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
1401 to 1425 of 1425 Research Studies DisplayedStarr P, Agarwal A, Singh G
Obstructive sleep apnea with chronic obstructive pulmonary disease among Medicare beneficiaries.
This research letter describes a claims-based study of Medicare beneficiaries conducted by the authors that examined the diagnosed prevalence and trend of overlap syndrome (the coexistence of chronic obstructive pulmonary disease [COPD] and obstructive sleep apnea [OSA] in a single individual). A total of 159,084 patients with COPD were included in the study; 11 percent had coexisting OSA. Data were gathered from multiple files: the Medicare Denominator File, the Medicare Provider Analysis and Review File, the Outpatient Standard Analytic File, the 100% Physician/Supplier Data File, and the Durable Medical Equipment File. Medicare enrollment files were used to gather information on patient characteristics and categorize subjects by age, sex, race, and socioeconomic status. The authors note that the prevalence of diagnosed overlap syndrome has increased fourfold during the 10-year study period.
AHRQ-funded; HS020642; HS022134.
Citation: Starr P, Agarwal A, Singh G .
Obstructive sleep apnea with chronic obstructive pulmonary disease among Medicare beneficiaries.
Ann Am Thorac Soc 2019 Jan;16(1):153-56. doi: 10.1513/AnnalsATS.201712-932OC..
Keywords: Sleep Problems, Respiratory Conditions, Medicare, Chronic Conditions
Son H, Nahm ES
Older adults' experience using patient portals in communities: challenges and opportunities.
The purpose of this study was to assess the perceived usability of patient portals currently used by older adults. 272 older adults were recruited from an online trial testing the effects of a 3-week Theory-Based Patient Portal eLearning Program. Self-efficacy and perceived usability of patient portals were both low; difficulties with using patient portals were primarily associated with login/access and specific portal functions. Favored features were review of medical information and eMessaging.
AHRQ-funded; HS024739.
Citation: Son H, Nahm ES .
Older adults' experience using patient portals in communities: challenges and opportunities.
Comput Inform Nurs 2019 Jan;37(1):4-10. doi: 10.1097/cin.0000000000000476..
Keywords: Clinician-Patient Communication, Communication, Elderly, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Web-Based
Norton PT, Rodriguez HP, Shortell SM
Organizational influences on healthcare system adoption and use of advanced health information technology capabilities.
The purpose of this study was to identify characteristics that may drive the variability of adopting of advanced health IT capabilities, such as predictive analytic functions and patient access to records, among health systems. Responses from the 2017/2018 National Survey of Healthcare Organizations and Systems were used to assess the extent to which healthcare system organizational structure, electronic health record standardization, and resource allocation practices were associated with the use of advanced health IT capabilities. Measures of adoption, organizational structure, and resource allocation were developed based on survey responses. Results suggest that health systems that standardize their electronic health records and that own and manage hospitals and medical groups have higher rates of advanced health IT adoption and use.
AHRQ-funded; HS024075.
Citation: Norton PT, Rodriguez HP, Shortell SM .
Organizational influences on healthcare system adoption and use of advanced health information technology capabilities.
Am J Manag Care 2019 Jan;25(1):e21-e25..
Keywords: Health Systems, Health Information Technology (HIT), Healthcare Delivery
Sobotka SA, Gaur DS, Goodman DM
Pediatric patients with home mechanical ventilation: the health services landscape.
Children with invasive home mechanical ventilation (HMV) are a growing population with complex health service needs. Single institution studies provide insight into successful program structures and outcomes. In this study, the investigators aimed to assess health service structures, providers, and programs caring for this population throughout the U.S., and to understand barriers to high-quality care.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Gaur DS, Goodman DM .
Pediatric patients with home mechanical ventilation: the health services landscape.
Pediatr Pulmonol 2019 Jan;54(1):40-46. doi: 10.1002/ppul.24196..
Keywords: Access to Care, Children/Adolescents, Healthcare Delivery, Home Healthcare, Children/Adolescents
Banks DE, Hershberger AR, Pemberton T
Poly-use of cannabis and other substances among juvenile-justice involved youth: variations in psychological and substance-related problems by typology.
