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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 195 Research Studies Displayed
Haukoos JS, Campbell JD, Conroy AA
Programmatic cost evaluation of nontargeted opt-out rapid HIV screening in the emergency department.
The researchers estimated the total direct costs associated with performing nontargeted opt-out rapid HIV screening in the emergency department per newly-identified HIV-infected patients and compared such costs to those associated with diagnostic rapid HIV testing. They found that compared to diagnostic testing, nontargeted opt-out rapid HIV screening was more costly but identified more HIV infections.
Citation: Haukoos JS, Campbell JD, Conroy AA . Programmatic cost evaluation of nontargeted opt-out rapid HIV screening in the emergency department. PLoS One. 2013 Dec 31;8(12):e81565. doi: 10.1371/journal.pone.0081565..
Keywords: Comparative Effectiveness, Human Immunodeficiency Virus (HIV), Emergency Medical Services (EMS), Healthcare Costs
Zurovac J, Moreno L, Crosson J
Using multifactorial experiments for comparative effectiveness research in physician practices with electronic health record.
This paper identifies the opportunities for using efficient multifactorial designs and electronic health records (EHR) data to evaluate quality-improvement efforts in physician practices. It concludes that the use of efficient multifactor experimental designs, especially coupled with EHR data, has great promise for helping physician practices, hospitals, and other stakeholders conduct rapid-cycle comparative effectiveness research in order to assess alternative ways of implementing various aspects of care.
Citation: Zurovac J, Moreno L, Crosson J . Using multifactorial experiments for comparative effectiveness research in physician practices with electronic health record. eGEMS 2013 Dec 30;1(3):1037. doi: 10.13063/2327-9214.1037..
Keywords: Patient-Centered Outcomes Research, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Comparative Effectiveness
Samji H, Cescon A, Hogg RS
Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada.
The researchers estimated changes in life expectancy among HIV-positive adults on antiretroviral therapy (ART) from 2000–2007 in the U.S. and Canada. They concluded that a 20-year-old HIV-positive adult on ART in the U.S. or Canada is expected to live into their early 70s, a life expectancy approaching that of the general population. Differences by sex, race, HIV transmission risk group, and CD4 count remain.
Citation: Samji H, Cescon A, Hogg RS . Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One 2013 Dec 18;8(12):e81355. doi: 10.1371/journal.pone.0081355..
Keywords: Human Immunodeficiency Virus (HIV), Mortality
Kuzniewicz MW, Wickremasinghe AC, Newman TB
Invited commentary: does neonatal hyperbilirubinemia cause asthma?
The researchers examined whether an association between neonatal total serum bilirubin levels and childhood asthma is causal. They found that the results do not appear to be due to chance or any obvious biases. It is likely that the observed association is the result of a common cause of both hyperbilirubinemia and asthma confounding. Polymorphisms in the glutathione S-transferase gene are a potential genetic confounder.
Citation: Kuzniewicz MW, Wickremasinghe AC, Newman TB . Invited commentary: does neonatal hyperbilirubinemia cause asthma? Am J Epidemiol 2013 Dec 15;178(12):1698-701. doi: 10.1093/aje/kwt249..
Keywords: Asthma, Children/Adolescents, Children/Adolescents
Jiang W, Li P, Wang S
WebGLORE: a web service for Grid LOgistic Regression.
This article describes and discusses WebGLORE, a free web service enabling privacy-preserving construction of a global logistic regression model from sensitive distributed datasets using HTTP to a trusted server, where the model is synthesized.
Citation: Jiang W, Li P, Wang S . WebGLORE: a web service for Grid LOgistic Regression. Bioinformatics. 2013 Dec 15;29(24):3238-40. doi: 10.1093/bioinformatics/btt559..
Keywords: Data, Health Information Technology (HIT), Web-Based
Minden SL, Ding L, Cleary PD
Improving the quality of mental health care in multiple sclerosis.
The researchers surveyed multiple sclerosis (MS) patients across the U.S. to determine how many experienced mental health problems and received treatment over the preceding year. Also studied were patient experiences with and ratings of care, type of treatment provider, and the location of care. The researchers found a high unmet need for mental health treatment among persons with MS.
Citation: Minden SL, Ding L, Cleary PD . Improving the quality of mental health care in multiple sclerosis. J Neurol Sci. 2013 Dec 15;335(1-2):42-7. doi: 10.1016/j.jns.2013.08.021..
Keywords: Behavioral Health, Quality of Care, Chronic Conditions
Schiff GD, Puopolo AL, Huben-Kearney A
Primary care closed claims experience of Massachusetts malpractice insurers.
The researchers studied patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. In Massachusetts, most primary care claims filed were related to alleged misdiagnosis.
