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 51 Research Studies DisplayedAneja S, Chang E, Omuro A
Applications of artificial intelligence in neuro-oncology.
This article explores the promise that artificial intelligence algorithms has for improving understanding of brain tumors and help drive future innovations in neuro-oncology.
AHRQ-funded; HS023000.
Citation: Aneja S, Chang E, Omuro A .
Applications of artificial intelligence in neuro-oncology.
Curr Opin Neurol 2019 Dec;32(6):850-56. doi: 10.1097/wco.0000000000000761.
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Keywords: Health Information Technology (HIT), Cancer, Diagnostic Safety and Quality, Imaging
Lacson R, Gujrathi I, Healey M
Closing the loop on unscheduled diagnostic imaging orders: a systems-based approach.
This study looked at the impact of implementing a tool called SCORE (System for Coordinating Orders for Radiology Exams), whose objective is to manage unscheduled orders for outpatient diagnostic imaging in an electronic health record (EHR) with embedded computerized physician order entry. The rate of unscheduled imaging orders was compared before SCORE (October 2017 to September 2018) and after (October 2018 to June 2019). There was a 49% reduction in unscheduled orders after SCORE implementation at a large academic institution.
AHRQ-funded; HS024722.
Citation: Lacson R, Gujrathi I, Healey M .
Closing the loop on unscheduled diagnostic imaging orders: a systems-based approach.
J Am Coll Radiol 2021 Jan;18(1 Pt A):60-67. doi: 10.1016/j.jacr.2020.09.031..
Keywords: Imaging, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Levy AE, Shah NR, Matheny ME
Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: implications for natural language processing tools.
The authors investigated whether Natural Language Processing (NLP) tools could potentially help estimate myocardial perfusion imaging (MPI) risk. Subjects were VA patients who underwent stress MPI and coronary angiography 2009-11; stress test reports were randomly selected for analysis. The authors found that post-test ischemic risk was determinable but rarely reported in this sample of stress MPI reports. They conclude that this supports the potential use of NLP to help clarify risk and recommend further study of NLP in this context.
AHRQ-funded; HS022998.
Citation: Levy AE, Shah NR, Matheny ME .
Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: implications for natural language processing tools.
J Nucl Cardiol 2019 Dec;26(6):1878-85. doi: 10.1007/s12350-018-1275-y..
Keywords: Imaging, Risk, Clinical Decision Support (CDS), Health Information Technology (HIT), Diagnostic Safety and Quality, Cardiovascular Conditions, Heart Disease and Health
Montgomery KB, Holder AM, Burgan CM
Is it time for synoptic reporting in melanoma nodal surveillance ultrasonography?
Previous qualitative research has identified a potential gap between surgeons’ and radiologists’ awareness of Second Multicenter Selective Lymphadenectomy Trial (MSLT-II) criteria. The purpose of this study was to explore how these criteria have been adopted and reported outside of clinical trial settings or utilized by surgical teams when interpreting ultrasound results. The study found that of the 269 nodal ultrasounds performed in 78 patients, 81.0% reported normal findings versus 19% abnormal findings. Researchers indicated that only 15% of normal ultrasounds had one or more MSLT-II criteria reported versus 88.9% abnormal ultrasounds. While 37% of abnormal ultrasounds had only one MSLT-II criterion reported, 27.8% had two criteria and 24.1% had three criteria. Of the eight abnormal ultrasounds with biopsy recommendation, 75% had two or more MSLT-II criteria reported. Clinically actionable recommendations were provided in 94.9% of normal ultrasounds compared with 64.8% of abnormal ultrasounds.
AHRQ-funded; HS013852.
Citation: Montgomery KB, Holder AM, Burgan CM .
Is it time for synoptic reporting in melanoma nodal surveillance ultrasonography?
Ann Surg Oncol 2023 Sep; 30(9):5327-28. doi: 10.1245/s10434-023-13749-0..
Keywords: Cancer: Skin Cancer, Cancer, Skin Conditions, Imaging
O'Reilly-Jacob M, Perloff J, Buerhaus P
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
This study measures the rates of low-value back images ordered by primary care physicians and nurse practitioners for Medicare beneficiaries, and there was no detectable difference between the two groups in 2012 and 2013.
AHRQ-funded; HS00062.
Citation: O'Reilly-Jacob M, Perloff J, Buerhaus P .
Comparing the rates of low-value back images ordered by physicians and nurse practitioners for Medicare beneficiaries in primary care.
