National Healthcare Quality and Disparities Report
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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 199 Research Studies DisplayedKnutzen KE, Schifferdecker KE, Murray GF
Role of norms in variation in cancer centers' end-of-life quality: qualitative case study protocol.
AHRQ-funded; HS022242.
Citation: Knutzen KE, Schifferdecker KE, Murray GF .
Role of norms in variation in cancer centers' end-of-life quality: qualitative case study protocol.
BMC Palliat Care 2020 Aug 27;19(1):136. doi: 10.1186/s12904-020-00641-x..
Keywords: Cancer, Quality of Life, Palliative Care, Quality of Care, Chronic Conditions
Poppert Cordts KM, Hall TA, Hartman ME
Sleep measure validation in a pediatric neurocritical care acquired brain injury population.
Lingering morbidities including physical, cognitive, emotional, and psychosocial sequelae, termed the Post-Intensive Care Syndrome, persist years after pediatric neurocritical care (PNCC) hospitalization. Sleep disturbances impact other Post-Intensive Care Syndrome domains and are under-evaluated to date due to a lack of appropriate measurement tools. The present study evaluated the validity of the Sleep Disturbance Scale for Children (SDSC) to address the growing need for assessing sleep problems after PNCC.
AHRQ-funded; HS022981.
Citation: Poppert Cordts KM, Hall TA, Hartman ME .
Sleep measure validation in a pediatric neurocritical care acquired brain injury population.
Neurocrit Care 2020 Aug;33(1):196-206. doi: 10.1007/s12028-019-00883-5..
Keywords: Children/Adolescents, Sleep Problems, Neurological Disorders, Intensive Care Unit (ICU), Hospitalization, Quality of Life
Kirby JS, Thorlacius L, Villumsen B L, Villumsen B
The Hidradenitis Suppurativa Quality of Life (HiSQOL) score: development and validation of a measure for clinical trials.
The authors sought to develop and validate the Hidradenitis Suppurativa Quality Of Life (HiSQOL©) scale, for clinical trial measurement of hidradenitis suppurativa (HS)-specific health-related quality of life (HRQOL). They found that the HiSQOL is a reliable and valid instrument to measure HS-specific HRQOL in clinical trials.
AHRQ-funded; HS024585.
Citation: Kirby JS, Thorlacius L, Villumsen B L, Villumsen B .
The Hidradenitis Suppurativa Quality of Life (HiSQOL) score: development and validation of a measure for clinical trials.
Br J Dermatol 2020 Aug;183(2):340-48. doi: 10.1111/bjd.18692..
Keywords: Quality of Life, Research Methodologies
Erim DO, Bennett AV, Gaynes BN
Associations between prostate cancer-related anxiety and health-related quality of life.
This study followed prostate cancer patients who were enrolled in the cohort study North Cancer Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCess) from January 2011 and June 2013. A 1-year follow-up survey was done to assess prostate cancer-related anxiety (PCRA) in the cohort. The researchers were interested in the association between PCRA and health-related quality of life (HRQOL). The risk of probable depression was significantly higher in participants with clinically significant PCRA compared with those without it.
AHRQ-funded; 29020050040I.
Citation: Erim DO, Bennett AV, Gaynes BN .
Associations between prostate cancer-related anxiety and health-related quality of life.
Cancer Med 2020 Jun;9(12):4467-73. doi: 10.1002/cam4.3069..
Keywords: Cancer: Prostate Cancer, Cancer, Anxiety, Quality of Life, Men's Health, Patient-Centered Outcomes Research, Depression, Evidence-Based Practice
Dominici LS, Rosenberg SM
Ductal carcinoma in situ (DCIS): the importance of patient-reported outcomes (PRO).
This review summarizes patient-reported outcomes (PROs) frequently assessed in the setting of a ductal carcinoma in situ (DCIS) diagnosis. Findings indicated that PROs provide critical information regarding the experiences of women following a DCIS diagnosis. Continued inclusion of PROs in clinical trials is warranted, further informing treatment decisions and adequately preparing patients for what to expect following treatment.
