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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 25 of 36 Research Studies Displayed
Rhee TG, Sint K, Olfson M
Association of ECT with risks of all-cause mortality and suicide in older Medicare patients.
This observational study examined the effects of electroconvulsive therapy (ECT) on suicide and all-cause mortality risk in Medicare psychiatric patients age 65 or older. Patients receiving ECT were exact matched to control subjects in a 1-to-3 ratio on age, gender, principal hospital diagnosis, past-year psychiatric hospitalizations, past-year suicide attempts, and Elixhauser comorbidity index. A total of 10,46 patients were in the ECT group and 31,160 in the control group. Compared with the control group, patients receiving ECT had lower all-cause mortality for up to 1 year following hospital discharge. For death by suicide, ECT was associated with short-lived effects which waned over time.
Citation: Rhee TG, Sint K, Olfson M . Association of ECT with risks of all-cause mortality and suicide in older Medicare patients. Am J Psychiatry 2021 Dec;178(12):1089-97. doi: 10.1176/appi.ajp.2021.21040351..
Keywords: Elderly, Behavioral Health, Mortality, Treatments
Ching JH, Owens DK, Trafton JA
Impact of treatment duration on mortality among Veterans with opioid use disorder in the United States Veterans Health Administration.
This study used simulation of a Veterans Health Administration cohort to identify the opioid use disorder (OUD) treatment durations necessary for the elevated mortality risks during treatment transitions balanced by reductions in mortality while receiving medication-assisted treatment (MAT) with methadone or buprenorphine. A simulated cohort of 10,000 individuals with OUD was created by using parameters obtained through calibration and published meta-analyses of studies from North America, Europe, and Australia. Methadone treatment for 4 months or longer or buprenorphine for 2 months or longer resulted in 54 and 65 fewer deaths relative to not receiving MAT for the same duration. The authors estimated shorter treatment durations necessary to achieve net mortality benefits of 2 months or longer for methadone and 1 month or longer for buprenorphine. Necessary treatment increased more with smaller mortality reductions on treatment with larger relative risks during treatment transitions.
AHRQ-funded; HS027935; HS026128.
Citation: Ching JH, Owens DK, Trafton JA . Impact of treatment duration on mortality among Veterans with opioid use disorder in the United States Veterans Health Administration. Addiction 2021 Dec;116(12):3494-503. doi: 10.1111/add.15574.
AHRQ-funded; HS027935; HS026128..
AHRQ-funded; HS027935; HS026128..
Keywords: Opioids, Substance Abuse, Behavioral Health, Veterans, Mortality
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.
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
Orth J, Li Y, Simning A
Nursing home residents with dementia: association between place of death and patient safety culture.
This study examined the association of place of death and patient safety culture among nursing home (NH) residents with dementia. The authors examined the estimated effects of patient safety culture (PSC) among 11,957 long-stay NH residents with dementia, aged 65+ who died in NHs or hospitals shortly following discharge from one of 800 US NHs in 2017. Residents with dementia in NHs with higher PSC scores in communication openness had lower odds of in-hospital death, with the strongest effect in NHs located in states with higher minimum NH nurse staffing requirements.
Citation: Orth J, Li Y, Simning A . Nursing home residents with dementia: association between place of death and patient safety culture. Gerontologist 2021 Nov 15;61(8):1296-306. doi: 10.1093/geront/gnaa188..
Keywords: Elderly, Dementia, Nursing Homes, Mortality, Patient Safety
Alagoz O, Lowry KP, Kurian AW
Impact of the COVID-19 pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling.
This study’s objective was to project the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. Three established Cancer Intervention and Surveillance Modeling Network breast cancer models were used to model reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. The models project by 2030 950 cumulative excess breast cancers deaths related to reduced screening, 1314 deaths associated with delayed diagnosis of symptomatic cases, and 151 deaths associated with reduced chemotherapy use in women with hormone positive, early-stage cancer.