Juvenile offenders engage in both cannabis use and polysubstance use at higher rates than the general adolescent population. Yet, limited research has examined the relationship between cannabis poly-use (e.g., cannabis and alcohol use) and functional or psychological problems among juvenile offenders. The current study addresses this gap by examining the association of polysubstance use of cannabis compared to cannabis only use with cognitive functioning, psychological distress, and substance-related problems among juvenile detainees.
AHRQ-funded; HS024296.
Citation: Banks DE, Hershberger AR, Pemberton T .
Poly-use of cannabis and other substances among juvenile-justice involved youth: variations in psychological and substance-related problems by typology.
Am J Drug Alcohol Abuse 2019;45(3):313-22. doi: 10.1080/00952990.2018.1558450..
Keywords: Children/Adolescents, Behavioral Health, Substance Abuse, Vulnerable Populations
McKernan LC, Johnson BN, Reynolds WS
Posttraumatic stress disorder in interstitial cystitis/bladder pain syndrome: relationship to patient phenotype and clinical practice implications.
The relationship between exposure to abuse and interstitial cystitis/bladder pain syndrome (IC/BPS) is well-documented. However, studies have yet to examine posttraumatic stress disorder (PTSD), which develops following exposure to trauma and worsens health outcomes in chronic pain. The authors of this study aimed to assess the prevalence and impact of PTSD in patients with IC/BPS, including their relation to genitourinary symptom presentation and widespread pain phenotype.
AHRQ-funded; HS022990.
Citation: McKernan LC, Johnson BN, Reynolds WS .
Posttraumatic stress disorder in interstitial cystitis/bladder pain syndrome: relationship to patient phenotype and clinical practice implications.
Neurourol Urodyn 2019 Jan;38(1):353-62. doi: 10.1002/nau.23861..
Keywords: Behavioral Health, Pain, Trauma
Anderson JB, Brown DW, Lihn S
Power of a learning network in congenital heart disease.
This paper discusses the efforts of the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC). The collaborative formed to improve outcomes in infants with hypoplastic left heart syndrome. It sought to (1) decrease mortality, (2) reduce growth failure, and (3) reduce hospital readmissions due to major medical problems during the interstage period between discharge following stage 1 palliation (S1P) and admission for stage 2 palliation (S2P).
AHRQ-funded; HS016957.
Citation: Anderson JB, Brown DW, Lihn S .
Power of a learning network in congenital heart disease.
World J Pediatr Congenit Heart Surg 2019 Jan;10(1):66-71. doi: 10.1177/2150135118815023..
Keywords: Cardiovascular Conditions, Children/Adolescents, Education: Continuing Medical Education, Palliative Care, Quality Improvement, Registries
Clowse MEB, Eudy AM, Revels J
Provider perceptions on the management of lupus during pregnancy: barriers to improved care.
This paper discusses a focus group that was created of women with lupus who either were pregnant or were planning to get pregnant. Outcomes in women with lupus is bad for more than half of pregnancies for the mother or the fetus. The focus group’s objective was to discuss issues about pregnancy planning and management. Problems include ill-timed pregnancies, and medication non-adherence. Communication gaps between the rheumatologist and the obstetrician/gynecologist can result in confusion for the patient with optimal treatment plans.
AHRQ-funded; HS023443.
Citation: Clowse MEB, Eudy AM, Revels J .
Provider perceptions on the management of lupus during pregnancy: barriers to improved care.
Lupus 2019 Jan;28(1):86-93. doi: 10.1177/0961203318815594..
Keywords: Care Management, Chronic Conditions, Maternal Care, Pregnancy, Provider, Women
Liu X, Shah V, Kubilis P
Psychotropic treatment pattern in Medicaid pediatric patients with concomitant ADHD and ODD/CD.
