National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (1)
- (-) Cancer (11)
- Cancer: Lung Cancer (2)
- Cancer: Prostate Cancer (1)
- Comparative Effectiveness (2)
- Diagnostic Safety and Quality (1)
- Disparities (2)
- Elderly (1)
- Evidence-Based Practice (1)
- Healthcare Costs (1)
- Mortality (2)
- Outcomes (1)
- Patient Safety (1)
- Practice Patterns (1)
- Provider: Physician (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Rural Health (1)
- Sexual Health (1)
- (-) Surgery (11)
- Treatments (4)
- Women (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 11 of 11 Research Studies DisplayedBonner SN, Lagisetty K, Reddy RM
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
This study’s objective was to identify how many hospitals providing lung cancer surgery use race correction in pulmonary function tests (PFTs), examine the association of race correction with predicted lung function, and test the effect of decorrection on surgeons' treatment recommendations. Percent predicted preoperative and postoperative forced expiratory volume in 1 second (FEV1) was calculated for African American patients who underwent lung cancer resection between January 1, 2015, and September 31, 2022, using race-corrected and race-neutral equations for hospitals performing race correction. Randomization of US cardiothoracic surgeons was conducted to receive 1 clinical vignette that differed by the use of Global Lung Function Initiative equations for (1) African American patients (percent predicted postoperative FEV1, 49%), (2) other race or multiracial patients (percent predicted postoperative FEV1, 45%), and (3) race-neutral patients (percent predicted postoperative FEV1, 42%). A total of 515 African American patients (308 [59.8%] female; mean age, 66.2 years) were included in the study. Among these patients, the percent predicted preoperative FEV1 and postoperative FEV1 would have decreased by 9.2% and 7.6%, respectively, if race-neutral equations had been used. A total of 225 surgeons (194 male [87.8%]; mean time in practice, 19.4 years) were successfully randomized and completed the vignette items regarding risk perception and treatment outcomes (76% completion rate). Surgeons randomized to the vignette with African American race-corrected PFTs were more likely to recommend lobectomy (79.2%) compared with surgeons randomized to the other race or multiracial-corrected (61.7%) or race-neutral PFTs (52.8%).
AHRQ-funded; HS028038.
Citation: Bonner SN, Lagisetty K, Reddy RM .
Clinical implications of removing race-corrected pulmonary function tests for African American patients requiring surgery for lung cancer.
JAMA Surg 2023 Oct; 158(10):1061-68. doi: 10.1001/jamasurg.2023.3239..
Keywords: Racial and Ethnic Minorities, Cancer: Lung Cancer, Cancer, Surgery, Diagnostic Safety and Quality
Montgomery KB, Fazendin JM, Broman KK
Evolving variation in the extent of surgery for low-risk papillary thyroid cancer in the United States.
This study looked at contemporary trends in the extent of surgery in patients with clinically node-negative papillary thyroid cancer ≤4 cm. Since 2015 there has been a debate over total thyroidectomy versus lobectomy and declining favor for prophylactic central neck dissection in this low-risk cohort. The authors used retrospective data from the National Cancer Database to identify adult patients with clinically node-negative papillary thyroid cancer ≤4 cm who underwent resection from 2012 to 2020. Primary outcome was the extent of surgery (lobectomy or total thyroidectomy, with or without prophylactic central neck dissection). Of 83,464 included patients, 79.3% were female with a median age of 51 years. Most patients underwent total thyroidectomy either with prophylactic central neck dissection (39.1%) or without (37.5%) versus lobectomy with prophylactic central neck dissection (7.2%) or without (16.2%). There was an increase in lobectomy from 18.3% in 2012 to 29.9% in 2020. Prophylactic central neck dissection rates also increased from 42.9% to 52.1%. There was a decreased likelihood of total thyroidectomy in patients who were male sex, Asian American, had smaller tumors or were treated at community cancer programs. There was a decreased likelihood of prophylactic central neck dissection in patients who were older, male sex, Black race, with smaller tumors, or were treated at community cancer programs or mid- or low-volume facilities.
AHRQ-funded; HS013852.
Citation: Montgomery KB, Fazendin JM, Broman KK .
Evolving variation in the extent of surgery for low-risk papillary thyroid cancer in the United States.
Surgery 2023 Oct; 174(4):828-35. doi: 10.1016/j.surg.2023.07.001.
Keywords: Surgery, Cancer
Krouse RS, Anderson GL, Arnold KB
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
The purpose of this study was to compare surgical versus non-surgical management with the goal of determining the optimal approach for managing malignant bowel obstruction. From May 11, 2015, to April 27, 2020, 221 patients were enrolled, with 199 evaluable participants. The study found no variation between surgery and non-surgery for the primary outcome of good days: mean 42·6 days in the randomized surgery group, 43·9 days (29·5) in the randomized non-surgery group, 54·8 days (27·0) in the patient choice surgery group, and 52·7 days (30·7) in the patient choice non-surgery group. During their initial hospital stay, six participants died, five due to cancer progression and one due to malignant bowel obstruction treatment complications The most common grade 3-4 malignant bowel obstruction treatment complication was anemia.
