National Healthcare Quality and Disparities Report
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Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Behavioral Health (3)
- Blood Thinners (2)
- Cardiovascular Conditions (3)
- Children/Adolescents (2)
- Chronic Conditions (1)
- Comparative Effectiveness (2)
- (-) Evidence-Based Practice (14)
- Guidelines (7)
- Healthcare Costs (1)
- Heart Disease and Health (1)
- Human Immunodeficiency Virus (HIV) (2)
- Implementation (1)
- Medicaid (1)
- (-) Medication (14)
- Medication: Safety (1)
- Opioids (3)
- Outcomes (2)
- Pain (1)
- Patient-Centered Outcomes Research (3)
- Patient Safety (2)
- Practice Patterns (2)
- Prevention (2)
- Quality Improvement (1)
- Quality of Care (2)
- Registries (1)
- Research Methodologies (1)
- Substance Abuse (1)
- Tools & Toolkits (1)
- Treatments (3)
- U.S. Preventive Services Task Force (USPSTF) (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 14 of 14 Research Studies DisplayedTracer H, Newhouse CN
AHRQ Author: Tracer H
Aspirin use to prevent cardiovascular disease.
This Putting Prevention into Practice case study involves a 56-year-old man, a wellness visit, and aspirin usage to prevent cardiovascular disease. Three questions based on U.S. Preventative Serices Task Force recommendations are presented, followed by the answers.
AHRQ-authored.
Citation: Tracer H, Newhouse CN .
Aspirin use to prevent cardiovascular disease.
Am Fam Physician 2022 Sep;106(3):327-28..
Keywords: Medication, Cardiovascular Conditions, Prevention, Guidelines, Evidence-Based Practice
Chou R, Cantor A, Dana T
Statin use for the primary prevention of cardiovascular disease in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to update the 2016 review on statins for the primary prevention of cardiovascular disease to inform the US Preventive Services Task Force (USPSTF). The researchers utilized the Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews (to November 2021), Ovid, and MEDLINE, and selected 26 randomized clinical trials on statins vs placebo or no statin and statin intensity in adults without prior cardiovascular events. The researchers found that statins were significantly associated with decreased risk of all-cause mortality absolute risk difference [ARD], stroke, myocardial infarction, and composite cardiovascular outcomes. The association with cardiovascular mortality was determined not to be statistically significant. Statin therapy was not significantly associated with increased risk of serious adverse events, myalgias, or elevated alanine aminotransferase level. Statin therapy was not significantly associated with increased diabetes risk overall, although 1 trial found high-intensity statin therapy was significantly associated with increased risk. The researchers concluded that statin therapy for primary prevention of CVD was associated with reduced risk of all-cause mortality and CVD events for adults with increased of risk of CVD, but without prior CVD events.
AHRQ-funded; 290201500007I.
Citation: Chou R, Cantor A, Dana T .
Statin use for the primary prevention of cardiovascular disease in adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2022 Aug 23;328(8):754-71. doi: 10.1001/jama.2022.12138..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Medication, Prevention, Evidence-Based Practice
Korthuis PT, Cook RR, Lum PJ
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Opioid Use Disorder (OUD) treatment medications can improve outcomes for human immunodeficiency virus (HIV) and also reduce opioid use. The purpose of the study was to determine if outpatient naltrexone treatment could also reduce opioid use and improve outcomes for HIV. The researchers reported that enrollment was stopped early because of slower than expected recruitment, resulting in 114 final participants with untreated OUD and HIV, with 62% positive for fentanyl, 60% positive for cocaine, and 47% positive for other opioids at the baseline. The intervention compared treatment as usual (TAU) of methadone or buprenorphine with extended-release naltrexone (XR-NTX) on group differences in viral suppression at 24 weeks and past 30-day use of opioids at 24 weeks. The study reported that at 24 weeks the outcome of viral suppression was similar for TAU and XR-NTX, and that fewer XR-NTX participants initiated medication than TAU participants. The outcome of previous 30-day use of opioids was similar for TAU as compared to XR-NTX. Of those participants who did initiate medication, those administered XR-NTX experienced less days of opioid use when compared with TAU in the prior 30 days. The researchers reported that the study evidence was not conclusive but did support that XR-NTX is not inferior to TAU for HIV viral suppression, and that study participants who started XR-NTX used less opioids at 24 weeks than participants who were administered TAU.