This study analyzed the use of psychotropic treatments in children with concomitant ADHD and oppositional defiant disorder/conduct disorder (ODD/CD). The data from a cross-sectional drug utilization study based on Medicaid fee-for-service programs in 26 U.S. states from 1999 to 2006. Children ages 4 to 18 were included, with a total of 121,740 children identified. There was a period prevalence of 38.1% for “no psychotropic therapy”, 44.7% for psychotropic monotherapy, and 9% for psychotropic dual therapy. Stimulants were the most common drug class prescribed. Psychotropic combination therapy was used most with whites, males, and children in foster care.
AHRQ-funded; HS0185606.
Citation: Liu X, Shah V, Kubilis P .
Psychotropic treatment pattern in Medicaid pediatric patients with concomitant ADHD and ODD/CD.
J Atten Disord 2019 Jan;23(2):140-48. doi: 10.1177/1087054715596574..
Keywords: Children/Adolescents, Behavioral Health, Medicaid, Medication
Davis KK, Mahishi V, Singal R
AHRQ Author: Miller MA
Quality improvement in ambulatory surgery centers: a major national effort aimed at reducing infections and other surgical complications.
Researchers recruited ambulatory surgery centers (ASCs) to implement and then modify patient safety practices that were used in hospitals, but may not be appropriate for ASCs. They recruited 665 ASCs in 47 US states and had them provide suggestions for modifying safe practices with the use of a surgical safety checklist and infection control practices.
AHRQ-authored.
Citation: Davis KK, Mahishi V, Singal R .
Quality improvement in ambulatory surgery centers: a major national effort aimed at reducing infections and other surgical complications.
J Clin Med Res 2019 Jan;11(1):7-14. doi: 10.14740/jocmr3603w..
Keywords: Adverse Events, Ambulatory Care and Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Quality Improvement, Surgery
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
This editorial viewpoint discusses structured approaches that emphasize the four critical time points (‘Moments’) in the process of antibiotic prescribing, and which may improve antibiotic decisionmaking by clinicians and communication about antibiotic decisions among health care practitioners. AHRQ’s Safety Program for Improving Antibiotic Use is highlighted, since it features the training of clinicians to incorporate the ‘4 moments’ of antibiotic decisionmaking into their thought processes when prescribing antibiotics. The 4 moments are described and an example provided for each. The authors conclude that an organized approach such as the 4 moments of antibiotic decisionmaking could be helpful if it is used every time antibiotic therapy is considered.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE .
Rethinking how antibiotics are prescribed: incorporating the 4 moments of antibiotic decision making into clinical practice.
JAMA 2019 Jan;321(2):139-40. doi: 10.1001/jama.2018.19509..
Keywords: Antibiotics, Decision Making, Medication, Patient Safety, Practice Patterns
Gordon SH, Sommers BD, Wilson IB
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
This study looked at risk factors for early disenrollment from Colorado’s Affordable Care Act marketplace. Researchers used all-payer claims data from individual market enrollees from 2014-2016. They discovered that nearly 25% Marketplace beneficiaries disenrolled midyear. The hazard rate of disenrollement was 30% lower in individuals with cost-sharing plans and 21% lower for those enrolled in gold plans compared to those enrolled in silver plans without cost-sharing subsidies. There was greater disenrollment in beneficiaries with greater hospital and emergency utilization before disenrollment. Also, young adults were 70% more likely to disenroll than older adults.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Risk factors for early disenrollment from Colorado's Affordable Care Act marketplace.
Med Care 2019 Jan;57(1):49-53. doi: 10.1097/mlr.0000000000001020..
Keywords: Healthcare Costs, Health Insurance, Policy, Risk, Uninsured
Albrecht JS, Al Kibria G, Gruber-Baldini A
Risk of mortality in individuals with hip fracture and traumatic brain injury.
Researchers estimated the prevalence of TBI (traumatic brain injury) with individuals hospitalized with hip fracture and their all-cause mortality. The population studied were Medicare beneficiaries aged 65 and older from 2006 to 2010. They concluded that there was a higher risk of death with individuals who had TBI than those who had only a hip fracture.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Al Kibria G, Gruber-Baldini A .