Nurs Outlook 2019 Nov - Dec;67(6):713-24. doi: 10.1016/j.outlook.2019.05.005..
Keywords: Imaging, Back Health and Pain, Primary Care, Imaging, Pain
Ray X, Bojechko C, Moore KL
Evaluating the sensitivity of Halcyon's automatic transit image acquisition for treatment error detection: a phantom study using static IMRT.
The Varian Halcyon electronic portal imaging detector is always in-line with the beam and automatically acquires transit images for every patient with full-field coverage. These images could be used for "every patient, every monitor unit" quality assurance (QA) and eventually adaptive radiotherapy. This study evaluated the imager's sensitivity to potential clinical errors and day-to-day variations from clinical exit images.
AHRQ-funded; HS025440.
Citation: Ray X, Bojechko C, Moore KL .
Evaluating the sensitivity of Halcyon's automatic transit image acquisition for treatment error detection: a phantom study using static IMRT.
J Appl Clin Med Phys 2019 Nov;20(11):131-43. doi: 10.1002/acm2.12749..
Keywords: Imaging, Quality of Care
Kang SK, Garry K, Chung R
Natural language processing for identification of incidental pulmonary nodules in radiology reports.
The authors developed natural language processing (NLP) to identify incidental lung nodules (ILNs) in radiology reports for assessment of management recommendations using the electronic health records for patients who underwent chest CT before and after implementation of a department-wide dictation macro of the Fleischner Society recommendations. They concluded that NLP reliably automates identification of ILNs in unstructured reports, pertinent to quality improvement efforts for ILN management.
AHRQ-funded; HS024376.
Citation: Kang SK, Garry K, Chung R .
Natural language processing for identification of incidental pulmonary nodules in radiology reports.
J Am Coll Radiol 2019 Nov;16(11):1587-94. doi: 10.1016/j.jacr.2019.04.026..
Keywords: Imaging, Diagnostic Safety and Quality, Health Information Technology (HIT), Electronic Health Records (EHRs), Quality Improvement, Quality of Care
Fu Y, Wu X, Thomas AM
Automatic large quantity landmark pairs detection in 4DCT lung images.
A new method was developed to automatically and precisely detect a large quantity of landmark pairs between lung computed tomography (CT) image pairs. The detected landmark pairs could be used as benchmark datasets for more accurate and informative quantitative evaluation of DIR algorithms. Target registration errors (TREs) were measured for 300 manually labeled landmark pairs in 10 lung 4DCT benchmark datasets (DIRLAB) with 97% of landmark pairs having a TRE smaller than 2 mm.
AHRQ-funded; HS022888.
Citation: Fu Y, Wu X, Thomas AM .
Automatic large quantity landmark pairs detection in 4DCT lung images.
Med Phys 2019 Oct;46(10):4490-501. doi: 10.1002/mp.13726..
Keywords: Imaging, Diagnostic Safety and Quality
Mower WR, Crisp JG, Krishnadasan A
Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management.
Researchers examined the utility of emergency department (ED) ultrasonography in treatment of skin and soft tissue infections. Study participants were ED patients with skin and soft tissue infections; the study also surveyed clinicians with regard to their pre-ultrasonography certainty about the presence or absence of an abscess, their planned management, post-ultrasonography findings, and actual management. The researchers found that ultrasonography rarely changed management when clinicians were certain about the presence or absence of an abscess. When clinicians were uncertain, ultrasonography changed drainage decisions in approximately one quarter of cases, of which most were appropriate.
AHRQ-funded; HS009699.
Citation: Mower WR, Crisp JG, Krishnadasan A .
Effect of initial bedside ultrasonography on emergency department skin and soft tissue infection management.
Ann Emerg Med 2019 Sep;74(3):372-80. doi: 10.1016/j.annemergmed.2019.02.002..
Keywords: Emergency Department, Imaging, Skin Conditions
Moore CL, Carpenter CR, Heilbrun ME
Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus.
This study conducted a Delphi process consensus on 29 specific clinical scenarios when kidney stones are suspected due to renal colic. The authors wanted to create an evidence-based, multispecialty consensus on optimal imaging for suspected renal colic in the acute setting. A 9-member panel was conducted with 3 physician representatives from the American College of Emergency Physicians (ACEP), 3 from the American College of Radiology, and 3 from the American Urology Association. First a systematic literature review was conducted. Out of 6,337 records, there were 232 relevant articles. Out of the 29 clinical scenarios examined, 15 were rated as perfect, 8 were excellent, and 3 good and 3 moderate.
