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AHRQ Research Studies Date
Topics
- Adverse Events (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 36 Research Studies DisplayedOatis CA, Konnyu KJ, Franklin PD
Generating consistent longitudinal real-world data to support research: lessons from physical therapists.
The purpose of this study was to evaluate whether clinicians can generate consistent and standardized real-world data (RWD) to enhance data quality in the course of routine patient care. The researchers collaborated with PT clinicians and experts to generate a web-based comprehensive system to quantify the total dose of PT interventions with type of modality, quantity, intensity, and progressions over time. The system was designed to be implemented in outpatient PT clinics capable of residing alongside or within a clinic’s existing EHR. The study goal was to collect routine clinical data in a format useable by the general population of outpatient physical therapists treating patients post Total Knee Replacement (TKR) and in a structure that would allow easy quantification and analysis across patients, therapists, and sites. Uniform and efficient documentation of real-world PT practice following TKR is essential for the necessary comparative effectiveness research demanded by the currently unexplained practice variation. Over a period of 2 years, physical therapists and PT assistants located in three US states entered data for a total of 161 patients post TKR with 2615 patient visits. No technical problems with the data capture system were reported, and physical therapists noted that data entry was efficient and simple. The researchers concluded that the results demonstrate that routine PT interventions can be captured thoroughly in an efficient, systematic, and consistent manner across real-world therapists and sites.
AHRQ-funded; 75Q80120D00001.
Citation: Oatis CA, Konnyu KJ, Franklin PD .
Generating consistent longitudinal real-world data to support research: lessons from physical therapists.
ACR Open Rheumatol 2022 Sep;4(9):771-74. doi: 10.1002/acr2.11465..
Keywords: Research Methodologies, Patient-Centered Outcomes Research, Evidence-Based Practice
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.
AHRQ-funded; 29020050016I.
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
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
Cuthel A, Rogers E, Daniel F
Barriers and facilitators in the recruitment and retention of more than 250 small independent primary care practices for EvidenceNOW.
This study examined barriers and facilitators in the recruitment and retention of small independent practices (SIPs) to participate in research studies. The authors used qualitative data from the HealthyHearts New York City program, part of the EvidenceNOW initiative. This randomized controlled trial took place from 2015 through 2018 across 5 boroughs in NYC. A total of 257 SIPs (<5 full-time clinicians) were recruited originally. The three main factors that facilitated rapid recruitment were: 1) a prior well-established relationship with the local health department; 2) alignment of project goals with practice priorities, and 3) having appropriate monetary incentives. Specific strategies that enhance recruitment of SIPS and fills gaps in knowledge about factors that influence retention are identified.
AHRQ-funded; HS023922.
Citation: Cuthel A, Rogers E, Daniel F .
Barriers and facilitators in the recruitment and retention of more than 250 small independent primary care practices for EvidenceNOW.
Am J Med Qual 2020 Sep/Oct;35(5):388-96. doi: 10.1177/1062860619893422..
Keywords: Primary Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Tsou AY, Treadwell JR, Erinoff E
Machine learning for screening prioritization in systematic reviews: comparative performance of Abstrackr and EPPI-Reviewer.
Improving the speed of systematic review (SR) development is key to supporting evidence-based medicine. Machine learning tools which semi-automate citation screening might improve efficiency. Few studies have assessed use of screening prioritization functionality or compared two tools head to head. In this project, the investigators compared performance of two machine-learning tools for potential use in citation screening.
AHRQ-funded; HS025859.
Citation: Tsou AY, Treadwell JR, Erinoff E .
Machine learning for screening prioritization in systematic reviews: comparative performance of Abstrackr and EPPI-Reviewer.
Syst Rev 2020 Apr 2;9(1):73. doi: 10.1186/s13643-020-01324-7..
Keywords: Health Services Research (HSR), Research Methodologies, Evidence-Based Practice, Patient-Centered Outcomes Research
Byham-Gray LD, Peters EN, Rothpletz-Puglia P
Patient-centered model for protein-energy wasting: stakeholder deliberative panels.
Integrating the patient's voice into research prioritization is essential for solving problems that patients care the most about in terms of health, symptom management, and survival. In this study, the investigators used deliberative processes for adapting the existing model of protein-energy wasting (PEW) to one that included stakeholder priorities, addressing gaps from the initial concept.
AHRQ-funded; HS023434.
Citation: Byham-Gray LD, Peters EN, Rothpletz-Puglia P .
