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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 17 of 17 Research Studies Displayed
Mejia-Chew c, O'Halloran JA, Olsen MA
Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective, cohort study.
Candida bloodstream infection is associated with high mortality. Infectious disease consultation improves outcomes in several infections, including Staphylococcus aureus and cryptococcosis, as well as multidrug-resistant organisms. In this study, the investigators aimed to examine the association between infectious disease consultation and differences in management with mortality in candida bloodstream infections.
Citation: Mejia-Chew c, O'Halloran JA, Olsen MA . Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective, cohort study. Lancet Infect Dis 2019 Dec;19(12):1336-44. doi: 10.1016/s1473-3099(19)30405-0..
Keywords: Infectious Diseases, Public Health, Mortality
Brault MA, Spiegelman D, Hargreaves J
Treatment as prevention: concepts and challenges for reducing HIV incidence.
This paper reviews the results and lessons learned from four large-scale HIV antiretroviral therapy (ART) clinical trials that were held in sub-Saharan Africa to reduce HIV transmission. These trials used treatment as prevention (TasP) to improve overall health and protect HIV-uninfected sexual partners from infection. There were seemingly inconsistent findings in the major TasP trials held in South African, Kenya, Uganda, Botswana, and Zambia. The review highlighted implementation challenges and identified approaches to optimize programs and incentivize uptake and engagement in HIV testing and ART-based care.
Citation: Brault MA, Spiegelman D, Hargreaves J . Treatment as prevention: concepts and challenges for reducing HIV incidence. J Acquir Immune Defic Syndr 2019 Dec 1;82 Suppl 2:S104-s12. doi: 10.1097/qai.0000000000002168..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Infectious Diseases, Public Health, Screening
Springs S, Rofeberg V, Brown S
Community-engaged evidence synthesis to inform public health policy and clinical practice: a case study.
This case study documents the work of the Rhode Island Arts and Health Advisory Group, which convened in 2016 to develop a set of policy, clinical practice, and research recommendations for implementation by the Rhode Island Department of Health, The Rhode Island State Council on the Arts, and partners. Comprised of artists, clinicians, community members, and patients, the group partnered with researchers to complete an evidence synthesis project of arts-based health care interventions.
AHRQ-funded; HS023299; HS022998.
Citation: Springs S, Rofeberg V, Brown S . Community-engaged evidence synthesis to inform public health policy and clinical practice: a case study. Med Care 2019 Oct;57 Suppl 10 Suppl 3:S253-s58. doi: 10.1097/mlr.0000000000001180..
Keywords: Public Health, Policy, Case Study, Evidence-Based Practice, Implementation, Patient-Centered Outcomes Research
Ji W, McKenna C, Ochoa A
Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia.
The authors sought to propose and assess potentially objective, efficient, and reproducible surveillance definitions for non-ventilator hospital-acquired pneumonia (NV-HAP) using routine clinical data stored in electronic health record systems. They found that objective surveillance for NV-HAP using electronically computable definitions that incorporate common clinical criteria is feasible and generates incidence, mortality, and adjusted odds ratios for hospital mortality similar to estimates from manual surveillance. They concluded that these definitions have the potential to facilitate widespread, automated surveillance for NV-HAP and thus inform the development and evaluation of prevention programs.
Citation: Ji W, McKenna C, Ochoa A . Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia. JAMA Netw Open 2019 Oct 2;2(10):e1913674. doi: 10.1001/jamanetworkopen.2019.13674..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Respiratory Conditions, Public Health, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bacon E, Budney G, Bondy J
Developing a regional distributed data network for surveillance of chronic health conditions: the Colorado Health Observation Regional Data Service.
This article describes attributes of regional distributed data networks using electronic health records (EHR) data and the history and design of Colorado Health Observation Regional Data Service as an emerging public health surveillance tool for chronic health conditions. The authors indicate that while benefits from EHR-based surveillance are described, a number of technology, partnership, and value proposition challenges remain.
