National Healthcare Quality and Disparities Report
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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 63 Research Studies DisplayedAdisa O, Jaar BG, Masud T
Association of social worker-assessed psychosocial factors with 30-day hospital readmissions among hemodialysis patients.
In this study, the investigators examined whether social worker-assessed factors were associated with 30-day readmission among prevalent hemodialysis patients. Data on 14 factors were extracted from the first available psychosocial assessment performed by social workers at three metropolitan Atlanta dialysis centers. The authors indicated that results suggested psychosocial issues may be associated with risk of 30-day readmission among dialysis patients.
AHRQ-funded; HS025018.
Citation: Adisa O, Jaar BG, Masud T .
Association of social worker-assessed psychosocial factors with 30-day hospital readmissions among hemodialysis patients.
BMC Nephrol 2018 Dec 17;19(1):360. doi: 10.1186/s12882-018-1162-4..
Keywords: Kidney Disease and Health, Hospital Readmissions
Lee T, Qian J, Thamer M
Tradeoffs in vascular access selection in elderly patients initiating hemodialysis with a catheter.
In this study the investigators evaluated clinically relevant vascular access outcomes in elderly patients receiving an arteriovenous fistulas (AVF) or arteriovenous grafts AVG after hemodialysis therapy initiation. The investigators found that in elderly hemodialysis patients initiating hemodialysis therapy with a catheter, the optimal vascular access selection depended on tradeoffs between shorter catheter dependence and less frequent interventions to make the vascular access (AVG) functional versus longer access patency and fewer interventions after successful use of the vascular access (AVF).
AHRQ-funded; HS022931; HS021229.
Citation: Lee T, Qian J, Thamer M .
Tradeoffs in vascular access selection in elderly patients initiating hemodialysis with a catheter.
Am J Kidney Dis 2018 Oct;72(4):509-18. doi: 10.1053/j.ajkd.2018.03.023..
Keywords: Dialysis, Kidney Disease and Health, Elderly, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Wahl TS, Graham LA, Morris MS
Association between preoperative proteinuria and postoperative acute kidney injury and readmission.
This retrospective cohort study investigated whether preoperative proteinuria is associated with surgical outcomes including postoperative acute kidney injury (AKI) and readmission. The cohort used were undergoing elective inpatient surgery at 119 Veterans Affairs facilities from October 2007 to September 2014. The data collected was for a 7-month period in 2016. A higher probability of 30-day unplanned readmission was associated with preoperative proteinuria and postoperative AKI.
AHRQ-funded; HS013852.
Citation: Wahl TS, Graham LA, Morris MS .
Association between preoperative proteinuria and postoperative acute kidney injury and readmission.
JAMA Surg 2018 Sep;153(9):e182009. doi: 10.1001/jamasurg.2018.2009..
Keywords: Kidney Disease and Health, Injuries and Wounds, Adverse Events, Surgery, Risk, Hospital Readmissions, Outcomes
Shetterly Shetterly, S Flory, J
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
This study used data from FDA’s Sentinel System to determine if augmenting a diagnosis-based chronic kidney disease cohort with patients identified through laboratory results impacted cohort characteristics and outcomes. They divided the cohort into three different groups to compare demographic, clinical, and health care utilization characteristics. They observed mortality rates between the different groups.
AHRQ-funded; HS023898.
Citation: Shetterly Shetterly, S Flory, J .
Diagnosis-based cohort augmentation using laboratory results data: the case of chronic kidney disease.
Pharmacoepidemiol Drug Saf 2018 Aug;27(8):872-77. doi: 10.1002/pds.4583..
Keywords: Diagnostic Safety and Quality, Kidney Disease and Health, Chronic Conditions, Adverse Drug Events (ADE), Medication, Adverse Events
Plantinga LC, Masud T, Lea JP
Post-hospitalization dialysis facility processes of care and hospital readmissions among hemodialysis patients: a retrospective cohort study.
This study examined the association of post-hospitalization processes of care at hemodialysis facilities with pulmonary edema-related and other readmissions. The study results suggested that some interventions performed at the dialysis facility in the post-hospitalization period may be associated with reduced readmission risk, while others may provide a potential existing means of identifying patients at higher risk for readmissions, to whom such interventions could be efficiently targeted.
