National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Antibiotics (5)
- Antimicrobial Stewardship (3)
- Asthma (12)
- Behavioral Health (1)
- Blood Pressure (1)
- Cancer (2)
- Cancer: Lung Cancer (1)
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- Critical Care (2)
- Decision Making (1)
- Dental and Oral Health (1)
- Diagnostic Safety and Quality (3)
- Disparities (2)
- Elderly (1)
- Electronic Health Records (EHRs) (4)
- Evidence-Based Practice (5)
- Guidelines (3)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (6)
- Hospital Discharge (2)
- Hospitalization (3)
- Hospital Readmissions (3)
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- Infectious Diseases (2)
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- Methicillin-Resistant Staphylococcus aureus (MRSA) (1)
- Mortality (5)
- Neurological Disorders (1)
- Newborns/Infants (4)
- Nursing Homes (1)
- Obesity (1)
- Obesity: Weight Management (1)
- Opioids (2)
- Outcomes (6)
- Patient-Centered Outcomes Research (3)
- Patient Adherence/Compliance (1)
- Patient Safety (1)
- Pneumonia (4)
- Practice Patterns (3)
- Prevention (3)
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- Quality of Care (2)
- Quality of Life (2)
- (-) Respiratory Conditions (47)
- Risk (5)
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- Sleep Problems (4)
- Surgery (2)
- Telehealth (2)
- Training (2)
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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
26 to 47 of 47 Research Studies DisplayedAllgaier J, Lagu T, Haessler S
Risk factors, management, and outcomes of legionella pneumonia in a large, nationally representative sample.
The authors sought to describe testing, empiric treatment, and outcomes for patients with Legionella pneumonia (LP). They found that LP was an uncommon cause of community-acquired pneumonia, occurring primarily from late spring through early autumn. Further, testing was uncommon, even among patients with risk factors, and many patients with positive test results failed to receive empiric coverage for LP.
AHRQ-funded; HS024277.
Citation: Allgaier J, Lagu T, Haessler S .
Risk factors, management, and outcomes of legionella pneumonia in a large, nationally representative sample.
Chest 2021 May;159(5):1782-92. doi: 10.1016/j.chest.2020.12.013..
Keywords: Respiratory Conditions
Deshpande A, Richter SS, Haessler S
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
This study assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients diagnosed with pneumonia with negative cultures. The authors included 14,170 adults admitted with pneumonia in 2010-2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. If empiric drugs were stopped on day 4 while continuing another antibiotic it was defined at de-escalation. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration with ICU transfer, length-of-stay (LOS) and costs. Thirteen percent (1924 patients) had both initial empiric drugs stopped by hospital day 4. De-escalation rates at hospitals ranged from 2-35% and the established rate quartiles were not significantly associated with outcomes. Even at hospitals in the top quartile of de-escalation, the de-escalation rates were lower than 50%.
AHRQ-funded; HS025026; HS024277.
Citation: Deshpande A, Richter SS, Haessler S .
De-escalation of empiric antibiotics following negative cultures in hospitalized patients with pneumonia: rates and outcomes.
Clin Infect Dis 2021 Apr 26;72(8):1314-22. doi: 10.1093/cid/ciaa212..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Pneumonia, Respiratory Conditions, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Inpatient Care
Rhee C, Kanjilal S, Baker M
Duration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infectivity: when is it safe to discontinue isolation?
This review examined the current evidence of when a Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patient is no longer infectious and no longer needs to be in isolation. Most patients have persistently positive tests for weeks to months following clinical recovery; but this may not indicate their infectivity. SARS-CoV-2 appears to be most contagious around the time of symptom onset. Infectivity decreases to near-zero after about 10 days in mild-moderately ill patients and 15 days in severely-critically ill and immunocompromised patients. The longest interval associated with replication-competent virus found so far is 20 days from symptom onset.
AHRQ-funded; HS025008.
Citation: Rhee C, Kanjilal S, Baker M .