Citation: Alagoz O, Lowry KP, Kurian AW . Impact of the COVID-19 pandemic on breast cancer mortality in the US: estimates from collaborative simulation modeling. J Natl Cancer Inst 2021 Nov 2;113(11):1484-94. doi: 10.1093/jnci/djab097..
Keywords: COVID-19, Cancer: Breast Cancer, Cancer, Mortality, Women
Greenwood-Ericksen M, Kamdar N, Lin P
Association of rural and critical access hospital status with patient outcomes after emergency department visits among Medicare beneficiaries.
This study compared 30-day mortality rates after emergency department (ED) visits to rural or critical access hospitals (CAHs) compared to urban hospitals for Medicare beneficiaries. A 20% sample of Medicare beneficiaries was used from January 2011 to October 31, 2015. The primary outcome measured was 30-day mortality. Secondary outcome examined was ED visits with and without rehospitalization. Mortality rates were comparable with both groups, although patients in rural EDs experienced more transfers and less hospitalization.
Citation: Greenwood-Ericksen M, Kamdar N, Lin P . Association of rural and critical access hospital status with patient outcomes after emergency department visits among Medicare beneficiaries. JAMA Netw Open 2021 Nov;4(11):e2134980. doi: 10.1001/jamanetworkopen.2021.34980..
Keywords: Hospitals, Rural Health, Urban Health, Emergency Department, Mortality, Outcomes
Arntson E, Dimick JB, Nuliyalu U
Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program.
This study evaluated changes in Hospital-Acquired Conditions (HACs) and 30-day mortality after the announcement of the Centers for Medicare and Medicare Services’ Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The authors evaluated models to test for changes in HACs and 30-day mortality before and after the Affordable Care Act (ACA), and after the HACRP. Fee-for-service Medicare claims from 2009 to 2015 were used. The HAC rate declined after the ACA was passed and declined further after the HACRP announcement. However, 30-day mortality rates were unchanged.
Citation: Arntson E, Dimick JB, Nuliyalu U . Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program. Ann Surg 2021 Oct 1;274(4):e301-e07. doi: 10.1097/sla.0000000000003641..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Mortality, Medicare, Payment, Prevention, Patient Safety
Bongiovanni T, Hernandez S, Ledesma Y
Surviving traumatic injury, only to die of acute drug poisoning: should trauma centers be a path for intervention?
This study’s objective was to determine the incidence and characteristics of and risk factors for trauma patients suffering death by unintentional drug overdose. This retrospective chart review was conducted on all admitted trauma patients 18 years or older at the only level-1 trauma center in the San Francisco area from 2012 to 2012, matched with unintentional overdose decedents from the California death registry. Of 9,860 patients residing in San Francisco at the time of their trauma during the study period 1,418 died, 107 (0.3/100 person-years) from unintentional overdose. Overdose decedents were 84% male, 50% white, with a mean age of 48 years. Twenty percent of deaths occurred within 3 months of hospitalization, and 40% were attributed to a prescription opioid.
AHRQ-funded; HS026383; 233201500020I.
Citation: Bongiovanni T, Hernandez S, Ledesma Y . Surviving traumatic injury, only to die of acute drug poisoning: should trauma centers be a path for intervention? Surgery 2021 Oct;170(4):1249-54. doi: 10.1016/j.surg.2021.03.003.
AHRQ-funded; HS026383; 233201500020I..
AHRQ-funded; HS026383; 233201500020I..
Keywords: Trauma, Medication, Risk, Mortality
Stevens JP, Dechen T, Schwartzstein RM
Association of dyspnoea, mortality and resource use in hospitalised patients.
As many as one in 10 patients experience dyspnoea at hospital admission but the relationship between dyspnoea and patient outcomes is unknown. In this study, the investigators sought to determine whether dyspnoea on admission predicts outcomes. They conducted a retrospective cohort study in a single, academic medical centre. They analysed 67 362 consecutive hospital admissions with available data on dyspnoea, pain and outcomes.