AHRQ-funded; HS025018.
Citation: Plantinga LC, Masud T, Lea JP .
Post-hospitalization dialysis facility processes of care and hospital readmissions among hemodialysis patients: a retrospective cohort study.
BMC Nephrol 2018 Jul 31;19(1):186. doi: 10.1186/s12882-018-0983-5..
Keywords: Kidney Disease and Health, Hospital Readmissions, Hospitalization
Plantinga LC, King LM, Masud T
Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study.
Pulmonary edema is prevalent and may be a common cause of hospital readmissions in hemodialysis patients. In this retrospective cohort study, the investigators aimed to estimate the national burden of, and identify correlates of, readmissions related to pulmonary edema among hemodialysis patients. The investigators concluded that readmissions related to pulmonary edema were common in hemodialysis patients. They suggest that interventions aimed at preventing such readmissions could have a substantial impact on readmissions overall, particularly targeted at incident hemodialysis patients with a prior history of heart failure and patients initially admitted for pulmonary edema.
AHRQ-funded; HS025018.
Citation: Plantinga LC, King LM, Masud T .
Burden and correlates of readmissions related to pulmonary edema in US hemodialysis patients: a cohort study.
Nephrol Dial Transplant 2018 Jul;33(7):1215-23. doi: 10.1093/ndt/gfx335..
Keywords: Adverse Events, Dialysis, Heart Disease and Health, Hospital Readmissions, Hospitalization, Kidney Disease and Health
Kumar K, Tonascia JM, Muzaale AD
Racial differences in completion of the living kidney donor evaluation process.
Racial disparities in living donor kidney transplantation (LDKT) persist, but the most effective target to eliminate these disparities remains unknown. The researchers investigated delays during completion of the live donor evaluation process. They concluded that delays may be a manifestation of the transplant candidate's social network and recommended targeted efforts to optimize networks for identification of donor candidates in order to address LDKT disparities.
AHRQ-funded; HS024600.
Citation: Kumar K, Tonascia JM, Muzaale AD .
Racial differences in completion of the living kidney donor evaluation process.
Clin Transplant 2018 Jul;32(7):e13291. doi: 10.1111/ctr.13291..
Keywords: Transplantation, Racial and Ethnic Minorities, Disparities, Kidney Disease and Health
Eaton EF, Tamhane A, Davy-Mendez T
Brief report: kidney dysfunction does not contribute significantly to antiretroviral therapy modification in treatment-naive PLWH receiving initial ART.
Antiretroviral therapy (ART) durability, time to modification or cessation, has declined. The objective of this retrospective follow up study was to determine whether kidney dysfunction was contributing to reduced durability. The investigator found that for patients in their study initiated on ART, including TDF-based ART, in the last decade, kidney dysfunction was not a major factor leading to regimen modification.
AHRQ-funded; HS023009.
Citation: Eaton EF, Tamhane A, Davy-Mendez T .
Brief report: kidney dysfunction does not contribute significantly to antiretroviral therapy modification in treatment-naive PLWH receiving initial ART.
J Acquir Immune Defic Syndr 2019 May 1;81(1):e6-e9. doi: 10.1097/qai.0000000000001999..
Keywords: Patient-Centered Outcomes Research, Kidney Disease and Health, Evidence-Based Practice, Outcomes
Ashlagi I, Bingaman A, Burq M
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Many U.S. kidney paired donation (KPD) registries have gradually shifted to high-frequency match-runs, raising the question of whether this harms the number of transplants. The authors conducted simulations and found that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting these patients. Further, increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.
AHRQ-funded; HS020610.
Citation: Ashlagi I, Bingaman A, Burq M .
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Am J Transplant 2018 May;18(5):1177-86. doi: 10.1111/ajt.14566..
Keywords: Transplantation, Kidney Disease and Health, Health Services Research (HSR), Policy, Registries
Wey A, Salkowski N, Kremers WK
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
The researchers developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and they characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kremers WK .
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
Am J Transplant 2018 Apr;18(4):897-906. doi: 10.1111/ajt.14506.
