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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 15 of 15 Research Studies DisplayedKim HS, Hernaez R, Sansgiry S
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
The purpose of this study was to determine the comparative effectiveness of varying colonoscopy intervals on colorectal cancer (CRC) outcomes among patients with inflammatory bowel disease (IBD). Data was from the National Veterans Health Administration. Findings showed that, in a national cohort of patients with CRC-IBD, colonoscopy within 3 years prior to CRC diagnosis was associated with early tumor stage at diagnosis, and colonoscopy within 1 year was associated with a reduced all-cause mortality compared with no colonoscopy, supporting colonoscopy intervals of 1 to 3 years in patients with IBD in order to reduce late-stage CRC and all-cause mortality.
AHRQ-funded; HS024122.
Citation: Kim HS, Hernaez R, Sansgiry S .
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
Clin Gastroenterol Hepatol 2022 Dec;20(12):2848-57.e2. doi: 10.1016/j.cgh.2022.02.048..
Keywords: Cancer: Colorectal Cancer, Cancer, Digestive Disease and Health, Imaging, Screening, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research
Arora S, Fowler ME, Harmon C
Differences in pretreatment frailty across gastrointestinal cancers in older adults: results from the Cancer and Aging Resilience Evaluation registry.
The purpose of this study was to explore differences in pretreatment frailty between colorectal (CRC), hepatobiliary, and pancreatic cancers. The researchers included adults aged 60 years and higher enrolled in the Cancer and Aging Resilience Evaluation registry. A 44-item Cancer and Aging Resilience Evaluation frailty index was utilized to define frailty, which included geriatric assessment impairments of functional status, cognitive complaints, health-related quality of life, comorbidities, polypharmacy, anxiety, depression, malnutrition, falls, ability to walk one block, and interference in social activities. A total of 505 patients were included in the study: 41.8% with CRC, 35.2% with pancreatic cancer, and 116 23.0% with hepatobiliary cancer. The study found the following prevalence of frailty: 40.6% pancreatic, 34.3% hepatobiliary, and 23.3% CRC. Frailty was linked with higher rates of malnutrition and instrumental activities of daily living impairments in patients with pancreatic cancer and higher number of comorbidities in patients with hepatobiliary cancer. The study concluded that adults aged 60 and over with pancreatic and hepatobiliary cancers are at high-risk of pretreatment frailty.
AHRQ-funded; HS013852.
Citation: Arora S, Fowler ME, Harmon C .
Differences in pretreatment frailty across gastrointestinal cancers in older adults: results from the Cancer and Aging Resilience Evaluation registry.
JCO Oncol Pract 2022 Nov;18(11):e1796-e806. doi: 10.1200/op.22.00270..
Keywords: Elderly, Cancer, Digestive Disease and Health
Huang RJ, Epplein M, Hamashima C
An approach to the primary and secondary prevention of gastric cancer in the United States.
In 2020, a summit was convened at Stanford University to address the disparity of gastric cancer as a leading cause of mortality among certain racial, ethnic and immigrant groups in the United States, and the absence of a national strategy for addressing gastric cancer prevention. A working group was formed to conduct a structured literature review to critically evaluate the effectiveness, potential benefits, and potential harms of methods of primary and secondary prevention. The purpose of this article was to provide a consensus statement from that group. The authors found that the distribution of gastric cancer rates is highly inequitable and falls primarily on Asian, African American, Hispanic, and American Indian/Alaskan Native populations. The group concluded that there is an urgent need for cancer prevention trials in high-risk minority populations in the United States.
AHRQ-funded; HS026395.
Citation: Huang RJ, Epplein M, Hamashima C .
An approach to the primary and secondary prevention of gastric cancer in the United States.
Clin Gastroenterol Hepatol 2022 Oct;20(10):2218-28.e2. doi: 10.1016/j.cgh.2021.09.039..
Keywords: Cancer, Digestive Disease and Health, Prevention
Shah SC, Bonnet K, Schulte R
Helicobacter pylori management is associated with predominantly negative patient experiences: results from a focused qualitative analysis.
This paper is a qualitative analysis of the patient experience of H. pylori management using a focus group and one-on-one telephone interviews. A total of 13 participants were included (mean age 50.4 years; 62% female; 38% non-Hispanic white). A total of 987 codes were yielded that five major themes related to the patient H. pylori experience: context of decision-making; health beliefs; barriers experienced; cues to action; and impact of new knowledge. The perceived patient-provider interaction contributed most prominently to the negative patient experience along with treatment-related side effects. Knowledge that lack of treatment can lead to gastric cancer along with symptoms modified participants’ perceptions and motivation to accept treatment.