Citation: Stevens JP, Dechen T, Schwartzstein RM . Association of dyspnoea, mortality and resource use in hospitalised patients. Eur Respir J 2021 Sep 2;58(3). doi: 10.1183/13993003.02107-2019..
Keywords: Respiratory Conditions, Mortality, Outcomes
Papaleontiou M, Norton EC, Reyes-Gastelum D
Competing causes of death in older adults with thyroid cancer.
Understanding the impact of comorbidities and competing risks of death when caring for older adults with thyroid cancer is key for personalized management. The objective of this study was to determine whether older adults with thyroid cancer are more likely to die from thyroid cancer or other etiologies and determine patient factors associated with each.
Citation: Papaleontiou M, Norton EC, Reyes-Gastelum D . Competing causes of death in older adults with thyroid cancer. Thyroid 2021 Sep;31(9):1359-65. doi: 10.1089/thy.2020.0929..
Keywords: Elderly, Cancer, Mortality
Klein IA, Rosenberg SM, Reynolds KL
Impact of cancer history on outcomes among hospitalized patients with COVID-19.
Researchers investigated whether a current cancer diagnosis or cancer history is an independent risk factor for death in hospitalized patients with COVID-19. They found that patients with a history of cancer hospitalized for COVID-19 had similar mortality to matched hospitalized patients with COVID-19 without cancer, and a lower risk of complications, while patients with active cancer or recent cancer treatment had a similar risk for adverse outcomes compared with survivors of cancer. They concluded that active cancer, systemic cancer therapy, and a cancer history are not independent risk factors for death from COVID-19 among hospitalized patients, and hospitalized patients without cancer are more likely to have severe COVID-19.
Citation: Klein IA, Rosenberg SM, Reynolds KL . Impact of cancer history on outcomes among hospitalized patients with COVID-19. Oncologist 2021 Aug;26(8):685-93. doi: 10.1002/onco.13794..
Keywords: COVID-19, Cancer, Risk, Mortality, Hospitalization, Outcomes
Dixon BE, Grannis SJ, Lembcke LR
The synchronicity of COVID-19 disparities: statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America.
Researchers sought to examine trends in COVID-19 morbidity, hospitalization, and mortality over time for minority and rural populations, especially during the U.S. fall surge. Data were taken from a statewide cohort of adult residents in Indiana tested for SARS-CoV-2 infection. The researchers found that, by the fall of 2020, hospitalization and mortality rates in rural areas surpassed those of urban areas, and gaps between black/brown and white populations narrowed. Cumulative morbidity and mortality were highest among minority groups and in rural communities. They concluded that the synchronicity of disparities in COVID-19 by race and geography suggested that health officials explicitly measure disparities and adjust mitigation as well as vaccination strategies to protect those sub-populations with greater disease burden.
Citation: Dixon BE, Grannis SJ, Lembcke LR . The synchronicity of COVID-19 disparities: statewide epidemiologic trends in SARS-CoV-2 morbidity, hospitalization, and mortality among racial minorities and in rural America. PLoS One 2021 Jul 23;16(7):e0255063. doi: 10.1371/journal.pone.0255063..
Keywords: COVID-19, Disparities, Racial / Ethnic Minorities, Hospitalization, Mortality, Rural Health
Chandran A, Xu C, Gross J
A web-based tool for quantification of potential gains in life expectancy by preventing cause-specific mortality.
In collaboration with the Baltimore City Health Department, the authors aimed to develop a web-based tool to estimate the potential lives saved and gains in life expectance (LE) in specific neighborhoods following interventions targeting achievable reductions in preventable deaths. Using the PROLONGER (ImPROved LONGEvity through Reductions in Cause-Specific Deaths) tool, they found that, if heart disease deaths could be reduced by 20% in a given neighborhood in Baltimore City, there could be up to a 2.3-year increase in neighborhood LE. Further, the neighborhoods with highest expected LE increase are not the same as those with highest heart disease mortality burden or lowest overall life expectancies. They concluded that focusing programs based on potential LE impact at the neighborhood level could lend new information for targeting of place-based public health interventions.