AHRQ-funded; HS023680.
Citation: Dominici LS, Rosenberg SM .
Ductal carcinoma in situ (DCIS): the importance of patient-reported outcomes (PRO).
Curr Breast Cancer Rep 2020 Jun;12(2):90-97. doi: 10.1007/s12609-020-00363-2..
Keywords: Cancer: Breast Cancer, Cancer, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice, Women, Quality of Life
Silverberg JI, Lai JS, Kantor RW
Development, validation, and interpretation of the PROMIS Itch Questionnaire: a patient-reported outcome measure for the quality of life impact of itch.
Current patient-reported outcome measures for itch are limited and may not capture its full impact on health-related quality of life. In this study, the investigators sought to develop, calibrate, and validate banks of questions assessing the health-related quality of life impact of itch as part of the Patient-Reported Outcomes Measurement Information System. A systematic process of literature review, content-expert review, qualitative research, testing in a sample of 600 adults, classical test theory methods, and item response theory analyses were applied.
AHRQ-funded; HS023011.
Citation: Silverberg JI, Lai JS, Kantor RW .
Development, validation, and interpretation of the PROMIS Itch Questionnaire: a patient-reported outcome measure for the quality of life impact of itch.
J Invest Dermatol 2020 May;140(5):986-94.e6. doi: 10.1016/j.jid.2019.08.452..
Keywords: Quality of Life, Quality of Care
Gaskin DJ, Karmarkar TD, Maurer A
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
This study examined whether using a decision-making tool would aid Latina and African-American women over age 45 years with arthritic knee pain in making more informed treatment decisions. The researchers conducted 4 focus groups of Latina and African-American women and 2 focus groups with primary care providers who treated them for knee pain. They found that minority women and primary care providers all endorsed the use of a decision-making tool that provided information on the impact of treatment on quality of life, medical care costs, and work productivity.
AHRQ-funded; HS000029.
Citation: Gaskin DJ, Karmarkar TD, Maurer A .
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
Arthritis Care Res 2020 May;72(5):692-98. doi: 10.1002/acr.23903..
Keywords: Arthritis, Orthopedics, Pain, Quality of Life, Healthcare Costs, Shared Decision Making, Racial and Ethnic Minorities, Women
Penedo FJ, Oswald LB, Kronenfeld JP
The increasing value of eHealth in the delivery of patient-centred cancer care.
This paper is an appraisal of peer literature over the past 10 years on patient-centered eHealth to improve cancer care delivery. Uses of eHealth include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. Challenges of, and opportunities for accessibility, scalability, and implementation of these technologies is also discussed.
AHRQ-funded; HS026170.
Citation: Penedo FJ, Oswald LB, Kronenfeld JP .
The increasing value of eHealth in the delivery of patient-centred cancer care.
Lancet Oncol 2020 May;21(5):e240-e51. doi: 10.1016/s1470-2045(20)30021-8.
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Keywords: Cancer, Patient-Centered Healthcare, Healthcare Delivery, Telehealth, Health Information Technology (HIT), Quality of Life, Implementation
Abedini NC, Choi H, Wei MY
The relationship of loneliness to end-of-life experience in older Americans: a cohort study.
This study examined the relationship of loneliness to end-of-life-experiences for older Americans. Cohort data of decedents older than 50 years old was analyzed from the Health and Retirement Study (HRS). Individuals were characterized as lonely based on the three-item Revised University of California, Los Angeles Loneliness Scale from the most recent HRS survey taken before death. Individuals who were lonely were more likely to die in a nursing home and also have been on life support in the last 2 years of life. There were no other significant differences between lonely and nonlonely people.
AHRQ-funded; HS025891.
Citation: Abedini NC, Choi H, Wei MY .
The relationship of loneliness to end-of-life experience in older Americans: a cohort study.
J Am Geriatr Soc 2020 May;68(5):1064-71. doi: 10.1111/jgs.16354.
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Keywords: Elderly, Quality of Life
Chen DW, Reyes-Gastelum D, Wallner LP
Disparities in risk perception of thyroid cancer recurrence and death.