Citation: Schiff GD, Puopolo AL, Huben-Kearney A . Primary care closed claims experience of Massachusetts malpractice insurers. JAMA Intern Med 2013 Dec 9-23;173(22):2063-8. doi: 10.1001/jamainternmed.2013.11070..
Keywords: Primary Care, Medical Errors, Health Insurance, Patient Safety, Medical Liability
Addressing tensions when popular media and evidence-based care collide.
This paper documents recurring problems in media messages about health-care interventions and offers suggestions for new or expanded efforts to improve the public dialogue about health care. It concluded that inaccurate, imbalanced, incomplete news stories may drown out more careful scrutiny of the evidence by many influential news organizations.
Citation: Schwitzer G . Addressing tensions when popular media and evidence-based care collide. BMC Med Inform Decis Making 2013;13 Suppl 3:S3. doi: 10.1186/1472-6947-13-s3-s3..
Keywords: Communications, Education: Patient and Caregiver, Evidence-Based Practice
Starmer AJ, Sectish TC, Simon DW
Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.
The researchers sought to determine whether introduction of a multifaceted handoff program was associated with reduced rates of medical errors and preventable adverse events, fewer omissions of key data in written handoffs, improved verbal handoffs, and changes in resident-physician workflow. They found that implementation of a handoff bundle was associated with a significant reduction in medical errors and preventable adverse events among hospitalized children.
Citation: Starmer AJ, Sectish TC, Simon DW . Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA 2013 Dec 4;310(21):2262-70. doi: 10.1001/jama.2013.281961..
Keywords: Medical Errors, Adverse Events, Children/Adolescents, Hospitalization, Patient Safety
Gilbert AL, Bauer NS, Carroll AE
Child exposure to parental violence and psychological distress associated with delayed milestones.
The researchers examined the association between parental report of intimate partner violence (IPV) and parental psychological distress (PPD) with child attainment of developmental milestones. They found that parental report of both IPV and PPD during the first 72 months of a child’s life is significantly associated with developmental milestone failure across all 4 developmental domains and within the domains of language, personal-social, and gross motor development.
AHRQ-funded; HS017939; HS018453.
Citation: Gilbert AL, Bauer NS, Carroll AE . Child exposure to parental violence and psychological distress associated with delayed milestones. Pediatrics 2013 Dec;132(6):e1577-83. doi: 10.1542/peds.2013-1020..
Keywords: Children/Adolescents, Domestic Violence, Family Health and History, Depression, Anxiety, Behavioral Health
Taliani CA, Bricker PL, Adelman AM
Implementing effective care management in the patient-centered medical home.
The investigators explored how a disparate group of patient-centered medical homes (PCMHs) embedded care management in their team care environment to identify best practices. They concluded that PCMHs may want to ensure that care managers are available to meet with patients during visits, support patient self-management, fully leverage the electronic medical record for team messaging and patient tracking, and ensure integration into the care team with office huddles and ongoing communication.
Citation: Taliani CA, Bricker PL, Adelman AM . Implementing effective care management in the patient-centered medical home. Am J Manag Care 2013 Dec;19(12):957-64.
Keywords: Care Management, Diabetes, Healthcare Delivery, Patient-Centered Healthcare, Quality Improvement, Teams
Stuart B, Davidoff A, Erten M
AHRQ Author: Davidoff A
How Medicare Part D benefit phases affect adherence with evidence-based medications following acute myocardial infarction.
The authors assessed the impact of Medicare Part D benefit phases on adherence with evidence-based medications after hospitalization for an acute myocardial infarction (AMI). They found that as the Part D doughnut hole is gradually filled in by 2020, Medicare Part D enrollees with critical diseases such as AMI who rely heavily on brand name drugs are likely to exhibit modest increases in adherence, while those reliant on generic drugs are less likely to be affected.
Citation: Stuart B, Davidoff A, Erten M . How Medicare Part D benefit phases affect adherence with evidence-based medications following acute myocardial infarction. Health Serv Res 2013 Dec;48(6 Pt 1):1960-77. doi: 10.1111/1475-6773.12073.
Keywords: Evidence-Based Practice, Medicare, Medication, Heart Disease and Health, Patient Adherence/Compliance
Moy E, Mau MK, Raetzman S
AHRQ Author: Moy E, Andrews R
Ethnic differences in potentially preventable hospitalizations among Asian Americans, Native Hawaiians, and other Pacific Islanders: implications for reducing health care disparities.
This study aimed to produce reliable estimates of health care quality among Native Hawaiian (NH), Other Pacific Islander (PI), and Asian American (AA) small population subgroups. Results showed that, despite efforts to reduce racial/ethnic health care disparities, significant gaps remain in potentially preventable hospitalization rates.
Citation: Moy E, Mau MK, Raetzman S . Ethnic differences in potentially preventable hospitalizations among Asian Americans, Native Hawaiians, and other Pacific Islanders: implications for reducing health care disparities. Ethn Dis 2013 Winter;23(1):6-11.
