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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 38 Research Studies DisplayedBlanchard J, Weiss AJ, Barrett ML
State variation in opioid treatment policies and opioid-related hospital readmissions.
In this study, the investigators used 2013-2015 hospital inpatient discharge data from 13 states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project to examine the relationship between state opioid treatment policies and 90-day opioid-related readmissions after a stay involving an opioid diagnosis. The concluded that differences in index hospitalization rates suggested that states with opioid treatment policies had a higher level of need for opioid-related intervention, which also may account for higher rates of readmission.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Blanchard J, Weiss AJ, Barrett ML .
State variation in opioid treatment policies and opioid-related hospital readmissions.
BMC Health Serv Res 2018 Dec 17;18(1):971. doi: 10.1186/s12913-018-3703-8..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Medication, Opioids, Substance Abuse
Zhang Y, Johnson P, Jeng PJ
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
This study examined the association between a first opioid prescription and high-risk opioid use in the 18 months following the first prescription. A retrospective cohort study was conducted using data from a large commercial insurance claims database for patients aged 18-64 and also Medicare Advantage patients aged 65 or older for 2011-2014. The patients initially had not used opioids. The features the researchers were looking for were: 1) opioid or benzodiazepine prescriptions overlapping 7 days or more, 2) opioid prescriptions overlapping for 7 days or more; 3) three or more prescribers of opioids; and 4) a daily dosage exceeding 120 morphine milligram equivalents, in each of the six quarters following the first prescription. All of those features were strongly associated with high-risk use.
AHRQ-funded; HS021531.
Citation: Zhang Y, Johnson P, Jeng PJ .
First opioid prescription and subsequent high-risk opioid use: a national study of privately insured and Medicare Advantage adults.
J Gen Intern Med 2018 Dec;33(12):2156-62. doi: 10.1007/s11606-018-4628-y..
Keywords: Opioids, Substance Abuse, Medication, Risk, Medicare, Health Insurance
Samples H, Williams AR, Olfson M
Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees.
The purpose of this study was to examine duration of buprenorphine treatment for opioid use disorder (OUD) following the initiation of treatment in order to identify risk factors for early discontinuation. Researchers analyzed insurance claims from the MarketScan multi-state Medicaid database for 2013 through 2015; their sample included adults aged 18-64 years who had an OUD diagnosis 6 months before initiating buprenorphine treatment. More than 1/4 of the sample discontinued buprenorphine in the first month of treatment, and most of the sample discontinued before 180 days. Risk factors for discontinuation were associated with significantly lower odds of treatment retention for at least 180 days. The study concludes that there is need to implement treatment models that address barriers to treatment retention more effectively.
AHRQ-funded; HS021112.
Citation: Samples H, Williams AR, Olfson M .
Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees.
J Subst Abuse Treat 2018 Dec;95:9-17. doi: 10.1016/j.jsat.2018.09.001..
Keywords: Medicaid, Medication, Opioids, Risk, Substance Abuse
Heslin KC, Barrett ML
AHRQ Author: Heslin KC
Shifts in alcohol-related diagnoses after the introduction of International Classification of Diseases, Tenth Revision, clinical modification coding in U.S. hospitals: implications for epidemiologic research.
This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses. Using 2014 to 2017 HCUP data, results indicated that, on average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, alcohol-induced mental disorders, and intoxication or toxic effects. Researchers conducting trend analyses of inpatient stays involving alcohol-related diagnoses should consider how ongoing modifications in the ICD-10-CM code system and coding guidelines might affect their work.
AHRQ-authored; AHRQ-funded.
Citation: Heslin KC, Barrett ML .
Shifts in alcohol-related diagnoses after the introduction of International Classification of Diseases, Tenth Revision, clinical modification coding in U.S. hospitals: implications for epidemiologic research.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Alcohol Use, Diagnostic Safety and Quality, Substance Abuse
Lapham GT, Lee AK, Caldeiro RM
Prevalence of behavioral health conditions across frequency of cannabis use among adult primary care patients in Washington state.
This population-based study of primary care patients reports on the prevalence of common behavioral health conditions across cannabis use frequency. The investigators concluded that their study found a strong association between the frequency of cannabis use and tobacco use, depression symptoms, and other drug use, and as well as diagnosed mental health and substance use disorders.
AHRQ-funded; HS023173.