The authors studied risk perception among survivors of thyroid cancer. Patients diagnosed with differentiated thyroid cancer from the Surveillance, Epidemiology, and End Results registries were surveyed and an analytic cohort defined by a 5% or greater risk of disease recurrence and mortality. The authors found that less educated patients and Hispanic patients were more likely to report inaccurate risk perceptions, which were associated with worry and a decreased quality of life.
AHRQ-funded; HS024512.
Citation: Chen DW, Reyes-Gastelum D, Wallner LP .
Disparities in risk perception of thyroid cancer recurrence and death.
Cancer 2020 Apr 1;126(7):1512-21. doi: 10.1002/cncr.32670..
Keywords: Disparities, Cancer, Risk, Quality of Life, Social Determinants of Health, Racial and Ethnic Minorities
Laughlin-Tommaso SK, Lu D, Thomas L
Short-term quality of life after myomectomy for uterine fibroids from the COMPARE-UF fibroid registry.
Investigators compared women's perception of their short-term health-related quality of life measures and reported time to return to usual activities and return to work for different routes of myomectomy. Using data from the Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF) registry, and including abdominal and laparoscopic myomectomy procedures, they found that women who underwent myomectomy had substantial improvement in health-related quality of life, regardless of route of myomectomy; abdominal myomectomy was associated with a nearly 2-week longer time to return to work than laparoscopic myomectomy.
AHRQ-funded; HS023418.
Citation: Laughlin-Tommaso SK, Lu D, Thomas L .
Short-term quality of life after myomectomy for uterine fibroids from the COMPARE-UF fibroid registry.
Am J Obstet Gynecol 2020 Apr;222(4):345.e1-45.e22. doi: 10.1016/j.ajog.2019.09.052..
Keywords: Quality of Life, Women, Surgery, Patient-Centered Outcomes Research, Registries
Desai AD, Zhou C, Haaland W
Social disadvantage, access to care, and disparities in physical functioning among children hospitalized with respiratory illness.
This study examined associations between social disadvantage, access to care, and disparities in physical functioning among children hospitalized with acute respiratory illness. The study cohort included children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children’s hospitals for three common respiratory illnesses from July 2014 through June 2016. Surveys were completed within 2 to 8 weeks after discharge. The survey assessed social disadvantage, difficulty/delays accessing care, and baseline and follow-up health-related quality of life (HRQoL), and physical functioning using the Pediatric Quality of Life Inventory (PedsQL). A total of 1,325 patients and/or their caregivers completed both PedsQL surveys. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage (minority race/ethnicity, limited English proficiency, low education, and low income), than for patients with none. There were also disadvantage markers or difficulty/delays accessing care which were associated with lower physical functioning. However, these differences were reduced after hospital discharge.
AHRQ-funded; HS024299.
Citation: Desai AD, Zhou C, Haaland W .
Social disadvantage, access to care, and disparities in physical functioning among children hospitalized with respiratory illness.
J Hosp Med 2020 Apr;15(4):211-18. doi: 10.12788/jhm.3359..
Keywords: Children/Adolescents, Respiratory Conditions, Hospitalization, Access to Care, Disparities, Vulnerable Populations, Quality of Life
Wallace K, Zhang S, Thomas L
Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids.
The purpose of this prospective cohort study was to compare long-term health-related quality of life (HRQOL) 1 year after hysterectomy or myomectomy for treatment of uterine fibroids (UFs) and to determine whether route of procedure, race, or age affected improvements in HRQOL. The investigators concluded that HRQOL improved in all women 1 year after hysterectomy or myomectomy.
AHRQ-funded; HS023418.
Citation: Wallace K, Zhang S, Thomas L .
Comparative effectiveness of hysterectomy versus myomectomy on one-year health-related quality of life in women with uterine fibroids.
Fertil Steril 2020 Mar;113(3):618-26. doi: 10.1016/j.fertnstert.2019.10.028..