Risk of mortality in individuals with hip fracture and traumatic brain injury.
J Am Geriatr Soc 2019 Jan;67(1):124-27. doi: 10.1111/jgs.15661..
Keywords: Brain Injury, Injuries and Wounds, Mortality, Risk, Trauma
Ishihara M, Harel D, Levis B
Shortening self-report mental health symptom measures through optimal test assembly methods: development and validation of the Patient Health Questionnaire-Depression-4.
Researchers developed and validated a short form of the Patient Health Questionnaire-9 (PHQ-9) which assesses depression symptoms. This form was tested on 7,850 English-speaking patients enrolled in 20 diagnostic accuracy studies. The questions were optimized using Optimal test assembly (OTA) methods. Questionnaires from one to eight items were tried, with four questions found to be the optimal number with minimal loss of information compared to a full-length PHQ-9.
AHRQ-funded; HS018246.
Citation: Ishihara M, Harel D, Levis B .
Shortening self-report mental health symptom measures through optimal test assembly methods: development and validation of the Patient Health Questionnaire-Depression-4.
Depress Anxiety 2019 Jan;36(1):82-92. doi: 10.1002/da.22841..
Keywords: Depression, Diagnostic Safety and Quality, Behavioral Health
McCarron HR, Finlay JM, Sims T
Stakeholder engagement to enhance interventions for family caregivers of people with dementia: a case study of care to plan.
This study discusses a case study that uses a community advisory board (CAB) to help interventions for family caregivers of people with dementia. The intervention used is an online dementia caregiver resource called Care to Plan. Transcripts of seven CAB meetings over a 3-year period were reviewed. They looked at: how meetings were conducted and issues that arose; and Care to Plan improvements, how CAB members provided key stakeholder perspectives that resulted in changes in language, functionality, substance and dissemination.
AHRQ-funded; HS022445.
Citation: McCarron HR, Finlay JM, Sims T .
Stakeholder engagement to enhance interventions for family caregivers of people with dementia: a case study of care to plan.
J Gerontol Soc Work 2019 Jan;62(1):29-47. doi: 10.1080/01634372.2018.1505797..
Keywords: Caregiving, Dementia, Neurological Disorders, Patient and Family Engagement
Bramante CT, Thornton RLJ, Bennett WL
Systematic review of natural experiments for childhood obesity prevention and control.
This article reviews the effectiveness of population-level policies and programs from natural experiments for childhood obesity prevention. A search of PubMed, CINAHL, PsycINFO, and EconLit from 2000 to 2017 sought studies about policies evaluated by natural experiments reporting childhood BMI outcomes. Interventions were classified by environmental focus and stratified by setting; risk of bias was evaluated for each study. Most of the studies evaluated took place in a school setting. The most common environmental focus in any setting was food/beverage. All four of the studies that focused on food/beverage and physical activity in schools showed decreased prevalence of overweight/obesity in the subjects. BMI decreased in all four studies in both school and community settings. The authors note that while school-based policies focusing on both food/beverage and physical activity environments showed consistent improvement in BMI, most of these studies had high risk of bias. Improved methods for the evaluation of natural experiments for childhood obesity prevention are needed.
AHRQ-funded; 290201200007I.
Citation: Bramante CT, Thornton RLJ, Bennett WL .
Systematic review of natural experiments for childhood obesity prevention and control.
Am J Prev Med 2019 Jan;56(1):147-58. doi: 10.1016/j.amepre.2018.08.023..
Keywords: Children/Adolescents, Evidence-Based Practice, Obesity, Obesity: Weight Management, Prevention
Nonzee NJ, Luu TH
The drug shortage crisis in the United States: impact on cancer pharmaceutical safety.
This study examined the drug short crisis in the United States and its impact on cancer pharmaceutical safety. These shortages present safety risk for patients and adversely affect patient outcomes. There are multiple drivers of this problem including manufacturing disruptions, raw material shortages, regulatory issues, market dynamics and limited financial incentives for off-patent drugs.