AHRQ-funded; HS026370.
Citation: Korthuis PT, Cook RR, Lum PJ .
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Addiction 2022 Jul;117(7):1961-71. doi: 10.1111/add.15836..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Behavioral Health, Medication, Treatments, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Cedillo G, George MC, Deshpande R
Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial.
Healthcare and behavioral health providers are lacking a methodology to implement the 2016 U.S. Centers for Disease Control and Prevention Opioid Prescribing Guideline (CDC Guideline), measure prescriber adherence to it, and systematically test its effect on patient and public health outcomes. The Guideline is currently being reviewed and revised due to concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). The purpose of the study was to develop and test a CDC Guideline implementation strategy termed “TOWER,” focused on an outpatient HIV primary care setting with patients with CP-LTOT. The TOWER strategy included: 1) a patient-facing app for opioid management (OM-App); 2) a template for progress notes (OM-Note) intended to guide the patient’s office visit; and 3) a primary care provider (PCP) training. TOWER was developed in a multi-step, stakeholder-engaged process within a behavioral change framework. The researchers evaluated the TOWER strategy in a randomized-controlled trial of HIV-PCPs (N=11) and their patients with HIV and CP-LTOT (N=40). The main outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the Safer Opioid Prescribing Tool (SOPTET). Qualitative data was also collected, including one-on-one PCP interviews. The study found that the PCPs randomized to utilize the TOWER strategy were 48% more CDC Guideline adherent. Qualitative data reflected high levels of intervention provider confidence in administering the TOWER processes, and that the OM-Note supported provider efforts, but experience with the patient-facing OM-App was mixed. The study concluded that adherence to the 2016 CDC Guidelines is not associated with worsening of outcomes for people with HIV with CP-LTOT, and adherence to the CDC Guidelines can be promoted and measured. The researchers recommend additional research into the scalability of these results and the impact of CDC Guideline adherence on public health.
AHRQ-funded; HS025641.
Citation: Cedillo G, George MC, Deshpande R .
Toward safer opioid prescribing in HIV care (TOWER): a mixed-methods, cluster-randomized trial.
Addict Sci Clin Pract 2022 May 16;17(1):28. doi: 10.1186/s13722-022-00311-8..
Keywords: Opioids, Medication, Human Immunodeficiency Virus (HIV), Guidelines, Evidence-Based Practice
Schnipper JL, Reyes Nieva H, Mallouk M
Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study.
This study was a follow-up of the first Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS1) that demonstrated mentored implementation of a medication reconciliation best practices toolkit. The toolkit decreased total unintentional medication discrepancies in five hospitals, but results varied by site. The toolkit has been refined with lessons learned and retooled as MARQUIS2. The tool was implemented at 18 North American hospitals or hospital systems from 2016 to 2018, offering 17 system-level and 6-patient-level interventions. One of eight physicians coached each site remotely via monthly calls and one or two site visits. A total of 4947 patients were sampled, with 1229 preimplementation and 3718 postimplementation. A steady decline in medication discrepancy rates were experienced from 2.85 discrepancies per patient down to 0.98 discrepancies. An interrupted time series analysis of the 17 sites showed the intervention was associated with a 5% relative decrease in discrepancies per month.
AHRQ-funded; HS025486; HS023757.
Citation: Schnipper JL, Reyes Nieva H, Mallouk M .
Effects of a refined evidence-based toolkit and mentored implementation on medication reconciliation at 18 hospitals: results of the MARQUIS2 study.
BMJ Qual Saf 2022 Apr;31(4):278-86. doi: 10.1136/bmjqs-2020-012709..
Keywords: Medication, Evidence-Based Practice, Tools & Toolkits, Implementation, Quality Improvement, Quality of Care, Medication: Safety, Patient Safety
Barkun AN, Douketis J, Noseworthy PA
Management of patients on anticoagulants and antiplatelets during acute gastrointestinal bleeding and the peri-endoscopic period: a clinical practice guideline dissemination tool.
