National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Back Health and Pain (1)
- Behavioral Health (3)
- Blood Pressure (1)
- Blood Thinners (2)
- Cardiovascular Conditions (4)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Communication (1)
- Comparative Effectiveness (3)
- (-) Evidence-Based Practice (16)
- Guidelines (6)
- Healthcare Costs (1)
- Heart Disease and Health (2)
- Human Immunodeficiency Virus (HIV) (2)
- Implementation (2)
- Long-Term Care (1)
- (-) Medication (16)
- Medication: Safety (1)
- Nursing Homes (1)
- Opioids (2)
- Outcomes (2)
- Patient-Centered Outcomes Research (6)
- Patient Safety (2)
- Practice Patterns (1)
- Pregnancy (1)
- Prevention (3)
- Provider (1)
- Provider: Pharmacist (1)
- Quality Improvement (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Substance Abuse (1)
- Tobacco Use (1)
- Tools & Toolkits (2)
- Treatments (3)
- U.S. Preventive Services Task Force (USPSTF) (2)
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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 16 of 16 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
Bangalore S, Ogedegbe G, Gyamfi J
Outcomes with angiotensin-converting enzyme inhibitors vs other antihypertensive agents in hypertensive blacks.
The study’s objective was to evaluate the effectiveness of angiotensin-converting enzyme inhibitors when compared with other antihypertensive agents in hypertensive blacks. It found that in a large cohort of hypertensive blacks, angiotensin-converting enzyme inhibitors were associated with less benefit when compared with calcium channel blockers or thiazide diuretics.
AHRQ-funded; HS018589.
Citation: Bangalore S, Ogedegbe G, Gyamfi J .
Outcomes with angiotensin-converting enzyme inhibitors vs other antihypertensive agents in hypertensive blacks.
Am J Med 2015 Nov;128(11):1195-203. doi: 10.1016/j.amjmed.2015.04.034..
Keywords: Blood Pressure, Racial and Ethnic Minorities, Medication, Outcomes, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Comparative Effectiveness
Patnode CD, Henderson JT, Thompson JH
Behavioral counseling and pharmacotherapy interventions for tobacco cessation in adults, including pregnant women: a review of reviews for the U.S. Preventive Services Task Force.
The researchers reviewed the effectiveness and safety of pharmacotherapy and behavioral interventions for tobacco cessation. They concluded that behavioral and pharmacotherapy interventions improve rates of smoking cessation among the general adult population, alone or in combination. Data on the effectiveness and safety of electronic nicotine delivery systems are limited.
AHRQ-funded; 290201200015I.
Citation: Patnode CD, Henderson JT, Thompson JH .
Behavioral counseling and pharmacotherapy interventions for tobacco cessation in adults, including pregnant women: a review of reviews for the U.S. Preventive Services Task Force.
Ann Intern Med 2015 Oct 20;163(8):608-21. doi: 10.7326/m15-0171..
Keywords: Behavioral Health, Evidence-Based Practice, Medication, Pregnancy, Prevention, Tobacco Use, U.S. Preventive Services Task Force (USPSTF), Women
Desai NR, Sabatine MS
PCSK9 inhibition in patients with hypercholesterolemia.
The authors specified that large, cardiovascular outcomes trials are underway to assess definitively the efficacy and safety of 3 monoclonal antibodies (evolocumab, alirocumab, and bococizumab), while additional non-monoclonal antibody approaches to inhibit PCSK9 continue in the early-phase development.
AHRQ-funded; HS023000.
Citation: Desai NR, Sabatine MS .
PCSK9 inhibition in patients with hypercholesterolemia.
Trends Cardiovasc Med 2015 Oct;25(7):567-74. doi: 10.1016/j.tcm.2015.01.009.
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Keywords: Adverse Drug Events (ADE), Heart Disease and Health, Evidence-Based Practice, Medication, Patient-Centered Outcomes Research
Chou R, Hashimoto R, Friedly J
Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis.
