National Healthcare Quality and Disparities Report
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Topics
- Ambulatory Care and Surgery (1)
- Blood Pressure (6)
- Cardiovascular Conditions (4)
- Care Management (1)
- Children/Adolescents (3)
- Chronic Conditions (29)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (1)
- Community-Based Practice (2)
- Comparative Effectiveness (4)
- Critical Care (1)
- Cultural Competence (1)
- Decision Making (5)
- (-) Diabetes (56)
- Diagnostic Safety and Quality (6)
- Digestive Disease and Health (1)
- Disparities (5)
- Education: Patient and Caregiver (2)
- Elderly (2)
- Electronic Health Records (EHRs) (7)
- Evidence-Based Practice (4)
- Eye Disease and Health (1)
- Healthcare Costs (3)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (13)
- Health Insurance (1)
- Health Promotion (2)
- Health Status (1)
- Health Systems (1)
- Heart Disease and Health (3)
- Hospitalization (1)
- Hospital Readmissions (1)
- Lifestyle Changes (2)
- Low-Income (1)
- Maternal Care (1)
- Medicaid (1)
- Medicare (1)
- Medication (12)
- Mortality (1)
- Obesity (2)
- Obesity: Weight Management (2)
- Orthopedics (1)
- Outcomes (5)
- Pain (1)
- Patient-Centered Healthcare (6)
- Patient-Centered Outcomes Research (4)
- Patient Adherence/Compliance (6)
- Patient and Family Engagement (2)
- Patient Experience (2)
- Patient Self-Management (11)
- Practice Patterns (2)
- Pregnancy (1)
- Prevention (4)
- Primary Care (4)
- Provider: Health Personnel (1)
- Quality Improvement (3)
- Quality Indicators (QIs) (1)
- Quality Measures (3)
- Quality of Care (3)
- Quality of Life (3)
- Racial and Ethnic Minorities (9)
- Risk (4)
- Rural Health (1)
- Screening (3)
- Sex Factors (2)
- Social Determinants of Health (1)
- Surgery (1)
- Teams (2)
- Telehealth (4)
- Transitions of Care (2)
- Treatments (1)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Urban Health (1)
- Women (2)
- Young Adults (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 25 of 56 Research Studies DisplayedNa A, Middleton A, Haas A
Impact of diabetes on 90-day episodes of care after elective total joint arthroplasty among Medicare beneficiaries.
This study examined the impact of diabetes on 90-day episodes of care after elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the United States. Complication (n = 521,230) and readmission (n = 515,691) data was extracted on Medicare beneficiaries using files from 2013 and 2014. Diabetes status was identified with ICD-9 codes. The odds ratio (OR) of TKA complications was significantly higher for patients with uncontrolled diabetes than those with no diabetes. The OR of THA complications was also significantly higher for controlled-complicated diabetes. OR of readmission was significantly higher for all diabetes groups.
AHRQ-funded; HS026133.
Citation: Na A, Middleton A, Haas A .
Impact of diabetes on 90-day episodes of care after elective total joint arthroplasty among Medicare beneficiaries.
J Bone Joint Surg Am 2020 Dec 16;102(24):2157-65. doi: 10.2106/jbjs.20.00203..
Keywords: Diabetes, Chronic Conditions, Orthopedics, Surgery
Rosas LG, Lv N, Xiao L
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. The purpose of this study was to determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. The investigators concluded that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Xiao L .
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
JAMA Netw Open 2020 Dec;3(12):e2027744. doi: 10.1001/jamanetworkopen.2020.27744..
Keywords: Racial and Ethnic Minorities, Obesity: Weight Management, Obesity, Cultural Competence, Diabetes, Primary Care, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Orloff JN, Touhamy SH, Truong W
Trial of restarting and tolerating metformin (TreatMet).