AHRQ-funded; HS023778.
Citation: Moore CL, Carpenter CR, Heilbrun ME .
Imaging in suspected renal colic: systematic review of the literature and multispecialty consensus.
Ann Emerg Med 2019 Sep;74(3):391-99. doi: 10.1016/j.annemergmed.2019.04.021..
Keywords: Imaging, Diagnostic Safety and Quality, Emergency Department
Deng F, Li MD, Wong A
Quality of documentation of contrast agent allergies in electronic health records.
The purpose of this study was to describe and appraise contrast agent allergy documentation in the electronic health record (EHR). The investigators concluded that contrast allergy records in EHRs were diverse and commonly low quality. They suggest that continued EHR enhancements and training are needed to support contrast allergy documentation to facilitate improved patient care and medical research.
AHRQ-funded; HS025375.
Citation: Deng F, Li MD, Wong A .
Quality of documentation of contrast agent allergies in electronic health records.
J Am Coll Radiol 2019 Aug;16(8):1027-35. doi: 10.1016/j.jacr.2019.01.027..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging
Kirk PS, Borza T, Caram MEV
Characterising potential bone scan overuse amongst men treated with radical prostatectomy.
The authors characterized bone scan use after radical prostatectomy (RP) using data from a large, national integrated delivery system. They found a substantial rate of bone scan utilization after RP. The majority were performed for prostate-specific antigen levels in which the likelihood of a positive test was low. They recommended more judicious use of imaging in the post-RP setting.
AHRQ-funded; HS025707.
Citation: Kirk PS, Borza T, Caram MEV .
Characterising potential bone scan overuse amongst men treated with radical prostatectomy.
BJU Int 2019 Jul;124(1):55-61. doi: 10.1111/bju.14551..
Keywords: Cancer: Prostate Cancer, Cancer, Surgery, Imaging, Healthcare Utilization
Shah NR, Ahmed ST, Winchester DE
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
The aim of this study was to quantify variation in cardiac stress test utilization across the Veterans Health Administration (VA) in patients with established ischemic heart disease (IHD). The investigators used VA datasets to identify adults with IHD (myocardial infarction, percutaneous coronary intervention, and/or coronary artery bypass grafting) with a primary care clinic visit at the VA in fiscal year 2014.
AHRQ-funded; HS022998.
Citation: Shah NR, Ahmed ST, Winchester DE .
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
JACC Cardiovasc Imaging 2019 Jul;12(7 Pt 1):1292-93. doi: 10.1016/j.jcmg.2019.02.020..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality, Healthcare Utilization, Practice Patterns, Imaging
Armstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Miglioretti DL, Abraham L, Lee CI
Digital breast tomosynthesis: radiologist learning curve.
This study examined if detect rates and lower recall rates occurred with the adoption of digital breast tomosynthesis (DBT) than for traditional breast mammography. Performance was compared before and after DBT adoption using data from the Breast Cancer Surveillance Consortium cohort. There was a small improvement in recall rates, with more improvement in women with nondense breasts. Cancer detection rates were similar.
AHRQ-funded; HS018366.
Citation: Miglioretti DL, Abraham L, Lee CI .
Digital breast tomosynthesis: radiologist learning curve.
Radiology 2019 Apr;291(1):34-42. doi: 10.1148/radiol.2019182305..
Keywords: Cancer, Cancer: Breast Cancer, Diagnostic Safety and Quality, Imaging, Screening, Women
Sprague BL, Kerlikowske K, Bowles EJA
Trends in clinical breast density assessment from the Breast Cancer Surveillance Consortium.
Changes to mammography practice, including revised Breast Imaging Reporting and Data System (BI-RADS) density classification guidelines and implementation of digital breast tomosynthesis (DBT), may impact clinical breast density assessment. In this study, the authors investigated temporal trends in clinical breast density assessment among 2 990 291 digital mammography (DM) screens and 221 063 DBT screens interpreted by 722 radiologists from 144 facilities in the Breast Cancer Surveillance Consortium.
AHRQ-funded; HS018366.
Citation: Sprague BL, Kerlikowske K, Bowles EJA .
Trends in clinical breast density assessment from the Breast Cancer Surveillance Consortium.
J Natl Cancer Inst 2019 Jun;111(6):629-32. doi: 10.1093/jnci/djy210..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women
Pruitt P, Naidech A, Ornam J
A natural language processing algorithm to extract characteristics of subdural hematoma from head CT reports.