AHRQ-funded; HS026395.
Citation: Shah SC, Bonnet K, Schulte R .
Helicobacter pylori management is associated with predominantly negative patient experiences: results from a focused qualitative analysis.
Dig Dis Sci 2022 Sep;67(9):4387-94. doi: 10.1007/s10620-021-07320-8..
Keywords: Digestive Disease and Health, Patient Experience
Kanters AE, Evilsizer SK, Regenbogen SE
Correlation of colorectal surgical skill with patient outcomes: a cautionary tale.
Some have proposed that video-based skill assessments be used as a way to measure technical skills, quality improvement, and credentialing in colorectal surgeons and other practitioners. However, it must first be determined whether video-based assessments can accurately predict patient outcomes. The researchers assembled a panel of 10 peer surgeons to evaluate videos of minimally invasive colectomy procedures submitted by 21 surgeons. Each surgeon submitted one video, and the videos were edited to highlight key steps in the procedure. The panel and the surgeon participants were all associated with the Michigan Surgical Quality Collaborative. The panel used a validated American Society of Colon and Rectal Surgeons assessment instrument to rate the surgeon’s skills. The surgeon’s ratings were then linked to a validated registry of surgical outcomes, and the researchers assessed the relationship between skill level and risk-adjusted complication rates. The researchers found that after risk-adjustment there was no statistically significant difference in complication rates between the bottom (17.5%) and top (16.8%) quartile surgeons (p=0.41). The study concluded that there was no correlation between video-based peer rating of minimally invasive colectomy and postoperative complications among specialty surgeons, and that caution should be used when utilizing video review in credentialing.
AHRQ-funded; HS025365.
Citation: Kanters AE, Evilsizer SK, Regenbogen SE .
Correlation of colorectal surgical skill with patient outcomes: a cautionary tale.
Dis Colon Rectum 2022 Mar;65(3):444-51. doi: 10.1097/dcr.0000000000002124..
Keywords: Surgery, Provider: Physician, Provider Performance, Digestive Disease and Health, Outcomes
Dos Santos Marques IC, Herbey II, Theiss LM
Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): the importance of health literacy.
The purpose of this qualitative study was to describe the surgical experience for Black and White inflammatory bowel disease patients. Same race, semi-structured qualitative interviews with patients with IBD who had undergone surgery were conducted to explore barriers and facilitators to a positive or negative surgical experience. The study reported that 6 focus groups were conducted with 10 Black and 17 White IBD participants with a mean age of 44.8 years, 52% of whom were male and 65% of whom had Crohn’s disease. Four themes were identified that most characterized the surgical experience: the impact of the IBD diagnosis, the quality of the information that was provided, disease management, and the surgery. Within these theme groupings, identified barriers to a positive surgical experience included inadequate personal knowledge of IBD, ineffective written and verbal communication, lack of a support system and complications after surgery. Both groups indicated that information was provided inconsistently which led to unclear expectations of surgical outcomes. The study concluded that surgical experiences vary between Black and White patients, but both groups emphasized the need for understandable, accurate, and trustworthy health information.
AHRQ-funded; HS023009; HS013852.
Citation: Dos Santos Marques IC, Herbey II, Theiss LM .
Understanding the surgical experience for Black and White patients with inflammatory bowel disease (IBD): the importance of health literacy.
Am J Surg 2022 Feb;223(2):303-11. doi: 10.1016/j.amjsurg.2021.06.003..
Keywords: Health Literacy, Surgery, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Digestive Disease and Health, Patient Experience
Ingraham NE, King S, Proper J
Morbidity and mortality trends of pancreatitis: an observational study.
The authors assessed temporal trends of incidence, complications, management, and outcomes for acute pancreatitis in hospitalized patients at the national level. Using HCUP data, they found that the incidence of pancreatitis, from 2008 to 2015, has increased whereas inpatient mortality has decreased.
AHRQ-funded; HS026732.
Citation: Ingraham NE, King S, Proper J .
Morbidity and mortality trends of pancreatitis: an observational study.
Surg Infect 2021 Dec;22(10):1021-30. doi: 10.1089/sur.2020.473..
