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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
76 to 100 of 3928 Research Studies DisplayedSwietek KE, Domino ME, Beadles C
Do medical homes improve quality of care for persons with multiple chronic conditions?
The purpose of this study was to examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC). The investigators found that patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia.
AHRQ-funded; HS019659.
Citation: Swietek KE, Domino ME, Beadles C .
Do medical homes improve quality of care for persons with multiple chronic conditions?
Health Serv Res 2018 Dec;53(6):4667-81. doi: 10.1111/1475-6773.13024..
Keywords: Chronic Conditions, Quality of Care, Patient-Centered Healthcare, Quality Improvement
Repplinger MD, Bracken RL, Patterson BW
Downstream imaging utilization after mr angiography versus CT angiography for the initial evaluation of pulmonary embolism.
This single-center, retrospective, observational study examined the use of chest CT or MR for ED patients with MR angiography (MRA) negative for PE during April 2008 to March 2013. The investigators concluded that when comparing patients initially undergoing MRA versus CTA for the evaluation of PE, there was no difference in downstream chest CT or MR use at 1 year.
AHRQ-funded; HS024558; HS024342.
Citation: Repplinger MD, Bracken RL, Patterson BW .
Downstream imaging utilization after mr angiography versus CT angiography for the initial evaluation of pulmonary embolism.
J Am Coll Radiol 2018 Dec;15(12):1692-97. doi: 10.1016/j.jacr.2018.04.017..
Keywords: Blood Clots, Emergency Department, Imaging
Bateni SB, Olson JL, Hoch JS
Drivers of cost for pancreatic surgery: it's not about hospital volume.
Researchers compared healthcare costs of pancreatic surgery between high- and low-volume centers. They found there was no significant difference in costs, however high-volume centers have better outcomes for morbidity and mortality.
AHRQ-funded; HS022236.
Citation: Bateni SB, Olson JL, Hoch JS .
Drivers of cost for pancreatic surgery: it's not about hospital volume.
Ann Surg Oncol 2018 Dec;25(13):3804-11. doi: 10.1245/s10434-018-6758-1..
Keywords: Healthcare Costs, Hospitals, Outcomes, Patient Safety, Surgery
Agarwal D, Werner RM
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
The purpose of this study was to test for differences in patient outcomes when hospital and post-acute care (PAC) providers participated in accountable care organizations (ACOs). The investigators concluded that hospital and skilled nursing facilities (SNF) participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay.
AHRQ-funded; HS024266.
Citation: Agarwal D, Werner RM .
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
Health Serv Res 2018 Dec;53(6):5035-56. doi: 10.1111/1475-6773.13023..
Keywords: Hospital Readmissions, Hospitals, Medicare, Nursing Homes, Outcomes
Schnipper JL, Mixon A, Stein J
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study.
The authors of this paper conducted a pragmatic quality improvement (QI) study at five US hospitals, two of which included concurrent controls. The investigators found that a mentored implementation of a multifaceted medication reconciliation QI initiative was associated with a reduction in total, but not potentially harmful, medication discrepancies. They suggest that the effect of EHR implementation on medication discrepancies warrants further study.
AHRQ-funded; HS019598.
Citation: Schnipper JL, Mixon A, Stein J .
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study.
BMJ Qual Saf 2018 Dec;27(12):954-64. doi: 10.1136/bmjqs-2018-008233..
Keywords: Hospitals, Medication, Medication: Safety, Patient Safety, Quality Improvement
Vakharia PP, Chopra R, Silverberg NB
Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review.
The objective of this systematic review was to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts. The investigators found that topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety.
AHRQ-funded; HS023011.
Citation: Vakharia PP, Chopra R, Silverberg NB .
Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review.
Am J Clin Dermatol 2018 Dec;19(6):791-803. doi: 10.1007/s40257-018-0375-4..
Keywords: Evidence-Based Practice, Skin Conditions, Treatments
Abdus S, Keenan PS
AHRQ Author: Abdus S, Keenan PS
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
In this research letter, the authors used 2011-2015 Medical Expenditure Panel Survey Household Component data on adults 19 to 64 years of age enrolled in employer-sponsored insurance plans throughout the year to examine the burden of high deductible health plans on low income adults with chronic health conditions.
AHRQ-authored.
Citation: Abdus S, Keenan PS .
Financial burden of employer-sponsored high-deductible health plans for low-income adults with chronic health conditions.
JAMA Intern Med 2018 Dec;178(12):1706-08. doi: 10.1001/jamainternmed.2018.4706..
Keywords: Chronic Conditions, Healthcare Costs, Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS)
Jacobs PD, Kronick R
AHRQ Author: Jacobs PD
Getting what we pay for: how do risk-based payments to Medicare Advantage plans compare with alternative measures of beneficiary health risk?