Duration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infectivity: when is it safe to discontinue isolation?
Clin Infect Dis 2021 Apr 26;72(8):1467-74. doi: 10.1093/cid/ciaa1249..
Keywords: COVID-19, Respiratory Conditions, Public Health, Infectious Diseases
Li KY, Zhu Z, Ng S
Direct-to-consumer telemedicine visits for acute respiratory infections linked to more downstream visits.
The authors compared downstream care utilization data from a large, commercial payer for the period 2016-19. They found that the telemedicine cohort had fewer emergency department visits but more subsequent office, urgent care, and telemedicine visits. These findings suggest that potential savings from shifting initial care to a direct-to-consumer telemedicine setting should be balanced against the potential for higher spending on downstream care.
AHRQ-funded; HS027632.
Citation: Li KY, Zhu Z, Ng S .
Direct-to-consumer telemedicine visits for acute respiratory infections linked to more downstream visits.
Health Affairs 2021 Apr;40(4):596-602. doi: 10.1377/hlthaff.2020.01741..
Keywords: Telehealth, Health Information Technology (HIT), Respiratory Conditions, Healthcare Delivery
Makarem N, Alcántara C, Williams N
Effect of sleep disturbances on blood pressure.
This review summarizes recent literature addressing the association of short sleep duration, shift work, and obstructive sleep apnea with hypertension risk, blood pressure (BP) levels, and 24-hour ambulatory BP. Recommendations include efforts to educate patients and health care providers about the importance of identifying and treating sleep disturbances for hypertension prevention and management. Empirically supported sleep health interventions represent a critical next step to advance this research area and establish causality.
AHRQ-funded; HS024274.
Citation: Makarem N, Alcántara C, Williams N .
Effect of sleep disturbances on blood pressure.
Hypertension 2021 Apr;77(4):1036-46. doi: 10.1161/hypertensionaha.120.14479..
Keywords: Sleep Problems, Blood Pressure, Respiratory Conditions
Beam KS, Lee M, Hirst K
Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.
This study analyzed the accuracy of International Classification of Diseases (ICD) codes to identify bronchopulmonary dysplasia (BPD) in newborns. A retrospective cohort study in a single-center NICU (n=166) was conducted to evaluate sensitivity and specificity of ICD-10 codes for BPD diagnosis. The sensitivity of any BPD-related codes ranged from 0.82 to 0.95, while specificity range was 0.25 to 0.36. The most common date of BPD diagnosis was the day of birth, which is inconsistent with the clinical definition. The authors conclude that the ICD codes for BPD are unlikely to accurately reflect the current clinical definition and should be interpreted with caution.
AHRQ-funded; HS000063.
Citation: Beam KS, Lee M, Hirst K .
Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.
J Perinatol 2021 Apr;41(4):764-71. doi: 10.1038/s41372-021-00965-3..
Keywords: Newborns/Infants, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
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.
AHRQ-funded; HS026188.
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
Volerman A, Kan K, Carpenter D
Strategies for improving inhalation technique in children: a narrative review.
Inhaled medicines are commonly utilized by children for various respiratory conditions and must be used effectively for the medication to reach the airways. Poor inhaler technique contributes to poorly controlled asthma with significant associated morbidity. In this paper the authors provide a narrative review of strategies for improving inhalation technique in children.
AHRQ-funded; HS026385.
Citation: Volerman A, Kan K, Carpenter D .
Strategies for improving inhalation technique in children: a narrative review.
Patient Prefer Adherence 2021 Mar 29;15:665-75. doi: 10.2147/ppa.S267053..
Keywords: Children/Adolescents, Respiratory Conditions, Training
Leu GR, Links AR, Ryan MA
Assessment of parental choice predisposition for tonsillectomy in children.