AHRQ-funded; HS021491.
Citation: Krouse RS, Anderson GL, Arnold KB .
Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial.
Lancet Gastroenterol Hepatol 2023 Oct; 8(10):908-18. doi: 10.1016/s2468-1253(23)00191-7..
Keywords: Cancer, Surgery, Treatments, Comparative Effectiveness, Evidence-Based Practice
Gupta N, Kucirka L, Semerjian A
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
The purpose of this study was to describe practice patterns regarding female reproductive organ-sparing (ROS) and nerve-sparing radical cystectomy nerve-sparing radical cystectomy (RC) among US urologists. The researchers conducted a cross-sectional survey of members of the Society of Urologic Oncology to evaluate provider-reported frequency of ROS and nerve-sparing RC in premenopausal and postmenopausal patients with non-muscle-invasive bladder cancer that failed intravesical therapy or clinically localized muscle-invasive bladder cancer. The study found that among 101 urologists, 79.2% reported that they routinely resect the uterus/cervix, 67.3% the neurovascular bundle, 48.5% the ovaries, and 18.8% a portion of the vagina when performing RC in premenopausal patients with organ-confined disease. When asked about changes to approach in postmenopausal patients, 70.3% reported that they were less likely to spare the uterus/cervix, 43.6% were less likely to spare the neurovascular bundle, 69.3% were less likely to spare the ovaries, and 22.8% were less likely to spare a portion of the vagina.
AHRQ-funded; HS026120.
Citation: Gupta N, Kucirka L, Semerjian A .
Practice patterns regarding female reproductive organ-sparing and nerve-sparing radical cystectomy among urologic oncologists in the United States.
Clin Genitourin Cancer 2023 Aug; 21(4):e236-e41. doi: 10.1016/j.clgc.2023.01.010..
Keywords: Practice Patterns, Women, Sexual Health, Surgery, Cancer
Hu FY, Tabata-Kelly M, Johnston FM
Surgeon-reported factors influencing adoption of quality standards for goal-concordant care in patients with advanced cancer: a qualitative study.
This study’s objective was to explore surgical oncologists' perspectives on factors influencing adoption of quality standards in patients with advanced cancer. While the American College of Surgeons has adopted a Geriatric Surgery Verification Program that includes communication standards designed to facilitate goal-concordant care, little is known about how surgeons believe these standards align with clinical practice. The authors conducted semistructured video-based interviews from November 2020 to January 2021 with academic surgical oncologists purposively sampled based on demographics, region, palliative care certification, and years in practice. These interviews addressed: (1) adherence to standards documenting care preferences for life-sustaining treatment, surrogate decision-maker, and goals of surgery; and (2) factors influencing their adoption into practice. Participants included 26 surgeons (57.7% male, 8.5 mean years in practice, 19.2% palliative care board-certified). While goals of surgery are commonly discussed, there is low consistency of documenting these goals. There were conflicting views about the relevance of care preferences to preoperative conversations and surrogate decision-maker documentation by the surgeon and questioned the direct connection between documentation of quality standards and higher value patient care. Key themes in adopting quality standards of documentation included organizational culture, workflow, and multidisciplinary collaboration.
AHRQ-funded; HS024736.
Citation: Hu FY, Tabata-Kelly M, Johnston FM .
Surgeon-reported factors influencing adoption of quality standards for goal-concordant care in patients with advanced cancer: a qualitative study.
Ann Surg 2023 May; 277(5):e1000-e05. doi: 10.1097/sla.0000000000005441..
Keywords: Surgery, Provider: Physician, Cancer
Logan CD, Feinglass J, Halverson AL
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
This study examined the reasons there are lower rates of surgical treatment for potentially resectable non-small cell lung cancer (NSCLC) for patients living in rural areas than in urban areas. The National Cancer Database was used to identify patients with clinical stage I-IIIA NSCLC between 2004 and 2018. Reasons for nonreceipt of surgery was evaluated for rural and urban area patients. The study included 328,785 patients with NSCLC with 13% from rural areas. Overall, 62.4% of patients from urban areas and 58.8% of patients from rural areas underwent surgery. Patients from rural areas had increased odds of (1) being recommended primary nonsurgical management, (2) surgery being deemed contraindicated due to risk, (3) surgery being recommended but not performed, and (4) overall failure to receive surgery.
AHRQ-funded; HS026385.
Citation: Logan CD, Feinglass J, Halverson AL .