The purpose of this study was to estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM). The investigators indicate that their findings add to a growing body of evidence suggesting MA receives favorable, or, at worst, neutral selection. They assert that if MA beneficiaries are no healthier and no sicker than similar beneficiaries in TM, then payments to MA plans exceed what is warranted based on their health status.
AHRQ-authored.
Citation: Jacobs PD, Kronick R .
Getting what we pay for: how do risk-based payments to Medicare Advantage plans compare with alternative measures of beneficiary health risk?
Health Serv Res 2018 Dec;53(6):4997-5015. doi: 10.1111/1475-6773.12977..
Keywords: Payment, Medicare
Selden TM, Karaca Z, Decker S
AHRQ Author: Selden TM, Karaca Z, Decker S
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
This study examined whether inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates widened. Using a large discharge dataset covering the period 2001-2011, the investigators tracked changes at age 65 in multiple dimensions of hospital care.
AHRQ-authored.
Citation: Selden TM, Karaca Z, Decker S .
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
Int J Health Econ Manag 2018 Dec;18(4):409-23. doi: 10.1007/s10754-018-9240-5..
Keywords: Payment, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Inpatient Care, Medicare
Goodman KE, Simner PJ, Klein EY
How frequently are hospitalized patients colonized with carbapenem-resistant
This study evaluated whether hospitalized patients who tested positive for carbapenem-resistant Enteriobacteriaceae (CRE) were on contact precautions so that staff and other patients would not risk transmission. Since CRE colonization at admission was infrequent, there is some risk of transmission.
AHRQ-funded; HS025089.
Citation: Goodman KE, Simner PJ, Klein EY .
How frequently are hospitalized patients colonized with carbapenem-resistant
Infect Control Hosp Epidemiol 2018 Dec;39(12):1491-93. doi: 10.1017/ice.2018.236..
Keywords: Hospitalization, Hospitals, Infectious Diseases, Prevention, Risk
Symer MM, Abelson JS, Wong NZ
Impact of medical school experience on attrition from general surgery residency.
This article describes a national prospective cohort study in which general surgery interns who entered training in the 2007-2008 academic year were asked questions about their medical school experience and reasons for pursuing general surgery residency. The purpose was to discover if inadequate preparation in medical school was responsible for high attrition rates in general surgery residency. Intern responses were linked with American Board of Surgery residency completion data. The results indicate that increased quality, not quantity, of surgery clerkships is associated with improved completion rates of residency. Relationships with positive yet demanding role models were also associated with a lower rate of attrition.
AHRQ-funded; HS000066.
Citation: Symer MM, Abelson JS, Wong NZ .
Impact of medical school experience on attrition from general surgery residency.
J Surg Res 2018 Dec;232:7-14. doi: 10.1016/j.jss.2018.06.002..
Keywords: Education: Continuing Medical Education, Surgery
Bath J, Dombrovskiy VY, Vogel TR
Impact of patient safety indicators on readmission after abdominal aortic surgery.
This analysis evaluated whether Patient Safety Indicator (PSI) events after open surgical repair or endovascular aneurysm repair of abdominal aortic aneurysm (AAA) were associated with increased risk of readmission. The investigators concluded that Agency for Healthcare Quality and Research PSI events may be used to identify patients at the greatest risk for readmission after AAA repair. The risk for 30-day readmission was 71% higher when a PSI event occurred and was not associated with the type of repair.
AHRQ-funded; HS022140.
Citation: Bath J, Dombrovskiy VY, Vogel TR .
Impact of patient safety indicators on readmission after abdominal aortic surgery.
J Vasc Nurs 2018 Dec;36(4):189-95. doi: 10.1016/j.jvn.2018.08.002..
Keywords: Patient Safety, Quality Indicators (QIs), Surgery
Cherrington AL, Khodneva Y, Richman JS
Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial.
This study examined the impact of peer support on the number of acute care visits and hospitalizations for individuals with diabetes with and without depressive symptoms. This randomized controlled trial was conducted from 2010-2012. One year of peer support was given to intervention participants, and the usual care to control participants. A Patient Health Questionnaire (PHQ-8) was given to participants to assess depression symptoms at the beginning of the trial, at 6 months and then at 12 months. There was a lower rate of acute care visits and hospitalizations in those patients with depressive symptoms in the intervention group, but it made no difference for individuals without depressive symptoms.
AHRQ-funded; HS013852.
Citation: Cherrington AL, Khodneva Y, Richman JS .
Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial.
Diabetes Care 2018 Dec;41(12):2463-70. doi: 10.2337/dc18-0550..
