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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 1419 Research Studies DisplayedNorton WE, Zwarenstein M, Czajkowski S
Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.
This article describes a workshop put together by the authors for program scientists at the National Cancer Institute (NCI) to help them become better researchers and stewards of research funds. The workshop got good reviews from the attendees and many felt it will help them develop funding opportunities and advise grantees.
AHRQ-authored.
Citation: Norton WE, Zwarenstein M, Czajkowski S .
Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.
Trials 2019 Dec 27;20(1):779. doi: 10.1186/s13063-019-3934-y..
Keywords: Research Methodologies, Health Services Research (HSR), Cancer, Healthcare Delivery
French DD, Wang A, Prager AJ
Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare ocular hospitalizations: a cross sectional data analysis.
The purpose of this paper was to determine whether social determinants of health are associated with ocular hospitalizations. Results showed that, compared to an all-condition hospitalized population, ocular hospitalizations tended to have small, yet statistically significant, associations with health behaviors, socioeconomic, and physical environment factors. Further research is recommended on how these variables affect ocular health relative to all-cause hospitalizations.
AHRQ-funded; HS000078; HS000084.
Citation: French DD, Wang A, Prager AJ .
Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare ocular hospitalizations: a cross sectional data analysis.
Ophthalmol Ther 2019 Dec;8(4):611-22. doi: 10.1007/s40123-019-00220-1..
Keywords: Social Determinants of Health, Eye Disease and Health, Hospitalization, Medicare
Bernard D, Fang Z
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
Researchers examined the prevalence of high burdens and barriers to care among adults with heart disease treatment. Using MEPS data, they found that public insurance provides protection against high burdens but not against forgoing or delaying care. They recommended that future research investigate whether, and to what extent, barriers to care are associated with worse health outcomes and higher costs in the long term.
AHRQ-authored.
Citation: Bernard D, Fang Z .
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
J Am Heart Assoc 2019 Dec 17;8(24):e008831. doi: 10.1161/jaha.118.008831..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Heart Disease and Health, Cardiovascular Conditions, Access to Care
Pacheco TB, Hettinger AZ, Ratwani RM
Identifying potential patient safety issues from the federal electronic health record surveillance program.
This research letter analyzed HHS’ Office of the National Coordinator (ONC) surveillance data on electronic health records (EHRs) to determine whether these vendor products may potentially create patient harm. The researchers analyzed records from 195 vendors and identified 3.7% total product IDs having a nonconformity issue that could be a contributing factor to a patient harm event. However, it is unknown whether these IDs might actually result in patient harm.
AHRQ-funded; HS025136; HS023701.
Citation: Pacheco TB, Hettinger AZ, Ratwani RM .
Identifying potential patient safety issues from the federal electronic health record surveillance program.
JAMA 2019 Dec 17;322(23):2339-40. doi: 10.1001/jama.2019.17242..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Kelly JP, DeVore AD, Wu J
Rhythm control versus rate control in patients with atrial fibrillation and heart failure with preserved ejection fraction: insights from get with the guidelines-heart failure.
Researchers analyzed the Get With The Guidelines - Heart Failure (GWTG-HF) registry linked to Medicare claims data to describe current treatments for rate versus rhythm control and subsequent outcomes in patients with heart failure with preserved ejection fraction and atrial fibrillation. They found that rhythm control in patients aged 65 and older with heart failure with preserved ejection fraction and AF was associated with a lower risk of one-year all-cause mortality. They recommended future prospective randomized studies to explore this potential benefit.
AHRQ-funded; HS021092.
Citation: Kelly JP, DeVore AD, Wu J .
Rhythm control versus rate control in patients with atrial fibrillation and heart failure with preserved ejection fraction: insights from get with the guidelines-heart failure.
J Am Heart Assoc 2019 Dec 17;8(24):e011560. doi: 10.1161/jaha.118.011560.
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Keywords: Heart Disease and Health, Cardiovascular Conditions, Guidelines, Evidence-Based Practice, Registries, Patient-Centered Outcomes Research
Kuhn J, Sheldrick RC, Broder-Fingert S
Simulation and minimization: technical advances for factorial experiments designed to optimize clinical interventions.