Keywords: Disparities, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Quality Indicators (QIs), Racial / Ethnic Minorities
Miller WL, Crabtree BF, Harrison MI
AHRQ Author: Harrison MI
Integrating mixed methods in health services and delivery system research.
The authors introduced this AHRQ-sponsored issue of Health Services Research, describing the papers and briefly indicating where they fit into the emerging mixed methods mosaic. They then provided some suggestions about what may be missing and anticipated a future state of a more integrated approach to health services research and richer dialogue between researchers and those engaged in health care.
Citation: Miller WL, Crabtree BF, Harrison MI . Integrating mixed methods in health services and delivery system research. Health Serv Res 2013 Dec;48(6 Pt 2):2125-33. doi: 10.1111/1475-6773.12123.
Keywords: Healthcare Delivery, Health Services Research (HSR), Research Methodologies
Sarpong EM, Miller GE
AHRQ Author: Sarpong EM, Miller GE
Racial and ethnic differences in childhood asthma treatment in the United States.
The authors examined racial-ethnic differences in asthma controller medication use among insured U.S. children. They found that non-Hispanic black and Hispanic children were less likely to use controllers than non-Hispanic white children. They concluded that the large observed differences in controller use highlight the continuing challenges of ensuring that all U.S. children have access to quality asthma care.
Citation: Sarpong EM, Miller GE . Racial and ethnic differences in childhood asthma treatment in the United States. Health Serv Res 2013 Dec;48(6 Pt 1):2014-36. doi: 10.1111/1475-6773.12077.
Keywords: Asthma, Children/Adolescents, Medical Expenditure Panel Survey (MEPS), Medication, Racial / Ethnic Minorities
Lomotan EA, Dougherty D
AHRQ Author: Lomotan EA, Dougherty D
Pediatric health care quality measures: considerations for pharmacotherapy.
The authors used the Pediatric Quality Measures Program that arose from the Children's Health Insurance Program Reauthorization Act in the United States to illustrate the challenges in developing quality measures of pediatric pharmacotherapy. They identified the challenges aw being twofold: (i) weak evidence base for the specific pharmacotherapy in children and (ii) limited data to calculate the measure. They concluded that health information technology is emerging as a tool to improve quality measurement but presents additional challenges.
Citation: Lomotan EA, Dougherty D . Pediatric health care quality measures: considerations for pharmacotherapy. Paediatr Drugs 2013 Dec;15(6):441-7. doi: 10.1007/s40272-013-0042-4.
Keywords: Children's Health Insurance Program (CHIP), Quality of Care, Medication, Children/Adolescents, Quality Measures
Zhang S, Senteio C, Felizzola J
Racial/ethnic disparities in antiretroviral treatment among HIV-infected pregnant Medicaid enrollees, 2005-2007.
The purpose of this study was to describe racial/ethnic disparities in ARV treatment of low-income Medicaid-eligible HIV-infected women, with a focus on minority populations in southern states. It found that Hispanic or Latino women are a specific subgroup at risk for inadequate ARV therapy in pregnancy. The researchers point out a specific policy issue with regard to the systematic exclusion of many immigrants from Medicaid-covered care during the prenatal period.
Citation: Zhang S, Senteio C, Felizzola J . Racial/ethnic disparities in antiretroviral treatment among HIV-infected pregnant Medicaid enrollees, 2005-2007. Am J Public Health 2013 Dec;103(12):e46-53. doi: 10.2105/ajph.2013.301328..
Keywords: Disparities, Human Immunodeficiency Virus (HIV), Pregnancy, Socioeconomic Factors
Zanocco K, Elaraj D, Sturgeon C
Routine prophylactic central neck dissection for low-risk papillary thyroid cancer: a cost-effectiveness analysis.
The researchers hypothesized that routine prophylactic central neck dissection (pCND) is not cost-effective in low-risk papillary thyroid cancer (PTC).Using a Markov transition-state model, they found that pCND cost $10,315 and produced an effectiveness of 23.785 quality-adjusted life years. They concluded that routine pCND for low-risk PTC is not cost-effective unless the recurrence rate is greater than 10.3 percent.
Citation: Zanocco K, Elaraj D, Sturgeon C . Routine prophylactic central neck dissection for low-risk papillary thyroid cancer: a cost-effectiveness analysis. Surgery 2013 Dec;154(6):1148-55; discussion 54-5..
Keywords: Cancer, Surgery, Prevention, Healthcare Costs, Quality of Life
Waters TM, Chandler AM, Mion LC
Use of International Classification of Diseases, Ninth Revision, Clinical Modification, codes to identify inpatient fall-related injuries.
