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
26 to 50 of 51 Research Studies DisplayedMisra-Hebert AD, Pantalone KM, Ji X
Patient characteristics associated with severe hypoglycemia in a type 2 diabetes cohort in a large, integrated health care system from 2006 to 2015.
hospitalizations for hypoglycemia, in patients with type 2 diabetes receiving care in a large health system and to identify patient characteristics associated with severe hypoglycemia events. The study found that patients with severe hypoglycemia had previous nonsevere hypoglycemia diagnoses more frequently than those without.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Pantalone KM, Ji X .
Patient characteristics associated with severe hypoglycemia in a type 2 diabetes cohort in a large, integrated health care system from 2006 to 2015.
Diabetes Care 2018 Jun;41(6):1164-71. doi: 10.2337/dc17-1834.
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Keywords: Diabetes, Medication, Patient-Centered Outcomes Research
Sorkin DH, Rook KS, Campos B
AHRQ Author: Ngo-Metzger Q
Rationale and study protocol for Unidas por la Vida (United for Life): a dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters.
The intervention aims to improve health behaviors and promote weight loss in two at-risk members of the same family: mothers with type 2 diabetes and their overweight/obese adult daughters who are at risk for developing diabetes. Both the dyadic and individual lifestyle interventions are expected to produce greater weight loss at 6, 12, and 18 months than those in minimal intervention control group.
AHRQ-authored.
Citation: Sorkin DH, Rook KS, Campos B .
Rationale and study protocol for Unidas por la Vida (United for Life): a dyadic weight-loss intervention for high-risk Latina mothers and their adult daughters.
Contemp Clin Trials 2018 Jun;69:10-20. doi: 10.1016/j.cct.2018.03.013.
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Keywords: Diabetes, Lifestyle Changes, Obesity, Racial and Ethnic Minorities, Obesity: Weight Management
Rosas LG, Lv N, Lewis MA
A Latino patient-centered, evidence-based approach to diabetes prevention.
Cultural tailoring of evidence-based diabetes prevention program (DPP) interventions is needed to effectively address obesity and its related chronic diseases among Latinos in primary care. This article described the patient-centered process used to adapt the DPP and reported cultural adaptations. The investigators concluded that the 2-stage approach actively engaging patients, family members, providers, and health care system leaders reinforced the cultural congruence of the existing intervention while further strengthening it with adaptations promoting Latino family and community support.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Lewis MA .
A Latino patient-centered, evidence-based approach to diabetes prevention.
J Am Board Fam Med 2018 May-Jun;31(3):364-74. doi: 10.3122/jabfm.2018.03.170280..
Keywords: Cultural Competence, Diabetes, Evidence-Based Practice, Patient and Family Engagement, Patient-Centered Healthcare, Racial and Ethnic Minorities
Nuckols TK, Keeler E, Anderson LJ
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
This study systematically reviewed economic evaluations of quality improvement (QI) interventions for glycemic control among adults with type 1 or type 2 diabetes. Using English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, the researchers extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost, incremental cost-effectiveness ratio, and study quality. They conclude that diverse and multifaceted QI interventions which lower HbA1c appear to be a fair-to-good value, relative to usual care.
AHRQ-funded; HS022644.
Citation: Nuckols TK, Keeler E, Anderson LJ .
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
Diabetes Care 2018 May;41(5):985-93. doi: 10.2337/dc17-1495..
Keywords: Diabetes, Healthcare Costs, Quality of Care, Quality Improvement
Chaddha A, Smith MA, Palta M
Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: a multidisciplinary group practice observational study.
The objective of the study was to determine rates and predictors of achieving hypertension control among Medicare patients with diabetes and uncontrolled hypertension after hospital discharge for an initial cardiac event. A retrospective analysis of linked electronic health record and Medicare data was performed. The study findings demonstrated the importance of implementing guideline-directed multidisciplinary care in this population.
AHRQ-funded; HS018368; HS017646.
Citation: Chaddha A, Smith MA, Palta M .
Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: a multidisciplinary group practice observational study.
J Clin Hypertens 2018 May;20(5):891-901. doi: 10.1111/jch.13282..