Citation: Bacon E, Budney G, Bondy J . Developing a regional distributed data network for surveillance of chronic health conditions: the Colorado Health Observation Regional Data Service. J Public Health Manag Pract 2019 Sep/Oct;25(5):498-507. doi: 10.1097/phh.0000000000000810..
Keywords: Chronic Conditions, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Public Health
Bartsch SM, Asti L, Cox SN
What is the value of different Zika vaccination strategies to prevent and mitigate Zika outbreaks?
The authors developed models of Honduras, Brazil, and Puerto Rico, simulated targeting different populations for Zika vaccination, and then introduced various Zika outbreaks. Their models showed that, when considering transmission, while vaccinating everyone naturally averted the most cases, specifically targeting women of childbearing age or young adults was the most cost-effective.
Citation: Bartsch SM, Asti L, Cox SN . What is the value of different Zika vaccination strategies to prevent and mitigate Zika outbreaks? J Infect Dis 2019 Aug 9;220(6):920-31. doi: 10.1093/infdis/jiy688..
Keywords: Healthcare Costs, Vaccination, Value, Public Health, Infectious Diseases
Chu KH, Colditz J, Malik M
Identifying key target audiences for public health campaigns: leveraging machine learning in the case of hookah tobacco smoking.
Current social media platforms provide researchers with opportunities to better identify and target specific audiences and even individuals. However, the investigators were not aware of systematic research attempting to identify audiences with mixed or ambivalent views toward hookah tobacco smoking (HTS). The objective of their study was to (1) confirm previous research showing positively skewed HTS sentiment on Twitter using a larger dataset by leveraging machine learning techniques and (2) systematically identify individuals who exhibit mixed opinions about HTS via the Twitter platform and therefore represent key audiences for intervention.
Citation: Chu KH, Colditz J, Malik M . Identifying key target audiences for public health campaigns: leveraging machine learning in the case of hookah tobacco smoking. J Med Internet Res 2019 Jul 8;21(7):e12443. doi: 10.2196/12443..
Keywords: Health Promotion, Public Health, Social Media, Tobacco Use, Tobacco Use: Smoking Cessation
Livingston CJ, Allison RD, Niebuhr DW
AHRQ Author: Niebuhr DW
Preventive medicine physicians and the Centers for Disease Control and Prevention's 6|18 Initiative.
This paper describes the American College of Preventive Medicine (ACPM) and Centers for Disease Control and Prevention (CDC) work done as part of the cooperative 5-year agreement called the 6|18 Initiative to improve population health through primary care and public health integration. This initiative is called 6|18 because its’ aim was to target six common and high-cost health behaviors/conditions with 18 proven interventions. CDC created three different buckets to describe the preventions. The six health behaviors/conditions targeted included reducing tobacco use, control high blood pressure, improve antibiotic use, control asthma, prevent unintended pregnancy, and prevent type 2 diabetes. The initiative aligned recommendations from national and professional societies and focused the guidelines from the U.S. Preventive Services Task Force (USPSTF). After six telephone-moderated discussions of the authors, three themes were developed as to how physicians may perceive the 6|18 interventions. The problems included lack of knowledge/awareness, variations in financial incentives and operational challenges such as time constraints.
Citation: Livingston CJ, Allison RD, Niebuhr DW . Preventive medicine physicians and the Centers for Disease Control and Prevention's 6|18 Initiative. Am J Prev Med 2019 Jul;57(1):127-33. doi: 10.1016/j.amepre.2019.02.014..
Keywords: Hypertension, Medication, Pregnancy, Prevention, Primary Care, Public Health, Tobacco Use, U.S. Preventive Services Task Force (USPSTF)
Malloy GSP, Brandeau ML, Goldhaber-Fiebert JD
Modeling the cost-effectiveness of interventions to prevent plague in Madagascar.