Researchers created a natural language processing (NLP) algorithm to predict radiographic characteristics of subdural hematomas (SDH). The NLP was used to extract data from cranial computed tomography (CT) scan reports for patients with SDH. The results were measured for accuracy compared to cranial CT scan interpretations by board-certified attending radiologists and data coded by two ED physicians.. Output performance was considered high, with an algorithm accuracy of 0.84 for side of largest SDH, 0.88 for thickness of largest SDH, and 0.92 for size of midline shift.
AHRQ-funded; HS000078.
Citation: Pruitt P, Naidech A, Ornam J .
A natural language processing algorithm to extract characteristics of subdural hematoma from head CT reports.
Emerg Radiol 2019 Jun;26(3):301-06. doi: 10.1007/s10140-019-01673-4..
Keywords: Diagnostic Safety and Quality, Imaging, Trauma
Arana E, Carroll-Scott A, Massey PM
Racial/ethnic disparities in mammogram frequency among women with intellectual disability.
The purpose of this study was to collect survey and medical record data to examine associations between intellectual disability (ID) and race/ethnicity on mammogram frequency. Hispanic and Black women with ID are more likely than White women with ID to have mammograms every 2 years. Women who live in State-funded residences, are aged 50 and over, and had a mild or moderate level of ID impairment were more likely to have mammograms compared to those who lived with family or alone, were under 50, or who had severe ID impairment. The authors conclude that further research is needed to understand the mechanisms that explain these disparities.
AHRQ-funded; HS023966.
Citation: Arana E, Carroll-Scott A, Massey PM .
Racial/ethnic disparities in mammogram frequency among women with intellectual disability.
Intellect Dev Disabil 2019 Jun;57(3):177-87. doi: 10.1352/1934-9556-57.3.177..
Keywords: Disabilities, Disparities, Imaging, Prevention, Racial and Ethnic Minorities, Screening, Women
Cochon LR, Kapoor N, Carrodeguas E
Variation in follow-up imaging recommendations in radiology reports: patient, modality, and radiologist predictors.
The purpose of this study was to determine the incidence and to identify factors associated with follow-up recommendations in radiology reports from multiple modalities, patient care settings, and imaging divisions. A trained algorithm classified 318,366 report; the findings indicate that substantial interradiologist variation exists in the probability of recommending a follow-up examination in a radiology report.
AHRQ-funded; HS024722.
Citation: Cochon LR, Kapoor N, Carrodeguas E .
Variation in follow-up imaging recommendations in radiology reports: patient, modality, and radiologist predictors.
Radiology 2019 Jun;291(3):700-07. doi: 10.1148/radiol.2019182826..
Keywords: Decision Making, Diagnostic Safety and Quality, Imaging, Patient Safety, Quality of Care, Quality Improvement
Hammer MM, Kapoor N, Desai SP
Adoption of a closed-loop communication tool to establish and execute a collaborative follow-up plan for incidental pulmonary nodules.
The purpose of this study was to assess radiologists' adoption of a closed-loop communication and tracking system, Result Alert and Development of Automated Resolution (RADAR), for incidental pulmonary nodules and to measure its effect on the completeness of radiologists' follow-up recommendations. Results showed that a closed-loop communication system that enables establishing and executing a collaborative follow-up plan for incidental pulmonary nodules can be adopted and improves the quality of radiologists' follow-up recommendations.
AHRQ-funded; HS024722.
Citation: Hammer MM, Kapoor N, Desai SP .
Adoption of a closed-loop communication tool to establish and execute a collaborative follow-up plan for incidental pulmonary nodules.
AJR Am J Roentgenol 2019 May;212(5):1077-81. doi: 10.2214/ajr.18.20692..
Keywords: Diagnostic Safety and Quality, Imaging, Communication
Ablordeppey EA, Drewry AM, Theodoro DL
Current practices in central venous catheter position confirmation by point of care ultrasound: a survey of early adopters.
Although routine chest radiographs (CXR) to verify correct central venous catheter (CVC) position and exclude pneumothorax are commonly performed, emerging evidence suggests that this practice can be replaced by point of care ultrasound (POCUS). POCUS is advantageous over CXR because it avoids radiation while verifying correct placement and lack of pneumothorax without delay. In this study, they aimed to describe the current clinical practice regarding POCUS alone for CVC position confirmation and pneumothorax exclusion as compared with chest radiography.