This randomized, double-blind, placebo-controlled, n-of-1 crossover study assessed whether metformin's side effects are reproducible in patients with a history of metformin intolerance. Participants completed up to four cycles of 2 weeks of metformin exposure and 2 weeks of placebo exposure. Participants completed surveys based on the Gastrointestinal Symptom Rating Scale and the Treatment Satisfaction Questionnaire for Medication.
AHRQ-funded; HS023898.
Citation: Orloff JN, Touhamy SH, Truong W .
Trial of restarting and tolerating metformin (TreatMet).
Diabetes Obes Metab 2020 Nov;22(11):2189-92. doi: 10.1111/dom.14137..
Keywords: Medication, Digestive Disease and Health, Diabetes, Chronic Conditions
Odlum M, Moise N, Kronish IM
Trends in poor health indicators among Black and Hispanic middle-aged and older adults in the United States, 1999-2018.
This study used records extracted from the Behavioral Risk Factor Surveillance System to determine which health indicators have improved or became worse among Black and Hispanic middle-aged (45 and older) adults compared to Whites from 1999 to 2018. This data is required by the Minority Health and Health Disparities Research and Education Act of 2000. A sample included of 4,856,326 participants, of them 60.9% women, mean age 60.4. During the last 20 years, Black adults showed an overall decrease showing improvement in uninsured status and physical inactivity while showing an overall increase in hypertension, diabetes, asthma, and stroke, and also the same increases and decreases in the Black-White gap. Hispanic adults showed improvement in physical inactivity and perceived poor health, while they showed overall deterioration in hypertension and diabetes. The Hispanic-White gap improved in coronary heart disease, stroke, kidney disease, asthma, arthritis, depression and physical inactivity while it increased for diabetes, hypertension, and uninsured status.
AHRQ-funded; HS025198.
Citation: Odlum M, Moise N, Kronish IM .
Trends in poor health indicators among Black and Hispanic middle-aged and older adults in the United States, 1999-2018.
JAMA Netw Open 2020 Nov 2;3(11):e2025134. doi: 10.1001/jamanetworkopen.2020.25134..
Keywords: Elderly, Racial and Ethnic Minorities, Disparities, Health Status, Health Insurance, Diabetes, Blood Pressure, Chronic Conditions
Tremblay ES, Ruiz J, Buccigrosso T
Health care transition in youth with type 1 diabetes and an A1C >9%: qualitative analysis of pre-transition perspectives.
The purpose of this training was to explore expectations for transition to adult care and experiences with transition planning among adolescents and young adults with type 1 diabetes and an A1C >9% at a tertiary care U.S. pediatric center. The investigators concluded that a lack of transition preparation and anxiety about transition and adult care among youth with type 1 diabetes and elevated A1C.
AHRQ-funded; HS000063.
Citation: Tremblay ES, Ruiz J, Buccigrosso T .
Health care transition in youth with type 1 diabetes and an A1C >9%: qualitative analysis of pre-transition perspectives.
Diabetes Spectr 2020 Nov;33(4):331-38. doi: 10.2337/ds20-0011..
Keywords: Children/Adolescents, Young Adults, Diabetes, Chronic Conditions, Transitions of Care, Patient Experience
Presley C, Agne A, Shelton T
Mobile-enhanced peer support for African Americans with Type 2 diabetes: a randomized controlled trial.
This study compared the effectiveness of a community-based diabetes self-management education (DSME) plus mobile health (mHealth)-enhanced peer support intervention to community-based DSME alone for African American adults with poorly controlled type 2 diabetes. This randomized controlled trial took place in Jefferson County, Alabama within a safety-net healthcare system with a group diagnosed with type 2 diabetes and hemoglobin A1C ≥ 7.5%. The intervention group reviewed community-based DSME plus 6 months of mHealth-enhanced peer support, including 12 weekly phone calls, then 3 monthly calls from community health workers. The control group received community based DSME only. Primary outcomes were lower A1C and secondary outcomes were lower diabetes distress, depressive symptoms, self-efficacy or confidence in their ability to manage diabetes, and social support. Of 120 participants selected, 97 completed the study. Both groups experienced clinical meaning reduction in A1C. Participants in the intervention group experienced a significantly larger reduction in diabetes distress compared to the control group.