Patient-centered model for protein-energy wasting: stakeholder deliberative panels.
J Ren Nutr 2020 Mar;30(2):137-44. doi: 10.1053/j.jrn.2019.06.001..
Keywords: Patient-Centered Healthcare, Patient-Centered Outcomes Research, Evidence-Based Practice, Patient and Family Engagement, Research Methodologies
Gates A, Guitard S, Pillay J
Performance and usability of machine learning for screening in systematic reviews: a comparative evaluation of three tools.
Researchers explored the performance of three machine learning tools designed to facilitate title and abstract screening in systematic reviews (SRs) when used to eliminate irrelevant records and complement the work of a single reviewer. Using Abstrackr, DistillerSR, and RobotAnalyst, they found that the workload savings afforded in the automated simulation came with increased risk of missing relevant records. Supplementing a single reviewer's decisions with relevance predictions sometimes reduced the proportion missed, but performance varied by tool and SR. They recommend designing tools based on reviewers' self-identified preferences to improve compatibility with present workflows.
AHRQ-funded; 290201500001I.
Citation: Gates A, Guitard S, Pillay J .
Performance and usability of machine learning for screening in systematic reviews: a comparative evaluation of three tools.
Syst Rev 2019 Nov 15;8(1):278. doi: 10.1186/s13643-019-1222-2..
Keywords: Patient-Centered Outcomes Research, Health Services Research (HSR), Research Methodologies, Evidence-Based Practice, Comparative Effectiveness
Gartlehner G, Wagner G, Lux L
Assessing the accuracy of machine-assisted abstract screening with DistillerAI: a user study.
The goal of this project was to conduct a case study to explore a screening approach that temporarily replaces a human screener with a semi-automated screening tool. The authors used DistillerAI as a semi-automated screening tool, and a published comparative effectiveness review served as their reference standard. They found that the accuracy of DistillerAI was not yet adequate to replace a human screener temporarily during abstract screening for systematic reviews.
AHRQ-funded; 290201500011I.
Citation: Gartlehner G, Wagner G, Lux L .
Assessing the accuracy of machine-assisted abstract screening with DistillerAI: a user study.
Syst Rev 2019 Nov 15;8(1):277. doi: 10.1186/s13643-019-1221-3..
Keywords: Patient-Centered Outcomes Research, Health Services Research (HSR), Research Methodologies, Evidence-Based Practice
Ivlev I, Vander Ley KJ, Wiedrick J
Training patients to review scientific reports for the Patient-Centered Outcomes Research Institute: an observational study.
This observational study aimed to evaluate the effect of new training for patient peer reviewers of scientific reports for the Patient-Centered Outcomes Research Institute (PCORI). A new online training in peer review was used to help change reviewers’ knowledge and skills and change self-efficacy and attitudes. Reviewers improved their answers to the knowledge questions. Median numbers of answers improved after the training, particularly in questions targeting the specifics of PCORI peer review. It modestly increased reviewers’ confidence in completing a high-quality peer review. Their excitement about providing a review slightly increased. All reviewers were satisfied with the training.
AHRQ-funded; HS026370.
Citation: Ivlev I, Vander Ley KJ, Wiedrick J .
Training patients to review scientific reports for the Patient-Centered Outcomes Research Institute: an observational study.
BMJ Open 2019 Sep;9(9):e028732. doi: 10.1136/bmjopen-2018-028732..
Keywords: Patient-Centered Outcomes Research, Evidence-Based Practice, Research Methodologies, Patient and Family Engagement, Education: Patient and Caregiver, Training
Millar MM, Kinney AY, Camp NJ
Predictors of response outcomes for research recruitment through a central cancer registry: evidence from 17 recruitment efforts for population-based studies.
The authors conducted multivariable mixed-effects logistic regression to identify case and study characteristics associated with making contact with and obtaining cooperation of Utah cancer cases. They found that characteristics associated with lower odds of contact included Hispanic ethnicity, nonwhite race, and younger age at contact. Years since diagnosis was inversely associated with making contact. Increased odds of cooperation were associated with including a questionnaire, postage stamps, and incentives. They concluded that obtaining high response is challenging, but study features identified in this analysis support better results when recruiting through central cancer registries.
AHRQ-funded; HS019356; HS022640.
Citation: Millar MM, Kinney AY, Camp NJ .
Predictors of response outcomes for research recruitment through a central cancer registry: evidence from 17 recruitment efforts for population-based studies.