AHRQ-funded; R18 HS025052.
Citation: Ablordeppey EA, Drewry AM, Theodoro DL .
Current practices in central venous catheter position confirmation by point of care ultrasound: a survey of early adopters.
Shock 2019 May;51(5):613-18. doi: 10.1097/shk.0000000000001218..
Keywords: Imaging, Diagnostic Safety and Quality, Patient Safety
Russell FM, Ehman RR, Ferre R
Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial.
Medical treatment for acute heart failure (AHF) has not changed substantially over the last four decades. Emergency department (ED)-based evidence for treatment is limited. The investigators discuss BLUSHED-AHF, a multicenter, randomized, pilot trial designed to test whether a strategy of care that utilizes a LUS-driven treatment protocol outperforms usual care for reducing pulmonary congestion in the ED.
AHRQ-funded; HS025411.
Citation: Russell FM, Ehman RR, Ferre R .
Design and rationale of the B-lines lung ultrasound guided emergency department management of acute heart failure (BLUSHED-AHF) pilot trial.
Heart Lung 2019 May - Jun;48(3):186-92. doi: 10.1016/j.hrtlng.2018.10.027..
Keywords: Emergency Department, Heart Disease and Health, Cardiovascular Conditions, Imaging, Respiratory Conditions
Strom JB, Shen C, Yeh RW
SCOT-HEART: does it live up to the PROMISE?
This paper examines the Scottish Computed Tomography of the Heart (SCOT-HEART) trial which was a prospective, openlabel, parallel group, multicenter trial that randomized 4146 adults (ages 18–75), referred for suspected angina to 12 cardiology clinics across Scotland between November 18, 2010 and September 24, 2014, to an initial strategy of computed tomographic Angiography (CTA) plus standard care or standard care alone in a 1:1 fashion.
AHRQ-funded; R01 HS024520.
Citation: Strom JB, Shen C, Yeh RW .
SCOT-HEART: does it live up to the PROMISE?
J Cardiovasc Comput Tomogr 2019 May - Jun;13(3):48-50. doi: 10.1016/j.jcct.2019.01.008..
Keywords: Imaging, Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Perez FA, Quinet S, Jarvik JG
Lumbar spinal stenosis severity by CT or MRI does not predict response to epidural corticosteroid versus lidocaine injections.
This study compared the results of patients with lumbar spinal stenosis injected epidurally with corticosteroids and lidocaine, or lidocaine alone. A prospective, double-blind study was conducted on 350 patients who were then evaluated for qualitative or quantitative MR imaging or CT measures of lumbar spinal stenosis. There were no differences in improvement of disability or leg pain scores at 3 weeks between the two subgroups.
AHRQ-funded; HS019222; HS022972.
Citation: Perez FA, Quinet S, Jarvik JG .
Lumbar spinal stenosis severity by CT or MRI does not predict response to epidural corticosteroid versus lidocaine injections.
AJNR Am J Neuroradiol 2019 May;40(5):908-15. doi: 10.3174/ajnr.A6050..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Imaging, Medication, Orthopedics, Outcomes, Patient-Centered Outcomes Research
Shah SC, Nakata C, Polydorides AD
Upper endoscopy up to 3 years prior to a diagnosis of gastric cancer is associated with lower stage of disease in a USA multiethnic urban population, a retrospective study.
This study focused on the feasibility of earlier diagnosis of non-cardia gastic cancer (NCGC) for high-risk populations in the US who include multiracial and ethnic populations. A retrospective study was conducted with patients who were positively identified endoscopically with NCGC at Mount Sinai Hospital in New York City. The primary outcome was an increased frequency of patients diagnosed with stage 0-Ia (38%) as opposed to stage Ib-III (34%) and stage IV (20.3%). For patients with stage 0-Ia if they had a prior negative endoscopy there was a 94% higher likelihood of the NCGC being in a curable stage.
AHRQ-funded; HS026395.
Citation: Shah SC, Nakata C, Polydorides AD .
Upper endoscopy up to 3 years prior to a diagnosis of gastric cancer is associated with lower stage of disease in a USA multiethnic urban population, a retrospective study.
J Prev Med Public Health 2019 May;52(3):179-87. doi: 10.3961/jpmph.18.262..
Keywords: Cancer, Diagnostic Safety and Quality, Digestive Disease and Health, Imaging, Racial and Ethnic Minorities, Urban Health