Citation: Chandran A, Xu C, Gross J . A web-based tool for quantification of potential gains in life expectancy by preventing cause-specific mortality. Front Public Health 2021 Jul 1;9:663825. doi: 10.3389/fpubh.2021.663825..
Keywords: Mortality, Health Information Technology (HIT)
Burris HH, Passarella M, Handley SC
Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status.
This study’s objective was to determine whether black-white disparities in maternal in-hospital mortality during delivery vary across hospital types (black-serving vs non-black and teaching vs non-teaching) and whether overall maternal mortality differs across hospital types. The authors performed a population-based, retrospective cohort study of 5,679,044 deliveries among black (14.2%) and white patients (85.8%) in 3 states (California, Missouri, and Pennsylvania) from 1995 to 2009. Examination of black-white disparities found that after risk adjustment, black patients had significantly greater risk of death and that the disparity was similar within each of the hospital types. At teaching hospitals, mortality was similar in black-serving and nonblack-serving hospitals. Among non-teaching hospitals, mortality was significantly higher in black-serving vs nonblack-serving hospitals. Over half (53%) of black patients delivered in nonteaching black-serving hospitals compared with just 19% of white patients.
Citation: Burris HH, Passarella M, Handley SC . Black-white disparities in maternal in-hospital mortality according to teaching and black-serving hospital status. Am J Obstet Gynecol 2021 Jul;225(1):83.e1-83.e9. doi: 10.1016/j.ajog.2021.01.004..
Keywords: Maternal Care, Pregnancy, Mortality, Women, Racial / Ethnic Minorities, Disparities, Hospitals
Young JC, Pack C, Gibson TB
Machine learning can unlock insights into mortality.
In this study, the investigators discuss the research implications of having disparate streams of health and mortality data; introduce how machine learning can help overcome these limitations; highlight important considerations for machine learning, including the risk of algorithmic bias; and briefly discuss best practices for applying machine learning to enhance public health research.
Citation: Young JC, Pack C, Gibson TB . Machine learning can unlock insights into mortality. Am J Public Health 2021 Jul;111(S2):S65-S68. doi: 10.2105/ajph.2021.306418..
Keywords: Health Information Technology (HIT), Mortality
Coley RY, Johnson E, Simon GE
Racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visits.
This study looked at racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visit. The main outcome measured was the suicide rate within 90 days after a mental health visit. The study used a 50% sample of visits from a random set of outpatients at 7 large integrated health care systems by patients 13 years and older (6,984,184 visits). Suicide rates were highest for visits by patients with no race/ethnicity recorded, followed by Asian, White, American Indian/Alaskan Native, Hispanic, and Black. Sensitivity of both models used were high for White, Hispanic, and Asian patients and poor for Black and American Indian/Alaskan Native patients and patients with no race/ethnicity recorded.
Citation: Coley RY, Johnson E, Simon GE . Racial/ethnic disparities in the performance of prediction models for death by suicide after mental health visits. JAMA Psychiatry 2021 Jul;78(7):726-34. doi: 10.1001/jamapsychiatry.2021.0493..
Keywords: Disparities, Racial / Ethnic Minorities, Behavioral Health, Mortality, Risk
Brauer DG, Wu N, Keller MR
Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database.
This study investigates patient-level and hospital-level variables associated with the mortality difference at referral centers and, postoperatively, outside hospitals, in patients undergoing hepatopancreatobiliary (HPB) and gastric oncologic surgeries. Using HCUP data, findings showed that, for readmissions following HPB and gastric oncologic surgery, travel distance and timing were major determinants of care fragmentation. However, these variables were not associated with mortality, nor was annual hospital surgical volume after risk-adjustment.