The American College of Gastroenterology and the Canadian Association of Gastroenterology jointly created recommendations on the management of anticoagulants and antiplatelets during acute gastrointestinal (GI) bleeding and the elective per-endoscopic period. The clinical practice guideline (CPG) panel was restricted in making strong recommendations regarding some relevant clinical questions because of the limited certainty of evidence in the literature. The purpose of this paper was to describe a clinical practice guideline dissemination tool for the management of patients on anticoagulants and antiplatelets during acute gastrointestinal bleeding and the peri-endoscopic period. The dissemination tool addresses provider concerns about limited certainty of evidence in the literature by providing clinicians with a companion piece to execute recommendations with contextual guidance and practical algorithms. The patient’s risks of a thromboembolic event versus the procedural risk of GI bleeding is taken into account in the implementation of the tool. The authors concluded that the clinical practice guideline dissemination tool provides both contextual information in interpreting the clinical guideline panel’s recommendations and algorithmic guidance for common scenarios encountered during endoscopic practice.
AHRQ-funded; HS025402.
Citation: Barkun AN, Douketis J, Noseworthy PA .
Management of patients on anticoagulants and antiplatelets during acute gastrointestinal bleeding and the peri-endoscopic period: a clinical practice guideline dissemination tool.
Am J Gastroenterol 2022 Apr;117(4):513-19. doi: 10.14309/ajg.0000000000001688..
Keywords: Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events, Evidence-Based Practice, Guidelines
Sun D, Heimall JR, Greenhawt MJ
Cost utility of lifelong immunoglobulin replacement therapy vs hematopoietic stem cell transplant to treat agammaglobulinemia.
This study evaluated the cost utility of lifelong immunoglobulin replacement therapy (IRT) versus hematopoietic stem cell transplant (HSCT) to treat agammaglobulinemia. This economic evaluation used Markov analysis to model the base-case scenario of a patient aged 12 months to receive lifelong IRT vs matched sibling donor (MSD) or matched unrelated donor (MUD) HSCT. In this evaluation, lifelong IRT cost more than HSCT ($1,512,946 compared with $563,776 [MSD] and $637,036 [MUD]) and generated similar quality-adjusted life-years (QALYs) (20.61 vs 17.25 [MSD] and 17.18 [MUD]). While choosing IRT over HSCT generated higher incremental cost-effectiveness ratios (ICERs), it exceeded US willing-to-pay threshold of $100,000/QALY. However, IRT prevented at least 2488 premature deaths per 10,000 microsimulations compared with HSCT treatment. But when the annual IRT price was reduced from $60,145 to below $29,469, IRT became the cost-effective strategy.
AHRQ-funded; HS024599.
Citation: Sun D, Heimall JR, Greenhawt MJ .
Cost utility of lifelong immunoglobulin replacement therapy vs hematopoietic stem cell transplant to treat agammaglobulinemia.
JAMA Pediatr 2022 Feb; 176(2):176-84. doi: 10.1001/jamapediatrics.2021.4583..
Keywords: Medication, Healthcare Costs, Treatments, Evidence-Based Practice
Penfold RB, Thompson EE, Hilt RJ
Development of a symptom-focused model to guide the prescribing of antipsychotics in children and adolescents: results of the first phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial.
The purpose of this study was to develop a new approach to prescribing guidelines as part of a pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. The investigators indicated that their approach addressed some of these concerns.
AHRQ-funded; HS026001; HS023258.
Citation: Penfold RB, Thompson EE, Hilt RJ .
Development of a symptom-focused model to guide the prescribing of antipsychotics in children and adolescents: results of the first phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial.
J Am Acad Child Adolesc Psychiatry 2022 Jan;61(1):93-102. doi: 10.1016/j.jaac.2021.04.010..
Keywords: Children/Adolescents, Medication, Behavioral Health, Patient Safety, Guidelines, Evidence-Based Practice
Dulai PS, Siegel CA, Colombel JF
Systematic review: monotherapy with antitumour necrosis factor alpha agents versus combination therapy with an immunosuppressive for IBD.
The authors discussed the efficacy and the risks of anti-TNF monotherapy versus combination therapy with an immunosuppressive in patients with IBD. They concluded that the addition of an immunosuppressive to anti-TNF therapy improves treatment efficacy for infliximab in ulcerative colitis and Crohn’s disease. Further, the use of combination therapy appears to add no significant incremental risk for serious infections above that seen with anti-TNF or immunosuppressive monotherapy in most patients.
AHRQ-funded; HS021747.
Citation: Dulai PS, Siegel CA, Colombel JF .
Systematic review: monotherapy with antitumour necrosis factor alpha agents versus combination therapy with an immunosuppressive for IBD.
