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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.
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1 to 25 of 369 Research Studies Displayed
Dahabreh IJ, Haneuse SJA, Robins JM
Study designs for extending causal inferences from a randomized trial to a target population.
In this article, the authors examined study designs for extending causal inferences from a randomized trial to a target population. They showed that the counterfactual quantities that can be identified in each study design depend on what is known about the probability of sampling nonrandomized individuals. They explored the implications of the sampling properties underlying the designs for the identification and estimation of the probability of trial participation.
AHRQ-funded; HS000011.
Citation:
Dahabreh IJ, Haneuse SJA, Robins JM .
Study designs for extending causal inferences from a randomized trial to a target population.
Am J Epidemiol 2021 Aug;190(8):1632-42. doi: 10.1093/aje/kwaa270..
Keywords:
Research Methodologies
Wells RD, Guastaferro K, Azuero A
Applying the multiphase optimization strategy for the development of optimized interventions in palliative care.
This article provides a brief overview and application of Multiphase Optimization Strategy, a framework informed by engineering principles, that uses a systematic process to empirically identify an intervention comprised of components that positively contribute to desired outcomes under real-life constraints. The paper includes the authors’ insights from conducting a pilot factorial trial of an early palliative care intervention to enhance the decision support skills of advanced cancer family caregivers (Project CASCADE).
AHRQ-funded; HS013852.
Citation:
Wells RD, Guastaferro K, Azuero A .
Applying the multiphase optimization strategy for the development of optimized interventions in palliative care.
J Pain Symptom Manage 2021 Jul;62(1):174-82. doi: 10.1016/j.jpainsymman.2020.11.017..
Keywords:
Palliative Care, Research Methodologies
Van Domelen DR, Mitchell EM, Perkins NJ
Gamma models for estimating the odds ratio for a skewed biomarker measured in pools and subject to errors.
Measuring a biomarker in pooled samples from multiple cases or controls can lead to cost-effective estimation of a covariate-adjusted odds ratio, particularly for expensive assays. But pooled measurements may be affected by assay-related measurement error (ME) and/or pooling-related processing error (PE), which can induce bias if ignored. Building on recently developed methods for a normal biomarker subject to additive errors, the authors present two related estimators for a right-skewed biomarker subject to multiplicative errors: one based on logistic regression and the other based on a Gamma discriminant function model.
AHRQ-authored.
Citation:
Van Domelen DR, Mitchell EM, Perkins NJ .
Gamma models for estimating the odds ratio for a skewed biomarker measured in pools and subject to errors.
Biostatistics 2021 Apr;22(2):250-65. doi: 10.1093/biostatistics/kxz028..
Keywords:
Research Methodologies
Sinclair KA, Muller C, Noonan C
Increasing health equity through biospecimen research: Identification of factors that influence willingness of Native Americans to donate biospecimens.
American Indian and Alaska Native (AI/AN) people are underrepresented in biomedical research, particularly in biospecimen research, yet little research has been conducted to assess AI/AN attitudes about biospecimen donation. In this study, the researchers identified factors that influence willingness of Native Americans to donate biospecimens. Their results highlighted areas in which interventions could be developed to increase AI/AN donation of biospecimens for research with the ultimate goal of reducing health disparities.
AHRQ-funded; HS023576.
Citation:
Sinclair KA, Muller C, Noonan C .
Increasing health equity through biospecimen research: Identification of factors that influence willingness of Native Americans to donate biospecimens.
Prev Med Rep 2021 Mar;21:101311. doi: 10.1016/j.pmedr.2021.101311..
Keywords:
Disparities, Racial / Ethnic Minorities, Research Methodologies
Shu D, Toh S
ppmHR: a privacy-protecting tool to fit inverse probability weighted Cox models in multisite studies.
