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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 36 Research Studies DisplayedHassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Symer MM, Sedrakyan A, Yeo HL
Case sequence analysis of the robotic colorectal resection learning curve.
This study examined trends in the increasing rate of resection surgery for colorectal cancer using robots. It has a major learning curve so investigators wanted to see if complication rates went down as the technology become more common. The cohort included adults undergoing colorectal section from 2008 through 2016 from data in the New York Statewide Planning and Research Cooperative database. The number of procedures started at 76 cases in 2010 and increased to 702 cases in 2015. Findings were that major complications (myocardial infarction, pulmonary embolism, shock, and death) did not decrease but iatrogenic complications were reduced. The odds of prolonged length of stay also decreased over time.
AHRQ-funded; HS000066.
Citation: Symer MM, Sedrakyan A, Yeo HL .
Case sequence analysis of the robotic colorectal resection learning curve.
Dis Colon Rectum 2019 Sep;62(9):1071-78. doi: 10.1097/dcr.0000000000001437..
Keywords: Cancer: Colorectal Cancer, Cancer, Surgery, Education: Continuing Medical Education, Outcomes
Niu X, Amendola LM, Hart R
Clinical exome sequencing vs. usual care for hereditary colorectal cancer diagnosis: a pilot comparative effectiveness study.
The purpose of this study was to evaluate clinical exome sequencing (CES) compared to usual care (UC) in the diagnostic work-up of inherited colorectal cancer/polyposis (CRCP) in a randomized controlled trial (RCT). The investigators indicate that their results suggest that CES provides similar clinical benefits to multi-gene panels in the diagnosis of hereditary CRCP.
AHRQ-funded; HS021686.
Citation: Niu X, Amendola LM, Hart R .
Clinical exome sequencing vs. usual care for hereditary colorectal cancer diagnosis: a pilot comparative effectiveness study.
Contemp Clin Trials 2019 Sep;84:105820. doi: 10.1016/j.cct.2019.105820..
Keywords: Cancer: Colorectal Cancer, Cancer, Diagnostic Safety and Quality, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice
Emani S, Sequist TD, Lacson R
Ambulatory safety nets to reduce missed and delayed diagnoses of cancer.
An ambulatory safety net (ASN) is an innovative organizational intervention for addressing patient safety related to missed and delayed diagnoses of abnormal test results. ASNs consist of a set of tools, reports and registries, and associated work flows to create a high-reliability system for abnormal test result management. In this paper, two ASNs implemented at an academic medical center are described, one focusing on colon cancer and the other on lung cancer.
AHRQ-funded; HS024722.
Citation: Emani S, Sequist TD, Lacson R .
Ambulatory safety nets to reduce missed and delayed diagnoses of cancer.
Jt Comm J Qual Patient Saf 2019 Aug;45(8):552-57. doi: 10.1016/j.jcjq.2019.05.010.
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Keywords: Cancer, Diagnostic Safety and Quality, Cancer: Lung Cancer, Cancer: Colorectal Cancer, Ambulatory Care and Surgery
Davis MM, Gunn R, Pham R
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
This study focused on ways that Medicaid Accountable Care Organizations (ACOs) are implementing interventions with primary care clinics to improve colorectal cancer screening. The researchers conducted a comparative case study of 14 Medicaid ACOs in Oregon and their contracted primary care clinics. They focused on interventions that reduced structural barriers (12 ACOs), delivered provider assessment and feedback (11 ACOs), and provided patient reminders (7 ACOs). There was an unintended consequence of potential exclusion of smaller clinics and metric focus and fatigue.
AHRQ-funded; HS022981.
Citation: Davis MM, Gunn R, Pham R .
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
Prev Chronic Dis 2019 Aug 15;16:E107. doi: 10.5888/pcd16.180395..
Keywords: Primary Care: Models of Care, Primary Care, Screening, Colonoscopy, Cancer: Colorectal Cancer, Cancer, Quality Improvement, Quality of Care, Care Coordination, Patient-Centered Healthcare
Bravo RI, Kietzman KG, Toy P
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
This paper describes the Healthy Aging Partnerships in Prevention Initiative (HAPPI) which aims to increase colorectal cancer screening and other preventive services among underserved Latinos and African-Americans in South Los Angeles who are 50 years and older. It uses an evidence-based model (SPARC) to leverage existing resources and has multi-sectoral partnerships among different agencies, community health centers (CHCs), and a university. The authors engaged five CHCs in quality improvement activities and eight non-governmental organizations in networking and programming to increase awareness of these preventive services.