Citation: Lapham GT, Lee AK, Caldeiro RM .
Prevalence of behavioral health conditions across frequency of cannabis use among adult primary care patients in Washington state.
J Gen Intern Med 2018 Nov;33(11):1833-35. doi: 10.1007/s11606-018-4558-8..
Keywords: Behavioral Health, Depression, Primary Care, Substance Abuse, Tobacco Use
Heslin KC, Barrett ML
AHRQ Author: Heslin KC
Shifts in alcohol-related diagnoses after the introduction of International Classification of Diseases, Tenth Revision, clinical modification coding in U.S. hospitals: implications for epidemiologic research.
This study examined the impact of the ICD-10-CM coding system on estimates of hospital stays involving alcohol-related diagnoses. This analysis used 2014 to 2017 administrative data from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project State Inpatient Databases for 17 states. The investigators found that on average, the number of stays involving any alcohol-related diagnosis in the 6 quarters before and after the ICD-10-CM transition was stable. However, substantial shifts in stays occurred for alcohol abuse, alcohol-induced mental disorders, and intoxication or toxic effects.
AHRQ-authored.
Citation: Heslin KC, Barrett ML .
Shifts in alcohol-related diagnoses after the introduction of International Classification of Diseases, Tenth Revision, clinical modification coding in U.S. hospitals: implications for epidemiologic research.
Alcohol Clin Exp Res 2018 Nov;42(11):2205-13. doi: 10.1111/acer.13866..
Keywords: Alcohol Use, Diagnostic Safety and Quality, Healthcare Cost and Utilization Project (HCUP), Substance Abuse
Moulin A, Evans EJ, Xing G
Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization.
The objective of this study was to identify characteristics unique to patients with psychiatric illness who are frequent emergency department (ED) users for mental health care. The authors suggest that understanding unique features of this population could lead to better care and lower healthcare costs. The authors concluded that patients with substance use disorders, homelessness and public healthcare coverage were more likely to be frequent users of EDs for mental illness.
AHRQ-funded; HS022236.
Citation: Moulin A, Evans EJ, Xing G .
Substance use, homelessness, mental illness and Medicaid coverage: a set-up for high emergency department utilization.
West J Emerg Med 2018 Nov;19(6):902-06. doi: 10.5811/westjem.2018.9.38954..
Keywords: Emergency Department, Medicaid, Healthcare Utilization, Behavioral Health, Substance Abuse, Vulnerable Populations
Klueh MP, Hu HM, Howard RA
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review.
The purpose of this study was to identify specialties prescribing opioids to surgical patients who develop new persistent opioid use. Results showed that, among surgical patients who developed new persistent opioid use, surgeons provided the majority of opioid prescriptions during the first 3 months after surgery, but by 9 to 12 months after surgery, the majority of opioid prescriptions were provided by primary care physicians. Recommendations included enhanced care coordination between surgeons and primary care physicians to allow earlier identification of patients at risk for new persistent opioid use in order to prevent misuse and dependence.
AHRQ-funded; HS023313.
Citation: Klueh MP, Hu HM, Howard RA .
Transitions of care for postoperative opioid prescribing in previously opioid-naive patients in the USA: a retrospective review.
J Gen Intern Med 2018 Oct;33(10):1685-91. doi: 10.1007/s11606-018-4463-1..
Keywords: Transitions of Care, Opioids, Substance Abuse, Surgery, Pain, Medication, Patient-Centered Outcomes Research
Barry DT, Marshall BDL, Becker WC
Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care.
Although nonmedical use of prescription opioids (NMUPO) is a public health problem, few studies have examined the new-onset NMUPO in clinical populations. This prospective cohort study estimated NMUPO incidence among veterans in medical care who had received prescription opioid medication and examined correlates of new-onset NMUPO. The investigators concluded that duration of prescription opioid receipt was a risk factor for incident NMUPO among veterans receiving medical care.
AHRQ-funded; HS021112; HS023258.
Citation: Barry DT, Marshall BDL, Becker WC .
Duration of opioid prescriptions predicts incident nonmedical use of prescription opioids among U.S. veterans receiving medical care.
Drug Alcohol Depend 2018 Oct 1;191:348-54. doi: 10.1016/j.drugalcdep.2018.07.008..
Keywords: Medication, Opioids, Substance Abuse
Cartmell KB, Dismuke CE, Dooley M
Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year postdischarge health care costs.