AHRQ-funded; HS019465.
Citation: Presley C, Agne A, Shelton T .
Mobile-enhanced peer support for African Americans with Type 2 diabetes: a randomized controlled trial.
J Gen Intern Med 2020 Oct;35(10):2889-96. doi: 10.1007/s11606-020-06011-w..
Keywords: Telehealth, Health Information Technology (HIT), Patient Self-Management, Diabetes, Chronic Conditions, Racial and Ethnic Minorities, Community-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Education: Patient and Caregiver
Tassone C, Keshavjee K, Paglialonga A
Evaluation of mobile apps for treatment of patients at risk of developing gestational diabetes.
This study evaluated mobile apps using a theory-based evaluation framework to discover their applicability for patients at risk of gestational diabetes. It assessed how well the existing mobile apps on the market met the information and tracking needs of patients with gestational diabetes and evaluated the feasibility of how to integrate these apps into patient care.
AHRQ-funded; HS021495; HS24869.
Citation: Tassone C, Keshavjee K, Paglialonga A .
Evaluation of mobile apps for treatment of patients at risk of developing gestational diabetes.
Health Informatics J 2020 Sep;26(3):1983-94. doi: 10.1177/1460458219896639..
Keywords: Diabetes, Risk, Health Information Technology (HIT), Women
Koller KR, Day GE, Hiratsuka VY
Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: a call for prediabetes screening, diagnosis, and referral for intervention.
This study estimated incidence of diabetes (DM) and pre-DM relative to DM risk factors among relatively healthy Alaska Native and American Indian (AN) adults living in urban south-central Alaska. Results showed that, controlling for age and sex, obesity, abdominal adiposity, pre-DM, and metabolic syndrome independently increased DM risk. Recommendations included advising health care providers of AN populations to seize the opportunity to screen, refer, and treat individuals with pre-DM and other modifiable DM risk factors prior to DM diagnosis in order to alter the epidemiologic course of disease progression in this urban AN population.
AHRQ-funded; HS000084.
Citation: Koller KR, Day GE, Hiratsuka VY .
Increase in diabetes among urban Alaska Native people in the Alaska EARTH follow-up study: a call for prediabetes screening, diagnosis, and referral for intervention.
Diabetes Res Clin Pract 2020 Sep;167:108357. doi: 10.1016/j.diabres.2020.108357..
Keywords: Diabetes, Racial and Ethnic Minorities, Urban Health, Risk, Prevention, Screening, Diagnostic Safety and Quality, Chronic Conditions
Aguilera A, Figueroa CA, Hernandez-Ramos R
mHealth app using machine learning to increase physical activity in diabetes and depression: clinical trial protocol for the DIAMANTE study.
In this randomized controlled trial, the researchers’ goal is to examine the effect of a text-messaging smartphone application to encourage physical activity in low-income ethnic minority patients with comorbid diabetes and depression. They will compare passively collected daily step counts, self-reported PHQ-8 and most recent hemoglobin A1c from medical records at baseline and at intervention completion at 6-month follow-up. They plan to submit manuscripts describing their user-designed methods and testing of the adaptive learning algorithm and will submit the results of the trial for publication in peer-reviewed journals and presentations at scientific meetings.
AHRQ-funded; HS025429.
Citation: Aguilera A, Figueroa CA, Hernandez-Ramos R .
mHealth app using machine learning to increase physical activity in diabetes and depression: clinical trial protocol for the DIAMANTE study.