AHRQ-funded; HS000046.
Citation: Nonzee NJ, Luu TH .
The drug shortage crisis in the United States: impact on cancer pharmaceutical safety.
Cancer Treat Res 2019;171:75-92. doi: 10.1007/978-3-319-43896-2_6..
Keywords: Cancer, Medication, Medication: Safety, Patient Safety
Ghosh A, Simon K, Sommers BD
The effect of health insurance on prescription drug use among low-income adults: evidence from recent Medicaid expansions.
This study examined how subsidized coverage affected prescription drug utilization among low-income non-elderly adults. Among other results, the investigators found that within the first 15 months of new health insurance availability, aggregate Medicaid-paid prescriptions increased 19 percent, amounting to nearly 9 new prescriptions a year, per new enrollee. They also found no evidence of reductions in uninsured or privately-insured prescriptions, suggesting that new coverage did not simply substitute for other payment sources.
AHRQ-funded; HS021291.
Citation: Ghosh A, Simon K, Sommers BD .
The effect of health insurance on prescription drug use among low-income adults: evidence from recent Medicaid expansions.
J Health Econ 2019 Jan;63:64-80. doi: 10.1016/j.jhealeco.2018.11.002..
Keywords: Health Insurance, Healthcare Utilization, Low-Income, Medicaid, Medication
Patil SJ, Koopman RJ, Belden J
The role of home BP monitoring: answers to 10 common questions.
This review examines what role home blood-pressure monitoring (HBPM) should take in the management of patients with hypertension. The answers to ten evidence-based questions, with reference to USPSTF recommendations, are used to provide insight. These questions include: Can HPBM be used to confirm a hypertension diagnosis? What are the diagnostic and treatment targets for HBPM? Does HBPM improve control of hypertension? Does HBPM help improve medication adherence? Does HBPM improve BP outcomes?
AHRQ-funded; HS023328.
Citation: Patil SJ, Koopman RJ, Belden J .
The role of home BP monitoring: answers to 10 common questions.
J Fam Pract 2019 Jan/Feb;68(1):29-33..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Home Healthcare, Evidence-Based Practice, Care Management, Guidelines
Lee JH, Nuthall G, Ikeyama T
Tracheal intubation practice and safety across international PICUs: a report from national emergency airway registry for children.
Researchers hypothesized that there would be differences in the process of care and adverse outcomes for tracheal intubation across pediatric ICUs (PICUs) in six different geographical regions: Germany, Japan, Singapore, India, New Zealand, and North America. Adverse tracheal intubation-associated events and desaturation occurrences in PICUS in these regions were evaluated, and the international PICUs compared with those in North America. The proportion of tracheal intubations for endotracheal tube change was greater in international PICUs, and the median age for international tracheal intubations was younger when compared with North America PICUs. Occurrences of adverse tracheal intubation-associated events were slightly lower for international than for North American PICUs, except for Germany and Japan, which were slightly higher.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Lee JH, Nuthall G, Ikeyama T .
Tracheal intubation practice and safety across international PICUs: a report from national emergency airway registry for children.
Pediatr Crit Care Med 2019 Jan;20(1):1-8. doi: 10.1097/pcc.0000000000001782..
Keywords: Adverse Events, Care Management, Children/Adolescents, Intensive Care Unit (ICU), Respiratory Conditions, Outcomes, Patient Safety
Srinivas P, Campbell NL, Clark DO
Understanding older adults' medication decision making and behavior: a study on over-the-counter (OTC) anticholinergic medications.
The purpose of this study was to inform the design of future over the counter (OTC) medication safety interventions for older adults, this study investigated consumers' decision making and behavior related to OTC medication purchasing and use, with a focus on OTC anticholinergic medications. Drawing on study findings and behavioral theories, the model depicted dual processes for OTC medication decision making - habit-based and deliberation-based - as well as the antecedents and consequences of decision making.
AHRQ-funded; HS024384.
Citation: Srinivas P, Campbell NL, Clark DO .