This study examined the best way to maximize the Multiphase Optimization Strategy (MOST) which is designed to maximize the impact of clinical healthcare interventions. Computer simulations were run to empirically test five subject allocation procedures. Simple and stratified randomization performed the poorest; while maximum tolerated imbalance, minimal sufficient balance, and minimization were more successful in achieving balanced sample sizes and equivalence across a large number of covariates. Minimization was recommended for further research studies.
AHRQ-funded; 2T32HS022242.
Citation: Kuhn J, Sheldrick RC, Broder-Fingert S .
Simulation and minimization: technical advances for factorial experiments designed to optimize clinical interventions.
BMC Med Res Methodol 2019 Dec 16;19(1):239. doi: 10.1186/s12874-019-0883-9..
Keywords: Research Methodologies
Rafferty MR, MacDonald J, Byskosh A
Using implementation frameworks to provide proactive physical therapy for people with Parkinson disease: case report.
European clinical practice guidelines recommend physical therapy for people with Parkinson disease (PD) soon after diagnosis to provide education, physical activity advice, and individualized interventions when needed. However, therapy is frequently not used until after gait and balance problems occur. The purpose of this administrative case study was to present the application of a proactive physical therapy (PAPT) approach at 1 rehabilitation center using implementation frameworks to support the (1) implementation process, (2) determinants of implementation success, and (3) implementation evaluation.
AHRQ-funded; HS025077.
Citation: Rafferty MR, MacDonald J, Byskosh A .
Using implementation frameworks to provide proactive physical therapy for people with Parkinson disease: case report.
Phys Ther 2019 Dec 16;99(12):1644-55. doi: 10.1093/ptj/pzz129..
Keywords: Neurological Disorders, Rehabilitation, Case Study
Vila PM, Olsen MA, Piccirillo JF
Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance.
The purpose of this study was to determine frequencies and trends in sialoendoscopy and sialoadenectomy for the treatment of obstructive, non-neoplastic submandibular salivary gland disease. Researchers conducted an epidemiologic study of insurance claims from 2006 to 2013 in a large, private insurance claims database; 5,111 adults with sialadenitis who had a sialoendoscopy or submandibular gland excision were included. The results of this study indicate that the use of sialoendoscopy procedures has increased over time, while the overall rate of sialoadenectomy has decreased, but the authors conclude that both procedures are safe for the treatment of patients with sialadenitis and sialolithiasis.
AHRQ-funded; HS019455.
Citation: Vila PM, Olsen MA, Piccirillo JF .
Rates of sialoendoscopy and sialoadenectomy in 5,111 adults with private insurance.
Laryngoscope 2019 Dec 16;129(3):602-06. doi: 10.1002/lary.27243..
Keywords: Healthcare Utilization, Health Insurance, Surgery
Tracer H, Sanou A
Screening for pancreatic cancer.
This “Putting Prevention into Practice: An Evidence Based Approach” case study, is based on the U.S. Preventive Services Task Force (USPSTF) recommendation for pancreatic cancer screening. It describes a patient scenario and poses questions.
AHRQ-authored.
Citation: Tracer H, Sanou A .
Screening for pancreatic cancer.
Am Fam Physician 2019 Dec 15;100(12):771-72..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Prevention, Cancer, Case Study, Primary Care
Ferguson WJ, Johnston J, Clarke JG
Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails.
Four jail and prison systems partnered with researchers to document their adoption of medication assisted therapy (MAT) for incarcerated individuals with opioid use disorders using their established treatment protocols. Despite efforts at all four sites to increase utilization of MAT, only one site achieved sustained growth in the proportion of individuals treated over the course of the project. Recommendations included adoption of evidence-based MATs for opioid use disorders in prisons and jails with persistent effort to identify and overcome challenges and dedicated funding to sustain programs.
AHRQ-funded; HS024243.
Citation: Ferguson WJ, Johnston J, Clarke JG .
Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails.
Health Justice 2019 Dec 12;7(1):19. doi: 10.1186/s40352-019-0100-2..
Keywords: Opioids, Medication, Substance Abuse, Vulnerable Populations
Venema DM, Skinner AM, Nailon R
Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study.
Unassisted falls are more likely to result in injury than assisted falls. However, little is known about risk factors for falling unassisted. Furthermore, rural hospitals, which care for a high proportion of older adults, are underrepresented in research on hospital falls. This study identified risk factors for unassisted and injurious falls in rural hospitals.