BMJ Open 2020 Aug 20;10(8):e034723. doi: 10.1136/bmjopen-2019-034723..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Chronic Conditions, Racial and Ethnic Minorities, Low-Income, Health Promotion
Misra-Hebert AD, Milinovich A, Zajichek A
Natural language processing improves detection of nonsevere hypoglycemia in medical records versus coding alone in patients with type 2 diabetes but does not improve prediction of severe hypoglycemia events: an analysis using the electronic medical record
The purpose of this study was to determine if natural language processing (NLP) improves detection of non-severe hypoglycemia (NSH) in patients with type 2 diabetes and no NSH documentation by diagnosis codes and to measure if NLP detection improves the prediction of future severe hypoglycemia (SH). The authors identified NSH events by diagnosis codes and NLP 2005 to 2017 and built an SH prediction model. Their findings showed that detection of NSH improved with NLP in patients with type 2 diabetes without improving SH prediction.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Milinovich A, Zajichek A .
Natural language processing improves detection of nonsevere hypoglycemia in medical records versus coding alone in patients with type 2 diabetes but does not improve prediction of severe hypoglycemia events: an analysis using the electronic medical record
Diabetes Care 2020 Aug;43(8):1937-40. doi: 10.2337/dc19-1791..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality
Schroeder EB, Adams JL, Chonchol M
Predictors of hyperkalemia and hypokalemia in individuals with diabetes: a classification and regression tree analysis.
Both hyperkalemia and hypokalemia can lead to cardiac arrhythmias and are associated with increased mortality. Information on the predictors of potassium in individuals with diabetes in routine clinical practice is lacking. The objective of this study was to identify predictors of hyperkalemia and hypokalemia in adults with diabetes.
AHRQ-funded; HS022963; HS019859.
Citation: Schroeder EB, Adams JL, Chonchol M .
Predictors of hyperkalemia and hypokalemia in individuals with diabetes: a classification and regression tree analysis.
J Gen Intern Med 2020 Aug;35(8):2321-28. doi: 10.1007/s11606-020-05799-x..
Keywords: Diabetes, Diagnostic Safety and Quality
Pantalone KM, Misra-Hebert AD, Hobbs TM
The probability of a1c goal attainment in patients with uncontrolled type 2 diabetes in a large integrated delivery system: a prediction model.
Researchers assessed patient characteristics and treatment factors associated with uncontrolled type 2 diabetes and the probability of hemoglobin A(1c) (A1C) goal attainment. Using electronic health record data at Cleveland Clinic, they found that a minority of patients with an A1C >9% achieved an A1C <8% at 1 year. While most identified predictive factors are nonmodifiable by the clinician, pursuit of frequent patient engagement and tailored drug regimens may help to improve A1C goal attainment.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
The probability of a1c goal attainment in patients with uncontrolled type 2 diabetes in a large integrated delivery system: a prediction model.
Diabetes Care 2020 Aug;43(8):1910-19. doi: 10.2337/dc19-0968..
Keywords: Diabetes, Patient-Centered Healthcare, Patient and Family Engagement, Chronic Conditions
Despins LA, Wakefield BJ
Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: a qualitative study.
The purpose of this study was to describe individuals' with type 2 diabetes mellitus sense-making of blood glucose data and other influences impacting self-management behavior. One-on-one interviews with adults diagnosed with type 2 diabetes mellitus were used. Results showed that individuals used self-monitored glucose values and/or HbA1C values to evaluate glucose control. Recommendations included having nurses assess sense-making processes in self-management decisions and providing periodic refresher diabetes education for individuals with type 2 diabetes mellitus.
AHRQ-funded; HS022140.
Citation: Despins LA, Wakefield BJ .
Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: a qualitative study.
J Clin Nurs 2020 Jul;29(13-14):2572-88. doi: 10.1111/jocn.15280..