Gut 2014 Dec;63(12):1843-53. doi: 10.1136/gutjnl-2014-307126.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Medication, Outcomes, Patient-Centered Outcomes Research, Treatments
Finnerty M, Neese-Todd S, Bilder S
Best practices: MEDNET: a multistate policy maker-researcher collaboration to improve prescribing practices.
The authors describe the Medicaid/ Mental Health Network for Evidence-Based Treatment (MEDNET), the first multistate Medicaid QI collaborative to focus on improving psychotropic prescribing. In particular, this article includes the development, infrastructure challenges, and early evidence of success of this public-academic partnership.
AHRQ-funded; HSO19937; HS021112.
Citation: Finnerty M, Neese-Todd S, Bilder S .
Best practices: MEDNET: a multistate policy maker-researcher collaboration to improve prescribing practices.
Psychiatr Serv 2014 Nov 1;65(11):1297-9. doi: 10.1176/appi.ps.201400343..
Keywords: Behavioral Health, Evidence-Based Practice, Medication, Medicaid, Practice Patterns
Kealey E, Scholle SH, Byron SC
Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines.
The authors reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics.They found that all 7 quality concepts were strongly endorsed by 1 or more guidelines, and 2 or more guidelines assigned their highest strength of recommendation ratings to 6 of the 7 concepts. Two guidelines rated evidence, providing high strength of evidence for 2 quality concepts.
AHRQ-funded; HS020503.
Citation: Kealey E, Scholle SH, Byron SC .
Quality concerns in antipsychotic prescribing for youth: a review of treatment guidelines.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S68-75. doi: 10.1016/j.acap.2014.05.009.
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Keywords: Evidence-Based Practice, Children/Adolescents, Guidelines, Quality of Care, Medication
Camp KM, Parisi MA, Acosta PB
AHRQ Author: Chang CS
Phenylketonuria Scientific Review Conference: state of the science and future research needs.
An NIH State-of-the-Science Conference was convened in 2012 to address new findings, particularly the use of the medication sapropterin to treat some individuals with phenylketonuria (PKU), and to develop a research agenda. An AHRQ Evidence-based Practice Center conducted a systematic review of adjuvant treatments for PKU and presented its conclusions at the conference. New drugs that are safe, efficacious, and impact a larger proportion of individuals with PKU are needed. The identification of a research agenda has facilitated the development of clinical practice guidelines by professional organizations and serves as a model for other inborn errors of metabolism.
AHRQ-authored.
Citation: Camp KM, Parisi MA, Acosta PB .
Phenylketonuria Scientific Review Conference: state of the science and future research needs.
Mol Genet Metab 2014 Jun;112(2):87-122. doi: 10.1016/j.ymgme.2014.02.013.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Guidelines, Medication, Research Methodologies
O'Brien EC, Holmes DN, Ansell JE
Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
This study describes the frequencies of and factors associated with oral anticoagulation (OAC) contraindications in clinical practice for patients with atrial fibrillation (AF). Contraindications to OAC therapy among patients with AF are common but subjective. Many patients with reported contraindications were receiving OAC, suggesting that the perceived benefits outweighed the potential harm posed by the relative contraindication.
AHRQ-funded; HS021092
Citation: O'Brien EC, Holmes DN, Ansell JE .
Physician practices regarding contraindications to oral anticoagulation in atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) registry.
Am Heart J. 2014 Apr;167(4):601-609.e1. doi: 10.1016/j.ahj.2013.12.014..
Keywords: Heart Disease and Health, Blood Thinners, Medication, Registries, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Practice Patterns
Nuckols TK, Anderson L, Popescu I
Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.
This review evaluated the quality and content of guidelines on the use of opioids for chronic pain. Despite limited evidence and variable development methods, it concluded that recent guidelines on chronic pain agree on several opioid risk mitigation strategies, including upper dosing thresholds; cautions with certain medications; attention to drug–drug and drug–disease interactions; and use of risk assessment tools, treatment agreements, and urine drug testing.
AHRQ-funded; HS017954.
Citation: Nuckols TK, Anderson L, Popescu I .
Opioid prescribing: a systematic review and critical appraisal of guidelines for chronic pain.
Ann Intern Med 2014 Jan 7;160(1):38-47. doi: 10.7326/0003-4819-160-1-201401070-00732..
Keywords: Opioids, Pain, Guidelines, Medication, Evidence-Based Practice, Chronic Conditions