Rural-urban disparities in receipt of surgery for potentially resectable non-small cell lung cancer.
J Surg Res 2023 Mar;283:1053-63. doi: 10.1016/j.jss.2022.10.097.
Keywords: Cancer: Lung Cancer, Cancer, Disparities, Surgery, Rural Health, Access to Care
Vemana G, Kim EH, Bhayani SB
Survival comparison between endoscopic and surgical management for patients with upper tract urothelial cancer: a matched propensity score analysis using surveillance, epidemiology and end results-Medicare data.
The researchers sought to determine survival differences among patients receiving endoscopic vs surgical management for upper tract urothelial carcinoma (UTUC). They found that although initial survival outcomes are similar for endoscopic and surgical management of nonmuscle-invasive, low-grade UTUC, both cancer-specific survival and overall survival are significantly inferior for the endoscopic management group in the longer term. They also found that transition from initial endoscopic management to surgical intervention appears to have limited impact on survival.
AHRQ-funded; HS019455.
Citation: Vemana G, Kim EH, Bhayani SB .
Survival comparison between endoscopic and surgical management for patients with upper tract urothelial cancer: a matched propensity score analysis using surveillance, epidemiology and end results-Medicare data.
Urology 2016 Sep;95:115-20. doi: 10.1016/j.urology.2016.05.033.
.
.
Keywords: Cancer, Comparative Effectiveness, Elderly, Mortality, Surgery
Wong SL, Revels SL, Yin H
Variation in hospital mortality rates with inpatient cancer surgery.
The purpose of this national study was to elucidate clinical mechanisms underlying variation in hospital mortality with major cancer surgery. It found that case-fatality rates among patients with complications at high-mortality hospitals were approximately twice as high as at low-mortality hospitals. This study implicates failure to rescue as the major reason for differences in hospital mortality rates with major cancer surgery.
AHRQ-funded; HS020937.
Citation: Wong SL, Revels SL, Yin H .
Variation in hospital mortality rates with inpatient cancer surgery.
Ann Surg 2015 Apr;261(4):632-6. doi: 10.1097/sla.0000000000000690..
Keywords: Mortality, Surgery, Cancer, Patient Safety, Quality of Care
Healy MA, Yin H, Wong SL
Multimodal cancer care in poor prognosis cancers: resection drives long-term outcomes.
The researchers compared effects of resection with other therapies on long-term outcomes across U.S. hospitals. They examined claims in the Surveillance, Epidemiology, and End Results (SEER) Medicare dataset for patients with esophageal and pancreatic cancers and found that a significant association exists between long-term survival and rates of cancer-directed surgery across hospitals, without variation in rates of other therapies.
AHRQ-funded; HS020937.
Citation: Healy MA, Yin H, Wong SL .
Multimodal cancer care in poor prognosis cancers: resection drives long-term outcomes.
J Surg Oncol 2016 May;113(6):599-604. doi: 10.1002/jso.24217.
.
.
Keywords: Cancer, Outcomes, Surgery, Treatments, Disparities
Mohanty S, Rajaram R, Bilimoria KY
Assessment of non-surgical versus surgical therapy for localized hepatocellular carcinoma.
Hypothesizing that non-surgical techniques have expanded to localized disease, the researchers examined treatment patterns, factors associated with surgical therapy, and the impact of modality on survival for patients with hepatocellular carcinoma (HCC). They concluded that non-surgical therapy has become as common as surgery in the treatment of non-cirrhotic, localized HCC.
AHRQ-funded; HS000078.
Citation: Mohanty S, Rajaram R, Bilimoria KY .
Assessment of non-surgical versus surgical therapy for localized hepatocellular carcinoma.
J Surg Oncol 2016 Feb;113(2):175-80. doi: 10.1002/jso.24113.
.
.
Keywords: Cancer, Surgery, Treatments
Shen C, Tina Shih YC
Therapeutic substitutions in the midst of new technology diffusion: the case of treatment for localized prostate cancer.
The authors studied the impact of the fast diffusion of robotic surgical systems on the overall treatment pattern of localized prostate cancer. They found that the density of robotic systems at state-level had a significantly positive impact on the rate of surgery and a significantly negative impact on the rate of radiation therapy. They concluded that part of the increase in the rate of surgery was driven by substitution across treatment types with a large proportion originating from the younger population.
AHRQ-funded; HS018535; HS020263.
Citation: Shen C, Tina Shih YC .
Therapeutic substitutions in the midst of new technology diffusion: the case of treatment for localized prostate cancer.
Soc Sci Med 2016 Feb;151:110-20. doi: 10.1016/j.socscimed.2016.01.016.
.
.
Keywords: Surgery, Cancer: Prostate Cancer, Cancer, Healthcare Costs, Treatments