Keywords: Ambulatory Care and Surgery, Chronic Conditions, Depression, Diabetes, Hospitalization, Behavioral Health, Patient Self-Management
Weintraub JA, Zimmerman S, Ward K
Improving nursing home residents' oral hygiene: results of a cluster randomized intervention trial.
This paper describes a 2-year cluster randomized trial of Mouth Care Without a Battle (MCWB) that was conducted in nursing homes (NHs) to determine if recommended mouth care practices provided by NH staff could improve residents' oral hygiene and denture outcomes. The investigators found that training NH staff to attend to residents' oral hygiene and denture care had a sustained, favorable impact on residents' oral and denture hygiene after 24 months compared with usual care.
AHRQ-funded; HS022298.
Citation: Weintraub JA, Zimmerman S, Ward K .
Improving nursing home residents' oral hygiene: results of a cluster randomized intervention trial.
J Am Med Dir Assoc 2018 Dec;19(12):1086-91. doi: 10.1016/j.jamda.2018.09.036.
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Keywords: Dental and Oral Health, Elderly, Nursing Homes
Garg R, Prabhakaran S, Holl JL
Improving the accuracy of scores to predict gastrostomy after intracerebral hemorrhage with machine learning.
Gastrostomy placement after intracerebral hemorrhage indicates the need for continued medical care and predicts patient dependence. The objective of this study was to determine the optimal machine learning technique to predict gastrostomy. The investigators concluded that machine learning techniques other than logistic regression (eg, random forests, extreme gradient boost, and kth nearest neighbors) were significantly more accurate for predicting gastrostomy using the same independent variables.
AHRQ-funded; HS023437.
Citation: Garg R, Prabhakaran S, Holl JL .
Improving the accuracy of scores to predict gastrostomy after intracerebral hemorrhage with machine learning.
J Stroke Cerebrovasc Dis 2018 Dec;27(12):3570-74. doi: 10.1016/j.jstrokecerebrovasdis.2018.08.026..
Keywords: Stroke
Lacson R, Laroya R, Wang A
Integrity of clinical information in computerized order requisitions for diagnostic imaging.
This study compared the integrity of electronic health record (EHR) imaging order requisitions with EHR provider notes and their potential impact on order inaccuracies and interpretation of results. This retrospective study was conducted at a tertiary academic medical center using MRI lumbar spine and CT abdomen/pelvis orders performed from April 1 to May 31, 2016. Results showed that requisition indications were more likely to be incomplete than provider notes. Researchers recommended that relevant documentation be more readily available in EHRs.
Citation: Lacson R, Laroya R, Wang A .
Integrity of clinical information in computerized order requisitions for diagnostic imaging.
J Am Med Inform Assoc 2018 Dec;25(12):1651-56. doi: 10.1093/jamia/ocy133..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging
Fisher KA, Tan ASL, Matlock DD
Keeping the patient in the center: common challenges in the practice of shared decision making.
This study examines the practice of shared-decision making (SDM) to achieve patient-centered decisions. It was determined that not all circumstances make it possible for that to happen and there have to be some basic elements present. Those elements include the patients’ health literacy, their emotional state, their relationship with the clinician and the nature of the decision.
AHRQ-funded; HS024596.
Citation: Fisher KA, Tan ASL, Matlock DD .
Keeping the patient in the center: common challenges in the practice of shared decision making.
Patient Educ Couns 2018 Dec;101(12):2195-201. doi: 10.1016/j.pec.2018.08.007..
Keywords: Clinician-Patient Communication, Decision Making, Health Literacy, Patient-Centered Healthcare, Patient and Family Engagement
Neal JL, Lowe NK, Phillippi JC
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
The goals of this study were: Determine the proportions of women admitted to the hospital before or in active labor per the leading National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines; Compare associations of labor status at admission with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. Active labor diagnostic guidelines were applied retrospectively to cervical examination data. The authors conclude that many parous women with spontaneous labor onset are admitted to the hospital before active labor, and these women are more likely to receive oxytocin augmentation during labor and to have a cesarean birth. Implications for practice are discussed.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Phillippi JC .
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
Midwifery 2018 Dec;67:64-69. doi: 10.1016/j.midw.2018.09.007..
Keywords: Decision Making, Guidelines, Hospitalization, Labor and Delivery, Pregnancy, Women
Marshall IJ, Noel-Storr A, Kuiper J
Machine learning for identifying randomized controlled trials: an evaluation and practitioner's guide.
The purpose of this study was to evaluate machine learning models for RCT classification. Models were evaluated on an external dataset. The authors demonstrate that machine learning approaches are better able to discriminate between RCTs and non-RCTs than traditional database search filters, and also provide practical guidance on the role of machine learning in systematic reviews, and rapid reviews and clinical question answering as well as an open-source software.