AHRQ-funded; HS021429.
Citation: Venema DM, Skinner AM, Nailon R .
Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study.
BMC Geriatr 2019 Dec 11;19(1):348. doi: 10.1186/s12877-019-1368-8..
Keywords: Falls, Injuries and Wounds, Patient Safety, Elderly, Risk, Hospitals, Adverse Events
Xu X, Lin H, Wright JD
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
Despite concerns that power morcellation may adversely affect prognosis of patients with occult uterine cancer, empirical evidence has been limited and inconclusive. In this study, the investigators aimed to determine whether uncontained power morcellation at the time of hysterectomy or myomectomy was associated with increased mortality risk in women with occult uterine cancer.
AHRQ-funded; HS024702.
Citation: Xu X, Lin H, Wright JD .
Association between power morcellation and mortality in women with unexpected uterine cancer undergoing hysterectomy or myomectomy.
J Clin Oncol 2019 Dec 10;37(35):3412-24. doi: 10.1200/jco.19.00562..
Keywords: Cancer, Mortality, Women, Surgery, Risk, Adverse Events
Burnham JP, Fritz SA, Yaeger LH
Telemedicine infectious diseases consultations and clinical outcomes: a systematic review.
Researchers reviewed the current evidence for clinical effectiveness of telemedicine infectious diseases consultations. They found that the outcomes tracked were heterogeneous, precluding meta-analysis, and the majority of studies were of poor quality. Overall, clinical outcomes with telemedicine infectious diseases consultation seem comparable to in-person infectious diseases consultation. They concluded that, although in widespread use, the clinical effectiveness of telemedicine infectious diseases consultations has yet to be sufficiently studied.
AHRQ-funded; R01 HS024269.
Citation: Burnham JP, Fritz SA, Yaeger LH .
Telemedicine infectious diseases consultations and clinical outcomes: a systematic review.
Open Forum Infect Dis 2019 Dec 5;6(12):ofz517. doi: 10.1093/ofid/ofz517..
Keywords: Telehealth, Infectious Diseases, Health Information Technology (HIT), Evidence-Based Practice, Outcomes, Patient-Centered Outcomes Research
Wesley DB, Schubel L, Hsiao C-J
A socio-technical systems approach to the use of health IT for patient reported outcomes: patient and healthcare provider perspectives.
The purpose of this study was to apply the socio-technical systems (STS) model as a framework for understanding the usability and functional requirements of patients collecting PRO data using applications (apps), and of healthcare providers using these data at the point of care in ambulatory settings. The authors concluded that the STS model provides a comprehensive framework that can be applied to collect patient and healthcare provider feedback to better guide the design and implementation of new health information technology.
AHRQ-funded; 233201500022I
Citation: Wesley DB, Schubel L, Hsiao C-J .
A socio-technical systems approach to the use of health IT for patient reported outcomes: patient and healthcare provider perspectives.
Journal of biomedical Informatics: X 2019 Dec;4:100048. doi: 10.1016/j.yjbinx.2019.100048..
Keywords: Health Information Technology (HIT), Patient-Centered Outcomes Research
Conroy MB, McTigue KM, Bryce CL
Effect of electronic health record-based coaching on weight maintenance: a randomized trial.
This study compared long-term weight regain after participation in a weight loss management program using an electronic health record (EHR)-based weight maintenance intervention program. Participants were adult outpatients with a BMI of 25 kg/m2 or higher, had intentional weight loss of at least 5% in the previous 2 years, and had no bariatric procedures in the previous 5 years. The EHR tools included weight, diet and physical activity tracking sheets, standardized surveys and reminders. Patients were randomly assigned to the coaching or non-coaching group. They were tracked for 24 months with 24 scheduled contacts. Results showed patients who used the EHR tools plus coaching had less weight regain than patients using EHR tools alone.
AHRQ-funded; HS021162.
Citation: Conroy MB, McTigue KM, Bryce CL .
Effect of electronic health record-based coaching on weight maintenance: a randomized trial.
Ann Intern Med 2019 Dec 3;171(11):777-84. doi: 10.7326/m18-3337..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Obesity: Weight Management, Obesity, Lifestyle Changes
Horng S, Joseph JW, Calder S
Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system.