Keywords: Patient Self-Management, Diabetes, Chronic Conditions, Patient Adherence/Compliance, Decision Making
Sutherland BL, Pecanac K, Bartels CM
Expect delays: poor connections between rural and urban health systems challenge
Rural Americans with diabetic foot ulcers (DFUs) face a 50% increased risk of major amputation compared to their urban counterparts. In this study, the investigators sought to identify health system barriers contributing to this disparity. The investigators concluded that poor connections across rural and urban healthcare systems were described as the primary health system barrier driving the rural disparity in major amputations.
AHRQ-funded; HS026279.
Citation: Sutherland BL, Pecanac K, Bartels CM .
Expect delays: poor connections between rural and urban health systems challenge
J Foot Ankle Res 2020 Jun 16;13(1):32. doi: 10.1186/s13047-020-00395-y..
Keywords: Rural Health, Health Systems, Disparities, Diabetes, Chronic Conditions, Healthcare Delivery
Flory JH, Mushlin AI
Effect of cost and formulation on persistence and adherence to initial metformin therapy for type 2 diabetes.
This paper studied whether persistence and adherence to initial release (IR) metformin was at the same levels as extended release (ER) metform for adults with type 2 diabetes. A study was conducted using merged de-identified claims data from commercial insurance carriers in the US from 2012 to 2016. The cohort used was identified as patients aged 18 years or older who filled an initial 30-day prescription for metformin monotherapy with a baseline type 2 diabetes diagnosis, at least 1 year of baseline and follow-up data, and no prior antidiabetes drug use. “Persistence” was defined as at least one metformin prescription claim during the 6-12 month window after the initial prescription. “Adherence” was defined as the percentage of days for which the patient had filled sufficient prescriptions to be taking it “as prescribed”. The final study population was 81,406 patients, with 78% having commercial insurance, 19% Medicare Advantage, and 2.5% were dual-eligible for Medicare and Medicare. Persistence was slightly higher for ER metformin than for IR metformin, as was adherence and adequate adherence (80% or more). Despite the slightly higher cost, initial use of ER metformin was associated with better adherence.
AHRQ-funded; HS023898.
Citation: Flory JH, Mushlin AI .
Effect of cost and formulation on persistence and adherence to initial metformin therapy for type 2 diabetes.
Diabetes Care 2020 Jun;43(6):e66-e67. doi: 10.2337/dc19-2426..
Keywords: Diabetes, Chronic Conditions, Healthcare Costs, Medication, Patient Adherence/Compliance
Rodríguez HP, Fulton BD, Phillips AZ
The early impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-day hospital readmissions among adults with diabetes.
The Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) Initiative funds states to accelerate delivery system and payment reforms. All SIM states focus on improving diabetes care, but SIM's effect on 30-day readmissions among adults with diabetes remains unclear. In this study, the investigators found no evidence that SIM reduced 30-day readmission rates among adults with diabetes during the first 2 years of round 1 implementation, even among CMS beneficiaries.
AHRQ-funded; HS022241.
Citation: Rodríguez HP, Fulton BD, Phillips AZ .
The early impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-day hospital readmissions among adults with diabetes.
Med Care 2020 Jun;58(6 Suppl 1):S22-s30. doi: 10.1097/mlr.0000000000001276..
Keywords: Diabetes, Chronic Conditions, Hospital Readmissions, Quality Improvement, Quality of Care
Aronson BD, Sittner KJ, Walls ML
The mediating role of diabetes distress and depressive symptoms in type 2 diabetes medication adherence gender differences.
Medication adherence is negatively related to both diabetes distress (DD) and depressive symptoms (DS). Past research suggests gender differences in adherence, DD, and DS. A gap exists in determining if gender differences in adherence are mediated by DD and DS, or if gender moderates differences in adherence by DD/DS. Aims. This study investigated the relationship between gender, DD, DS, and medication adherence and tested for mediating and moderating effects on medication adherence among American Indian adults with type 2 diabetes.
AHRQ-funded; HS024180.
Citation: Aronson BD, Sittner KJ, Walls ML .