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Keywords: Clinical Decision Support (CDS), Decision Making, Kidney Disease and Health, Medical Expenditure Panel Survey (MEPS), Transplantation
Shah PK, Yan PL, Dauw CA
Emergency department switching and duplicate computed tomography scans in patients with kidney stones.
The researchers measured the association between emergency department (ED) switching during a kidney stone episode and receipt of a repeat computed tomography (CT) scan. They found that 12% of patients who received a CT scan at their initial ED encounter had a revisit within 30 days of discharge. One-third of their revisits were made to a different ED than the iniital one. Duplicate CT scans were obtained at nearly 40% of all revisits. The risk of receiving a repeat CT was 12% higher if this revisit was made to a different ED. They concluded that their findings support the role of better health information exchange among providers to help reduce waste in the health-care system.
AHRQ-funded; HS024525; HS024728.
Citation: Shah PK, Yan PL, Dauw CA .
Emergency department switching and duplicate computed tomography scans in patients with kidney stones.
Urology 2018 Apr;114:41-44. doi: 10.1016/j.urology.2018.01.013.
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Keywords: Emergency Department, Imaging, Kidney Disease and Health
Sequist TD, Holliday AM, Orav EJ
Physician and patient tools to improve chronic kidney disease care.
This study sought to determine if electronic health record (EHR) tools and patient engagement can improve the quality of chronic kidney disease (CKD) care. It found that, among high-risk patients, those in the intervention arm were significantly more likely to have an office visit with a nephrologist compared with those in the control arm.
AHRQ-funded; HS018226.
Citation: Sequist TD, Holliday AM, Orav EJ .
Physician and patient tools to improve chronic kidney disease care.
Am J Manag Care 2018 Apr;24(4):e107-e14.
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Keywords: Chronic Conditions, Electronic Health Records (EHRs), Kidney Disease and Health, Patient and Family Engagement, Quality Improvement
Ruck JM, Holscher CM, Purnell TS
https://www.ncbi.nlm.nih.gov/pubmed/29068176
Factors associated with perceived donation-related financial burden among living kidney donors.
The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. In this study, the investigators sought to identify characteristics that predicted higher risk of perceived financial burden.
AHRQ-funded; HS024600.
Citation: Ruck JM, Holscher CM, Purnell TS .
Factors associated with perceived donation-related financial burden among living kidney donors.
Am J Transplant 2018 Mar;18(3):715-19. doi: 10.1111/ajt.14548..
Keywords: Transplantation, Healthcare Costs, Kidney Disease and Health
Bozek DN, Dunn TB, Kuhr CS
Complete chain of the first global kidney exchange transplant and 3-yr follow-up.
While the promise of Global Kidney Exchange (GKE) is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines. The authors concluded that, although criticisms of GKE highlight concerns for possible exploitation of financially disadvantaged groups, their results demonstrated that these concerns did not come to fruition.
AHRQ-funded; HS020610.
Citation: Bozek DN, Dunn TB, Kuhr CS .
Complete chain of the first global kidney exchange transplant and 3-yr follow-up.
Eur Urol Focus 2018 Mar;4(2):190-97. doi: 10.1016/j.euf.2018.07.021..
Keywords: Kidney Disease and Health, Transplantation
Vranian SC, Covert KL, Mardis CR
Assessment of risk factors for increased resource utilization in kidney transplantation.
The purpose of this study was to identify risk factors for increased health care resource utilization in kidney transplant recipients, based on drug-related problems and self-administered surveys. Adult kidney transplant recipients seen in the transplant clinic were surveyed for self-reported demographics, then assessed for associations between survey results, pharmacist-derived drug-related problems, and health resource utilization over a minimum 6-month follow-up period. The authors conclude that Medicaid insurance, self-rated poor health status, and errors in the medication regimen were significant risk factors for increased health care utilization in kidney transplant recipients. Further research is warranted to validate these potential risk factors.
AHRQ-funded; HS023754.
Citation: Vranian SC, Covert KL, Mardis CR .
Assessment of risk factors for increased resource utilization in kidney transplantation.
J Surg Res 2018 Feb;222:195-202.e2. doi: 10.1016/j.jss.2017.09.037..