It is increasingly common in epidemiologic research to analyze data from multiple
sources. However, data sharing is often a challenge in multisite studies. In this letter to the editor, the investigators introduced an R package, ppmHR, which implements a one-step risk set approach to fit inverse probability weighted (IPW) Cox models without sharing individual level data in multisite studies.
sources. However, data sharing is often a challenge in multisite studies. In this letter to the editor, the investigators introduced an R package, ppmHR, which implements a one-step risk set approach to fit inverse probability weighted (IPW) Cox models without sharing individual level data in multisite studies.
AHRQ-funded; HS026214.
Citation:
Shu D, Toh S .
ppmHR: a privacy-protecting tool to fit inverse probability weighted Cox models in multisite studies.
Epidemiology 2021 Mar 1;32(2):e6-e7. doi: 10.1097/ede.0000000000001300..
Keywords:
Research Methodologies
Covele BM, Carroll CJ, Moore KL
A practical method to quantify knowledge-based DVH prediction accuracy and uncertainty with reference cohorts.
This study compared two dose-volume histogram (DVH) prediction models for assessing organ-at-risk (OAR) sparing in radiotherapy treatment. ORBIT-RT and RapidPlan prediction modules were used to generate OAR DVH predictions for two separate sets of 45 prostate volumetric modulated arc therapy (VMAT) plans. Dose-volume histogram predictions were then compared to their analogous clinical DVHs to define prediction errors. For prostate OARS above 50% Rx dose, ORBIT-RT prediction bias and prediction error variations were comparable to or less than those of RapidPlan. Above 80% Rx dose, prediction bias was less than 1% and prediction error variations less than 3-4% for both models.
AHRQ-funded; HS025440.
Citation:
Covele BM, Carroll CJ, Moore KL .
A practical method to quantify knowledge-based DVH prediction accuracy and uncertainty with reference cohorts.
J Appl Clin Med Phys 2021 Mar;22(3):279-84. doi: 10.1002/acm2.13199..
Keywords:
Research Methodologies
Sood E, Wysocki T, Alderfer MA
Topical review: crowdsourcing as a novel approach to qualitative research.
The purpose of this paper was to describe a novel, five-phase approach to collecting qualitative data from hard-to-reach populations using crowdsourcing methods. The phases of crowdsourcing methodology described were: (I) Preparing; (II) Forming Crowds; (III) Collecting Crowdsourced Data; (IV) Coding and Analyzing Crowdsourced Data; and (V) Generating and Disseminating Findings. The investigators concluded that crowdsourcing is an innovative, efficient, feasible, and timely approach to engaging hard-to-reach populations in qualitative research.
AHRQ-funded; HS026393.
Citation:
Sood E, Wysocki T, Alderfer MA .
Topical review: crowdsourcing as a novel approach to qualitative research.
J Pediatr Psychol 2021 Feb 19;46(2):189-96. doi: 10.1093/jpepsy/jsaa096..
Keywords:
Health Services Research (HSR), Research Methodologies
Rodriguez PJ, Ward ZJ, Long MW
Applied methods for estimating transition probabilities from electronic health record data.
This study examined the usefulness of electronic health records (EHRs) in estimating transition probabilities for state-transition models. No guidelines exist on appropriate methods. The authors used 3 potential methods to estimate transition probabilities for EHR data, using pediatric eating disorders (EDs) as a case study. They mapped diagnoses to 3 ED health states: anorexia nervous, bulimia nervosa, and other specified feeding or eating disorder using data from PEDsnet, which includes 8 US children’s hospitals. They used 3 approaches: simple first-last proportions, a multistate Markov (MSM) model, and independent survival models. The first-last proportion approach estimated higher probabilities of remaining the same health state, while the other two approaches estimated higher probabilities of transitioning to a different health state. Published literature differed substantially from these estimates. Further research is needed to improve methods for using EHR data to inform transition probabilities.
AHRQ-funded; HS013853.
Citation:
Rodriguez PJ, Ward ZJ, Long MW .