In 2014, the Medical University of South Carolina (MUSC) implemented a Tobacco Dependence Treatment Service (TDTS) consistent with the Joint Commission (JC) standards recommending that hospitals screen patients for smoking, provide cessation support, and follow-up contact for relapse prevention within 1 month of discharge. This paper examined whether exposure to the TDTS influenced downstream health care charges 12 months after patients were discharged from the hospital.
AHRQ-funded; HS023863.
Citation: Cartmell KB, Dismuke CE, Dooley M .
Effect of an evidence-based inpatient tobacco dependence treatment service on 1-year postdischarge health care costs.
Med Care 2018 Oct;56(10):883-89. doi: 10.1097/mlr.0000000000000979..
Keywords: Healthcare Costs, Inpatient Care, Screening, Substance Abuse, Tobacco Use: Smoking Cessation
Davis CS, Green TC, Hernandez-Delgado H
Status of US state laws mandating timely reporting of nonfatal overdose.
Timely, actionable, nonfatal overdose data are urgently needed to improve public health response to the overdose crisis. The purpose of this paper was to provide background and catalyze discussion regarding this important issue. The authors briefly report the results of a systematic analysis of state laws mandating reporting of nonfatal overdose, and provide suggestions for improving the collection and use of nonfatal overdose data to improve the public health response to this ongoing epidemic.
AHRQ-funded; HS024021.
Citation: Davis CS, Green TC, Hernandez-Delgado H .
Status of US state laws mandating timely reporting of nonfatal overdose.
Am J Public Health 2018 Sep;108(9):1159-61. doi: 10.2105/ajph.2018.304589..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Opioids, Policy, Public Health, Substance Abuse
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Friedman SA, Azocar F, Xu H
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
The purpose of the stud was to assess whether implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with: 1. Reduced differences in financial requirements (i.e., copayments and coinsurance) for substance use disorder (SUD) versus specialty mental health (MH) care and 2. Reductions in the level of cost-sharing for SUD-specific services.
AHRQ-funded; HS024866.
Citation: Friedman SA, Azocar F, Xu H .
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
Drug Alcohol Depend 2018 Sep 1;190:151-58. doi: 10.1016/j.drugalcdep.2018.06.008..
Keywords: Behavioral Health, Health Insurance, Policy, Substance Abuse
Marshall BDL, Green TC, Elston B
The effectiveness of internet- and field-based methods to recruit young adults who use prescription opioids nonmedically.
This study researched the effectiveness of field- and Internet-based methods to recruit young adults who are nonmedical prescription opioid (NMPO) users into intervention and treatment. Data was analyzed from the Rhode Island Young Adult Prescription Drug Study (RAPiDS). Internet-based recruitment was more successful (60.1%). Out of 198 eligible participants, median age was 25, and the majority were male, white, and resided in an urban area. Field-based recruited participants were more likely to be homeless, have been incarcerated and engage in daily NMPO use.
AHRQ-funded; HS024021.
Citation: Marshall BDL, Green TC, Elston B .
The effectiveness of internet- and field-based methods to recruit young adults who use prescription opioids nonmedically.
Subst Use Misuse 2018 Aug 24;53(10):1688-99. doi: 10.1080/10826084.2018.1425725.
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Keywords: Health Information Technology (HIT), Medication, Opioids, Substance Abuse, Young Adults
Sekhri S, Arora NS, Cottrell H
Probability of opioid prescription refilling after surgery: does initial prescription dose matter?
In this study, the investigators sought to determine the correlation between the probability of postoperative opioid prescription refills and the amount of opioid prescribed, hypothesizing that a greater initial prescription yields a lower probability of refill. The investigators concluded that the probability of refilling prescription opioids after surgery was not correlated with initial prescription strength, suggesting surgeons could prescribe smaller prescriptions without influencing refill requests.
AHRQ-funded; HS023313.
Citation: Sekhri S, Arora NS, Cottrell H .
Probability of opioid prescription refilling after surgery: does initial prescription dose matter?
Ann Surg 2018 Aug;268(2):271-76. doi: 10.1097/sla.0000000000002308..
Keywords: Medication, Opioids, Pain, Practice Patterns, Substance Abuse, Surgery
Olfson M, Crystal S, Wall M
Causes of death after nonfatal opioid overdose.