Keywords: Cardiovascular Conditions, Diabetes, Blood Pressure
Pantalone KM, Misra-Hebert AD, Hobbs TM
Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease.
The researchers evaluated real-world patient characteristics, medication use, and health care utilization patterns in patients with type 2 diabetes with established cardiovascular disease (CVD). Their data indicated underutilization of specialists and antidiabetic medications reported to confer CV benefit in patients with type 2 diabetes and CVD. The impact of recently updated guidelines and cardiovascular outcome trial results on management patterns in such patients remains to be seen.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease.
Cardiovasc Diabetol 2018 Apr 10;17(1):54. doi: 10.1186/s12933-018-0699-7.
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Keywords: Cardiovascular Conditions, Diabetes, Healthcare Utilization, Patient-Centered Healthcare
Karter AJ, Parker MM, Solomon MD
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
This study estimated the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index.
AHRQ-funded; HS022408.
Citation: Karter AJ, Parker MM, Solomon MD .
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
Health Serv Res 2018 Apr;53(2):1227-47. doi: 10.1111/1475-6773.12700.
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Keywords: Diabetes, Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance
Bishwakarma R, Zhang W, Lin YL
Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus.
This study aimed at investigating the effect of metformin on health care utilizations in patients with coexisting chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). The authors concluded that the use of metformin in patients with coexisting COPD and DM was associated with fewer COPD-specific ER visits and hospitalizations, especially in low-complexity COPD.
AHRQ-funded; HS020642.
Citation: Bishwakarma R, Zhang W, Lin YL .
Metformin use and health care utilization in patients with coexisting chronic obstructive pulmonary disease and diabetes mellitus.
Int J Chron Obstruct Pulmon Dis 2018 Mar 5;13:793-800. doi: 10.2147/copd.s150047..
Keywords: Respiratory Conditions, Diabetes, Healthcare Utilization, Medication
Lobo JM, Anderson R, Stukenborg GJ
Disparities in the use of diabetes screening in Appalachia.
This study examines disparities in the use of diabetes screening in Appalachia. Results showed that at-risk counties had significantly lower screening rates than competitive counties. Recommendations include introducing social policies that improve socioeconomic status and educational attainment, and health policies that reduce barriers to access to care in order to reduce disparities in diabetes screening rates in the less affluent Appalachian counties.
AHRQ-funded; HS018542.
Citation: Lobo JM, Anderson R, Stukenborg GJ .
Disparities in the use of diabetes screening in Appalachia.
J Rural Health 2018 Mar;34(2):173-81. doi: 10.1111/jrh.12247..
Keywords: Diabetes, Rural Health, Disparities, Social Determinants of Health, Screening, Prevention
McCreedy EM, Kane RL, Gollust SE
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explored how patient characteristics associated with a high risk-to-benefit ratio with hypoglycemia medications affected decision making by primary care clinicians. The investigators found that primary care clinicians often chose to intensify glycemic control despite individual patient factors that warranted higher glycemic targets based on existing guidelines.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Kane RL, Gollust SE .
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
J Am Board Fam Med 2018 Mar-Apr;31(2):192-200. doi: 10.3122/jabfm.2018.02.170141..
Keywords: Diabetes, Elderly, Patient-Centered Healthcare, Guidelines, Evidence-Based Practice, Shared Decision Making, Medication, Primary Care, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Aysola J, Tahirovic E, Troxel AB
A randomized controlled trial of opt-in versus opt-out enrollment into a diabetes behavioral intervention.
This study compared an opt-out default recruitment strategy with a conventional opt-in strategy for enrollment in behavioral intervention for poorly controlled diabetic patients. The patients were put in a randomized controlled trial at the University of Pennsylvania-associated primary care practices. Enrollment rates were improved for the opt-out default patients.
AHRQ-funded; HS021706.
Citation: Aysola J, Tahirovic E, Troxel AB .
A randomized controlled trial of opt-in versus opt-out enrollment into a diabetes behavioral intervention.
Am J Health Promot 2018 Mar;32(3):745-52. doi: 10.1177/0890117116671673..