Keywords: Comparative Effectiveness, Women, Quality of Life, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Rundell SD, Resnik L, Heagerty PJ
Comparing the performance of comorbidity indices in predicting functional status, health-related quality of life, and total health care use in older adults with back pain.
The purpose of this prospective cohort study was to determine how well the functional comorbidity index (FCI) predicted outcomes in older adults with back pain compared to Quan's modification of the Charlson comorbidity index (Quan-Charlson comorbidity index) and the Elixhauser comorbidity index. The investigators concluded that all indices performed similarly in predicting outcomes. The authors indicated that there is still a need to develop better function-based risk-adjustment models that improve prediction of functional outcomes versus standard comorbidity indices.
AHRQ-funded; HS019222; HS022972.
Citation: Rundell SD, Resnik L, Heagerty PJ .
Comparing the performance of comorbidity indices in predicting functional status, health-related quality of life, and total health care use in older adults with back pain.
J Orthop Sports Phys Ther 2020 Mar;50(3):143-48. doi: 10.2519/jospt.2020.8764..
Keywords: Elderly, Back Health and Pain, Pain, Chronic Conditions, Quality of Life, Healthcare Utilization, Health Status
Lei D, Yousaf M, Janmohamed SR
Validation of four single-item patient-reported assessments of sleep in adult atopic dermatitis patients.
The purpose of this study was to assess the measurement properties of sleep-related items from the Patient-Oriented Eczema Measure (POEM), SCORing AD (SCORAD), 5-dimensions of itch (5D), and Itch-Related Quality of Life (ItchyQOL) in adults with atopic dermatitis (AD). Results showed modest overlap and weak to moderate concordance of responses to the different assessments. The researchers conclude that sleep-related items from POEM, SCORAD, 5D, and ItchyQOL showed good validity and responsiveness to monitor sleep disturbances in adult AD patients.
AHRQ-funded; HS023011.
Citation: Lei D, Yousaf M, Janmohamed SR .
Validation of four single-item patient-reported assessments of sleep in adult atopic dermatitis patients.
Ann Allergy Asthma Immunol 2020 Mar;124(3):261-66. doi: 10.1016/j.anai.2019.12.002..
Keywords: Sleep Problems, Skin Conditions, Quality of Life, Patient-Centered Outcomes Research
Parekh TM, Bhatia S, Cherrington A
Factors influencing decline in quality of life in smokers without airflow obstruction: the COPDGene study.
This study looked at factors influencing decline in quality of life (QoL) in smokers without airflow obstruction using participants from the COPDGene study, a multicenter, longitudinal US study designed to determine genetic determinants of chronic obstructive pulmonary disease (COPD). The authors hypothesized that exacerbations and changes in exacerbation status would predict QoL decline among normal spirometry and Preserved Ratio Impaired Spirometry (PRISm) populations. They enrolled study subjects from Phase 1 of COPDGene and performed multivariable logistic regression models to determine independent predictors of decline in quality of life. Independent predictors of QoL deterioration included current smoking, higher exacerbation frequency, and a change from infrequent to frequent exacerbation status in both groups.
AHRQ-funded; HS023009.
Citation: Parekh TM, Bhatia S, Cherrington A .
Factors influencing decline in quality of life in smokers without airflow obstruction: the COPDGene study.
Respir Med 2020 Jan;161:105820. doi: 10.1016/j.rmed.2019.105820..
Keywords: Respiratory Conditions, Chronic Conditions, Tobacco Use, Quality of Life
Cheng BT, Smith SS, Fishbein AB
Functional burden and limitations in children with chronic sinusitis.
The objective of this study was to use a validated pediatric quality of life (QOL) tool to quantify the impact of pediatric chronic rhinosinusitis (CRS) in a representative epidemiological sample. Findings showed that pediatric CRS was associated with substantial QOL burden across multiple psychosocial and cognitive domains and that CRS children with lower family income and comorbid asthma, anxiety, and depression had higher Columbia Impairment Scale scores associated with even greater functional impairment. These findings suggested that pediatric CRS might be a population requiring greater attention and screening for mental health symptoms.