Applied methods for estimating transition probabilities from electronic health record data.
Med Decis Making 2021 Feb;41(2):143-52. doi: 10.1177/0272989x20985752..
Keywords:
Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Research Methodologies
Shu D, Han P, Wang R, Toh S. D, Han P, Wang R
Estimating the marginal hazard ratio by simultaneously using a set of propensity score models: a multiply robust approach.
The inverse probability weighted Cox model is frequently used to estimate the marginal hazard ratio. Its validity requires a crucial condition that the propensity score model be correctly specified. To provide protection against misspecification of the propensity score model, the investigators proposed a weighted estimation method rooted in the empirical likelihood theory. They applied the proposed method to compare the risk of postoperative hospitalization between sleeve gastrectomy and Roux-en-Y gastric bypass using data from a large medical claims and billing database.
AHRQ-funded; HS026214.
Citation:
Shu D, Han P, Wang R, Toh S. D, Han P, Wang R .
Estimating the marginal hazard ratio by simultaneously using a set of propensity score models: a multiply robust approach.
Stat Med 2021 Feb;40(5):1224-42. doi: 10.1002/sim.8837..
Keywords:
Research Methodologies, Health Services Research (HSR)
Murad MH, Fiordalisi C, Pillay J
Making narrative statements to describe treatment effects.
The Agency for Healthcare Research and Quality Evidence-based Practice Center Program developed guidance for narrative summaries of treatment effects that identifies five constructs. In this paper the investigators explicitly identified these constructs to facilitate developing narrative statements: (1) direction of effect, (2) size of effect, (3) clinical importance, (4) statistical significance, and (5) strength or certainty of evidence.
AHRQ-authored; AHRQ-funded; 290201500013I; 290201700003C; 290201500001I; 290201500008I; 290201500007I; 290201500011I; 290201500010I; 290201500012I; 290201500009I; 290201500002; HS025840.
Citation:
Murad MH, Fiordalisi C, Pillay J .
Making narrative statements to describe treatment effects.
J Gen Intern Med 2021 Jan;36(1):196-99. doi: 10.1007/s11606-020-06330-y..
Keywords:
Evidence-Based Practice, Research Methodologies
Reid E, JM JM, Fiordalisi C
NxGen evidence: redesigning the Agency for Healthcare Research and Quality Effective Health Care website to promote engagement, interactivity and usability of systematic reviews.
This Brief Methods Note critiques the current paper-based format for systematic reviews and describes the development of a next generation (NxGen) AHRQ EPC Effective Health Care website. The authors suggest that this redesigned platform will allow end-users of all types to find and share the evidence they need through data visualizations and other interactive displays. Several design principles guided the development of NxGen to make systematic review findings more accessible, customizable, adaptable, interactive, and shareable.
AHRQ-authored; AHRQ-funded; 290201700003C.
Citation:
Reid E, JM JM, Fiordalisi C .
NxGen evidence: redesigning the Agency for Healthcare Research and Quality Effective Health Care website to promote engagement, interactivity and usability of systematic reviews.
Res Synth Methods 2021 Jan;12(1):118-23. doi: 10.1002/jrsm.1438..
Keywords:
Research Methodologies, Evidence-Based Practice, Patient-Centered Outcomes Research, Comparative Effectiveness
Caves Sivaraman JJ, Naumann RB
Estimating the association between mental health disorders and suicide: a review of common sources of bias and challenges and opportunities for US-based research.
The purpose of this review was 1) to illuminate prevalent methodological approaches and estimates of association between mental health diagnoses and suicide from the meta-analytic literature; 2) to discuss key internal and external validity concerns with these estimates; and 3) to highlight some of the unique attributes and challenges in US-based suicide research and opportunities to move the evidence base forward. The authors offered methodological considerations for future research and discussed opportunities made possible by the recent expansion of the US National Violent Death Reporting System to a nationwide registry.