Keywords: Behavioral Health, Diabetes, Lifestyle Changes, Patient Adherence/Compliance
DuGoff EH, Walden E, Ronk K
Can claims data algorithms identify the physician of record?
This study sought to determine the agreement of the primary care physician (PCP) identified by claims algorithms with the PCP of record in electronic health record data. It concluded that researchers may be more likely to identify a patient's PCP when focusing on primary care visits only; however, these algorithms perform less well among vulnerable populations and those experiencing fragmented care.
AHRQ-funded; HS021899.
Citation: DuGoff EH, Walden E, Ronk K .
Can claims data algorithms identify the physician of record?
Med Care 2018 Mar;56(3):e16-e20. doi: 10.1097/mlr.0000000000000709.
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Keywords: Diabetes, Elderly, Electronic Health Records (EHRs), Primary Care
Pantalone KM, Misra-Hebert AD, Hobbs TM
Effect of glycemic control on the Diabetes Complications Severity Index score and development of complications in people with newly diagnosed type 2 diabetes.
The aim of the present study was to assess the longitudinal accumulation of diabetes-related complications and the effect of glycemic control on the Diabetes Complications Severity Index (DCSI) score in people with newly diagnosed type 2 diabetes (T2D). The study concluded that baseline glycemic control had no apparent effect on longitudinal changes in DCSI score. Worsening or persistently poor glycemic control was associated with an increased risk of an increase in the DCSI score.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
Effect of glycemic control on the Diabetes Complications Severity Index score and development of complications in people with newly diagnosed type 2 diabetes.
J Diabetes 2018 Mar;10(3):192-99. doi: 10.1111/1753-0407.12613..
Keywords: Diabetes, Patient-Centered Outcomes Research, Risk
Misra-Hebert AD, Hu B, Le PH
Effect of health plan financial incentive offering on employees with prediabetes.
Researchers studied the effect of employee health plan financial incentives on health outcomes for employees with prediabetes. They found that employees who participated in disease management lost more weight than those who did not. A worksite wellness program offering health plan financial incentives for participation and outcomes was associated with improvements not only in weight but also in HbA1c.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Le PH .
Effect of health plan financial incentive offering on employees with prediabetes.
Am J Med 2018 Mar;131(3):293-99. doi: 10.1016/j.amjmed.2017.09.024.
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Keywords: Healthcare Costs, Patient-Centered Outcomes Research, Patient Self-Management, Obesity: Weight Management, Diabetes, Health Status
Stocco FG, Evaristo E, Shah NR
Marked exercise-induced T-wave heterogeneity in symptomatic diabetic patients with nonflow-limiting coronary artery stenosis.
The authors investigated whether T-wave heterogeneity (TWH) is elevated during exercise tolerance testing (ETT) in symptomatic diabetic patients with nonflow-limiting coronary artery stenosis compared to control subjects without diabetes. They found that TWH is capable of detecting latent repolarization abnormalities, which are present during ETT in diabetic patients with nonflow-limiting stenosis but not in control subjects. They concluded that the technique developed in this study permits TWH analysis from archived ECGs and thereby enables mining of extensive databases for retrospective studies and hypothesis testing.
AHRQ-funded; HS022998.
Citation: Stocco FG, Evaristo E, Shah NR .
Marked exercise-induced T-wave heterogeneity in symptomatic diabetic patients with nonflow-limiting coronary artery stenosis.
Ann Noninvasive Electrocardiol 2018 Mar;23(2):e12503. doi: 10.1111/anec.12503.
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Keywords: Cardiovascular Conditions, Data, Diabetes, Research Methodologies
Harper KJ, Osborn CY, Mayberry LS
Patient-perceived family stigma of type 2 diabetes and its consequences.
The objective of this study was to assess the frequency of type two diabetes (T2D) family stigma and its association with helpful and harmful diabetes-specific family behaviors and psychological and behavioral consequences of stigma. Perceptions/experiences of T2D-related family stigma were common in the study’s sample and associated with consequences of stigma including concealment and resentment of self-care, which may affect clinical outcomes.
AHRQ-funded; HS022990.
Citation: Harper KJ, Osborn CY, Mayberry LS .
Patient-perceived family stigma of type 2 diabetes and its consequences.
