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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 386 Research Studies Displayed
Kalenderian E, Lee JH, Obadan-Udoh EM
Development of an inventory of dental harms: methods and rationale.
The authors sought to standardize the language of dental adverse events (AEs). Using a multimodal approach, they developed a broad list of dental AEs in which the AEs were classed into 12 categories, with hard tissue injury being noted frequently. Pain was the unexpected AE that was consistently identified with every modality used.
Citation: Kalenderian E, Lee JH, Obadan-Udoh EM . Development of an inventory of dental harms: methods and rationale. J Patient Saf 2022 Sep 1;18(6):559-64. doi: 10.1097/pts.0000000000001033..
Keywords: Dental and Oral Health, Patient Safety, Research Methodologies
Young JC, Dasgupta N, Stürmer T
Considerations for observational study design: comparing the evidence of opioid use between electronic health records and insurance claims.
The authors linked electronic health record (EHR) data from a large academic health system to Medicare insurance claims for patients undergoing surgery. When characterizing opioid exposure, they found substantial discrepancies between EHR medication orders and prescription claims data. In all time periods assessed, most patients' use was reflected only in the EHR, or only in the claims, but not both.
Citation: Young JC, Dasgupta N, Stürmer T . Considerations for observational study design: comparing the evidence of opioid use between electronic health records and insurance claims. Pharmacoepidemiol Drug Saf 2022 Aug;31(8):913-20. doi: 10.1002/pds.5452..
Keywords: Research Methodologies, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kumamaru H, Jalbert JJ, Nguyen LL
Utility of automated data-adaptive propensity score method for confounding by indication in comparative effectiveness study in real world Medicare and registry data.
The authors assessed the utility of an automated data-adaptive analytic approach for confounding adjustment when both claims and clinical registry data are available. Using a comparative study example of carotid artery stenting vs. carotid endarterectomy with strong confounding by indication, they found that the automated data-adaptive propensity score performed better than the investigator-specified propensity score in general, but both claims and registry data were needed to adequately control for bias.
Citation: Kumamaru H, Jalbert JJ, Nguyen LL . Utility of automated data-adaptive propensity score method for confounding by indication in comparative effectiveness study in real world Medicare and registry data. PLoS One 2022 Aug;17(8):e0272975. doi: 10.1371/journal.pone.0272975..
Keywords: Registries, Comparative Effectiveness, Research Methodologies, Patient-Centered Outcomes Research, Evidence-Based Practice
Djulbegovic B, Ahmed MM, Hozo I
High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence.
The study researchers state that assumptions and general beliefs exist about certainty of evidence (CoE) and its impact on estimates of treatment effects, however empirical assessment of those assumptions and beliefs is lacking. The purpose of this study was to evaluate the differences between low CoE (low-quality evidence) and high CoE (high-quality evidence) in precision of estimating treatment effects. The researchers reviewed the Cochrane Database of Systematic Reviews from January 2016 through May 2021 for pairs of original and updated reviews for change in CoE assessments based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Differences in effect sizes between the original reviews and the updated reviews were assessed as a function of change in CoE. The researchers concluded that low CoE changes more frequently than high CoE, but the effect size in low CoE studies did not differ from the effect size in high CoE studies. The researchers state that the effect size finding is an indicator of the need to further assess and improve the critical appraisal methods currently utilized in evidence-based medicine.
Citation: Djulbegovic B, Ahmed MM, Hozo I . High quality (certainty) evidence changes less often than low-quality evidence, but the magnitude of effect size does not systematically differ between studies with low versus high-quality evidence. J Eval Clin Pract 2022 Jun;28(3):353-62. doi: 10.1111/jep.13657..
Keywords: Research Methodologies, Evidence-Based Practice
Nguyen AM, Cleland CM, Dickinson LM
Considerations before selecting a stepped-wedge cluster randomized trial design for a practice improvement study.
This study’s objective was to identify the advantages and challenges of the stepped-wedge cluster randomized trial (SW-CRT) design for large-scale intervention implementations in primary care settings. The authors interviewed grantees from the EvidenceNOW: Advancing Heart Health initiative, which included a large collection of SW-CRTs. A total of 17 key informants were given qualitative interviews. All interviewees reported that SW-CRT can be an effective study design. The advantages of SW-CRT include incentivized recruitment, staggered resource allocation, and statistical power. The challenges included time-sensitive recruitment, retention, randomization requirements and practice preferences, achieving treatment schedule fidelity, intensive data collection, the Hawthorne effect, and temporal trends.
Citation: Nguyen AM, Cleland CM, Dickinson LM . Considerations before selecting a stepped-wedge cluster randomized trial design for a practice improvement study. Ann Fam Med 2022 May-Jun;20(3):255-61. doi: 10.1370/afm.2810..
Keywords: Research Methodologies
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
Reeves SL, Dombkowski KJ, Madden B
Considerations when aggregating data to measure performance across levels of the health care system.
Investigators examined attribution when measuring quality at varying levels of the health care system. Using Medicaid claims, they concluded that, when applying attribution models, it was essential to consider the potential to induce health disparities. Further, differential attribution may have unintentional consequences that deepen health disparities, particularly when considering incentive programs for health plans to improve the quality of care.
AHRQ-funded; HS025292; HS025299.
Citation: Reeves SL, Dombkowski KJ, Madden B . Considerations when aggregating data to measure performance across levels of the health care system. Acad Pediatr 2022 Apr;22(3s):S119-s24. doi: 10.1016/j.acap.2021.11.013..
Keywords: Sickle Cell Disease, Research Methodologies, Provider Performance
Ellis RP, Hsu HE, Siracuse JJ
Development and assessment of a new framework for disease surveillance, prediction, and risk adjustment: the diagnostic items classification system.
The purpose of this study was to develop an updated classification framework for predicting diverse health care payment, quality, and performance outcomes, based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). All ICD-10-CM diagnoses were mapped into 3 types of diagnostic items (DXIs): main effect DXIs that specify diseases; modifiers, such as timing and acuity; and scaled variables, such as body mass index, gestational age, and birth weight. The primary outcome was annual health care spending top-coded at $250 000, and the researchers predicted 14 different outcomes, including: hospital days and admissions; emergency department visits; enrollee out-of-pocket spending; spending for 6 types of services; and overall and plan-paid health care spending. The researchers created 3223 DXIs: 2435 main effects, 772 modifiers, and 16 scaled items. The study found that relative to HHS-HCCs, the use of DXIs reduced underpayment for enrollees with rare diagnoses by 83%. The researchers concluded that in this study, for all spending and utilization outcomes considered, the new DXI classification system demonstrated improved predictions over current diagnostic classification systems.
Citation: Ellis RP, Hsu HE, Siracuse JJ . Development and assessment of a new framework for disease surveillance, prediction, and risk adjustment: the diagnostic items classification system. JAMA Health Forum 2022 Mar;3(3):e220276. doi: 10.1001/jamahealthforum.2022.0276..
Keywords: Risk, 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