Keywords: Healthcare Cost and Utilization Project (HCUP), Digestive Disease and Health, Mortality
Bajaj JS, Shamsaddini A, Acharya C
Multiple bacterial virulence factors focused on adherence and biofilm formation associate with outcomes in cirrhosis.
This study’s goal was to define the association of bacterial virulence factors (VFs) with cirrhosis severity and infections, their linkage with outcomes, and impact of fecal microbiota transplant (FMT). This case-control study followed 233 subjects (40 controls, 43 compensated, 30 HE-only (hepatic encephalopathy), 20 ascites-only, 70 both, and 30 infected. Stool samples were collected before and after a 90-day FMT trial. Bacterial species and VFs for all species and selected pathogens (Escherichia, Klebsiella, Pseudomonas, Staphylococcus, Streptococcus, and Enterococcus species) were compared between groups. Decompensated patients, especially those with infections, had higher VFs coding versus the rest. Biofilm and adhesion VFs from Enterobacteriaceae and Enterococcus species were associated with death and hospitalizations independent of clinical factors regardless of when all VFs or selected pathogens were analyzed. FMT was associated with reduced VF post-FMT versus pre-FMT and post-placebo.
AHRQ-funded; HS025412.
Citation: Bajaj JS, Shamsaddini A, Acharya C .
Multiple bacterial virulence factors focused on adherence and biofilm formation associate with outcomes in cirrhosis.
Gut Microbes 2021 Jan-Dec;13(1):1993584. doi: 10.1080/19490976.2021.1993584..
Keywords: Digestive Disease and Health
Bajaj JS, Shamsaddini A, Fagan A
Distinct gut microbial compositional and functional changes associated with impaired inhibitory control in patients with cirrhosis.
The authors sought to assess the impact of inhibitory control versus traditional cirrhosis-related cognitive performance on gut microbial composition and function. They found that the gut microbial signature of impaired inhibitory control, which is associated with addictive disorders that can lead to cirrhosis, is distinct from cirrhosis-related cognitive impairment.
AHRQ-funded; HS025412.
Citation: Bajaj JS, Shamsaddini A, Fagan A .
Distinct gut microbial compositional and functional changes associated with impaired inhibitory control in patients with cirrhosis.
Gut Microbes 2021 Jan-Dec;13(1):1953247. doi: 10.1080/19490976.2021.1953247..
Keywords: Digestive Disease and Health
Lumpkin ST, Harvey E, Mihas P
Understanding patients' decisions to obtain unplanned, high-resource health care after colorectal surgery.
Researchers investigated effective strategies to reduce unplanned post-discharge health care visits following colorectal surgery (CRS). They found that interview participants voiced clear mental algorithms about when to visit an emergency department, identified facilitators and barriers to optimal health care use, and identified tangible targets for health care utilization reduction efforts. The researchers concluded that efforts should be directed at improving post-discharge communication and care coordination in order to reduce CRS patients' high-resource health care utilization.
AHRQ-funded; HS026363.
Citation: Lumpkin ST, Harvey E, Mihas P .
Understanding patients' decisions to obtain unplanned, high-resource health care after colorectal surgery.
Qual Health Res 2021 Jul;31(9):1582-95. doi: 10.1177/10497323211002479..
Keywords: Decision Making, Digestive Disease and Health, Surgery
Dos Santos Marques IC, Theiss LM, Wood LN
Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease.
The authors hypothesized that racial disparities exist for Hispanic and Asian patients undergoing surgery for inflammatory bowel disease (IBD). Data from the American College of Surgeons National Surgical Quality Improvement Program (ACS- NSQIP) was used. They found that racial disparities do exist among IBD patients undergoing surgery. Black, Hispanic, and Asian IBD patients experience major disparities in post-operative complications, readmissions, and length of stay, respectively, when compared to White patients with IBD. They recommended future research to better understand the mechanisms of these disparities including evaluation of social determinants of health.
AHRQ-funded; HS023009.
Citation: Dos Santos Marques IC, Theiss LM, Wood LN .
Racial disparities exist in surgical outcomes for patients with inflammatory bowel disease.
Am J Surg 2021 Apr;221(4):668-74. doi: 10.1016/j.amjsurg.2020.12.010..
Keywords: Disparities, Racial and Ethnic Minorities, Surgery, Digestive Disease and Health, Outcomes
Shah SC, Zhu X, Dai Q
Magnesium intake is associated with a reduced risk of incident liver cancer, based on an analysis of the NIH-American Association of Retired Persons (NIH-AARP) Diet and Health Study prospective cohort.