The purpose of this cohort study was to determine whether a simple visual aid was associated with a reduction in duplicate ordering of tests and medications. An interrupted time series model was used to analyze a series of consecutive patients who visited the emergency department of a large volume academic hospital. The researchers conclude that passive visual cues that provided just-in-time decision support were associated with reductions in unintentional duplicate orders for laboratory and radiology tests but not in unintentional duplicate medication orders.
AHRQ-funded; HS024288.
Citation: Horng S, Joseph JW, Calder S .
Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system.
JAMA Netw Open 2019 Dec 2;2(12):e1916499. doi: 10.1001/jamanetworkopen.2019.16499..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Patient-Centered Outcomes Research, Medication
Schoenfeld EM, Shieh MS, Pekow PS
Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic.
Little is known about the timing of urologic interventions in patients with renal colic discharged from the emergency department. Understanding patients' likelihood of a subsequent urologic intervention could inform decision-making in this population. The objective of this study was to examine the rate and timing of urologic procedures performed after an emergency department visit for renal colic and the factors associated with receipt of an intervention.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Shieh MS, Pekow PS .
Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic.
JAMA Netw Open 2019 Dec 2;2(12):e1916454. doi: 10.1001/jamanetworkopen.2019.16454..
Keywords: Emergency Department, Kidney Disease and Health, Decision Making
Hong I, Goodwin JS, Reistetter TA, I, Goodwin JS, Reistetter TA
Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation vs skilled nursing facilities.
This cohort study compared functional status improvements of poststroke patients who either went to an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF). The study used data from Medicare claims for stroke from January 2013 through November 2014. A total of 99,185 patients were studied. Patients admitted to SNFs tended to be older, female, and had a longer hospital length of stay than those admitted to IRFs. Stroke patients admitted to IRFs had larger improvements for mobility score points and for self-care on admission compared with those admitted to SNFs. There was found to be no statistical difference in the odds of 30- to 365-day mortality.
AHRQ-funded; HS024711; HS022134.
Citation: Hong I, Goodwin JS, Reistetter TA, I, Goodwin JS, Reistetter TA .
Comparison of functional status improvements among patients with stroke receiving postacute care in inpatient rehabilitation vs skilled nursing facilities.
JAMA Netw Open 2019 Dec 2;2(12):e1916646. doi: 10.1001/jamanetworkopen.2019.16646..
Keywords: Stroke, Cardiovascular Conditions, Rehabilitation, Health Status, Hospitalization, Nursing Homes
Greenhawt M, Shaker M
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
The authors sought to identify scenarios in which current early peanut introduction guidelines would be cost-effective. They found that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, skin prick test sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to achieve realistically. They recommend further research to define the health state utility associated with reaction location.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Shaker M .
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
JAMA Netw Open 2019 Dec 2;2(12):e1918041. doi: 10.1001/jamanetworkopen.2019.18041..
Keywords: Patient-Centered Outcomes Research, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Skin Conditions, Screening, Healthcare Costs, Evidence-Based Practice, Guidelines
Gomes KM, Ratwani RM
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
In this research letter, the authors studied usability of electronic health records (EHR) with the system usability scale (SUS). They found that SUS scores decreased for 44% of vendors. Clinician satisfaction with EHR usability is not improving for many widely used products, and the authors recommended increased focus on clinician end users during product design and development as well as optimized certification requirements in order to improve usability.
AHRQ-funded; HS025136.
Citation: Gomes KM, Ratwani RM .
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
JAMA Netw Open 2019 Dec 2;2(12):e1916651. doi: 10.1001/jamanetworkopen.2019.16651..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Barber CEH, Zell J, Yazdany J
2019 American College of Rheumatology recommended patient-reported functional status assessment measures in rheumatoid arthritis.
This study’s objective was to develop American College of Rheumatology (ACR) Functional Status Assessment Measures (FSAMs) for patient reporting in most clinic settings. The authors convened a workgroup to conduct a systematic literature review through March 2017. They focused on the following FSAMs: the Health Assessment Questionnaire (HAQ) and derived measures from the Patient-Reported Outcomes Measurement Information System (PROMIS) tool. Out of 11,835 articles identified in the search, 56 were included in the review. A modified Delphi process identified 7 measures which fulfilled the minimum standard for regular use, and 3 measures were recommended: the PROMIS 10-item short form, the HAQ-II, and the Multidimensional HAQ.