AHRQ-funded; HS010858.
Citation: Bravo RI, Kietzman KG, Toy P .
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
Salud Publica Mex 2019 Jul-Aug;61(4):427-35. doi: 10.21149/9450..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Primary Care: Models of Care, Primary Care, Elderly, Racial and Ethnic Minorities, Vulnerable Populations, Patient-Centered Healthcare
Huguet N, Angier H, Rdesinski R
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
This study assessed changes in the prevalence of cervical and colorectal cancer screening from before and after the Affordable Care Act in Medicaid expansion and non-expansion states among patients seen in community health centers. Results showed that, despite increased prevalences of cervical and colorectal cancer screening in both expansion and non-expansion states across all race/ethnicity groups, rates remained suboptimal for this population of socioeconomically disadvantaged patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Angier H, Rdesinski R .
Cervical and colorectal cancer screening prevalence before and after Affordable Care Act Medicaid expansion.
Prev Med 2019 Jul;124:91-97. doi: 10.1016/j.ypmed.2019.05.003..
Keywords: Cancer, Cancer: Cervical Cancer, Cancer: Colorectal Cancer, Healthcare Delivery, Healthcare Utilization, Medicaid, Policy, Prevention, Screening
Antunez AG, Kanters AE, Regenbogen SE
Evaluation of access to hospitals most ready to achieve national accreditation for rectal cancer treatment.
This cohort study looked at hospitals’ readiness to be part of the American College of Surgeons National Accreditation Program for Rectal Cancer (NAPRC), and what types of hospitals are most likely to receive NAPRC accreditation. A total of 1315 American College of Surgeons Commission on Cancer-accredited hospitals from the National Cancer Database were sorted into 4 cohorts from 2011 to 2015. They were organized by high versus low volume, adherence to process standards, and patient and hospital characteristics and oncologic outcomes were compared. Among those hospitals, 38 (2.9%) met proposed thresholds for all 5 NAPRC process standards, and 220 (16.7%) met the threshold on 4 standards. Low-adherence hospitals were more likely to serve patients who were older, as well more public insurance recipients, or were black or Hispanic.
ARHQ-funded; HS000053.
Citation: Antunez AG, Kanters AE, Regenbogen SE .
Evaluation of access to hospitals most ready to achieve national accreditation for rectal cancer treatment.
JAMA Surg 2019 Jun;154(6):516-23. doi: 10.1001/jamasurg.2018.5521..
Keywords: Cancer: Colorectal Cancer, Cancer, Hospitals, Quality Improvement, Quality of Care
O'Leary MC, Lich KH, Gu Y
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
The goal of this study was to determine the impact of national and state policies enacted to increase access to Medicaid and to promote colorectal cancer (CRC) screening on newly enrolled, age-eligible Oregon Medicaid beneficiaries. 2010 - 2015 Oregon Medicaid claims data was used to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening. Individuals newly enrolled in Medicaid in 2013 or 2014 were more likely to initiate CRC screening than those enrolled by 2010, associated with the timing of policies such as Medicaid expansion and federal matching for preventive services. A primary care visit during the calendar year, one or more chronic conditions, and Hispanic ethnicity were also associated with CRC screening initiation.
AHRQ-funded; HS022981.
Citation: O'Leary MC, Lich KH, Gu Y .
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
BMC Health Serv Res 2019 May 9;19(1):298. doi: 10.1186/s12913-019-4113-2..
Keywords: Access to Care, Cancer, Cancer: Colorectal Cancer, Medicaid, Policy, Prevention, Screening
Ellis CT, Cole AL, Sanoff HK
Evaluating surveillance patterns after chemoradiation-only compared with conventional management for older patients with rectal cancer.
This study examined surveillance patterns for elderly patients who were treated only with chemoradiation (CR) as opposed to traditional treatment (chemoradiation and protectomy). In the cohort study, a total of 2,482 individuals met the inclusion criteria, with 21% receiving CR-only treatment, and 79% had conventional treatment. In comparison to patients who had traditional treatment, patients with CR-only treatment had far less follow-up during the first 2 years post-treatment. Adherence to guideline-recommended surveillance was poor for all Medicare patients, but especially for CR-only treated patients.
AHRQ-funded; HS000032.
Citation: Ellis CT, Cole AL, Sanoff HK .
Evaluating surveillance patterns after chemoradiation-only compared with conventional management for older patients with rectal cancer.
J Am Coll Surg 2019 May;228(5):782-91.e2. doi: 10.1016/j.jamcollsurg.2019.01.010..
