach for the Medicare Health Outcomes Study (MHOS). Data from over 2 million patients without cancer older than 66 years of age from SEER-MHOS linked databases were compared to the cohort with multiple myeloma. It was found that among patients without cancer, each 10% increase in the frailty index was associated with a 40% increased risk of death. For the multiple myeloma cohort, each 10% increase in the frailty index was associated with a 16% increased risk for death. Median time for overall survival was only 26.8 months for patients considered frail, compared with 43.7 months for those who were not. This frailty index could be used a predictor of overall survival in older multiple myeloma patients.
This study’s objective was to develop a frailty index for older patients and apply it to a subset of patients newly diagnosed with multiple myeloma. The study used the Rockwood Accumulation of Deficits approach for the Medicare Health Outcomes Study (MHOS). Data from over 2 million patients without cancer older than 66 years of age from SEER-MHOS linked databases were compared to the cohort with multiple myeloma. It was found that among patients without cancer, each 10% increase in the frailty index was associated with a 40% increased risk of death. For the multiple myeloma cohort, each 10% increase in the frailty index was associated with a 16% increased risk for death. Median time for overall survival was only 26.8 months for patients considered frail, compared with 43.7 months for those who were not. This frailty index could be used a predictor of overall survival in older multiple myeloma patients.
AHRQ-funded; HS019455.
Citation: Mian HS, Wildes TM, Fiala MA .
Development of a Medicare health outcomes survey deficit-accumulation frailty index and its application to older patients with newly diagnosed multiple myeloma.
JCO Clin Cancer Inform 2018;2. doi: 10.1200/cci.18.00043..
Keywords: Cancer, Diagnostic Safety and Quality, Elderly, Health Status, Medicare
Sloane PD, Ward K, Weber DJ
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
The purpose of this study was to determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic. The authors concluded that NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry.
AHRQ-funded; HS022846.
Citation: Sloane PD, Ward K, Weber DJ .
Can sepsis be detected in the nursing home prior to the need for hospital transfer?
J Am Med Dir Assoc 2018 Jun;19(6):492-96.e1. doi: 10.1016/j.jamda.2018.02.001..
Keywords: Sepsis, Nursing Homes, Long-Term Care, Diagnostic Safety and Quality, Elderly
Jorgensen SM, Carnahan RM, Weckmann MT
Validity of the delirium observation screening scale in identifying delirium in home hospice patients.
The Delirium Observation Screening Scale (DOS) was developed to improve delirium recognition but has yet to be validated in the home hospice setting. This pilot study aimed to explore the accuracy of the DOS for identifying delirium in home hospice patients. It concluded that the DOS appears to be an accurate way to screen for delirium in home hospice patients.
AHRQ-funded; HS022666.
Citation: Jorgensen SM, Carnahan RM, Weckmann MT .
Validity of the delirium observation screening scale in identifying delirium in home hospice patients.
Am J Hosp Palliat Care 2017 Sep;34(8):744-47. doi: 10.1177/1049909116658468.
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Keywords: Diagnostic Safety and Quality, Elderly, Home Healthcare, Neurological Disorders, Palliative Care
Sjoding MW, Prescott HC, Wunsch H
Longitudinal changes in ICU admissions among elderly patients in the United States.
The researchers sought to describe the changing demographics, diagnoses, and outcomes of patients admitted to critical care units in the U.S. hospitals. They ound that patients with infectious diseases increased from 8.8 percent to 17.2 percent of admissions, and explicitly labeled sepsis moved from the 11th-ranked diagnosis in 1996 to the top-ranked primary discharge diagnosis in 2010.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Prescott HC, Wunsch H .
Longitudinal changes in ICU admissions among elderly patients in the United States.
Crit Care Med 2016 Jul;44(7):1353-60. doi: 10.1097/ccm.0000000000001664.
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Keywords: Elderly, Intensive Care Unit (ICU), Hospitalization, Diagnostic Safety and Quality, Critical Care
Zimmerman S, Cohen LW, Scales K
Pneumonia identification using nursing home records.
The researchers compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes. They found that recorded diagnosis of pneumonia is a highly sensitive and pragmatic method to ascertain pneumonia in nursing homes, and is recommended for use in quality improvement and research.
AHRQ-funded; HS022298.
Citation: Zimmerman S, Cohen LW, Scales K .
Pneumonia identification using nursing home records.
Res Gerontol Nurs 2016 May 1;9(3):109-14. doi: 10.3928/19404921-20151218-01.
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Keywords: Antibiotics, Elderly, Diagnostic Safety and Quality, Nursing Homes, Pneumonia
Nadpara P, Madhavan SS, Tworek C
Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: a population-based study.
This study evaluated the variations in guideline-concordant timely lung cancer care and prognosis among elderly in the US. It found that the time to diagnosis and treatment varied significantly among the elderly. However, 77.5 percent received guideline-concordant timely lung cancer care. The likelihood of receiving timely care significantly decreased with early stage diagnosis, increasing age, non-white race, higher comorbidity score, and lower income.
AHRQ-funded; HS018622.
Citation: Nadpara P, Madhavan SS, Tworek C .
Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: a population-based study.
Cancer Epidemiol 2015 Dec;39(6):1136-44. doi: 10.1016/j.canep.2015.06.005.
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Keywords: Cancer: Lung Cancer, Elderly, Guidelines, Disparities, Diagnostic Safety and Quality
Jarvik JG, Gold LS, Comstock BA
Association of early imaging for back pain with clinical outcomes in older adults.
This study compared function and pain at the 12-month follow-up visit among older adults who received early imaging with those who did not receive early imaging after a new primary care visit for back pain without radiculopathy. It found that early imaging was not associated with better 1-year outcomes. The researchers concluded that the value of early diagnostic imaging in older adults for back pain with radiculopathy is uncertain.
AHRQ-funded; HS019222, HS022972
Citation: Jarvik JG, Gold LS, Comstock BA .
Association of early imaging for back pain with clinical outcomes in older adults.
JAMA. 2015 Mar 17;313(11):1143-53. doi: 10.1001/jama.2015.1871..
Keywords: Back Health and Pain, Elderly, Primary Care, Outcomes, Diagnostic Safety and Quality, Imaging
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
Leung LA, Swaminathan S, Trivedi AN
Diabetes diagnosis and exercise initiation among older Americans.
The investigators sought to determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. They found that over 35% of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis.
AHRQ-funded; HS000011.
Citation: Leung LA, Swaminathan S, Trivedi AN .
Diabetes diagnosis and exercise initiation among older Americans.
Prev Med 2014 Aug;65:128-32. doi: 10.1016/j.ypmed.2014.05.001.
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Keywords: Diabetes, Diagnostic Safety and Quality, Elderly, Lifestyle Changes, Patient Self-Management