The researchers compared falls and fall-related injuries that a fall evaluator or hospital incident report identified with injuries identified according to discharge ICD-9-CM codes for the same set of inpatient episodes of care. They found that the CMS-targeted ICD-9-CM codes used to identify fall-related injuries in claims data do not always detect the most-serious falls.
Citation: Waters TM, Chandler AM, Mion LC . Use of International Classification of Diseases, Ninth Revision, Clinical Modification, codes to identify inpatient fall-related injuries. J Am Geriatr Soc 2013 Dec;61(12):2186-91. doi: 10.1111/jgs.12539..
Keywords: Falls, Elderly, Patient Safety, Inpatient Care, Adverse Events
Sherman KL, Gordon EJ, Mahvi DM
Surgeons' perceptions of public reporting of hospital and individual surgeon quality.
This study (1) evaluated surgeons’ perceptions of public reporting of surgical quality; and (2) identified specific barriers to surgeons’ acceptance of public reporting. It found that surgeons are generally in favor of public reporting, but that they continue to have substantive concerns, particularly with respect to reporting individual level outcomes data.
Citation: Sherman KL, Gordon EJ, Mahvi DM . Surgeons' perceptions of public reporting of hospital and individual surgeon quality. Med Care 2013 Dec;51(12):1069-75. doi: 10.1097/mlr.0000000000000013..
Keywords: Public Reporting, Quality of Care, Hospitals, Surgery, Provider Performance
Nkoy FL, Stone BL, Fassl BA
Longitudinal validation of a tool for asthma self-monitoring.
The purpose of this study was to show longitudinal validation of a new tool, the Asthma Symptom Tracker (AST). The study established longitudinal validation of the AST, a novel tool designed for use by children or their parents to facilitate ongoing monitoring of patients’ asthma symptoms and proactive medical decision-making to prevent acute exacerbations.
AHRQ-funded; HS018166; HS018678.
Citation: Nkoy FL, Stone BL, Fassl BA . Longitudinal validation of a tool for asthma self-monitoring. Pediatrics 2013 Dec;132(6):e1554-61. doi: 10.1542/peds.2013-1389..
Keywords: Asthma, Children/Adolescents, Chronic Conditions, Decision Making, Patient Self-Management
Mukamel DB, Harrington C
Resident satisfaction surveys and clinical quality of care in nursing homes: two sides of the same coin?
The authors of this article believe that quality of nursing homes is a complex, multidimensional construct. Unlike acute care hospitals, where patients are typically treated for one specific condition and stay for a short period of time, the length of stays in nursing homes varies widely. They argue that neither the individual assessment of clinical quality nor evaluation of hotel services are sufficient.
Citation: Mukamel DB, Harrington C . Resident satisfaction surveys and clinical quality of care in nursing homes: two sides of the same coin? Aging Health 2013 Dec;9(6):607-9. doi: 10.2217/ahe.13.63..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Long-Term Care, Nursing Homes, Patient Experience, Quality of Care, Quality Improvement, Quality Measures
Mariscalco MW, Flanigan DC, Mitchell J
The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study.
The purpose of this study was to evaluate the effect of graft size on patient-reported outcomes and revision risk after anterior cruciate ligament (ACL) reconstruction. It found that smaller hamstring autograft size is a predictor of poorer Knee Injury and Osteoarthritis Outcome Score (sport/recreation subscale function) 2 years after primary ACL reconstruction.
Citation: Mariscalco MW, Flanigan DC, Mitchell J . The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: a Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study. Arthroscopy 2013 Dec;29(12):1948-53. doi: 10.1016/j.arthro.2013.08.025.
Keywords: Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Surgery
Hwang SW, Chambers C, Chiu S
A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance.
The researchers comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. They found that homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services.
Citation: Hwang SW, Chambers C, Chiu S . A comprehensive assessment of health care utilization among homeless adults under a system of universal health insurance. Am J Public Health 2013 Dec;103 Suppl 2:S294-301. doi: 10.2105/ajph.2013.301369..
Keywords: Healthcare Utilization, Socioeconomic Factors, Emergency Department, Emergency Medical Services (EMS)
Hearld LR, Weech-Maldonado R, Asagbra OE
Variations in patient-centered medical home capacity: a linear growth curve analysis.
This study documented physician practices’ PCMH capacity across 12 different domains (e.g., extended access, specialist referral, use of patient registry) over a 3-year period (2008-2010). It concluded that differences in PCMH capacity across the 12 domains and time suggest that more attention should be paid to the longitudinal nature of PCMH implementation and the differential challenges associated with its component parts.
Citation: Hearld LR, Weech-Maldonado R, Asagbra OE . Variations in patient-centered medical home capacity: a linear growth curve analysis. Med Care Res Rev 2013 Dec;70(6):597-620. doi: 10.1177/1077558713498117..
Keywords: Patient-Centered Healthcare, Practice Patterns