Liver cancer incidence and mortality are escalating globally. Magnesium intake has been studied extensively in nonmalignant liver pathology, but the association between dietary intake of magnesium and primary liver malignancy has not been previously evaluated. In this study, investigators aimed to determine the association between total magnesium intake and primary liver cancer risk. The investigators concluded that based on their prospective cohort analysis, magnesium intake was associated with a lower risk of primary liver cancer, which was more pronounced among moderate and heavy alcohol users.
AHRQ-funded; HS026395.
Citation: Shah SC, Zhu X, Dai Q .
Magnesium intake is associated with a reduced risk of incident liver cancer, based on an analysis of the NIH-American Association of Retired Persons (NIH-AARP) Diet and Health Study prospective cohort.
Am J Clin Nutr 2021 Mar 11;113(3):630-38. doi: 10.1093/ajcn/nqaa326..
Keywords: Cancer, Risk, Digestive Disease and Health, Prevention
Fischer CP, Knapp L, Cohen ME
Feasibility of enhanced recovery in emergency colorectal operation.
This study examines the feasibility of using enhanced recovery pathways (ERPs) in emergency colorectal operations. It has been successfully used with elective surgical care but has not been examined for emergency procedures. A total of 31,511 patients who underwent colorectal operations at 235 hospitals were identified from a national ERP collaborative. Most were elective surgeries (28,425), with 3,086 emergencies. For emergency cases, rates of early Foley removal and venous thromboembolism prophylaxis were highest. Rates of multimodal pain control, early mobilization, and early liquid intake were modest. Patients younger than age 65 years, those with independent functional status, American Society of Anesthesiologists Physical Status Classification 1 to 3, and without physiologic derangement had the most nonadherence. Lack of mobilization or liquid intake was independently associated with increased odds of ileus and prolonged length of stay.
AHRQ-funded; 233201500020I.
Citation: Fischer CP, Knapp L, Cohen ME .
Feasibility of enhanced recovery in emergency colorectal operation.
J Am Coll Surg 2021 Feb;232(2):178-85. doi: 10.1016/j.jamcollsurg.2020.10.004..
Keywords: Surgery, Digestive Disease and Health, Emergency Department, Patient-Centered Outcomes Research, Outcomes
Diaz A, Ricci KB, Rushing AP
Re-examining "never letting the sun rise or set on a bowel obstruction" in the era of acute care surgery.
This study looked at factors linked to emergency surgery practices for small bowel obstruction (SBO) as opposed to non-operative treatment. Data from adult SBO patients from 17 Statewide Inpatient Databases (SIDS) was linked to the authors’ 2015 survey on emergency general surgery (EGS) practices including queries on operating room (OR) availability and surgical staffing. Of the 32,422 SBO patients identified, 83% were treated non-operatively. Operative patients tended to be older, had more comorbidities (53% vs. 46% with 3 or greater), and experienced more systemic complications (36% vs. 23%), higher mortality (2.8% vs. 1.4%), and longer length of stay (median 10 vs. 4 days). Patients had higher odds of operation if they were treated at hospitals with surgeons sometimes or rarely/never covering EGS at more than one location compared to always.
AHRQ-funded; HS022694.
Citation: Diaz A, Ricci KB, Rushing AP .
Re-examining "never letting the sun rise or set on a bowel obstruction" in the era of acute care surgery.
J Gastrointest Surg 2021 Feb;25(2):512-22. doi: 10.1007/s11605-019-04496-3..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Digestive Disease and Health
Lumpkin ST, Mihas P, Baldwin X
Surgical patient values frame and modify the impact of risk factors for non-routine postdischarge care: a mixed-methods study.
This mixed methods study looked at patient perspectives on risk factors of non-routine postdischarge care (emergency department visit or rehospitalization) for adult colorectal surgery patients. Surgery patients were identified from hospital records from 2017 to 2018. The authors enrolled 258 participants, surveyed 167, and interviewed 18. Depressive symptoms were found to be one of the many risk factors confirmed to increase non-routine health utilization.
AHRQ-funded; HS026363.
Citation: Lumpkin ST, Mihas P, Baldwin X .
Surgical patient values frame and modify the impact of risk factors for non-routine postdischarge care: a mixed-methods study.
Am J Surg 2021 Jan;221(1):195-203. doi: 10.1016/j.amjsurg.2020.05.016..
Keywords: Digestive Disease and Health, Surgery, Risk, Hospital Readmissions, Emergency Department