AHRQ-funded; HS025024.
Citation: Marshall IJ, Noel-Storr A, Kuiper J .
Machine learning for identifying randomized controlled trials: an evaluation and practitioner's guide.
Res Synth Methods 2018 Dec;9(4):602-14. doi: 10.1002/jrsm.1287..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
Jacobs PD
AHRQ Author: Jacobs PD
Mandating health insurance coverage for high-income individuals.
In this study, the author describes the effect of the Affordable Care Act’s (ACA’s) individual mandate for health coverage by focusing on higher-income non-elderly adults and exploiting state differences in the rules governing premium setting and coverage issuance in the non-group market prior to 2014.
AHRQ-authored.
Citation: Jacobs PD .
Mandating health insurance coverage for high-income individuals.
National Tax Journal 2018 Dec;71(4):807-28. doi: 10.17310/ntj.2018.4.10..
Keywords: Health Insurance, Policy, Uninsured
Guise JM, Savitz LA, Friedman CP
Mind the gap: putting evidence into practice in the era of learning health systems.
This paper discusses two main mechanisms to close the evidence-to-practice gap: (1) integrating Learning Health System (LHS) results with existing systematic review evidence and (2) providing this combined evidence in a standardized, computable data format.
AHRQ-funded; 29020120004C.
Citation: Guise JM, Savitz LA, Friedman CP .
Mind the gap: putting evidence into practice in the era of learning health systems.
J Gen Intern Med 2018 Dec;33(12):2237-39. doi: 10.1007/s11606-018-4633-1..
Keywords: Evidence-Based Practice, Healthcare Delivery, Learning Health Systems, Implementation
Nattino G, Lu B
Model assisted sensitivity analyses for hidden bias with binary outcomes.
The authors designed a model assisted sensitivity analysis to find hidden bias in observational studies. Their framework worked to fix sensitivity parameter values. They illustrated their method using a U.S. trauma care database to examine mortality difference between trauma care levels.
AHRQ-funded; HS024263.
Citation: Nattino G, Lu B .
Model assisted sensitivity analyses for hidden bias with binary outcomes.
Biometrics 2018 Dec;74(4):1141-49. doi: 10.1111/biom.12919..
Keywords: Research Methodologies
Crockett KB, Turan B
Moment-to-moment changes in perceived social support and pain for men living with HIV: an experience sampling study.
In this study, the investigators used an experience sampling method (also called Ecological Momentary Assessment) to assess moment-to-moment experiences of pain and social support 3 times a day for 7 days in a sample of 109 men living with HIV. They found that within-persons, experiences of daily social support reduced experiences of pain. Between-persons, attachment style may have influenced how individuals make use of social support in coping with experiences of pain.
AHRQ-funded; HS013852.
Citation: Crockett KB, Turan B .
Moment-to-moment changes in perceived social support and pain for men living with HIV: an experience sampling study.
Pain 2018 Dec;159(12):2503-11. doi: 10.1097/j.pain.0000000000001354..
Keywords: Human Immunodeficiency Virus (HIV), Pain, Quality of Life
Goldberg EM, Marks SJ, Merchant RC
National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015.
This study researched treatment trends for emergency department (ED) visits for hypertension from 2005 to 2015. The study found that there is still room for improvement, and disparities still exist for Blacks and uninsured patients.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Marks SJ, Merchant RC .
National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015.
J Am Soc Hypertens 2018 Dec;12(12):858-66. doi: 10.1016/j.jash.2018.09.010..
Keywords: Blood Pressure, Emergency Department
Dodd JH, Hall TA, Guilliams K
Optimizing neurocritical care follow-up through the integration of neuropsychology.
The authors proposed that integration of neuropsychology into neurocritical care follow-up provides incremental benefit to the identification and treatment of persisting complications and reduction in co-morbidities. Studying sixteen patients over six months, they found that integration of neuropsychology into follow-up care resulted in recommendations being made for services or concerns not already addressed. Parents reported high satisfaction, indicating that neuropsychological consultation improved their understanding and communication with their child, aiding them in knowing what to expect from their child during post-acute recovery. The authors conclude that these results indicate that integration of neuropsychology into neurocritical care follow-up programs contributes not only to parent satisfaction, but may provide incremental benefits to patient care.
AHRQ-funded; HS022981.
Citation: Dodd JH, Hall TA, Guilliams K .
Optimizing neurocritical care follow-up through the integration of neuropsychology.
Pediatr Neurol 2018 Dec;89:58-62. doi: 10.1016/j.pediatrneurol.2018.09.007..
Keywords: Children/Adolescents, Chronic Conditions, Patient-Centered Healthcare, Primary Care: Models of Care