AHRQ-funded; HS000032.
Citation:
Caves Sivaraman JJ, Naumann RB .
Estimating the association between mental health disorders and suicide: a review of common sources of bias and challenges and opportunities for US-based research.
Curr Epidemiol Rep 2020 Dec;7(4):352-62. doi: 10.1007/s40471-020-00250-5..
Keywords:
Behavioral Health, Research Methodologies
Singer SJ, Sinaiko AD, Tietschert MV
Care integration within and outside health system boundaries.
The purpose of this study was to examine care integration-efforts to unify disparate parts of health care organizations to generate synergy across activities occurring within and between them-to understand whether and at which organizational level health systems impact care quality and staff experience. The investigators concluded that measures of clinical process integration related to higher staff ratings of quality and experience.
AHRQ-funded; HS024067.
Citation:
Singer SJ, Sinaiko AD, Tietschert MV .
Care integration within and outside health system boundaries.
Health Serv Res 2020 Dec;55(Suppl 3):1033-48. doi: 10.1111/1475-6773.13578..
Keywords:
Healthcare Systems, Healthcare Delivery, Health Services Research (HSR), Research Methodologies
Gates A, Gates M, DaRosa D
Decoding semi-automated title-abstract screening: findings from a convenience sample of reviews.
The authors evaluated the benefits and risks of using the Abstrackr machine learning (ML) tool to semi-automate title-abstract screening and explored whether Abstrackr's predictions varied by review or study-level characteristics. They concluded that their screening approach saved time and may be suitable in conditions where the limited risk of missing relevant records is acceptable. Several of their findings were paradoxical, and they recommended further study to understand fully the tasks to which ML-assisted screening is best suited.
AHRQ-funded; 290201500001I.
Citation:
Gates A, Gates M, DaRosa D .
Decoding semi-automated title-abstract screening: findings from a convenience sample of reviews.
Syst Rev 2020 Nov 27;9(1):272. doi: 10.1186/s13643-020-01528-x..
Keywords:
Research Methodologies
Kang M, Gurbani SS, Kempker JA
The published scientific literature on COVID-19: an analysis of PubMed abstracts.
This article describes a PubMed search done on the published scientific literature on COVID-19 from first reporting of the virus in late December 2019 through Nov. 9, 2020. A total of 57,263 articles were included, with 34% ahead of print, 25.1% e-published, and 40.9% print published at the time of data extraction. There was a peak of 2277 articles the week of May 11. The origin countries of publication were United States (35.7%), followed by England (27%), and the Netherlands (8.7%). Most publications (98%) were in English followed by less than 1% each in Spanish, German, and French.
AHRQ-funded; HS025240.
Citation:
Kang M, Gurbani SS, Kempker JA .
The published scientific literature on COVID-19: an analysis of PubMed abstracts.
J Med Syst 2020 Nov 25;45(1):3. doi: 10.1007/s10916-020-01678-4..
Keywords:
COVID-19, Public Health, Research Methodologies, Health Services Research (HSR)
Chen Y, Liang KY, Tong P
A pseudolikelihood approach for assessing genetic association in case-control studies with unmeasured population structure.
In this paper, researchers propose a novel statistical method to estimate the association between genetic markers and diseases in case-control studies with unmeasured population substructure. The performance of the proposed method, relative to the existing methods, on bias, coverage probability, and computational time, is assessed through simulations. The method is applied to an end-stage renal disease study in African Americans population.
AHRQ-funded; HS022900.
Citation:
Chen Y, Liang KY, Tong P .
A pseudolikelihood approach for assessing genetic association in case-control studies with unmeasured population structure.
Stat Methods Med Res 2020 Nov;29(11):3153-65. doi: 10.1177/0962280220921212..
Keywords:
Genetics, Research Methodologies
Gance-Cleveland B, McDonald CC, Walker RK
Use of theory to guide development and application of sensor technologies in nursing.