Citation: Brauer DG, Wu N, Keller MR . Care fragmentation and mortality in readmission after surgery for hepatopancreatobiliary and gastric cancer: a patient-level and hospital-level analysis of the Healthcare Cost and Utilization Project administrative database. J Am Coll Surg 2021 Jun;232(6):921-32. doi: 10.1016/j.jamcollsurg.2021.03.017..
Keywords: Healthcare Cost and Utilization Project (HCUP), Cancer, Surgery, Hospital Readmissions, Mortality
Anesi GL, Jablonski J, Harhay MO
Characteristics, outcomes, and trends of patients with COVID-19-related critical illness at a learning health system in the United States.
This study’s objective is to describe the epidemiology of COVID-19-related critical illness, including trends in outcomes and care delivery, using five hospitals within the University of Pennsylvania Health System as a setting. Findings showed that, among patients with COVID-19-related critical illness admitted to ICUs of a learning health system in the United States, mortality seemed to decrease over time despite stable patient characteristics. Recommendations included further studies to confirm this result and to investigate causal mechanisms.
Citation: Anesi GL, Jablonski J, Harhay MO . Characteristics, outcomes, and trends of patients with COVID-19-related critical illness at a learning health system in the United States. Ann Intern Med 2021 May;174(5):613-21. doi: 10.7326/m20-5327..
Keywords: COVID-19, Critical Care, Intensive Care Unit (ICU), Mortality, Hospitals, Outcomes, Infectious Diseases
Hollingsworth JM, Yu X, Yan PL
Provider care team segregation and operative mortality following coronary artery bypass grafting.
The purpose of this study was to examine whether provider care team segregation within hospitals contributes to the higher mortality rate of Black patients following coronary artery bypass grafting compared to their White counterparts. Using national Medicare data, findings showed that Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
Citation: Hollingsworth JM, Yu X, Yan PL . Provider care team segregation and operative mortality following coronary artery bypass grafting. Circ Cardiovasc Qual Outcomes 2021 May;14(5):e007778. doi: 10.1161/circoutcomes.120.007778..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Mortality, Teams, Healthcare Delivery, Racial / Ethnic Minorities
Kim D, Lee Y, Thorsness R
Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020.
This national study estimated excess deaths for the kidney failure population by race and ethnicity from March 1 through August 1, 2020. Findings showed that, among the US kidney failure population, the number of excess deaths was 16% higher than expected, similar to reports for the general population. However, results showed that the relative increase in deaths among Black and Hispanic patients was more than 4-fold higher than that observed among White patients. The magnitude of these disparities was larger than corresponding relative ratios reported among COVID-19–associated deaths in the general population.
Citation: Kim D, Lee Y, Thorsness R . Racial and ethnic disparities in excess deaths among persons with kidney failure during the COVID-19 pandemic, March-July 2020. Am J Kidney Dis 2021 May;77(5):827-29. doi: 10.1053/j.ajkd.2021.02.003..
Keywords: COVID-19, Racial / Ethnic Minorities, Disparities, Mortality, Kidney Disease and Health, Chronic Conditions, Social Determinants of Health
Baillargeon J, Polychronopoulou E, Kuo YF
The impact of substance use disorder on COVID-19 outcomes.
The goal of this study was to examine the impact of substance use disorder on the risk of hospitalization, complications, and mortality among adult patients diagnosed as having COVID-19. Using data from the TriNetX Research Network database, primary analysis showed that substance use disorder was associated with an increased risk of hospitalization, ventilator use, and mortality. These findings suggest that COVID-19 patients with substance use disorders are at increased risk for adverse outcomes.
Citation: Baillargeon J, Polychronopoulou E, Kuo YF . The impact of substance use disorder on COVID-19 outcomes. Psychiatr Serv 2021 May;72(5):578-81. doi: 10.1176/appi.ps.202000534..