The decision to proceed with tonsillectomy to treat pediatric obstructive sleep-disordered breathing (OSDB) often falls on individual families. Despite emphasis on shared decision-making between parents and surgeons about tonsillectomy for OSDB, the extent to which parents have already decided about surgery prior to the child's consultation is not known. The objective of this study was to identify predictors of parent choice predisposition for surgical treatment of OSDB with tonsillectomy and describe its association with parent-clinician communication.
AHRQ-funded; HS022932.
Citation: Leu GR, Links AR, Ryan MA .
Assessment of parental choice predisposition for tonsillectomy in children.
JAMA Otolaryngol Head Neck Surg 2021 Mar;147(3):263-70. doi: 10.1001/jamaoto.2020.5031..
Keywords: Children/Adolescents, Caregiving, Decision Making, Surgery, Sleep Problems, Respiratory Conditions
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
Miller AC, Arakkal AT, Koeneman S
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
Missed opportunities to diagnose tuberculosis are costly to patients and society. In this retrospective cohort study, the investigators (1) estimated the frequency and duration of diagnostic delays among patients with active pulmonary tuberculosis and (2) determined the risk factors for experiencing a diagnostic delay. The investigators found that many patients with tuberculosis experience multiple missed diagnostic opportunities prior to diagnosis.
AHRQ-funded; HS027375.
Citation: Miller AC, Arakkal AT, Koeneman S .
Incidence, duration and risk factors associated with delayed and missed diagnostic opportunities related to tuberculosis: a population-based longitudinal study.
BMJ Open 2021 Feb 18;11(2):e045605. doi: 10.1136/bmjopen-2020-045605..
Keywords: Respiratory Conditions, Diagnostic Safety and Quality, Risk
Puebla Neira DA, Hsu ES, Kuo YF
Readmissions reduction program: mortality and readmissions for chronic obstructive pulmonary disease.
Implementation of the Hospital Readmissions Reduction Program (HRRP) following discharge of patients with chronic obstructive pulmonary disease (COPD) has led to a reduction in 30-day readmissions with unknown effects on postdischarge mortality. The objective of this retrospective cohort study was to examine the association of HRRP with 30-day hospital readmission and 30-day postdischarge mortality rate in patients after discharge from COPD hospitalization.
AHRQ-funded; HS020642.
Citation: Puebla Neira DA, Hsu ES, Kuo YF .
Readmissions reduction program: mortality and readmissions for chronic obstructive pulmonary disease.
Am J Respir Crit Care Med 2021 Feb 15;203(4):437-46. doi: 10.1164/rccm.202002-0310OC..
Keywords: Hospital Readmissions, Respiratory Conditions, Chronic Conditions, Mortality, Hospital Discharge, Hospitalization
Turi KN, Gebretsadik T, Ding T
Dose, timing, and spectrum of prenatal antibiotic exposure and risk of childhood asthma.
The potential for prenatal antibiotic exposure to influence asthma risk is not clear. The investigators aimed to determine the effect of timing, dose, and spectrum of prenatal antibiotic exposure on the risk of childhood asthma. The investigators concluded that increased cumulative dose, early pregnancy first course, and broad-spectrum antibiotic exposure were associated with childhood asthma risk.
AHRQ-funded; HS026395; HS018454.
Citation: Turi KN, Gebretsadik T, Ding T .
Dose, timing, and spectrum of prenatal antibiotic exposure and risk of childhood asthma.
Clin Infect Dis 2021 Feb 1;72(3):455-62. doi: 10.1093/cid/ciaa085.
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Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Antibiotics, Medication, Risk
Gupta A, Sedhom R, Sharma R
Nonpharmacological interventions for managing breathlessness in patients with advanced cancer: a systematic review.
The purpose of this review was to evaluate the advantages and harms of nonpharmacological interventions for managing breathlessness in adults with advanced cancer. PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched for English-language studies about randomized and nonrandomized clinical trials, controlled trials, and observational studies. Findings included the safety and association with improved breathlessness of several nonpharmacological interventions for adults with advanced cancer. Recommendations included incorporating nonpharmacological interventions as first-line treatment for adults with advanced cancer and breathlessness.
AHRQ-funded; 290201500006I.
Citation: Gupta A, Sedhom R, Sharma R .
Nonpharmacological interventions for managing breathlessness in patients with advanced cancer: a systematic review.
JAMA Oncol 2021 Feb;7(2):290-98. doi: 10.1001/jamaoncol.2020.5184..
Keywords: Cancer, Respiratory Conditions, Treatments, Evidence-Based Practice, Comparative Effectiveness, Quality of Life, Outcomes, Patient-Centered Outcomes Research
Feliciano JL, Waldfogel JM, Sharma R
Pharmacologic interventions for breathlessness in patients with advanced cancer: a systematic review and meta-analysis.
This systematic review and meta-analysis examined the use of pharmacological interventions for breathlessness in patients with advanced cancer. Studies were identified from database inception to May 2020 using predefined eligibility criteria. Pharmacologic intervention benefits and harms were compared, focusing on breathlessness, anxiety, exercise capacity and health-related quality of life. Out of 7729 unique citations, 19 studies with a total of 1424 patients were included. Opioids were not associated with more effectiveness than placebo for improving breathlessness or exercise capacity. Anxiolytics were also not associated with more effectiveness than placebo for breathlessness or anxiety. There was limited evidence for other pharmacologic interventions. There was some harm, but it was minimal in those short-term studies.
AHRQ-funded; 290201500006I.
Citation: Feliciano JL, Waldfogel JM, Sharma R .
Pharmacologic interventions for breathlessness in patients with advanced cancer: a systematic review and meta-analysis.
JAMA Netw Open 2021 Feb;4(2):e2037632. doi: 10.1001/jamanetworkopen.2020.37632..
Keywords: Cancer: Lung Cancer, Cancer, Respiratory Conditions, Medication, Treatments, Opioids, Evidence-Based Practice, Comparative Effectiveness, Quality of Life, Outcomes, Patient-Centered Outcomes Research
Sabbagh SE, Neely J, Chow A
Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America.
Pneumocystis jirovecii pneumonia (PJP) is associated with significant morbidity and mortality in adult myositis patients; however, there are few studies examining PJP in juvenile myositis [juvenile idiopathic inflammatory myopathy (JIIM)]. The purpose of this study was to determine the risk factors and clinical phenotypes associated with PJP in JIIM. The investigators concluded that having PJP was associated with more immunosuppressive therapy, anti-MDA5 autoantibodies, Asian race and certain clinical features, including digital infarcts, cutaneous ulcerations and interstitial lung disease.
AHRQ-funded; HS000063.
Citation: Sabbagh SE, Neely J, Chow A .
Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America.
Rheumatology 2021 Feb;60(2):829-36. doi: 10.1093/rheumatology/keaa436..
Keywords: Children/Adolescents, Pneumonia, Respiratory Conditions, Risk
Shipe ME, Deppen SA, Sullivan S
Validation of histoplasmosis enzyme immunoassay to evaluate suspicious lung nodules.
Granulomas caused by infectious lung diseases can present as indeterminate pulmonary nodules (IPN). This study aimed to validate an enzyme immunoassay (EIA) for histoplasma immunoglobulins G and M (IgG, IgM) for diagnosing benign IPN in areas with endemic histoplasmosis. The investigators concluded that this study confirmed that histoplasma EIA testing could be useful for diagnosing benign IPN in areas with endemic histoplasmosis in a population at high risk for lung cancer.
AHRQ-funded; HS026122.
Citation: Shipe ME, Deppen SA, Sullivan S .
Validation of histoplasmosis enzyme immunoassay to evaluate suspicious lung nodules.
Ann Thorac Surg 2021 Feb;111(2):416-20. doi: 10.1016/j.athoracsur.2020.05.101..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Donnelly JP, Wang XQ, Iwashyna TJ
Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system.
This study describes reasons for readmission, use of intensive care unit (ICU) interventions during readmission, and proportions of death after initial hospital discharge of COVID-19 patients from US Veterans Affairs (VA) hospitals March-June 2020.
AHRQ-funded; HS026725.
Citation: Donnelly JP, Wang XQ, Iwashyna TJ .
Readmission and death after initial hospital discharge among patients with COVID-19 in a large multihospital system.
JAMA 2021 Jan 19;325(3):304-06. doi: 10.1001/jama.2020.21465.
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Keywords: Respiratory Conditions, COVID-19, Hospital Readmissions, Hospital Discharge, Mortality, Outcomes
Truitt KN, Brown T, Lee JY
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
The proportion of sinusitis visits that meet antibiotic prescribing criteria is unknown. In this cross-sectional study the authors investigated the appropriateness of antibiotic prescribing for acute sinusitis in primary care. The investigators found that of 425 randomly selected sinusitis visits, 50% met antibiotic prescribing criteria.
AHRQ-funded; HS024930; 233201500020I; HS026506.
Citation: Truitt KN, Brown T, Lee JY .
Appropriateness of antibiotic prescribing for acute sinusitis in primary care: a cross-sectional study.
Clin Infect Dis 2021 Jan 15;72(2):311-14. doi: 10.1093/cid/ciaa736..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Primary Care, Respiratory Conditions, Practice Patterns
Fleischer DM, Chan ES, Venter C
A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical
This paper provides a consensus approach to the primary prevention of pediatric food allergy through nutrition using data from a number of high-impact randomized controlled trials. Recommendations from the American Academy of Allergy, Asthma, and Immunology, American College of Allergy, Asthma, and Immunology, and the Canadian Society for Allergy and Clinical Immunology are to introduce peanut and egg around age 6 months, but not before 4 months as well as introducing other allergens. Maternal exclusion of allergens during pregnancy and/or breastfeeding to prevent food allergy is not recommended. No association was found between exclusive breast-feeding and the primary prevention of any specific food allergy.
AHRQ-funded; HS024599.
Citation: Fleischer DM, Chan ES, Venter C .
A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical
J Allergy Clin Immunol Pract 2021 Jan;9(1):22-43.e4. doi: 10.1016/j.jaip.2020.11.002..
Keywords: Asthma, Respiratory Conditions, Prevention, Guidelines, Evidence-Based Practice
Wolk CB, Schondelmeyer AC, Barg FK
Barriers and facilitators to guideline-adherent pulse oximetry use in bronchiolitis.
Continuous pulse oximetry monitoring (cSpO(2)) in children with bronchiolitis does not improve clinical outcomes and has been associated with increased resource use and alarm fatigue. It is critical to understand the factors that contribute to cSpO(2) overuse in order to reduce overuse and its associated harms. In this paper, the authors discuss the barriers and facilitators to guideline-adherent pulse oximetry use in bronchiolitis.
AHRQ-funded; HS023827; HS026763.
Citation: Wolk CB, Schondelmeyer AC, Barg FK .
Barriers and facilitators to guideline-adherent pulse oximetry use in bronchiolitis.
J Hosp Med 2021 Jan;16(1):23-30. doi: 10.12788/jhm.3535..
Keywords: Children/Adolescents, Respiratory Conditions, Guidelines
Lee BY, Bartsch SM, Ferguson MC
The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Researchers developed a computational model of the U.S. simulating the spread of SARS-CoV-2 and the potential clinical and economic impact of reducing the infectious period duration. They reported that their study quantifies the potential effects of reducing the SARS-CoV-2 infectious period duration.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Ferguson MC .
The value of decreasing the duration of the infectious period of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
PLoS Comput Biol 2021 Jan;17(1):e1008470. doi: 10.1371/journal.pcbi.1008470..
Keywords: COVID-19, Respiratory Conditions, Public Health, Prevention, Infectious Diseases