Keywords: Cancer, Cancer: Colorectal Cancer, Care Management, Treatments, Elderly, Patient-Centered Outcomes Research
Chapman WC, Subramanian M, Jayarajan S
First, do no harm: rethinking routine diversion in sphincter-preserving rectal cancer resection.
The authors hypothesized that routine temporary diversion is not associated with decreased rates of leak or reintervention in cancer patients at large undergoing sphincter-sparing procedures. Using HCUP data from the Florida State Inpatient Database, they found no association between diversion and anastomotic leak. However, temporary diversion was associated with increased incidence of nonelective reinterventions, readmissions, and higher costs. They recommended additional study to identify which patients would benefit most from diversion.
AHRQ-funded; HS019455.
Citation: Chapman WC, Subramanian M, Jayarajan S .
First, do no harm: rethinking routine diversion in sphincter-preserving rectal cancer resection.
J Am Coll Surg 2019 Apr;228(4):547-56.e8. doi: 10.1016/j.jamcollsurg.2018.12.012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer: Colorectal Cancer, Cancer, Surgery, Treatments
Mobley LR, Kuo TM, Zhou M
What happened to disparities in CRC screening among FFS Medicare enrollees following Medicare modernization?
This study examined the effects of the change in policy for colorectal screening that was implemented in 2006 for FFS Medicare beneficiaries. This new policy eliminated copayments for colonoscopies or sigmoidoscopies. Disparities in screening by race (Blacks, Asians and Hispanics relative to Whites), and gender (Males relative to Females). The time periods 2001-2005 and 2006-2009 were compared and while there was some improvement in screening rates for minorities and women, the progress was unevenly distributed across the USA.
AHRQ-funded; HS021752.
Citation: Mobley LR, Kuo TM, Zhou M .
What happened to disparities in CRC screening among FFS Medicare enrollees following Medicare modernization?
J Racial Ethn Health Disparities 2019 Apr;6(2):273-91. doi: 10.1007/s40615-018-0522-x..
Keywords: Cancer: Colorectal Cancer, Colonoscopy, Disparities, Medicare, Screening
Lin SC, Regenbogen SE, Hollingsworth JM
Coordination of care around surgery for colon cancer: insights from national patterns of physician encounters with Medicare beneficiaries.
This study researched the coordination of care before and after surgery for colon cancer patients using data from Medicare A and B records. There were quite a number of different combinations of care providers both preoperative and postoperative. Larger urban teaching hospitals had the most combinations in all phases.
AHRQ-funded; HS024525; HS024728.
Citation: Lin SC, Regenbogen SE, Hollingsworth JM .
Coordination of care around surgery for colon cancer: insights from national patterns of physician encounters with Medicare beneficiaries.
J Oncol Pract 2019 Feb;15(2):e110-e21. doi: 10.1200/jop.18.00228..
Keywords: Cancer, Cancer: Colorectal Cancer, Care Coordination, Medicare, Surgery
Abelson JS, Chait A, Shen MJ
Coping strategies among colorectal cancer patients undergoing surgery and the role of the surgeon in mitigating distress: a qualitative study.
This study researched the role that surgeons can play in managing stress in patients undergoing colorectal cancer surgery. Patients were interviewed in-depth using open-ended questions. While patients did not believe surgeons are responsible for helping them cope, they do believe that they can play a role in managing their distress.
AHRQ-funded; HS000066.
Citation: Abelson JS, Chait A, Shen MJ .
Coping strategies among colorectal cancer patients undergoing surgery and the role of the surgeon in mitigating distress: a qualitative study.
Surgery 2019 Feb;165(2):461-68. doi: 10.1016/j.surg.2018.06.005..
Keywords: Cancer: Colorectal Cancer, Clinician-Patient Communication, Provider: Physician, Stress, Surgery
Davis MM, Shafer P, Renfro S
Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?
This study investigated whether Medicaid expansion due to the Affordable Care Act (ACA) increased the number of patients who tested for colorectal cancer (CRC). Results in Oregon showed that there was an increased in statewide fecal testing mainly in Coordinated Care Organizations (CCOs).
AHRQ-funded; HS022981.
Citation: Davis MM, Shafer P, Renfro S .
Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?
BMC Health Serv Res 2019 Jan 21;19(1):54. doi: 10.1186/s12913-018-3864-5..