AHRQ-funded; HS023011.
Citation: Cheng BT, Smith SS, Fishbein AB .
Functional burden and limitations in children with chronic sinusitis.
Pediatr Allergy Immunol 2020 Jan;31(1):103-05. doi: 10.1111/pai.13121..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Quality of Life, Healthcare Costs, Respiratory Conditions, Chronic Conditions
Andreae SJ, Andreae LJ, Richman JS
Peer-delivered cognitive behavioral training to improve functioning in patients with diabetes: a cluster-randomized trial.
Cognitive behavioral therapy (CBT)-based programs delivered by trained community members could improve functioning and pain in individuals who lack access to such programs. In this study, the investigators tested the effectiveness of a peer-delivered diabetes self-management program integrating CBT principles in improving physical activity, functional status, pain, quality of life (QOL), and health outcomes in individuals with diabetes and chronic pain.
AHRQ-funded; HS019239.
Citation: Andreae SJ, Andreae LJ, Richman JS .
Peer-delivered cognitive behavioral training to improve functioning in patients with diabetes: a cluster-randomized trial.
Ann Fam Med 2020 Jan;18(1):15-23. doi: 10.1370/afm.2469..
Keywords: Diabetes, Chronic Conditions, Pain, Patient Self-Management, Quality of Life
Roy B, Riley C, Herrin J
Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states.
The objective of this study was to evaluate the association between community well-being, a positively framed, multidimensional assessment of the health and quality of life of a geographic community, and hospitalisation rates. The investigators found that community well-being was inversely associated with local hospitalisation rates. They suggest that in addition to health and quality-of-life benefits, higher community well-being may also result in fewer unnecessary hospitalisations.
AHRQ-funded; HS023000.
Citation: Roy B, Riley C, Herrin J .
Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states.
BMJ Open 2019 Nov 27;9(11):e030017. doi: 10.1136/bmjopen-2019-030017..
Keywords: Hospitalization, Health Status, Quality of Life, Healthcare Utilization, Social Determinants of Health
Parsons HM, Forte ML, Abdi HI
Nutrition as prevention for improved cancer health outcomes: a systematic literature review.
This systematic review examined evidence for the effectiveness of providing nutritional interventions before or during cancer therapy to improve cancer treatment outcomes. The studies examined focused primarily on non-vitamin/mineral dietary supplements, nutrition support, and route or timing of inpatient nutrition interventions for patients with gastrointestinal or head and neck cancer; most of the studies evaluated changes in body weight, adverse events from cancer treatment, length of hospital stay, or quality of life. While studies with low- or medium risk-of-bias reported mixed results on the effect of nutritional interventions, the authors concluded that the methodological limitations impair the translation of study findings into clinical practice or guidelines.
AHRQ-funded; 75Q80120D00008.
Citation: Parsons HM, Forte ML, Abdi HI .
Nutrition as prevention for improved cancer health outcomes: a systematic literature review.
JNCI Cancer Spectr 2023 May 2; 7(3):pkad035. doi: 10.1093/jncics/pkad035..
Keywords: Nutrition, Cancer, Prevention, Quality of Life, Evidence-Based Practice, Patient-Centered Outcomes Research
Volerman A, Fierstein J, Boon K
Factors associated with effective inhaler technique among children with moderate to severe asthma.
Guidelines recommend that children and families receive education about and demonstration of effective inhaler technique as part of asthma self-management education. For youth, improved inhaler technique is associated with better quality of life and decreased health care use, yet technique remains suboptimal. To understand potential reasons for differences in inhaler skills, this study examined individual- and health care-level factors associated with effective inhaler technique among children.
AHRQ-funded; HS026385.
Citation: Volerman A, Fierstein J, Boon K .
Factors associated with effective inhaler technique among children with moderate to severe asthma.
Ann Allergy Asthma Immunol 2019 Nov;123(5):511-12.e1. doi: 10.1016/j.anai.2019.08.017.