The authors assessed the cost-effectiveness of plague (Yersinia pestis) control interventions recommended by the World Health Organization with particular consideration to intervention coverage and timing. They calculated costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios from a healthcare perspective. The preferred intervention, using a cost-effectiveness threshold of $1350/QALY, was expanded access to antibiotic treatment with doxycycline with 100% coverage starting immediately after the first reported case, gaining 543 QALYs at an incremental cost of $1023/QALY gained. Sensitivity analyses support expanded access to antibiotic treatment and leave open the possibility that mass distribution of doxycycline prophylaxis or mass distribution of malathion could be cost-effective.
Citation: Malloy GSP, Brandeau ML, Goldhaber-Fiebert JD . Modeling the cost-effectiveness of interventions to prevent plague in Madagascar. Trop Med Infect Dis 2021 Jun 11;6(2). doi: 10.3390/tropicalmed6020101..
Keywords: Infectious Diseases, Healthcare Costs, Public Health, Prevention
Lee BY, Bartsch SM, Wong KF
Tracking the spread of carbapenem-resistant Enterobacteriaceae (CRE) through clinical cultures alone underestimates the spread of CRE even more than anticipated.
Clinical testing detects only a fraction of carbapenem-resistant Enterobacteriaceae (CRE) carriers, an estimated 1 of every 9 carriers; therefore, it may underestimate true CRE burden. Because targeted interventions to prevent spread are applied only to known cases, the unseen part of the “iceberg” of CRE carriers can exacerbate pathogen spread through lack of applied contact precautions and other infection prevention strategies. In this study, the investigators estimate the size of the iceberg in a large US metropolitan area.
Citation: Lee BY, Bartsch SM, Wong KF . Tracking the spread of carbapenem-resistant Enterobacteriaceae (CRE) through clinical cultures alone underestimates the spread of CRE even more than anticipated. .
Keywords: Infectious Diseases, Public Health, Prevention
Yoo BK, Schaffer SJ, Humiston SG
Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children.
This paper describes a clinical trial which created a school-located influenza vaccination (SLIV) program in upstate New York. Researchers wanted to determine if this was a cost-effective alternative to vaccination in primary care practices. Two groups of students were vaccinated – one in an elementary school and the other in a secondary school. Secondary school vaccinations were more cost-effective than elementary schools with a lower median cost per vaccination. The authors concluded that it does raise vaccination rates, but it is not cost-effective due to the higher costs for consent systems and project coordination.
Citation: Yoo BK, Schaffer SJ, Humiston SG . Cost effectiveness of school-located influenza vaccination programs for elementary and secondary school children. BMC Health Serv Res 2019 Jun 24;19(1):407. doi: 10.1186/s12913-019-4228-5..
Keywords: Children/Adolescents, Education, Healthcare Costs, Influenza, Public Health, Vaccination, Value
Hessels AJ, Kelly AM, Chen L
Impact of infectious exposures and outbreaks on nurse and infection preventionist workload.
Researchers evaluated workload increases reported by staff nurses and infection preventionists (IPs) in response to common exposures and outbreaks. Using surveys, they concluded that organisms that are easier to treat and more difficult to spread, such as scabies or lice, can contribute substantially to nursing workload. Additionally, three-quarters of the nurses and one-half of the IPs reported that C difficile adds more than one hour to their daily workload.
Citation: Hessels AJ, Kelly AM, Chen L . Impact of infectious exposures and outbreaks on nurse and infection preventionist workload. Am J Infect Control 2019 Jun;47(6):623-27. doi: 10.1016/j.ajic.2019.02.007..
Keywords: Burnout, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Provider: Nurse, Public Health
Woodard JA, Leekha S, Jackson SS
Beyond entry and exit: Hand hygiene at the bedside.
This study assessed compliance with, knowledge of, and attitudes toward the World Health Organization (WHO) 5 moments for hand hygiene (HH) using a modified WHO HH observation form and a survey that assessed health care personnel (HCP) knowledge, opinions, and barriers to HH. Of the 218 HCPs who completed the survey, less than one-third were familiar with the WHO 5 moments and only 21& of that group could recall the 5 moments. 302 HH opportunities in 104 unique HCP-patient interactions were observed, but with infrequent compliance. The researchers conclude that lack of recognition of opportunities at the bedside and for glove use may contribute to low compliance.