Keywords: Cancer: Colorectal Cancer, Healthcare Utilization, Medicaid, Prevention, Screening
Martens CE, Crutchfield TM, Laping JL
Why wait until our community gets cancer?: Exploring CRC screening barriers and facilitators in the Spanish-speaking community in North Carolina.
The objectives for this paper were: (1) to improve understanding of preferences regarding potential colorectal cancer (CRC) screening program characteristics, and (2) to improve understanding of the barriers and facilitators around CRC screening with the Hispanic, immigrant community in North Carolina. They found that Hispanics may have a general awareness of and interest in CRC screening, but multiple barriers prevent them from getting screened, and recommended that special attention be given to designing culturally and linguistically appropriate programs to improve access to healthcare resources, insurance, and associated costs among Hispanics.
AHRQ-funded; HS019468.
Citation: Martens CE, Crutchfield TM, Laping JL .
Why wait until our community gets cancer?: Exploring CRC screening barriers and facilitators in the Spanish-speaking community in North Carolina.
J Cancer Educ 2016 Dec;31(4):652-59. doi: 10.1007/s13187-015-0890-4.
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Keywords: Cancer: Colorectal Cancer, Cultural Competence, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Screening
Volk RJ, Linder SK, Lopez-Olivo MA
Patient decision aids for colorectal cancer screening: a systematic review and meta-analysis.
This systematic review describes studies evaluating patient decision aids for colorectal cancer screening in average-risk adults and their impact on knowledge, screening intentions, and uptake. It concluded that decision aids improve knowledge and interest in screening, and lead to increased screening over no information, but their impact on screening is similar to general colorectal cancer screening information.
AHRQ-funded; HS022134.
Citation: Volk RJ, Linder SK, Lopez-Olivo MA .
Patient decision aids for colorectal cancer screening: a systematic review and meta-analysis.
Am J Prev Med 2016 Nov;51(5):779-91. doi: 10.1016/j.amepre.2016.06.022.
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Keywords: Cancer: Colorectal Cancer, Decision Making, Education: Patient and Caregiver, Healthcare Utilization, Screening
McNellis RJ, Beswick-Escanlar V
Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer.
This case study involves a a 55-year-old man who presents to your office for a routine refill of his antihypertension medication, his 65-year-old brother who also visits you to ask about taking low-dose aspirin, and his 55-year-old wife, also your patient, who recently experienced abdominal pain,. It poses three multiple choice questions focused on the use of low-dose aspirin, together with the U.S. Preventive Services Task Force recommendations and related background information.
AHRQ-authored.
Citation: McNellis RJ, Beswick-Escanlar V .
Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer.
Am Fam Physician 2016 Oct 15;94(8):661-62.
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Keywords: Cancer: Colorectal Cancer, Cardiovascular Conditions, Medication, Prevention, U.S. Preventive Services Task Force (USPSTF), Case Study
Halm EA, Beaber EF, McLerran D
Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach.
The researchers assessed associations between primary care provider (PCP) visits and receipt of colorectal cancer (CRC) screening and colonoscopy after a positive fecal immunochemical (FIT) or fecal occult blood test (FOBT). They found that patients with a greater number of PCP visits had higher rates of both incident CRC screening and colonoscopy after positive FIT/FOBT, even in health systems with active population health outreach programs.
AHRQ-funded; HS022418.
Citation: Halm EA, Beaber EF, McLerran D .
Association between primary care visits and colorectal cancer screening outcomes in the era of population health outreach.
J Gen Intern Med 2016 Oct;31(10):1190-7. doi: 10.1007/s11606-016-3760-9..
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Keywords: Cancer: Colorectal Cancer, Colonoscopy, Patient-Centered Outcomes Research, Primary Care, Screening
Tyler Ellis C, Charlton ME, Stitzenberg KB
Patient-reported roles, preferences, and expectations regarding treatment of stage i rectal cancer in the cancer care outcomes research and surveillance consortium.
The researchers identified patient roles, preferences, and expectations as they relate to treatment decision making for patients with stage I rectal cancer. They found that, in this study of 154 adults with newly-diagnosed and surgically treated stage 1 rectal cancer, the preferred decision-making role for patients did not match the actual decision-making process. They recommended that future efforts focus on bridging the gap between the decision-making process and patient preferences regarding various treatment approaches.
AHRQ-funded; HS000032.
Citation: Tyler Ellis C, Charlton ME, Stitzenberg KB .
Patient-reported roles, preferences, and expectations regarding treatment of stage i rectal cancer in the cancer care outcomes research and surveillance consortium.
Dis Colon Rectum 2016 Oct;59(10):907-15. doi: 10.1097/dcr.0000000000000662.