Keywords: Healthcare Utilization, Kidney Disease and Health, Transplantation
Charytan DM, Skali H, Shah NR
Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage.
Microvascular rarefaction is found in experimental uremia, but data from patients with chronic kidney disease (CKD) are limited. The investigators, therefore, quantified absolute myocardial blood flow and coronary flow reserve (the ratio of peak to resting flow) from myocardial perfusion positron emission tomography scans at a single institution and classified individuals into standard CKD categories based on the estimated glomerular filtration rate.
AHRQ-funded; HS022998.
Citation: Charytan DM, Skali H, Shah NR .
Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage.
Kidney Int 2018 Feb;93(2):501-09. doi: 10.1016/j.kint.2017.07.025..
Keywords: Cardiovascular Conditions, Kidney Disease and Health, Mortality
Weisenthal K, Karthik P, Shaw M
Evaluation of kidney stones with reduced-radiation dose CT: progress from 2011-2012 to 2015-2016-not there yet.
Researchers determined if the use of reduced-dose computed tomography (CT) for evaluation of kidney stones increased in 2015-2016 compared with that in 2011-2012. Use of reduced-radiation dose CT for evaluation of kidney stones has increased, but remains low; variability of radiation dose according to facility continues to be wide. National mean CT radiation exposure for evaluation of renal colic during 2015-2016 decreased relative to 2011-2012 values.
AHRQ-funded; HS023778.
Citation: Weisenthal K, Karthik P, Shaw M .
Evaluation of kidney stones with reduced-radiation dose CT: progress from 2011-2012 to 2015-2016-not there yet.
Radiology 2018 Feb;286(2):581-89. doi: 10.1148/radiol.2017170285.
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Keywords: Imaging, Kidney Disease and Health
Purnell TS, Luo X, Cooper LA
Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.
This study estimated changes over time in racial/ethnic disparities in live donor kidney transplantation (LDKT) in the United States, accounting for differences in death and deceased donor kidney transplantation. Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014.
AHRQ-funded; HS024600.
Citation: Purnell TS, Luo X, Cooper LA .
Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.
JAMA 2018 Jan 2;319(1):49-61. doi: 10.1001/jama.2017.19152.
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Keywords: Disparities, Kidney Disease and Health, Kidney Disease and Health, Racial and Ethnic Minorities, Transplantation
Li Q, Trivedi AN, Galarraga O
Medicare Advantage ratings and voluntary disenrollment among patients with end-stage renal disease.
This study assessed the association between publicly reported Medicare Advantage plan star ratings and voluntary disenrollment of incident dialysis patients in the following year over the period 2007-13. The authors assert that their findings suggest that low plan quality may lead to increased expenditures, as this high-cost population generally must shift from Medicare Advantage to traditional Medicare upon disenrollment.
AHRQ-funded; HS023959.
Citation: Li Q, Trivedi AN, Galarraga O .
Medicare Advantage ratings and voluntary disenrollment among patients with end-stage renal disease.
Health Aff 2018 Jan;37(1):70-77. doi: 10.1377/hlthaff.2017.0974..
Keywords: Kidney Disease and Health, Medicare
Domenick Sridharan N, Fish L, Yu L
The associations of hemodialysis access type and access satisfaction with health-related quality of life.
This study sought to understand the impact of hemodialysis (HD) access type on health-related quality of life (HRQOL). The study concluded that HD patients experience greatest satisfaction with fistula, and access satisfaction is significantly associated with better HRQOL. Controlling for access satisfaction, there is no significant independent association of access type on HRQOL.
AHRQ-funded; HS019486.
Citation: Domenick Sridharan N, Fish L, Yu L .
The associations of hemodialysis access type and access satisfaction with health-related quality of life.
J Vasc Surg 2018 Jan;67(1):229-35. doi: 10.1016/j.jvs.2017.05.131..
Keywords: Kidney Disease and Health, Kidney Disease and Health, Patient Experience, Quality of Life, Surgery, Patient-Centered Outcomes Research
Cooper LB, Lippmann SJ, Greiner MA
Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease.
