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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 379 Research Studies Displayed
AHRQ Author: Huppert J
Adolescents with vulvar ulcers: COVID-19 disease, COVID-19 vaccines, and the value of case reports.
The author indicates that there are too few cases reporting aphthosis after COVID disease or COVID-19 vaccination to infer a statistical association, but that case reports are a valuable source of rich details about conditions that are difficult to study with more rigorous designs and can be synthesized to help guide medical care. She recommends that it is time for a high-quality systematic review of vulvar aphthosis in order for clinicians to incorporate the existing evidence into decision-making and best care for patients.
Citation: Huppert J . Adolescents with vulvar ulcers: COVID-19 disease, COVID-19 vaccines, and the value of case reports. J Pediatr Adolesc Gynecol 2022 Apr;35(2):109-11. doi: 10.1016/j.jpag.2022.01.006..
Keywords: Children/Adolescents, COVID-19, Vaccination, Research Methodologies
Kissler K, Breman RB, Carlson N
Innovations in prospective perinatal research as a result of the COVID-19 pandemic.
This paper provides a review of perinatal research adaptations which took place during the COVID-19 pandemic. Although in-person research activities ceased during the spread of SARS-CoV-2 and the resulting disease called COVID-19, the authors’ team of university scientists across the United States utilized adapted methods to allow prospective perinatal research to continue. Novel approaches included using new and underutilized techniques for distance research such as: online recruitment, enrollment, and consent; data collection via videoconferencing; self-collection of biological samples; and new applications of smart phones and wearable vital signs measurement. The researchers found that these methods may improve recruitment success and the quality of the experience for the participants, as well as provide improved access to historically vulnerable populations, such as low-income, rural, and racially diverse pregnant and postpartum individuals and communities. The researchers concluded that the implementation of these research strategies resulted in broader, more inclusive, and diverse perinatal research access, and many of the strategies will continue to be used and refined long after the pandemic.
Citation: Kissler K, Breman RB, Carlson N . Innovations in prospective perinatal research as a result of the COVID-19 pandemic. J Midwifery Womens Health 2022 Mar;67(2):264-69. doi: 10.1111/jmwh.13329..
Keywords: COVID-19, Research Methodologies
Wang Y, Lin L, Thompson CG
A penalization approach to random-effects meta-analysis.
Systematic reviews and meta-analyses are principal tools to synthesize evidence from multiple independent sources in many research fields. The assessment of heterogeneity among collected studies is a critical step when performing a meta-analysis, given its influence on model selection and conclusions about treatment effects. In this paper, the investigators compared the existing and proposed methods with simulated data and several case studies to illustrate the benefits of the penalization methods.
Citation: Wang Y, Lin L, Thompson CG . A penalization approach to random-effects meta-analysis. Stat Med 2022 Feb;41(3):500-16. doi: 10.1002/sim.9261..
Keywords: Research Methodologies
O'Malley AJ, Landon BE, Zaborski LA
Weak correlations in health services research: weak relationships or common error?
This study examined whether the correlation between a provider's effect on one population of patients and the same provider's effect on another population is underestimated if the effects for each population are estimated separately as opposed to being jointly modeled as random effects, and characterized how the impact of the estimation procedure varies with sample size. The authors used Medicare claims and enrollment data on emergency department (ED) visits, including patient characteristics, the patient’s hospitalization status, and identification of the doctor responsible for the decision to hospitalize the patient. The simulation analysis demonstrated that the joint modeling approach is generally close to unbiased, whereas the stratified approach can be severely biased in small samples. Correlations included 0.98 for female and male patients and only 0.38 using stratified estimation. Correlations for White and non-White patients are 0.99 and 0.28, and for Medicaid dual-eligible and non-dual-eligible patients 0.99 and 0.31, respectively.
Citation: O'Malley AJ, Landon BE, Zaborski LA . Weak correlations in health services research: weak relationships or common error? Health Serv Res 2022 Feb;57(1):182-91. doi: 10.1111/1475-6773.13882..
Keywords: Health Services Research (HSR), Research Methodologies
Silva GC, Gutman R
Multiple imputation procedures for estimating causal effects with multiple treatments with application to the comparison of healthcare providers.
Choosing between multiple healthcare providers requires us to simultaneously compare the expected outcomes under each provider. This comparison is complex because the composition of patients treated by each provider may differ. Similar issues arise when simultaneously comparing the adverse effects of interventions using non-randomized data. To simultaneously estimate the effects of multiple providers/interventions the investigators proposed procedures that explicitly imputed the set of potential outcomes for each subject.