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Keywords: Cancer: Colorectal Cancer, Decision Making, Patient-Centered Outcomes Research, Patient Experience, Patient and Family Engagement
Healy MA, Grenda TR, Suwanabol PA
Colon cancer operations at high- and low-mortality hospitals.
The authors sought to evaluate causes of mortality following colon cancer operations across hospitals. They found significant variation in mortality across hospitals for colon cancer operations, reflecting a need for improved operative decision-making to enhance outcomes and quality of care.
AHRQ-funded; HS020937; HS023621; HS000053.
Citation: Healy MA, Grenda TR, Suwanabol PA .
Colon cancer operations at high- and low-mortality hospitals.
Surgery 2016 Aug;160(2):359-65. doi: 10.1016/j.surg.2016.04.035.
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Keywords: Adverse Events, Cancer: Colorectal Cancer, Mortality, Patient Safety, Surgery
Liss DT, Brown T, Lee JY
Diagnostic colonoscopy following a positive fecal occult blood test in community health center patients.
Fecal occult blood testing (FOBT) is a pragmatic screening option for many community health centers (CHCs), but FOBT screening programs will not reduce mortality if patients with positive results do not undergo diagnostic colonoscopy (DC). This study was conducted to investigate DC completion among CHC patients. It found that DC completion was low overall, which raises concerns about whether FOBT can reduce CRC mortality in practice.
AHRQ-funded; HS021141.
Citation: Liss DT, Brown T, Lee JY .
Diagnostic colonoscopy following a positive fecal occult blood test in community health center patients.
Cancer Causes Control 2016 Jul;27(7):881-7. doi: 10.1007/s10552-016-0763-0.
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Keywords: Cancer: Colorectal Cancer, Colonoscopy, Community-Based Practice, Screening
John-Baptiste A, Schapira MM, Cravens C
The role of decision models in health care policy: a case study.
In 2009, the Centers for Medicare and Medicaid Services (CMS) underwent a National Coverage Determination on computed tomography colonography (CTC) to screen for colorectal cancer. The Cancer Intervention & Surveillance Network developed decision models to inform this decision. The purpose of this study was to investigate the role of models in this decision. It concluded that decision makers involved in the CTC decision believed in the adequacy of models to inform coverage decisions.
AHRQ-authored.
Citation: John-Baptiste A, Schapira MM, Cravens C .
The role of decision models in health care policy: a case study.
Med Decis Making 2016 Jul;36(5):666-79. doi: 10.1177/0272989x16646732.
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Keywords: Cancer: Colorectal Cancer, Decision Making, Imaging, Policy
Chubak J, Whitlock EP, Williams SB
Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services Task Force.
The researchers conducted systematic reviews of aspirin and 1) total cancer mortality and incidence in persons eligible for primary prevention of cardiovascular disease (CVD) and 2) colorectal cancer (CRC) mortality and incidence in persons at average CRC risk.. Evidence from CVD primary and secondary prevention studies suggested that aspirin therapy reduces CRC incidence and perhaps mortality approximately 10 years after initiation.
AHRQ-funded; 290201200151I.
Citation: Chubak J, Whitlock EP, Williams SB .
Aspirin for the prevention of cancer incidence and mortality: systematic evidence reviews for the U.S. Preventive Services Task Force.
Ann Intern Med 2016 Jun 21;164(12):814-25. doi: 10.7326/m15-2117.
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Keywords: Cancer: Colorectal Cancer, Cardiovascular Conditions, Medication, Mortality, U.S. Preventive Services Task Force (USPSTF)
Rust G, Zhang S, Yu Z
Counties eliminating racial disparities in colorectal cancer mortality.
The researchers attempted to identify county-level variations in racial-ethnic disparities in colorectal cancer mortality rates. They found that county-level variation in social determinants, health care workforce, and health systems all were found to contribute to variations in cancer mortality disparity trend patterns from 1990 through 2010. They concluded that counties sustaining equality over time or moving from disparities to equality in cancer mortality suggest that disparities are not inevitable, and provide hope that more communities can achieve optimal and equitable cancer outcomes for all.
AHRQ-funded; HS022444.
Citation: Rust G, Zhang S, Yu Z .
Counties eliminating racial disparities in colorectal cancer mortality.
Cancer 2016 Jun 1;122(11):1735-48. doi: 10.1002/cncr.29958.
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Keywords: Cancer: Colorectal Cancer, Disparities, Mortality, Racial and Ethnic Minorities