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Keywords: Children/Adolescents, Asthma, Chronic Conditions, Patient Self-Management, Education: Patient and Caregiver, Medication, Quality of Life
Smith JW, Knight Davis J, Quatman-Yates CC
Loss of community-dwelling status among survivors of high-acuity emergency general surgery disease.
The purpose of this study was to examine the loss of community-dwelling status 9 months after hospitalization for high-acuity emergency general surgery (HA-EGS) disease among older Americans. The investigators concluded that older Americans, known to prioritize living in the community, will experience substantial loss of independence due to HA-EGS. They indicate that long-term expectations after surviving HA-EGS must be framed from the perspective of the outcomes that older patients value the most.
AHRQ-funded; HS022694.
Citation: Smith JW, Knight Davis J, Quatman-Yates CC .
Loss of community-dwelling status among survivors of high-acuity emergency general surgery disease.
J Am Geriatr Soc 2019 Nov;67(11):2289-97. doi: 10.1111/jgs.16046..
Keywords: Elderly, Surgery, Outcomes, Quality of Life
Crossnohere NL, Richardson DR, Reinhart C
Side effects from acute myeloid leukemia treatment: results from a national survey.
Acute myeloid leukemia (AML) is experiencing a therapeutic renaissance due to the heightened biomedical understanding of AML and patient-focused drug development (PFDD). Many AML patients now live long-term with the side effects of treatment. This study documents the prevalence and severity of AML treatment-related side effects. This study documents the prevalence and severity of AML treatment-related side effects.
AHRQ-funded; HS000032.
Citation: Crossnohere NL, Richardson DR, Reinhart C .
Side effects from acute myeloid leukemia treatment: results from a national survey.
Curr Med Res Opin 2019 Nov;35(11):1965-70. doi: 10.1080/03007995.2019.1631149..
Keywords: Adverse Drug Events (ADE), Adverse Events, Cancer, Medication, Quality of Life
Mullins BT, Basak R, Broughman JR
Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: analysis of a population-based prospective cohort.
This study compares the effects of different types of radical prostatectomy and radiotherapy on sexual function. A population-based cohort of 835 men with newly diagnosed prostate cancer from 2011 through 2013 was recruited in collaboration with the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry. They were enrolled prior to treatment and followed retrospectively using the validated Prostate Cancer Symptom Indices (PCSI) instrument. The sexual function scores were compared among patients who received the following treatment types: external-beam RT (EBRT), EBRT with androgen deprivation therapy (ADT), brachytherapy, nerve-sparing radical prostatectomy (RP), and non-nerve-sparing RP. The cohort was surveyed at 24 months post-therapy, and RT alone was found to result in the best preservation of sexual function with brachytherapy, RT with ADT, and nerve-sparing RP yielding similar outcomes. Patients treated with non-nerve-sparing RP experienced the worst sexual function outcome.
AHRQ-funded.
Citation: Mullins BT, Basak R, Broughman JR .
Patient-reported sexual quality of life after different types of radical prostatectomy and radiotherapy: analysis of a population-based prospective cohort.
Cancer 2019 Oct 15;125(20):3657-65. doi: 10.1002/cncr.32288..
Keywords: Quality of Life, Sexual Health, Surgery, Treatments, Comparative Effectiveness, Patient-Centered Outcomes Research, Outcomes, Cancer: Prostate Cancer, Cancer, Evidence-Based Practice
Possin KL, Merrilees JJ, Dulaney S
Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial.
Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering care from centralized hubs across broad geographic areas to caregivers and persons with dementia (PWDs) independently of their health system affiliations. The purpose of this study was to determine whether the Care Ecosystem was effective in improving outcomes important to PWDs, their caregivers, and payers beyond those achieved with usual care.
AHRQ-funded; HS022241.
Citation: Possin KL, Merrilees JJ, Dulaney S .
Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial.
JAMA Intern Med 2019 Sep 30;179(12):1658-67. doi: 10.1001/jamainternmed.2019.4101..
Keywords: Dementia, Neurological Disorders, Telehealth, Health Information Technology (HIT), Care Management, Healthcare Delivery, Caregiving, Quality of Life