Citation: Silva GC, Gutman R . Multiple imputation procedures for estimating causal effects with multiple treatments with application to the comparison of healthcare providers. Stat Med 2022 Jan 15;41(1):208-26. correct. doi: 10.1002/sim.9231..
Keywords: Research Methodologies
Lin JS, Hoffman L, Bean SI
Addressing racism in preventive services: methods report to support the US Preventive Services Task Force.
The purpose of this report was to articulate the definitional and conceptual issues around racism and health inequity and to describe how racism and health inequities are currently addressed in preventive health. An audit was conducted assessing published literature on policy and position statements addressing racism, a subset of cancer and cardiovascular topics in USPSTF reports, recent systematic reviews on interventions to reduce health inequities, and societies, organizations, agencies, and funding bodies to gather information about how they address racism and health equity. Findings showed that racism is complex and pervasive, operates at multiple interrelated levels, and exerts negative effects on other social determinants and health and well-being through multiple pathways. The most directly relevant and immediately useful guidance identified is that from the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group.
Citation: Lin JS, Hoffman L, Bean SI . Addressing racism in preventive services: methods report to support the US Preventive Services Task Force. JAMA 2021 Dec 21;326(23):2412-20. doi: 10.1001/jama.2021.17579..
Keywords: U.S. Preventive Services Task Force (USPSTF), Social Determinants of Health, Racial / Ethnic Minorities, Disparities, Research Methodologies, Prevention, Evidence-Based Practice
Caughey AB, Krist AH, Wolff TA
AHRQ Author: Wolff TA
USPSTF approach to addressing sex and gender when making recommendations for clinical preventive services.
The USPSTF reviewed its past recommendations that included the use of sex and gender terms, reviewed the approaches of other guideline-making bodies, and pilot-tested strategies to address sex and gender diversity. Based on the findings, the USPSTF intends to use an inclusive approach to identify issues related to sex and gender at the start of the guideline development process; assess the applicability, variability, and quality of evidence as a function of sex and gender; ensure clarity in the use of language regarding sex and gender; and identify evidence gaps related to sex and gender. The USPSTF recognizes limited evidence to inform the preventive care of populations based on gender identity.
Citation: Caughey AB, Krist AH, Wolff TA . USPSTF approach to addressing sex and gender when making recommendations for clinical preventive services. JAMA 2021 Nov 16;326(19):1953-61. doi: 10.1001/jama.2021.15731..
Keywords: U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-Based Practice, Prevention, Research Methodologies
Yao L, Ahmed MM, Guyatt GH
Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis.
The purpose of this study was to investigate whether alignment of strength of recommendations with quality of evidence differs in consensus based versus evidence based guidelines. The investigators concluded that consensus based guidelines produced more recommendations violating the evidence based medicine principles than evidence based guidelines. They suggested that ensuring appropriate alignment of quality of evidence with the strength of recommendations is key to the development of "trustworthy" guidelines.
Citation: Yao L, Ahmed MM, Guyatt GH . Discordant and inappropriate discordant recommendations in consensus and evidence based guidelines: empirical analysis. BMJ 2021 Nov 25;375:e066045. doi: 10.1136/bmj-2021-066045..
Keywords: Guidelines, Evidence-Based Practice, Research Methodologies
Lewis CC, Powell BJ, Brewer SK
Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: protocol for generating a research agenda.
This article outlines the protocol for an AHRQ-funded initiative to: 1) establish priorities for an agenda to guide research on implementation mechanisms in health and public health, and 2) disseminate the agenda to research, policy, and practice audiences. The goal is to advance mechanisms of implementation to accelerate sustainable evidence-based practice integration. A network of scientific experts will be created to convene in “Deep Dive” meetings for 3 years. The research agenda will be generated through analysis and synthesis of information from 6 sources: (1) systematic reviews, (2) network members' approaches to studying mechanisms, (3) new proposals presented in implementation proposal feedback sessions, (4) working group sessions conducted in a leading implementation research training institute, (5) breakout sessions at the Society for Implementation Research Collaboration's (SIRC) 2019 conference and (6) SIRC conference abstracts. Mechanism-relevant text segments will be extracted by two members and a third member will generate statements as an input for concept mapping.
Citation: Lewis CC, Powell BJ, Brewer SK . Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: protocol for generating a research agenda. BMJ Open 2021 Oct 18;11(10):e053474. doi: 10.1136/bmjopen-2021-053474..