In this paper, three nurse scientists summarize their presentations at the Council for the Advancement of Nursing Science 2019 Advanced Methods Conference on Expanding Science of Sensor Technology in Research discussing the theoretical underpinnings of sensor technologies development and use in nursing research and practice.
AHRQ-funded; HS024738; HS018646.
Citation:
Gance-Cleveland B, McDonald CC, Walker RK .
Use of theory to guide development and application of sensor technologies in nursing.
Nurs Outlook 2020 Nov-Dec;68(6):698-710. doi: 10.1016/j.outlook.2020.04.007..
Keywords:
Health Information Technology (HIT), Nursing, Health Services Research (HSR), Research Methodologies
Ward TM, Skubic M, Rantz M
Human-centered approaches that integrate sensor technology across the lifespan: opportunities and challenges.
Children, parents, older adults, and caregivers routinely use sensor technology as a source of health information and health monitoring. The purpose of this paper was to describe three exemplars of research that used a human-centered approach to engage participants in the development, design, and usability of interventions that integrate technology to promote health. The exemplars were based on current research studies that integrated sensor technology into pediatric, adult, and older adult populations living with a chronic health condition.
AHRQ-funded; HS018477.
Citation:
Ward TM, Skubic M, Rantz M .
Human-centered approaches that integrate sensor technology across the lifespan: opportunities and challenges.
Nurs Outlook 2020 Nov-Dec;68(6):734-44. doi: 10.1016/j.outlook.2020.05.004..
Keywords:
Health Information Technology (HIT), Patient and Family Engagement, Health Services Research (HSR), Research Methodologies
Hernandez AV, Roman YM, White CM
Developing criteria and associated instructions for consistent and useful quality improvement study data extraction for health systems.
This paper describes AHRQ’s efforts to collate and assess quality improvement studies to support learning health systems (LHS). The authors identified quality improvement studies and evaluated the consistency of data extraction from two experienced independent reviewers at three time points: baseline, first revision, and final revision. Six investigators looked at the data extracted by the independent reviewers and determined the extent of similarity on a scale of 0 to 10. Two LHS participants were then asked to assess the relative value of their criteria. The consistency of extraction improved from a mean 1.17 score at baseline to 6.07 at first revision, and 6.81 at the final revision. There was not a significant improvement from the first to final revision. However, the LHS participants rated the value of these ratings a 9 and a 6, demonstrating that there is value in developing criteria.
AHRQ-funded; 290201500012I.
Citation:
Hernandez AV, Roman YM, White CM .
Developing criteria and associated instructions for consistent and useful quality improvement study data extraction for health systems.
J Gen Intern Med 2020 Nov;35(Suppl 2):802-07. doi: 10.1007/s11606-020-06098-1..
Keywords:
Quality Improvement, Quality of Care, Learning Health Systems, Healthcare Systems, Health Services Research (HSR), Research Methodologies
Anzuoni K, Field TS, Mazor KM
Recruitment challenges for low-risk health system intervention trials in older adults: a case study.
Researchers assessed factors associated with trial participation in the context of a low-risk intervention intended to reduce adverse drug events in recently hospitalized older adults. They found that recruiting older adults recently discharged from the hospital to participate in trials of low-risk, system-level interventions was challenging and may under-enroll the oldest individuals and those potentially at the highest risk for adverse events, limiting generalizability of study findings.
AHRQ-funded; HS023774.
Citation:
Anzuoni K, Field TS, Mazor KM .
Recruitment challenges for low-risk health system intervention trials in older adults: a case study.
J Am Geriatr Soc 2020 Nov;68(11):2558-64. doi: 10.1111/jgs.16696..
Keywords:
Elderly, Case Study, Research Methodologies, Health Services Research (HSR), Medication
Armstrong MJ, Gamez N, Alliance S
Research priorities of caregivers and individuals with dementia with Lewy bodies: an interview study.