Fam Syst Health 2018 Mar;36(1):113-17. doi: 10.1037/fsh0000316..
Keywords: Diabetes, Family Health and History, Social Stigma
Dickens LT, Naylor RN
Clinical management of women with monogenic diabetes during pregnancy.
This study discusses clinical management of women with monogenic diabetes during pregnancy. Monogenic diabetes is rare and only accounts for 1-2% of all diabetes cases so it is frequently misdiagnoses as one of the other diabetes types. Diabetes treatment is different for this type of diabetes, and if untreated can cause fetal mutations. However, if treated there can be transplacental transfer of the medication (sulfonylurea). The study authors recommend large prospective studies be conducted to better define the need and timing of initiation of insulin treatment.
AHRQ-funded; HS023007.
Citation: Dickens LT, Naylor RN .
Clinical management of women with monogenic diabetes during pregnancy.
Curr Diab Rep 2018 Feb 15;18(3):12. doi: 10.1007/s11892-018-0982-8..
Keywords: Care Management, Chronic Conditions, Diabetes, Maternal Care, Pregnancy, Women
Leung LB, Vargas-Bustamante A, Martinez AE
Disparities in diabetes care quality by English language preference in community health centers.
Researchers conducted a parallel analysis of disparities in diabetes care quality among Latino and Asian community health center (CHC) patients by English language preference. After adjusting for socioeconomic and health characteristics, disparities in patient experiences by English language preference were found only among Asian patients. There were no significant differences in glycemic control by language for either Latino or Asian patients.
AHRQ-funded; HS020120.
Citation: Leung LB, Vargas-Bustamante A, Martinez AE .
Disparities in diabetes care quality by English language preference in community health centers.
Health Serv Res 2018 Feb;53(1):509-31. doi: 10.1111/1475-6773.12590.
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Keywords: Community-Based Practice, Cultural Competence, Diabetes, Disparities, Racial and Ethnic Minorities
Bowen ME, Xuan L, Lingvay I
Doc, I just ate: interpreting random blood glucose values in patients with unknown glycemic status.
This study sought to improve interpretation of RBG values in non-fasting individuals without self-reported dysglycemia and characterize the relationship between RBG and time since last caloric intake. It concluded that, in a nationally representative sample of non-fasting, community-dwelling individuals, those with undiagnosed dysglycemia had significantly higher RBG values than those with normoglycemia within 9 hours of caloric intake.
AHRQ-funded; HS022418.
Citation: Bowen ME, Xuan L, Lingvay I .
Doc, I just ate: interpreting random blood glucose values in patients with unknown glycemic status.
J Gen Intern Med 2018 Feb;33(2):142-44. doi: 10.1007/s11606-017-4213-9.
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Keywords: Diabetes, Diagnostic Safety and Quality, Screening
Magnan EM, Bolt DM, Greenlee RT
Stratifying patients with diabetes into clinically relevant groups by combination of chronic conditions to identify gaps in quality of care.
The purpose of this paper was to find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics. The researchers analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions based on condition co-occurrence. They found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. They concluded that patients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics.
AHRQ-funded; HS021899; HS018368.
Citation: Magnan EM, Bolt DM, Greenlee RT .
Stratifying patients with diabetes into clinically relevant groups by combination of chronic conditions to identify gaps in quality of care.
Health Serv Res 2018 Feb;53(1):450-68. doi: 10.1111/1475-6773.12607.
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Keywords: Cardiovascular Conditions, Chronic Conditions, Diabetes, Quality of Care, Quality Measures
Graetz I, Huang J, Brand RJ
Bridging the digital divide: mobile access to personal health records among patients with diabetes.
The authors examined personal health record (PHR) use through a computer-based Web browser or mobile device. They found that mobile-ready PHRs may increase access among patients facing a digital divide in computer use, disproportionately reaching racial/ethnic minorities and lower socioeconomic status patients. They recommend continued efforts to increase equitable access to PHRs among patients with chronic conditions.
AHRQ-funded; HS015280.
Citation: Graetz I, Huang J, Brand RJ .
Bridging the digital divide: mobile access to personal health records among patients with diabetes.