Keywords: Implementation, Evidence-Based Practice, Research Methodologies, Health Services Research (HSR)
Davidson KW, Krist AH, Tseng CW
AHRQ Author: Mills J, Borsky A
Incorporation of social risk in US Preventive Services Task Force Recommendations and identification of key challenges for primary care.
The authors assessed how social risks have been considered in USPSTF recommendation statements and identified current gaps in evidence needed to expand the systematic inclusion of social risks in future recommendations. They concluded that their report serves as a benchmark and foundation for ongoing work to advance the goal of ensuring that health equity and social risks are incorporated into USPSTF methods and recommendations.
Citation: Davidson KW, Krist AH, Tseng CW . Incorporation of social risk in US Preventive Services Task Force Recommendations and identification of key challenges for primary care. JAMA 2021 Oct 12;326(14):1410-15. doi: 10.1001/jama.2021.12833..
Keywords: U.S. Preventive Services Task Force (USPSTF), Primary Care, Social Determinants of Health, Risk, Evidence-Based Practice, Research Methodologies, Guidelines
Erim DO, Bennett AV, Gaynes BN
Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D.
The purpose of this study was to create a crosswalk that predicts Short Form 6D (SF-6D) utilities from Memorial Anxiety Scale for Prostate Cancer (MAX-PC) scores. Findings showed that this study provided a crosswalk that converts MAX-PC scores to SF-6D utilities for economic evaluation of clinically significant prostate cancer-related anxiety treatment options for prostate cancer survivors.
Citation: Erim DO, Bennett AV, Gaynes BN . Mapping the Memorial Anxiety Scale for Prostate Cancer to the SF-6D. Qual Life Res 2021 Oct;30(10):2919-28. doi: 10.1007/s11136-021-02871-9..
Keywords: Cancer: Prostate Cancer, Cancer, Research Methodologies
Djulbegovic B, Hozo I, Li SA
Certainty of evidence and intervention's benefits and harms are key determinants of guidelines' recommendations.
This study’s goal was to identify the key determinants of clinical guideline development. This study used a web-based survey of 12 panels of 153 “voting” members who issued 2941 recommendations and a qualitative analysis of 13 panels of 311 attendees. When intervention’s benefits outweigh harms compared with no recommendations: the probability of issuing strong recommendations in favor of intervention was 0.22 when certainty of evidence (CoE) was very low; 0.5 when low; 0.74 when moderate, and 0.85 when high. No other factor significantly affected recommendations. Panelists spent over 50% of their time debating CoE with the chairs and co-chairs dominating discussion.
Citation: Djulbegovic B, Hozo I, Li SA . Certainty of evidence and intervention's benefits and harms are key determinants of guidelines' recommendations. J Clin Epidemiol 2021 Aug;136:1-9. doi: 10.1016/j.jclinepi.2021.02.025..
Keywords: Evidence-Based Practice, Guidelines, Research Methodologies, Decision Making
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.
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
Schulz GL, Patterson Kelly K, Armer J
Uncovering family treatment decision-making processes: the value and application of case study methods to family research.
Research on how and why family processes influence phenomena is essential to advancing many areas of science. Case study methods offer an approach that overcomes some of the sampling and analysis obstacles researchers face when studying families. This article aimed to illustrate the benefits of case study methods for studying complex family processes using an example from treatment decision-making in sickle cell disease.
Citation: Schulz GL, Patterson Kelly K, Armer J . Uncovering family treatment decision-making processes: the value and application of case study methods to family research. J Fam Nurs 2021 Aug;27(3):191-98. doi: 10.1177/1074840720987223..
Keywords: Decision Making, 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).
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
Boursaw B, Oetzel JG, Dickson E
Scales of practices and outcomes for community-engaged research.
The purpose of this study was to present the psychometric properties of scales from the Engage for Equity (E2) project, stemming from a long-term research partnership examining community-engaged research projects. This study used a three-stage, cross-sectional format: (a) a sampling frame of 413 CEnR projects was identified; (b) 210 principal investigators completed a project-level survey and nominated partners for another survey; (c) 457 investigators and partners completed a survey about project contexts, processes, interventions, and outcomes.
Citation: Boursaw B, Oetzel JG, Dickson E . Scales of practices and outcomes for community-engaged research. Am J Community Psychol 2021 Jun;67(3-4):256-70. doi: 10.1002/ajcp.12503..
Keywords: Outcomes, Research Methodologies
Van Domelen DR, Mitchell EM, Perkins NJ
AHRQ Author: Mitchell EM
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.
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
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.
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
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.
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.
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
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.
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.
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.
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
AHRQ Author: Chang S
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
AHRQ Author: Chang S
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