Understanding older adults' medication decision making and behavior: a study on over-the-counter (OTC) anticholinergic medications.
Res Social Adm Pharm 2019 Jan;15(1):53-60. doi: 10.1016/j.sapharm.2018.03.002..
Keywords: Decision Making, Elderly, Medication, Medication: Safety, Patient Safety
Dowding D, Merrill JA, Barron Y
Usability evaluation of a dashboard for home care nurses.
Usability tests were conducted on a creation of a dashboard prototype for home care nurses for their patients’ electronic health records (EHRs). The prototype was created by first observing and interviewing several nurses; getting feedback on paper versions of the dashboard; and then a usability evaluation of the electronic prototype. The dashboard was positively evaluated.
AHRQ-funded; HS023855.
Citation: Dowding D, Merrill JA, Barron Y .
Usability evaluation of a dashboard for home care nurses.
Comput Inform Nurs 2019 Jan;37(1):11-19. doi: 10.1097/cin.0000000000000484..
Keywords: Health Information Technology (HIT), Home Healthcare, Nursing, Provider
Wang S, Allen D, Perkins A
Validation of a new clinical tool for post-intensive care syndrome.
The objective of this study was to validate the self-report version of the Healthy Aging Brain Care Monitor as a clinical tool for detecting post-intensive care syndrome. 142 patients who survived stays in intensive care units (ICUs) following a critical illness completed the self-report and standardized assessments of their cognition, their psychological symptoms, and physical functioning. Patients who had post-ICU syndrome were compared with a sample of primary care patients. Based on their findings, the researchers conclude that the self-report version is a valid clinical tool for the assessment of symptoms of post-ICU syndrome.
AHRQ-funded; HS024384.
Citation: Wang S, Allen D, Perkins A .
Validation of a new clinical tool for post-intensive care syndrome.
Am J Crit Care 2019 Jan;28(1):10-18. doi: 10.4037/ajcc2019639..
Keywords: Diagnostic Safety and Quality, Intensive Care Unit (ICU), Neurological Disorders, Patient Safety
Graham AK, Minc A, Staab E
Validation of the computerized adaptive test for mental health in primary care.
This study compared the use of a computerized assessment tool with paper questionnaires to diagnose major depressive disorder (MDD) and general anxiety disorder (GAD). It was found that the majority of patients in the study preferred the computerized adaptive testing tool. Diagnostic accuracy of the tool was similar or higher than many of the traditional screening methods.
AHRQ-funded; HS000078.
Citation: Graham AK, Minc A, Staab E .
Validation of the computerized adaptive test for mental health in primary care.
Ann Fam Med 2019 Jan;17(1):23-30. doi: 10.1370/afm.2316..
Keywords: Anxiety, Depression, Diagnostic Safety and Quality, Behavioral Health, Primary Care, Screening
Karandikar MV, Coffin SE, Priebe GP
Variability in antimicrobial use in pediatric ventilator-associated events.
This article describes a study which assesses variability in antimicrobial use and associations with infection testing in pediatric ventilator-associated events (VAEs). 192 patients with ventilator-associated conditions were identified in neonatal, pediatric, and cardiac ICUs in six hospitals. Type and duration of antimicrobial use varied by ICU type. The authors conclude that antimicrobial use is common in pediatric ventilator-associated conditions, but pediatric VAP is uncommon; prolonged usage of antimicrobials in spite of low pediatric VAP rates or positive laboratory testing for infection suggests that pediatric ventilator-associated conditions with antimicrobial use for >/= 4 days may provide a lever for antimicrobial stewardship programs to improve utilization.
AHRQ-funded; HS021636.
Citation: Karandikar MV, Coffin SE, Priebe GP .
Variability in antimicrobial use in pediatric ventilator-associated events.
Infect Control Hosp Epidemiol 2019 Jan;40(1):32-39. doi: 10.1017/ice.2018.264..
Keywords: Adverse Events, Antimicrobial Stewardship, Children/Adolescents, Healthcare-Associated Infections (HAIs), Respiratory Conditions