Keywords: COVID-19, Substance Abuse, Hospitalization, Mortality, Risk
Downer B, Pritchard K, Thomas KS
Improvement in activities of daily living during a nursing home stay and one-year mortality among older adults with sepsis.
This study looked at the association between recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. This retrospective cohort study identified 59,383 Medicare beneficiaries who were admitted to an SNF within 3 days of discharge from hospitalization that included time in an ICU for sepsis from all of 2013 to October 2015. About 58% of SNF residents showed improvement in ADL function. The higher the improvement in ADL score the less the mortality risk compared to residents who did not improve.
Citation: Downer B, Pritchard K, Thomas KS . Improvement in activities of daily living during a nursing home stay and one-year mortality among older adults with sepsis. J Am Geriatr Soc 2021 Apr;69(4):938-45. doi: 10.1111/jgs.16915..
Keywords: Elderly, Nursing Homes, Medicare, Sepsis, Mortality, Outcomes
Gershengorn HB, Hu Y, Chen JT
The impact of high-flow nasal cannula use on patient mortality and the availability of mechanical ventilators in COVID-19.
This study looked at the effects of the use of high-flow nasal cannula for COVID-19 patients on mortality and the availability of mechanical ventilators. The authors constructed dynamical simulation models of high-flow nasal cannula and mechanical ventilation use in the United States. There were two outcomes looked for: 1) cumulative number of deaths; and 2) days without available ventilators. The strategy resulted in an estimated number of 10,000-40,000 fewer deaths than if high-flow nasal cannula were not available. This strategy also led up to 25 fewer days without available ventilators.
Citation: Gershengorn HB, Hu Y, Chen JT . The impact of high-flow nasal cannula use on patient mortality and the availability of mechanical ventilators in COVID-19. Ann Am Thorac Soc 2021 Apr;18(4):623-31. doi: 10.1513/AnnalsATS.202007-803OC..
Keywords: COVID-19, Respiratory Conditions, Mortality, Critical Care
Bae S, Johnson M, Massie AB
Mortality and access to kidney transplantation in patients with sickle cell disease-associated kidney failure.
Patients with sickle cell disease-associated kidney failure have high mortality, which might be lowered by kidney transplantation. However, because they show higher post-transplant mortality compared with patients with other kidney failure etiologies, kidney transplantation remains controversial in this population. In this study, the investigators aimed to quantify the decrease in mortality associated with transplantation in this population and determine the chance of receiving transplantation with sickle cell disease as the cause of kidney failure as compared with other etiologies of kidney failure.
Citation: Bae S, Johnson M, Massie AB . Mortality and access to kidney transplantation in patients with sickle cell disease-associated kidney failure. Clin J Am Soc Nephrol 2021 Mar 8;16(3):407-14. doi: 10.2215/cjn.02720320..
Keywords: Transplantation, Access to Care, Kidney Disease and Health, Mortality
Pennington KM, Dykhoff HJ, Yao X
The impact of antifungal prophylaxis in lung transplant recipients.
This study evaluated the effect of antifungal prophylaxis on all-cause mortality and invasive fungal infections (IFI) on lung transplant recipients. Administrative claims data was used to identify adult patients who underwent lung transplantation between 2005 and 2018. The authors identified 662 lung transplant recipients. All-cause mortality was found to be significantly lower in those receiving antifungal prophylaxis compared to those who did not. Patients receiving antifungal prophylaxis also had a lower rate of IFI, but it was not statistically significant.
AHRQ-funded; HS025164; HS025402; HS025517; HS024075.
Citation: Pennington KM, Dykhoff HJ, Yao X . The impact of antifungal prophylaxis in lung transplant recipients. Ann Am Thorac Soc 2021 Mar;18(3):468-76. doi: 10.1513/AnnalsATS.202003-267OC..
Keywords: Transplantation, Surgery, Medication, Prevention, Respiratory Conditions, Mortality, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice