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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.
Results
1 to 25 of 381 Research Studies Displayed
Kukhareva PV, Caverly TJ, Li H
Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility.
The authors sought to characterize EHR smoking data issues and to propose an approach to addressing these issues using longitudinal smoking data. They found that over 80% of evaluated records had inaccuracies, including missing packs-per-day or years-smoked, outdated data, missing years-quit, and a recent change in packs-per-day resulting in inaccurate lifetime pack-years estimation. Further, addressing these issues by using longitudinal data enabled the identification of 49.4% more patients potentially eligible for lung cancer screening.
AHRQ-funded; HS026198.
Citation:
Kukhareva PV, Caverly TJ, Li H .
Inaccuracies in electronic health records smoking data and a potential approach to address resulting underestimation in determining lung cancer screening eligibility.
J Am Med Inform Assoc 2022 Apr 13;29(5):779-88. doi: 10.1093/jamia/ocac020..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Screening, Cancer: Lung Cancer, Cancer
Lin Y, Sharma B, Thompson HM
External validation of a machine learning classifier to identify unhealthy alcohol use in hospitalized patients.
This study’s objective was to validate a machine learning approach to alcohol screening using a natural language processing (NLP) classifier developed at an independent medical center. This retrospective cohort study took place at a midwestern US tertiary-care, urban medical center that has an inpatient structured universal screening model for unhealthy substance use and an active addiction consult service. The cohort included 57,605 unplanned admissions of adult patients between October 23, 2017 and December 31, 2019 with electronic health record (EHR) documentation of manual alcohol screening. The authors examined error in manual screening and reviewed discordance between the NLP classifier and AUDIT-derived reference. The classifier demonstrated adequate sensitivity and specificity for routine clinical use as an automated screening tool for identifying at-risk patients.
AHRQ-funded; HS026385.
Citation:
Lin Y, Sharma B, Thompson HM .
External validation of a machine learning classifier to identify unhealthy alcohol use in hospitalized patients.
Addiction 2022 Apr;117(4):925-33. doi: 10.1111/add.15730..
Keywords:
Alcohol Use, Behavioral Health, Screening, Electronic Health Records (EHRs), Health Information Technology (HIT)
Murray E, Roosevelt GE, Vogel JA
Screening for health-related social needs in the emergency department: adaptability and fidelity during the COVID-19 pandemic.
Researchers sought to evaluate a screening and referral program for health-related social needs (HRSN) in an emergency department. Using the Accountable Health Communities Screening Tool, they found that, during the COVID-19 pandemic, HRSN doubled, likely reflecting the economic impact of the pandemic.
AHRQ-funded; HS023901.
Citation:
Murray E, Roosevelt GE, Vogel JA .
Screening for health-related social needs in the emergency department: adaptability and fidelity during the COVID-19 pandemic.
Am J Emerg Med 2022 Apr;54:323.e1-23.e4. doi: 10.1016/j.ajem.2021.09.071..
Keywords:
COVID-19, Social Determinants of Health, Emergency Department, Screening, Public Health
Mota L, Marcaccio CL, Dansey KD
Overview of screening eligibility in patients undergoing ruptured AAA repair from 2003 to 2019 in the Vascular Quality Initiative.
The authors examined patients in the Vascular Quality Initiative database who underwent repair of ruptured abdominal aortic aneurysm (AAA) to characterize those who are ineligible for screening under current guidelines and to evaluate the potential impact of these restrictions on their disease. They found that most patients who underwent ruptured AAA repair were ineligible for initial AAA screening or aged out of the screening window. Furthermore, ruptured AAA rates and screening ineligibility have not improved as much as expected since the passage of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act.
AHRQ-funded; HS027285.
Citation:
Mota L, Marcaccio CL, Dansey KD .
Overview of screening eligibility in patients undergoing ruptured AAA repair from 2003 to 2019 in the Vascular Quality Initiative.
J Vasc Surg 2022 Mar;75(3):884-92.e1. doi: 10.1016/j.jvs.2021.09.049..
Keywords:
Cardiovascular Conditions, Screening, Prevention
Harris S, Farah W, Snitchler C. S, Farah W, Snitchler C
Screening and interventions to prevent dental caries in children younger than five years.
This case study concerns Hispanic parents new to a practice who bring in their two children, two years of age and four months of age, for routine wellness visits. The parents have questions about dental care for their children. Three case study questions are provided along with answers. Bonus digital content provides an information sheet with a Clinical Summary of the USPSTF Recommendation.
AHRQ-authored.
Citation:
Harris S, Farah W, Snitchler C. S, Farah W, Snitchler C .
Screening and interventions to prevent dental caries in children younger than five years.
Am Fam Physician 2022 Mar;105(3):299-300..
Keywords:
Children/Adolescents, Dental and Oral Health, Screening, Guidelines, Evidence-Based Practice, Case Study
Reese TJ, Schlechter CR, Kramer H
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
This study explored the implementation of lung cancer screening with low-dose computed tomography (CT) in primary care. The study’s two goals included exploring the implementation of lung cancer screening primary care in the context of integrating a decision aid into the electronic health record and a designing of implementation strategies that target hypothesized mechanics of change and context-specific barriers. The two phases included a Qualitative Analysis phase including semi-structured interviews with primary care physicians to elicit key task behaviors, and an Implementation Strategy Design phase consisting of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Fourteen interviews were conducted and out of that 3 key task behaviors and four behavioral determinants emerged. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy, increasing social influence, and addressing key facilitators to using the decision aid.
AHRQ-funded; HS026198.
Citation:
Reese TJ, Schlechter CR, Kramer H .
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
Transl Behav Med 2022 Feb 16;12(2):187-97. doi: 10.1093/tbm/ibab115..
Keywords:
Cancer: Lung Cancer, Cancer, Primary Care, Screening, Implementation, Decision Making
Cham S, Landrum MB, Keating NL
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
The authors examined commercially insured populations to identify patient-, physician-, and practice-level characteristics associated with ovarian cancer testing rates. They found that only 33.9% of patients with commercial insurance were tested during the time period studied. Medical and gynecologic oncologists had similar rates of testing, while other physicians tested less often. Although independent practices often lack access to genetic counselors, women in this study had insurance coverage for in-person and telephonic counseling.
AHRQ-funded; HS024072.
Citation:
Cham S, Landrum MB, Keating NL .
Use of germline BRCA testing in patients with ovarian cancer and commercial insurance.
JAMA Netw Open 2022 Jan 4;5(1):e2142703. doi: 10.1001/jamanetworkopen.2021.42703..
Keywords:
Cancer: Ovarian Cancer, Cancer, Screening, Genetics, Health Insurance, Women
Mojica CM, Gunn R, Pham R
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
This study was conducted to describe clinical workflows for fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in Oregon primary care practices and to identify specific workflow processes that might be associated with higher colorectal cancer (CRC) screening rates. Findings showed that primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Higher CRC screening was associated with having medical assistants discuss and review FIT/FOBT screening and instructions with patients.
AHRQ-funded; HS022981.
Citation:
Mojica CM, Gunn R, Pham R .
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
BMC Cancer 2022 Jan 25;22(1):106. doi: 10.1186/s12885-021-09106-7..
Keywords:
Workflow, Screening, Cancer: Colorectal Cancer, Cancer, Primary Care, Vulnerable Populations
Frehn JL, Brewster AL, Shortell SM
Comparing health care system and physician practice influences on social risk screening.
This study examined the association of multilevel organizational capabilities and adoption of social risk screening among system-owned physician practices. A secondary analysis of the 2018 National Survey of Healthcare Organizations and Systems data was conducted. Five social risks were used as measures for physician and system screening: food insecurity, housing instability, utility needs, interpersonal violence, and transportation needs. System-owned practices screened an average of 1.7 of the 5 social risks assessed. The differences were 16% attributable to practice variation between their health system owners, and 84% attributable to differences between individual practices. Practices owned by hospital systems screened for an additional 0.44 social risks relative to practices of systems without hospitals. Characteristics associated with more social risk screening included health information technology capacity, innovation culture, and patient engagement strategies.
AHRQ-funded; HS024075; HS022241.
Citation:
Frehn JL, Brewster AL, Shortell SM .
Comparing health care system and physician practice influences on social risk screening.
Health Care Manage Rev 2022 Jan-Mar;47(1):E1-e10. doi: 10.1097/hmr.0000000000000309..
Keywords:
Healthcare Systems, Social Determinants of Health, Screening, Risk
Thomas TW, Golin CE, Kinlaw AC
Did the 2015 USPSTF abnormal blood glucose recommendations change clinician attitudes or behaviors? A mixed-method assessment.
In 2015, the US Preventive Services Task Force (USPSTF) revised clinical recommendations to more broadly recommend abnormal blood glucose screening and more clearly recommend referral to behavioral interventions for adults with prediabetes. The objective of this study was to assess the effects of the 2015 USPSTF recommendation changes on abnormal blood glucose screening and referral to behavioral interventions, and to examine physicians' perceptions of the revised recommendation.
AHRQ-funded; HS025561; HS000032.
Citation:
Thomas TW, Golin CE, Kinlaw AC .
Did the 2015 USPSTF abnormal blood glucose recommendations change clinician attitudes or behaviors? A mixed-method assessment.
J Gen Intern Med 2022 Jan;37(1):15-22. doi: 10.1007/s11606-021-06749-x..
Keywords:
U.S. Preventive Services Task Force (USPSTF), Diabetes, Screening, Guidelines, Prevention
Fendrick AM, Dalton VK, Tilea A
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
The objective of this study was to describe out-of-pocket costs for colposcopy and related services among age-appropriate, commercially insured women from 2006 to 2019. Findings suggested that out-of-pocket costs for colposcopy were very common and significant and have increased over time. Reported out-of-pocket costs for cervical cancer screening-related care, such as office visits, were not included, thus the findings may underestimate patients’ total financial burden.
AHRQ-funded; HS025465.
Citation:
Fendrick AM, Dalton VK, Tilea A .
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
Obstet Gynecol 2022 Jan;139(1):113-15. doi: 10.1097/aog.0000000000004582..
Keywords:
Healthcare Costs, Colonoscopy, Screening, Cancer: Cervical Cancer, Cancer, Prevention, Women
Tracer H, Mohnot S
Screening for prediabetes and type 2 diabetes mellitus.
In this “Putting Prevention Into Practice An Evidence-Based Approach”, the authors provide a case study with questions and answers related to Screening for Prediabetes and Type 2 Diabetes Mellitus.
AHRQ-authored.
Citation:
Tracer H, Mohnot S .
Screening for prediabetes and type 2 diabetes mellitus.
Screening for prediabetes and type 2 diabetes mellitus.
Am Fam Physician 2022 Jan 1;105(1):73-74..
Am Fam Physician 2022 Jan 1;105(1):73-74..
Keywords:
Diabetes, Screening, Prevention, Evidence-Based Practice, Guidelines, Case Study
Chou R, Pappas M, Dana T
Screening and interventions to prevent dental caries in children younger than 5 years: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this evidence review was to update the 2014 review on dental caries screening and preventive interventions to inform the USPSTF. Findings showed no direct evidence on benefits and harms of primary care oral health screening or referral to dentist, while dietary fluoride supplementation and fluoride varnish were associated with improved caries outcomes in higher-risk children and settings.
AHRQ-funded; 290201500009I.
Citation:
Chou R, Pappas M, Dana T .
Screening and interventions to prevent dental caries in children younger than 5 years: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2021 Dec 7;326(21):2179-92. doi: 10.1001/jama.2021.15658..
Keywords:
U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Dental and Oral Health, Screening, Evidence-Based Practice, Guidelines, Prevention
Mills J, Mohnot S
Screening for gestational diabetes.
This “Putting Prevention into Practice: An Evidence Based Approach” paper is a case study with questions and answers related to a patient with gestational diabetes.
AHRQ-authored.
Citation:
Mills J, Mohnot S .
Screening for gestational diabetes.
Am Fam Physician 2021 Dec 1;104(6):641-42..
Keywords:
U.S. Preventive Services Task Force (USPSTF), Diabetes, Pregnancy, Screening, Prevention, Women, Evidence-Based Practice, Guidelines, Case Study
Heller CG, Rehm CD, Parsons AH
The association between social needs and chronic conditions in a large, urban primary care population.
This study sought to understand the association between social needs and chronic health conditions using a screening tool and clinical data from Electronic Health Records. From April 2018 to December 2019, 33,550 adult patients completed a 10-item social needs screening tool during primary visits in Bronx and Westchester Counties, NY. A positive, cumulative association between social needs and each of the eight outcomes asked about was found. The relationship was strongest for elevated PHQ-2 (depression screening), alcohol/drug use disorder, and smoking. Those with 3 or greater social needs were 3.9 times more likely to have an elevated PHQ-2 than those without needs. Healthcare transportation challenges was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. Examples included those with an alcohol/drug use disorder (84% more likely), and smokers (41% more likely).
AHRQ-funded; HS026396.
Citation:
Heller CG, Rehm CD, Parsons AH .
The association between social needs and chronic conditions in a large, urban primary care population.
Prev Med 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752..
Keywords:
Chronic Conditions, Urban Health, Primary Care, Low-Income, Social Determinants of Health, Screening
Tobin JN, Cassells A, Weiss E
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
AHRQ-funded; HS021667.
Citation:
Tobin JN, Cassells A, Weiss E .
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
J Health Care Poor Underserved 2021;32(4):1907-34. doi: 10.1353/hpu.2021.0173..
Keywords:
Patient-Centered Healthcare, Cancer, Behavioral Health, Primary Care, Depression, Women, Screening
Jonas DE, Barclay C, Grammer D
The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care.
This paper describes a randomized, controlled trial to evaluate the effect of primary care practice facilitation and telehealth services on evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use in primary care practices in North Carolina with 10 or fewer providers. The study will produce important evidence about the effect of practice facilitation on uptake of evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use when delivered on a large scale to small and medium-sized practices. The results of this rigorously conducted evaluation are expected to have a positive impact by accelerating the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices.
AHRQ-funded; HS027078.
Citation:
Jonas DE, Barclay C, Grammer D .
The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care.
Trials 2021 Nov 16;22(1):810. doi: 10.1186/s13063-021-05641-7..
Keywords:
Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Screening, Implementation
Gorman DC, Ham SA, Staab EM
Medical assistant protocol improves disparities in depression screening rates.
This study examined the impacts of a medical assistant screening protocol on the rates of depression screening, overall and by sociodemographic groups, in a primary care setting. Findings showed that implementation of a medical assistant protocol in a primary care setting may significantly increase depression screening rates while mitigating or removing sociodemographic disparities.
AHRQ-funded; HS026151.
Citation:
Gorman DC, Ham SA, Staab EM .
Medical assistant protocol improves disparities in depression screening rates.
Am J Prev Med 2021 Nov;61(5):692-700. doi: 10.1016/j.amepre.2021.05.010..
Keywords:
Disparities, Depression, Behavioral Health, Screening, Racial / Ethnic Minorities
Tracer H, West R
Screening for vitamin D deficiency in adults.
This case study in the “Putting Prevention into Practice: An Evidence Based Approach” series focuses on screening for vitamin D deficiency in adults. It includes a case study, questions, and answers.
AHRQ-authored.
Citation:
Tracer H, West R .
Screening for vitamin D deficiency in adults.
Am Fam Physician 2021 Nov 1;104(5):515-16..
Keywords:
U.S. Preventive Services Task Force (USPSTF), Vitamins and Supplements, Screening, Prevention, Guidelines, Evidence-Based Practice, Case Study
Wallace AS, Luther BL, Sisler SM
Integrating social determinants of health screening and referral during routine emergency department care: evaluation of reach and implementation challenges.
Despite the importance of social determinants in health outcomes, little is known about the best practices for screening and referral during clinical encounters. This study aimed to implement universal social needs screening and community service referrals in an academic emergency department (ED), evaluating for feasibility, reach, and stakeholder perspectives. The investigators concluded that despite the limited time and technical barriers, few patients with social needs ultimately received service referrals.
AHRQ-funded; HS026505.
Citation:
Wallace AS, Luther BL, Sisler SM .
Integrating social determinants of health screening and referral during routine emergency department care: evaluation of reach and implementation challenges.
Implement Sci Commun 2021 Oct 7;2(1):114. doi: 10.1186/s43058-021-00212-y..
Keywords:
Social Determinants of Health, Emergency Department, Screening, Implementation
Krantz MS, Stone CA, Rolando LA
An academic hospital experience screening mRNA COVID-19 vaccine risk using patient allergy history.
This retrospective cohort study examined the outcomes of screening mRNA COVID-19 vaccine risk using patient-reported anaphylactic history at a single academic hospital employee vaccination program. Although rare, m-RNA COVID-19 vaccines have been contraindicated in patients with known allergy to polyethylene glycol (PEG) 2000 present in the lipid nanoparticle carrier system of these vaccines. Health care workers and other affiliates who met criteria based on the Tennessee Department of Health COVID-19 Vaccination Plan received the first dose of Pfizer m-RNA vaccine. Out of 23,035 individuals who were screened before dose 1, 31 reported a high-risk allergy history that triggered a focused review by the Allergist On-Call. Out of those 31, only 3 were recommended not to proceed to Dose 1 and were referred to the Drug Allergy Clinic for assessment. Ultimately, all individuals were cleared to receive their first dose, and none reported an adverse reaction.
AHRQ-funded; HS026395.
Citation:
Krantz MS, Stone CA, Rolando LA .
An academic hospital experience screening mRNA COVID-19 vaccine risk using patient allergy history.
J Allergy Clin Immunol Pract 2021 Oct;9(10):3807-10. doi: 10.1016/j.jaip.2021.07.010..
Keywords:
COVID-19, Screening, Vaccination
Schuttner L, Haraldsson B, Maynard C
Factors associated with low-value cancer screenings in the Veterans Health Administration.
Most clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. The objective of this study was to understand rates and factors associated with outpatient low-value cancer screenings.
AHRQ-funded; HS026369.
Citation:
Schuttner L, Haraldsson B, Maynard C .
Factors associated with low-value cancer screenings in the Veterans Health Administration.
JAMA Netw Open 2021 Oct;4(10):e2130581. doi: 10.1001/jamanetworkopen.2021.30581..
Keywords:
Veterans, Screening, Value, Cancer
Fiori KP, Heller CG, Flattau A
Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA.
This study describes a health system’s experience from 2018 to 2020 to scale social needs of screening of patients within a large urban primary care ambulatory network. This program took place at an academic medical center within an ambulatory network of 18 primary care practices located in the Bronx, New York. The study used electronic health records of 244,764 patients who had a clinical visit from April 2018 to 2019. The authors organized measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening. A total of 53,093 patients were screened for social needs, representing 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need, varying by both practice location and specialty within practices. Slightly more than half (51.8%) of providers screened at least one patient.
AHRQ-funded; HS026396.
Citation:
Fiori KP, Heller CG, Flattau A .
Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA.
BMJ Open 2021 Sep 29;11(9):e053633. doi: 10.1136/bmjopen-2021-053633..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Screening, Social Determinants of Health
Cantor A, Dana T, Griffin JC
Screening for chlamydial and gonococcal infections: updated evidence report and systematic review for the US Preventive Services Task Force.
This is the evidence summary and updated review for the September 2021 U.S. Preventive Services Task Force final recommendation on screening for chlamydial and gonococcal infections among sexually active women 25 years or older and sexually active men. The Task Force concluded that for women screening is recommended, but for men the current evidence is insufficient to assess the balance of benefits and harms. This systematic review screened over 2200 articles and included 20 articles. The articles included helped to answer the 4 key questions that were included in the research plan.
AHRQ-funded; 290201500009I.
Citation:
Cantor A, Dana T, Griffin JC .
Screening for chlamydial and gonococcal infections: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2021 Sep 14;326(10):957-66. doi: 10.1001/jama.2021.10577..
Keywords:
U.S. Preventive Services Task Force (USPSTF), Sexual Health, Infectious Diseases, Screening, Evidence-Based Practice, Guidelines, Prevention
Fan T, Stefanos R
Screening for colorectal cancer.
This AHRQ-authored Putting Preventions in Practice quiz has three questions and answers on the US Preventive Services Task Force final recommendation on screening for colorectal cancer. A case study is presented with questions on the best behavioral interventions, the effect of a patient’s age on the counseling approach, and what is an appropriate test and interval for colorectal screening. References are also provided at the end of the answers.
AHRQ-authored.
Citation:
Fan T, Stefanos R .
Screening for colorectal cancer.
Am Fam Physician 2021 Sep 1;104(3):295-96..
Keywords:
U.S. Preventive Services Task Force (USPSTF), Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Guidelines, Evidence-Based Practice, Case Study