The mediating role of diabetes distress and depressive symptoms in type 2 diabetes medication adherence gender differences.
Health Educ Behav 2020 Jun;47(3):474-82. doi: 10.1177/1090198119885416..
Keywords: Medication, Diabetes, Patient Adherence/Compliance, Chronic Conditions, Sex Factors
Le P, Chaitoff A, Misra-Hebert AD
Use of antihyperglycemic medications in U.S. adults: an analysis of the National Health and Nutrition Examination Survey.
The objectives of this study were to examine trends in the use of diabetes medications and to determine whether physicians individualize diabetes treatment as recommended by the American Diabetes Association (ADA). Using data from the National Health and Nutrition Examination Survey, findings suggested that the use of metformin and insulin analogs increased, while the use of sulfonylureas, TZDs, and human insulin decreased. Insurance, but not income, was associated with the use of higher-cost medications. Following ADA recommendations, the use of metformin increased, but physicians generally did not individualize treatment according to patients' characteristics.
AHRQ-funded; HS024128.
Citation: Le P, Chaitoff A, Misra-Hebert AD .
Use of antihyperglycemic medications in U.S. adults: an analysis of the National Health and Nutrition Examination Survey.
Diabetes Care 2020 Jun;43(6):1227-33. doi: 10.2337/dc19-2424..
Keywords: Medication, Diabetes, Practice Patterns, Chronic Conditions
Huguet N, Kaufmann J, O'Malley J
Using electronic health records in longitudinal studies: estimating patient attrition.
This study’s objective was to estimate overall and among adults with diabetes or hypertension: 1) patient attrition over a 3-year period at community health centers; and 2) the likelihood that patients with Medicaid switched their primary care source. Data was collected from the retrospective cohort study of 2012-2017 claims data Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Data Research Network of community health centers. This study focused on Oregon Medicaid enrollees with a total of 232,891 patients aged 19-64 with a gap of 6 months or more following a claim for a visit billed to a primary care source. The authors theorized the reason was due to patients with Medicaid permanently changing their primary care source. They found that attrition over 3 years averaged 33.5% but patients with diabetes or hypertension was lower (25% or less). Among Medicaid patients the attrition rate 12% for community health center patients compared with 39% for single-provider practice patients.
AHRQ-funded; HS025962.
Citation: Huguet N, Kaufmann J, O'Malley J .
Using electronic health records in longitudinal studies: estimating patient attrition.
Med Care 2020 Jun;58(Suppl 1):S46-S52. doi: 10.1097/mlr.0000000000001298...
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Blood Pressure, Chronic Conditions, Primary Care, Medicaid
Mszar R, Grandhi GR, Valero-Elizondo J
Cumulative burden of financial hardship from medical bills across the spectrum of diabetes mellitus and atherosclerotic cardiovascular disease among non-elderly adults in the United States.
This study looked at the rates of financial hardship from medical bills with non-elderly adults diagnosed with diabetes mellitus (DM) and diagnosed with and without atherosclerotic cardiovascular disease (ASCVD). ASCVD with DM accounts for approximately two-thirds of deaths in this patient population. Data from the National Health Interview Survey from 2013 to 2017 was used, with a total study population of 121,672 individuals. Approximately 3.1% of the population had ASCVD, 5.6% had DM, and 1.3% had both. Almost half of individuals with both conditions reported financial hardship from medical bills, with 23% unable to pay medical bills at all, compared to around 28% of those with neither ASCVD and DM reporting financial hardship with 8% being unable to pay at all.
AHRQ-funded; HS023000.
Citation: Mszar R, Grandhi GR, Valero-Elizondo J .
Cumulative burden of financial hardship from medical bills across the spectrum of diabetes mellitus and atherosclerotic cardiovascular disease among non-elderly adults in the United States.
J Am Heart Assoc 2020 May 18;9(10):e015523. doi: 10.1161/jaha.119.015523..