Citation: Woodard JA, Leekha S, Jackson SS . Beyond entry and exit: Hand hygiene at the bedside. Am J Infect Control 2019 May;47(5):487-91. doi: 10.1016/j.ajic.2018.10.026..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention, Provider, Public Health
Wedlock PT, Mitgang EA, Oron AP
Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines.
The lack of specific policies on how many children must be present at a vaccinating location before a healthcare worker can open a measles-containing vaccine (MCV) - i.e. the vial-opening threshold - has led to inconsistent practices, which can have wide-ranging systems effects. Using HERMES-generated simulation models of the routine immunization supply chains of Benin, Mozambique and Niger, the investigators evaluated the impact of different vial-opening thresholds (none, 30% of doses must be used, 60%) and MCV presentations (10-dose, 5-dose) on each supply chain.
Citation: Wedlock PT, Mitgang EA, Oron AP . Modeling the economic impact of different vial-opening thresholds for measles-containing vaccines. Vaccine 2019 Apr 17;37(17):2356-68. doi: 10.1016/j.vaccine.2019.03.017..
Keywords: Vaccination, Infectious Diseases, Healthcare Costs, Public Health
Vaidyanathan A, Saha S, Vicedo-Cabrera AM
AHRQ Author: Elixhauser A
Assessment of extreme heat and hospitalizations to inform early warning systems.
The purpose of this study was to conduct multistate analyses to explore associations between heat and all-cause and cause-specific hospitalizations, in order to inform the design and development of heat-health early warning systems. Researchers used a two-stage analysis to estimate heat-health risk relationships between heat index and hospitalizations, then used the results to identify heat index ranges that corresponded with a significant heat-attributable burden and compared these to National Weather Service (NWS) heat alert criteria used during the same time period. The study’s conclusions suggest that locally specific health evidence can inform and calibrate heat alert criteria.
Citation: Vaidyanathan A, Saha S, Vicedo-Cabrera AM . Assessment of extreme heat and hospitalizations to inform early warning systems. Proc Natl Acad Sci U S A 2019 Mar 19;116(12):5420-27. doi: 10.1073/pnas.1806393116..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Public Health, Risk
Pogorzelska-Maziarz M, de Cordova PB, Herzig M, de Cordova PB, Herzig CTA
Perceived impact of state-mandated reporting on infection prevention and control departments.
Currently, most US states have adopted legislation requiring hospitals to submit health care-associated infection (HAI) data. In this study, the authors evaluated the perceived impact of state HAI laws on infection prevention and control (IPC) departments. They concluded that respondents in states with laws reported negative effects on their IPC department, beyond what was required by federal mandates.
Citation: Pogorzelska-Maziarz M, de Cordova PB, Herzig M, de Cordova PB, Herzig CTA . Perceived impact of state-mandated reporting on infection prevention and control departments. Am J Infect Control 2019 Feb;47(2):118-22. doi: 10.1016/j.ajic.2018.08.012..
Keywords: Public Reporting, Policy, Public Health, Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Hospitals
Zelner J, Adams C, Havumaki J
Understanding the importance of contact heterogeneity and variable infectiousness in the dynamics of a large norovirus outbreak.
Large norovirus (NoV) outbreaks are explosive in nature and vary widely in final size and duration, suggesting that superspreading combined with heterogeneous contact may explain these dynamics. Modeling tools that can capture heterogeneity in infectiousness and contact are important for NoV outbreak prevention and control, yet they remain limited. In this study, the investigators examined the importance of contact heterogeneity and variable infectiousness in the dynamics of a large norovirus outbreak.
Citation: Zelner J, Adams C, Havumaki J . Understanding the importance of contact heterogeneity and variable infectiousness in the dynamics of a large norovirus outbreak. Clin Infect Dis 2020 Jan 16;70(3):493-500. doi: 10.1093/cid/ciz220..
Keywords: Infectious Diseases, Public Health