AHRQ-funded; HS025638.
Citation: Barber CEH, Zell J, Yazdany J .
2019 American College of Rheumatology recommended patient-reported functional status assessment measures in rheumatoid arthritis.
Arthritis Care Res 2019 Dec;71(12):1531-39. doi: 10.1002/acr.24040..
Keywords: Arthritis, Health Status, Guidelines, Evidence-Based Practice
Chan B, Lyles C, Kaplan C
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
In this study, the authors investigated differences in overall and patterns of portal use for patients with resident and attending primary care providers (PCPs). They concluded that given the lower patient-portal use among residents' patients, residency programs should develop curricula to bolster trainee competence in using the patient-portal for communication and to enhance the patient-physician relationship.
AHRQ-funded; HS022981; HS022408.
Citation: Chan B, Lyles C, Kaplan C .
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
J Gen Intern Med 2018 Dec;33(12):2085-91. doi: 10.1007/s11606-018-4637-x..
Keywords: Clinician-Patient Communication, Education: Continuing Medical Education, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider, Provider: Physician
McCarthy DM, Curtis LM, Courtney DM
A multifaceted intervention to improve patient knowledge and safe use of opioids: results of the ED EMC(2) randomized controlled trial.
Despite increased focus on opioid prescribing, little is known about the influence of prescription opioid medication information given to patients in the emergency department (ED). The objective of this study was to evaluate the effect of an Electronic Medication Complete Communication (EMC(2)) Opioid Strategy on patients' safe use of opioids and knowledge about opioids. The study found that the EMC(2) tools improved demonstrated safe dosing, but these benefits did not translate into actual use based on medication dairies. The text-messaging intervention did result in improved patient knowledge.
AHRQ-funded; HS023459.
Citation: McCarthy DM, Curtis LM, Courtney DM .
A multifaceted intervention to improve patient knowledge and safe use of opioids: results of the ED EMC(2) randomized controlled trial.
Acad Emerg Med 2019 Dec;26(12):1311-25. doi: 10.1111/acem.13860..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Health Literacy, Education: Patient and Caregiver, Clinician-Patient Communication, Communication, Health Information Technology (HIT)
Hsu HE, Abanyie F, Agus MSD
A national approach to pediatric sepsis surveillance.
The authors described the challenges specific to pediatric sepsis surveillance. They then proposed a preliminary pediatric sepsis event surveillance definition and outlined next steps for refining and validating these criteria so that they may be used to estimate the national burden of pediatric sepsis and support site-specific surveillance to complement ongoing initiatives to improve sepsis prevention, recognition, and treatment.
AHRQ-funded; HS023827; HS025008.
Citation: Hsu HE, Abanyie F, Agus MSD .
A national approach to pediatric sepsis surveillance.
Pediatrics 2019 Dec;144(6). doi: 10.1542/peds.2019-1790..
Keywords: Children/Adolescents, Sepsis
Almasri J, Tello M, Benkhadra R
A systematic review for variables to be collected in a transplant database for improving risk prediction.
This study is a systematic review that was commissioned to identify new variables associated with transplant outcomes that are not currently collected by the Organ Procurement and Transplantation Network. They identified 81 unique studies including almost 1.2 million patients with median follow-up of 36 months posttransplant. A total of 108 unique risk factors were reported with most (104) recipient related and only 4 donor related. Most risk factors were small to moderate (ranging between 1.0 and 2.0). There were four relative association measures that were the strongest: 1) heart transplant recipients with a previous Fontan operation (8.6); 2) kidney transplant recipients with sickle cell nephropathy as primary cause of end-stage renal disease (2.8); 3) liver transplant recipients with serum ferritin >500 microg/L (14.3); and 4) lung transplant recipients with Burkholderia cepacia complex infection for 1 year or less (63.). These four risk factors were considered candidates for collection in databases and registries.
AHRQ-funded; HS024527.
Citation: Almasri J, Tello M, Benkhadra R .
A systematic review for variables to be collected in a transplant database for improving risk prediction.
Transplantation 2019 Dec;103(12):2591-601. doi: 10.1097/tp.0000000000002652..
Keywords: Transplantation, Risk, Decision Making