Keywords: Diabetes, Cardiovascular Conditions, Chronic Conditions, Healthcare Costs
Mahtta D, Ahmed ST, Shah NR
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
The authors evaluate facility-level variation in cardiac stress test use among patients with diabetes mellitus (DM) across the Veterans Affairs (VA) health care system. Their results suggest that significant residual variation in overall stress test use exists among veterans with DM. They recommend future studies to assess system-wide appropriateness of stress testing, to assess patient-level symptom data, and to conduct qualitative analyses in order to understand individual provider-level drivers behind such variation.
AHRQ-funded; HS022998.
Citation: Mahtta D, Ahmed ST, Shah NR .
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
Diabetes Care 2020 May;43(5):e58-e60. doi: 10.2337/dc19-2160..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Diabetes, Decision Making, Diagnostic Safety and Quality, Chronic Conditions
Obinwa U, Pérez A, Lingvay I
Multilevel variation in diabetes screening within an integrated health system.
Variation in diabetes screening in clinical practice is poorly described. In this study, the investigators examined the interplay of patient, provider, and clinic factors explaining variation in diabetes screening within an integrated health care system in the U.S. They concluded that screening practices varied widely and were only partially explained by patient, provider, and clinic factors available in the EHR.
AHRQ-funded; HS022418.
Citation: Obinwa U, Pérez A, Lingvay I .
Multilevel variation in diabetes screening within an integrated health system.
Diabetes Care 2020 May;43(5):1016-24. doi: 10.2337/dc19-1622..
Keywords: U.S. Preventive Services Task Force (USPSTF), Diabetes, Screening, Primary Care, Prevention, Evidence-Based Practice, Chronic Conditions
Ramirez M, Chen K, Follett RW
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
The aim of the study was to evaluate whether the implementation of the Best Practice Advisory (BPA) was associated with changes in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-receptor blocker (ARB) prescribing during primary care encounters for patients with diabetes. The investigators concluded that a BPA with a "chart closure" hard stop is a promising tool for the treatment of patients with comorbid diabetes and hypertension with an ACEI or ARB, especially when implemented within the context of team-based care, wherein clinical pharmacists support the work of primary care providers.
AHRQ-funded; HS00046.
Citation: Ramirez M, Chen K, Follett RW .
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
JMIR Med Inform 2020 Apr 17;8(4):e16421. doi: 10.2196/16421..
Keywords: Blood Pressure, Medication, Diabetes, Clinical Decision Support (CDS), Decision Making, Chronic Conditions
Poon BY, Shortell SM, Rodriguez HP
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
Shared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed. In this study, the investigators examined the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship.
AHRQ-funded; HS022241.
Citation: Poon BY, Shortell SM, Rodriguez HP .
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
J Gen Intern Med 2020 Mar;35(3):732-42. doi: 10.1007/s11606-019-05351-6.
Keywords: Decision Making, Diabetes, Cardiovascular Conditions, Chronic Conditions, Patient-Centered Healthcare, Patient and Family Engagement
McCoy RG, Lipska KJ, Van Houten HK
Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes.
Researchers examined contemporary patterns of glycemic control and use of medications known to cause hypoglycemia among adults with diabetes across age and multimorbidity. They found that the proportion of patients achieving low HbA1c levels was highest among older and multimorbid patients. Older patients and patients with higher comorbidity burden were more likely to be treated with insulin to achieve these HbA1c levels despite the potential for hypoglycemia and uncertain long-term benefit.
AHRQ-funded; HS024075.
Citation: McCoy RG, Lipska KJ, Van Houten HK .
Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes.
BMJ Open Diabetes Res Care 2020 Feb;8(1). doi: 10.1136/bmjdrc-2019-001007..
Keywords: Diabetes, Medication, Patient-Centered Outcomes Research, Patient-Centered Healthcare, Evidence-Based Practice, Risk, Chronic Conditions