The researchers reviewed evidence on the benefits and harms of epidural corticosteroid injections in adults with radicular low back pain or spinal stenosis of any duration. They concluded that epidural corticosteroid injections for radiculopathy were associated with immediate reductions in pain and function. However, benefits were small and not sustained, and there was no effect on long-term surgery risk.
AHRQ-funded; 290201200014I.
Citation: Chou R, Hashimoto R, Friedly J .
Epidural corticosteroid injections for radiculopathy and spinal stenosis: a systematic review and meta-analysis.
Ann Intern Med 2015 Sep 1;163(5):373-81. doi: 10.7326/m15-0934.
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Keywords: Medication, Back Health and Pain, Chronic Conditions, Comparative Effectiveness, Evidence-Based Practice
Tjia J, Field T, Mazor K
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
This study evaluated the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). It found that RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends.
AHRQ-funded; HS019351.
Citation: Tjia J, Field T, Mazor K .
Dissemination of evidence-based antipsychotic prescribing guidelines to nursing homes: a cluster randomized trial.
J Am Geriatr Soc 2015 Jul;63(7):1289-98. doi: 10.1111/jgs.13488..
Keywords: Communication, Evidence-Based Practice, Guidelines, Long-Term Care, Medication, Nursing Homes, Practice Patterns, Tools & Toolkits, Implementation
Singh JA, Akhras KS, Shiozawa A
Comparative effectiveness of urate lowering with febuxostat versus allopurinol in gout: analyses from large U.S. managed care cohort.
The researchers sought to assess the comparative effectiveness of febuxostat and allopurinol in reducing serum urate (sUA) levels in a real-world U.S. managed care setting. It concluded that febuxostat was more effective than allopurinol at the currently used doses in lowering sUA in gout patients as demonstrated by post-index mean sUA level, the likelihood of and the time to achieving sUA goals.
AHRQ-funded; HS021110.
Citation: Singh JA, Akhras KS, Shiozawa A .
Comparative effectiveness of urate lowering with febuxostat versus allopurinol in gout: analyses from large U.S. managed care cohort.
Arthritis Res Ther 2015 May 12;17(1):120. doi: 10.1186/s13075-015-0624-3..
Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Medication, Treatments
O'Brien EC, Kim S, Hess PL
Effect of the 2014 atrial fibrillation guideline revisions on the proportion of patients recommended for oral anticoagulation.
Researchers assessed the potential effect of a new guideline for atrial fibrillation (AF) by comparing the proportion of patients with AF recommended for oral anticoagulation (OAC) under the 2011 and 2014 guidelines. They found that two-thirds of patients with AF who were previously not recommended for OAC are newly recommended under the 2014 guideline. They advised future studies evaluating longitudinal changes in anticoagulation treatment patterns and outcomes among patients reclassified by the new guidelines.
AHRQ-funded; HS021092.
Citation: O'Brien EC, Kim S, Hess PL .
Effect of the 2014 atrial fibrillation guideline revisions on the proportion of patients recommended for oral anticoagulation.
JAMA Intern Med 2015 May;175(5):848-50. doi: 10.1001/jamainternmed.2015.13.
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Keywords: Heart Disease and Health, Blood Thinners, Guidelines, Medication, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research
Viswanathan M, Kahwati LC, Golin CE
Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis.
Medication therapy management (MTM) services (also called clinical pharmacy services) aim to reduce medication-related problems and their downstream outcomes. The purpose of this study was to assess the effect of MTM interventions among outpatients with chronic illnesses. The investigators graded the evidence as insufficient for most outcomes because of inconsistency and imprecision that stemmed in part from underlying heterogeneity in populations and interventions.
AHRQ-funded; 290201200008I.
Citation: Viswanathan M, Kahwati LC, Golin CE .
Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis.
JAMA Intern Med 2015 Jan;175(1):76-87. doi: 10.1001/jamainternmed.2014.5841..
Keywords: Medication, Ambulatory Care and Surgery, Chronic Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Provider: Pharmacist, Provider