The purpose of this study was to describe all-cause mortality rates, selected cause-specific mortality rates, and standardized mortality rate ratios (SMRs) of adults during their first year after nonfatal opioid overdose. In a US national cohort of adults who had experienced a nonfatal opioid overdose, a marked excess of deaths was attributable to a wide range of substance use-associated, mental health, and medical conditions, underscoring the importance of closely coordinating the substance use, mental health, and medical care of this patient population.
AHRQ-funded; HS021112.
Citation: Olfson M, Crystal S, Wall M .
Causes of death after nonfatal opioid overdose.
JAMA Psychiatry 2018 Aug;75(8):820-27. doi: 10.1001/jamapsychiatry.2018.1471..
Keywords: Behavioral Health, Mortality, Opioids, Patient-Centered Healthcare, Substance Abuse
Andrews CM, Grogan CM, Smith BT
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
This study looked at the effects the Affordable Care Act (ACA) had on Medicaid benefits for addiction treatment. The ACA established a minimum standard of benefits and required state Medicaid programs to make changes to their treatment benefits. Researchers surveyed all 50 states and the District of Columbia in 2014 and 2017 when the ACA requirements came into effect. There was a substantial increase in benefits with a decrease in annual service limits of over 50 percent. There was a large reduction in preauthorization requirements for medications to treat opioid use disorder as well as other reductions in preauthorizations.
AHRQ-funded; HS000084.
Citation: Andrews CM, Grogan CM, Smith BT .
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
Health Aff 2018 Aug;37(8):1216-22. doi: 10.1377/hlthaff.2018.0272..
Keywords: Access to Care, Behavioral Health, Health Insurance, Medicaid, Policy, Substance Abuse
Axeen S, Seabury SA, Menchine M
Emergency department contribution to the prescription opioid epidemic.
The investigators used MEPS data to characterize the relative contribution of emergency departments (EDs) to national opioid prescribing, to estimate trends in opioid prescribing by site of care, and to examine whether higher-risk opioid users receive a disproportionate quantity of their opioids from ED settings. During the study period, they found that the relative contribution of EDs to the prescription opioid problem was modest and declining. They therefore recommended that further efforts to reduce the quantity of opioids prescribed focus on office-based settings.
AHRQ-funded; HS024251.
Citation: Axeen S, Seabury SA, Menchine M .
Emergency department contribution to the prescription opioid epidemic.
Ann Emerg Med 2018 Jun;71(6):659-67.e3. doi: 10.1016/j.annemergmed.2017.12.007..
Keywords: Behavioral Health, Emergency Department, Medical Expenditure Panel Survey (MEPS), Medication, Opioids, Practice Patterns, Substance Abuse
Cook B, Creedon T, Wang Y
Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse.
Electronic health record data from a large healthcare system were used to describe racial/ethnic, sex, and age differences in benzodiazepines (BZD) use and dependence. Among patients with a BZD prescription, the investigators assessed differences in: 1.) the likelihood of subsequently receiving a BZD dependence diagnosis, 2.) the number of BZD prescriptions, 3.) receiving only one BZD prescription, and 4.) receiving 18 or more BZD prescriptions.
AHRQ-funded; HS021486.
Citation: Cook B, Creedon T, Wang Y .
Examining racial/ethnic differences in patterns of benzodiazepine prescription and misuse.
Drug Alcohol Depend 2018 Jun 1;187:29-34. doi: 10.1016/j.drugalcdep.2018.02.011..
Keywords: Medication, Practice Patterns, Racial and Ethnic Minorities, Substance Abuse
Westover AN, Nakonezny PA, Halm EA
Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration.
This study's aims were to ascertain the demographics of stimulant medication users compared with non-users, examine temporal trends of stimulant medication use and estimate risk factors for development of amphetamine use disorder (AUD) and mortality among new users of stimulant medications. The investigators concluded that in their cohort comorbid substance use disorders were common and were risk factors for development of (AUD).
AHRQ-funded; HS022418.
Citation: Westover AN, Nakonezny PA, Halm EA .
Risk of amphetamine use disorder and mortality among incident users of prescribed stimulant medications in the Veterans Administration.
Addiction 2018 May;113(5):857-67. doi: 10.1111/add.14122..
Keywords: Substance Abuse, Medication, Risk, Mortality, Patient-Centered Outcomes Research, Outcomes
Ross MM, Arria AM, Brown JP
College students' perceived benefit-to-risk tradeoffs for nonmedical use of prescription stimulants: implications for intervention designs.