The authors investigated the research priorities of individuals and caregivers living with dementia with Lewy bodies (DLB). Through telephone interviews, they found that individuals with DLB and caregivers identified research needs and highlighted DLB symptoms needing additional research. They recommended that funding be informed by the priorities of all relevant stakeholders and support research investigating causes, natural history, biomarkers, and treatment in addition to research targeting themes regarding living with disease.
AHRQ-funded; HS024159.
Citation:
Armstrong MJ, Gamez N, Alliance S .
Research priorities of caregivers and individuals with dementia with Lewy bodies: an interview study.
PLoS One 2020 Oct 7;15(10):e0239279. doi: 10.1371/journal.pone.0239279..
Keywords:
Caregiving, Dementia, Neurological Disorders, Patient and Family Engagement, Elderly, Research Methodologies
Santry HP, Strassels SA, Ingraham AM
Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach.
Acute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. In this study, the investigators sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of acute care surgery care for EGS patients.
AHRQ-funded; HS022694.
Citation:
Santry HP, Strassels SA, Ingraham AM .
Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach.
BMC Med Res Methodol 2020 Oct 2;20(1):247. doi: 10.1186/s12874-020-01096-7..
Keywords:
Surgery, Critical Care, Healthcare Delivery, Health Services Research (HSR), Research Methodologies
Callejo-Black A, Wagner DV, Ramanujam K
A systematic review of external validity in pediatric integrated primary care trials.
This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns. A literature search was conducted to identify relevant literature from 1998 to 2018 reporting on open, randomized or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. The authors included 39 publications describing 25 studies in the review. Publications rarely reported indicators of external validity, including the representatives of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies also included key pragmatic factors such as cost or organizational change processes related to implementation and maintenance.
AHRQ-funded; HS022981.
Citation:
Callejo-Black A, Wagner DV, Ramanujam K .
A systematic review of external validity in pediatric integrated primary care trials.
J Pediatr Psychol 2020 Oct 1;45(9):1039-52. doi: 10.1093/jpepsy/jsaa068..
Keywords:
Children/Adolescents, Primary Care, Behavioral Health, Healthcare Delivery, Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
Nayfe R, Chansard M, Hynan LS
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain.
This study evaluated construct (convergent and discriminant) validity and time to complete NIH's Patient Reported Outcomes Measurement Information System (PROMIS) as compared to legacy instruments. Results showed that, given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional patient-reported outcomes in older Veterans with chronic low back pain for both research and clinical purposes.
AHRQ-funded; HS022418.
Citation:
Nayfe R, Chansard M, Hynan LS .
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain.
BMC Musculoskelet Disord 2020 Sep 8;21(1):598. doi: 10.1186/s12891-020-03587-6..
Keywords:
Elderly, Veterans, Back Health and Pain, Pain, Chronic Conditions, Patient-Centered Outcomes Research, Research Methodologies
Li X, Lewis KH, Callaway K
Suitability of administrative claims databases for bariatric surgery research - is the glass half-full or half-empty?
The authors assessed the availability and validity of claims-based weight-related diagnosis codes among bariatric surgery patients who underwent adjusted gastric banding, Roux-en-Y gastric bypass, or sleeve gastrectomy. They found that claims-based weight-related diagnosis codes had excellent validity before and after bariatric surgical operation but suboptimal availability after operation. Claims databases can be used for bariatric surgery studies of non-weight-related effectiveness and safety outcomes that are well-captured.
AHRQ-funded; HS026214.
Citation:
Li X, Lewis KH, Callaway K .
Suitability of administrative claims databases for bariatric surgery research - is the glass half-full or half-empty?
BMC Med Res Methodol 2020 Sep 7;20(1):225. doi: 10.1186/s12874-020-01106-8..
Keywords:
Obesity: Weight Management, Obesity, Surgery, Health Services Research (HSR), Research Methodologies