Perceived risks of hyperkalemia and acute renal insufficiency may limit use of mineralocorticoid receptor antagonist (MRA) therapy in patients with heart failure, especially those with diabetes mellitus or chronic kidney disease. In their study, the investigators found that among patients with heart failure and diabetes mellitus or chronic kidney disease, MRA use was associated with lower risk of all-cause readmission despite greater risk of hyperkalemia and acute renal insufficiency.
AHRQ-funded; HS021092.
Citation: Cooper LB, Lippmann SJ, Greiner MA .
Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease.
J Am Heart Assoc 2017 Dec 23;6(12):pii: e006540. doi: 10.1161/jaha.117.006540..
Keywords: Cardiovascular Conditions, Chronic Conditions, Diabetes, Evidence-Based Practice, Heart Disease and Health, Kidney Disease and Health, Outcomes, Patient-Centered Outcomes Research, Registries
Lee T, Thamer M, Zhang Z
Vascular access type and clinical outcomes among elderly patients on hemodialysis.
This observational study design was used to compare clinical outcomes in elderly patients who initiated hemodialysis with a central venous catheter and subsequently had an arteriovenous fistula or graft placed. The study concluded that despite extended central venous catheter dependence, elderly patients initiating hemodialysis with a central venous catheter who underwent arteriovenous fistula placement within 6 months had fewer hospitalizations due to infections and a lower likelihood of death than those receiving an arteriovenous graft.
AHRQ-funded; HS022931; HS021229
Citation: Lee T, Thamer M, Zhang Z .
Vascular access type and clinical outcomes among elderly patients on hemodialysis.
Clin J Am Soc Nephrol 2017 Nov 7;12(11):1823-30. doi: 10.2215/cjn.01410217..
Keywords: Elderly, Kidney Disease and Health, Outcomes, Patient-Centered Outcomes Research
Cotter D, Barrus D, Ma M
Effects of ESRD bundling on efficiency of U.S. dialysis centers.
The study aim was to evaluate whether the 2011 ESRD Prospective Payment System (PPS) improved the efficiency of U.S. dialysis centers and to identify which providers demonstrated changes in their efficiency after the PPS implementation. It found that about 36 percent of facilities were functioning efficiently in 2010, dropping to only 21-22 percent efficiently operating facilities in 2011-12.
AHRQ-funded; HS024190.
Citation: Cotter D, Barrus D, Ma M .
Effects of ESRD bundling on efficiency of U.S. dialysis centers.
Nephrol News Issues 2017 Oct 18.
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Keywords: Kidney Disease and Health, Payment, Ambulatory Care and Surgery
Platinga LC, King L, Patzer RE
Early hospital readmission among hemodialysis patients in the United States is associated with subsequent mortality.
The researchers examined the timing of readmissions of hemodialysis patients in the United States and its association with mortality among 285,795 prevalent adult Medicare-primary hemodialysis patients from a national registry. They concluded that regardless of timing, patients with readmissions had a higher risk of death within one year, compared to those with no readmissions.
AHRQ-funded; HS025018.
Citation: Platinga LC, King L, Patzer RE .
Early hospital readmission among hemodialysis patients in the United States is associated with subsequent mortality.
Kidney Int 2017 Oct;92(4):934-41. doi: 10.1016/j.kint.2017.03.025.
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Keywords: Kidney Disease and Health, Hospital Readmissions, Mortality
Amin AP, Bach RG, Caruso ML
Association of variation in contrast volume with acute kidney injury in patients undergoing percutaneous coronary intervention.
The purpose of this study was to examine the national variation in acute kidney injury (AKI) incidence and contrast use among US physicians and the variation's association with patients' risk of developing AKI after percutaneous coronary intervention (PCI). This cross-sectional study used the American College of Cardiology National Cardiovascular Data Registry (NCDR) CathPCI Registry to identify in-hospital care for percutaneous coronary intervention (PCI) in the United States.
AHRQ-funded; HS022481.
Citation: Amin AP, Bach RG, Caruso ML .
Association of variation in contrast volume with acute kidney injury in patients undergoing percutaneous coronary intervention.
JAMA Cardiol 2017 Sep;2(9):1007-12. doi: 10.1001/jamacardio.2017.2156..
Keywords: Adverse Events, Kidney Disease and Health, Cardiovascular Conditions, Patient Safety, Heart Disease and Health, Practice Patterns