This study examined the variation in college students' perceived risks and benefits for nonmedical use of prescription stimulants (NPS). The study findings identified subgroups of college NPS users that could have vastly different trajectories in terms of future drug use and college performance. The authors assert that given this heterogeneity among students regarding perceived risks and benefits of NPS, interventions should be designed to assess motives and provide personalized feedback.
AHRQ-funded; HS022135.
Citation: Ross MM, Arria AM, Brown JP .
College students' perceived benefit-to-risk tradeoffs for nonmedical use of prescription stimulants: implications for intervention designs.
Addict Behav 2018 Apr;79:45-51. doi: 10.1016/j.addbeh.2017.12.002..
Keywords: Medication, Substance Abuse, Young Adults
Cartmell KB, Dooley M, Mueller M
Effect of an evidence-based inpatient tobacco dependence treatment service on 30-, 90-, and 180-day hospital readmission rates.
This study explored the effect of an inpatient tobacco dependence treatment services (TDTS) on 30-, 90-, and 180-day hospital readmissions. The investigators suggest that findings from their study, which are supported by prior studies, provide evidence that delivery of TDTS is a strategy that may help to reduce hospital readmissions.
AHRQ-funded; HS023863.
Citation: Cartmell KB, Dooley M, Mueller M .
Effect of an evidence-based inpatient tobacco dependence treatment service on 30-, 90-, and 180-day hospital readmission rates.
Med Care 2018 Apr;56(4):358-63. doi: 10.1097/mlr.0000000000000884..
Keywords: Evidence-Based Practice, Hospital Readmissions, Substance Abuse, Tobacco Use
Marsh JC, Park K, Lin YA
Gender differences in trends for heroin use and nonmedical prescription opioid use, 2007-2014.
This study uses National Survey on Drug Use and Health (NSDUH) data to study gender differences in trends for heroin use and nonmedical prescription opioid use from 2007-2014. There has been a steady decline in nonmedical prescription heroin use but a notable increase in heroin use during this period for both men and women. However, women are increasing heroin use at a faster rate than men but their nonmedical prescription opioid use is not decreasing as fast as men. The researchers conclude that more study is needed on gender differences in use and treatment access.
AHRQ-funded; HS000084.
Citation: Marsh JC, Park K, Lin YA .
Gender differences in trends for heroin use and nonmedical prescription opioid use, 2007-2014.
J Subst Abuse Treat 2018 Apr;87:79-85. doi: 10.1016/j.jsat.2018.01.001..
Keywords: Medication, Opioids, Sex Factors, Substance Abuse
Chhatre S, Jayadevappa R
Racial and ethnic disparities in substance use disorders and outcomes in elderly prostate cancer patients.
This study used Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data to identify prevalence of substance use among patients with advanced-stage prostate cancer. There are racial and ethnic disparities between substance use and outcomes. A multidisciplinary coordinated care approach is recommended to address these disparities.
AHRQ-funded; HS024106.
Citation: Chhatre S, Jayadevappa R .
Racial and ethnic disparities in substance use disorders and outcomes in elderly prostate cancer patients.
J Ethn Subst Abuse 2018 Apr-Jun;17(2):135-49. doi: 10.1080/15332640.2016.1160019..
Keywords: Cancer: Prostate Cancer, Disparities, Elderly, Outcomes, Racial and Ethnic Minorities, Substance Abuse
Molfenter T, Brown R, O'Neill A
Use of telemedicine in addiction treatment: current practices and organizational implementation characteristics.
Telemedicine applications offer innovative approaches for treating and reducing the effects of substance use disorders (SUDs). This analysis assessed the interest in and use of 11 telemedicine applications in a sample of 363 SUD organizations. The top three self-reported telemedicine applications being used were (1) computerized screening/assessments (44.6 percent), (2) telephone-based recovery supports (29.5 percent), and (3) telephone-based therapy (28.37 percent).
AHRQ-funded; HS024086.
Citation: Molfenter T, Brown R, O'Neill A .
Use of telemedicine in addiction treatment: current practices and organizational implementation characteristics.
Int J Telemed Appl. 2018 Mar 11;2018:3932643. doi: 10.1155/2018/3932643. .
Keywords: Health Information Technology (HIT), Substance Abuse, Telehealth