Am J Manag Care 2018 Jan;24(1):43-48..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Racial and Ethnic Minorities, Social Determinants of Health
Leonard CE, Han X, Brensinger CM
Comparative risk of serious hypoglycemia with oral antidiabetic monotherapy: a retrospective cohort study.
The purpose of this study was to examine and compare risks of serious hypoglycemia among antidiabetic monotherapy-treated adults receiving metformin, a sulfonylurea, a meglitinide, or a thiazolidinedione. The investigators found that sulfonylureas were associated with the highest rates of serious hypoglycemia. Among all study drugs, the highest rate was seen with glyburide. Pioglitazone was associated with a lower adjusted hazard for serious hypoglycemia vs metformin, while rosiglitazone and nateglinide had hazards similar to that of metformin.
AHRQ-funded; HS023898.
Citation: Leonard CE, Han X, Brensinger CM .
Comparative risk of serious hypoglycemia with oral antidiabetic monotherapy: a retrospective cohort study.
Pharmacoepidemiol Drug Saf 2018 Jan;27(1):9-18. doi: 10.1002/pds.4337..
Keywords: Risk, Adverse Drug Events (ADE), Adverse Events, Diabetes, Medication
Brennan MB, Huang ES, Lobo JM
Longitudinal trends and predictors of statin use among patients with diabetes.
The purpose of this study was to understand longitudinal trends and predictors of statin use among patients with diabetes. The investigators found that statin use is slowly increasing among patients with diabetes, and at varying rates within subgroups of this population. Policies that prioritize these subgroups for statin promotion may help guide future, intervention-based research to increase compliance with current guidelines.
AHRQ-funded; HS018542.
Citation: Brennan MB, Huang ES, Lobo JM .
Longitudinal trends and predictors of statin use among patients with diabetes.
J Diabetes Complications 2018 Jan;32(1):27-33. doi: 10.1016/j.jdiacomp.2017.09.014..
Keywords: Diabetes, Medication, Healthcare Utilization
Black KZ, Johnson LS, Samuel-Hodge CD
Perceived barriers and preferred components for physical activity interventions in African-American survivors of breast or endometrial cancer with type 2 diabetes: the S.U.C.C.E.S.S. framework.
The study’s objectives were to explore the perspectives of African American survivors with type 2 diabetes on perceived barriers to physical activity (PA) and preferences for a PA intervention and develop a framework for a PA program after cancer treatment. Nine themes were identified that focused on post-treatment physical symptoms. The S.U.C.C.E.S.S. framework summarizes the survivors' preferences for effective lifestyle interventions such as supporting efforts to maintain PA.
AHRQ-funded; HS023418.
Citation: Black KZ, Johnson LS, Samuel-Hodge CD .
Perceived barriers and preferred components for physical activity interventions in African-American survivors of breast or endometrial cancer with type 2 diabetes: the S.U.C.C.E.S.S. framework.
Support Care Cancer 2018 Jan;26(1):231-40. doi: 10.1007/s00520-017-3839-9.
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Keywords: Cancer, Cancer: Breast Cancer, Diabetes, Lifestyle Changes, Racial and Ethnic Minorities
Evaristo E, Stocco FG, Shah NR
Ranolazine reduces repolarization heterogeneity in symptomatic patients with diabetes and non-flow-limiting coronary artery stenosis.
In symptomatic diabetic patients with non-flow-limiting coronary artery stenosis with diffuse atherosclerosis and/or microvascular dysfunction, the authors explored whether ranolazine reduces T-wave heterogeneity (TWH). They found that, in the studied population, ranolazine reduced TWH at rest but not during exercise; reduction in repolarization abnormalities appears to be independent of alterations in myocardial blood flow.
AHRQ-funded; HS022998.
Citation: Evaristo E, Stocco FG, Shah NR .
Ranolazine reduces repolarization heterogeneity in symptomatic patients with diabetes and non-flow-limiting coronary artery stenosis.
Ann Noninvasive Electrocardiol 2018 Jan;23(1). doi: 10.1111/anec.12480.
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Keywords: Cardiovascular Conditions, Diabetes, Medication, Patient-Centered Outcomes Research