Am J Epidemiol 2019 May;188(5):928-39. doi: 10.1093/aje/kwz011..
Keywords: Cancer, Patient-Centered Outcomes Research, Evidence-Based Practice, Registries, Outcomes, Research Methodologies
Natafgi N, Tafari AT, Chauhan C
Patients' early engagement in research proposal development (PEER-PD): patients guiding the proposal writing.
Patient engagement often starts after research funding is secured with little or no involvement of patients in the proposal development phase. This paper compared three levels of patient engagement and described patients' early engagement in the research proposal development process and its contemporary relevance to clinical and translational research. The paper also addressed key patient considerations and questions that had an impact on the proposal development.
AHRQ-funded; HS022135.
Citation: Natafgi N, Tafari AT, Chauhan C .
Patients' early engagement in research proposal development (PEER-PD): patients guiding the proposal writing.
J Comp Eff Res 2019 Apr;8(6):441-53. doi: 10.2217/cer-2018-0129..
Keywords: Research Methodologies, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Gartlehner G, Nussbaumer-Streit B, Wagner G
Increased risks for random errors are common in outcomes graded as high certainty of evidence.
The goal of this article was to assess the risk for random errors in outcomes graded as high certainty of evidence (CoE). Results showed that, overall, 38% of high CoE outcomes had increased risks for random errors. Outcomes assessing harms were more frequently affected than outcomes assessing benefits. Regrading of outcomes with increased random errors showed that 74% should have been downgraded based on current guidance. Recommendations included being aware that outcomes rated as high CoE often have increased risks for false-positive or false-negative findings.
AHRQ-funded; HS024749.
Citation: Gartlehner G, Nussbaumer-Streit B, Wagner G .
Increased risks for random errors are common in outcomes graded as high certainty of evidence.
J Clin Epidemiol 2019 Feb;106:50-59. doi: 10.1016/j.jclinepi.2018.10.009..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Patient-Centered Outcomes Research, Research Methodologies
Ishimine P, Adelgais K, Barata I
Executive summary: the 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps.
Emergency care providers share a compelling interest in developing an effective patient-centered, outcomes-based research agenda that can decrease variability in pediatric outcomes. The 2018 Academic Emergency Medicine Consensus Conference "Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps (AEMCC)" aimed to fulfill this role. This paper discusses the conference which convened major thought leaders and stakeholders to introduce a research, scholarship, and innovation agenda for pediatric emergency care specifically to reduce health outcome gaps.
AHRQ-funded; HS026101.
Citation: Ishimine P, Adelgais K, Barata I .
Executive summary: the 2018 Academic Emergency Medicine Consensus Conference: Aligning the Pediatric Emergency Medicine Research Agenda to Reduce Health Outcome Gaps.
Acad Emerg Med 2018 Dec;25(12):1317-26. doi: 10.1111/acem.13667..
Keywords: Implementation, Evidence-Based Practice, Patient-Centered Outcomes Research, Children/Adolescents, Emergency Department, Outcomes, Research Methodologies
Ma X, Lin L, Qu Z
Performance of between-study heterogeneity measures in the Cochrane Library.
The growth in comparative effectiveness research and evidence-based medicine has increased attention to systematic reviews and meta-analyses. Assessing heterogeneity is critical for performing a meta-analysis and interpreting results. This article evaluates two heterogeneity measures. To evaluate these measures' performance empirically, the investigators applied them to 20,599 meta-analyses in the Cochrane Library.
AHRQ-funded; HS024743.
Citation: Ma X, Lin L, Qu Z .
Performance of between-study heterogeneity measures in the Cochrane Library.
Epidemiology 2018 Nov;29(6):821-24. doi: 10.1097/ede.0000000000000857..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Chou R, Baker WL, Banez LL
Agency for Healthcare Research and Quality Evidence-based Practice Center methods provide guidance on prioritization and selection of harms in systematic reviews.
A workgroup of methodologists from Evidence-based Practice Centers (EPCs) developed consensus-based guidance on selection and prioritization of harms in systematic reviews. Ten recommendations were developed on selection and prioritization of harms, including routinely focusing on serious as well as less serious but frequent or bothersome harms; and routinely engaging stakeholders and using literature searches and other data sources to identify important harms.
AHRQ-authored; AHRQ-funded; HS022998.
Citation: Chou R, Baker WL, Banez LL .
Agency for Healthcare Research and Quality Evidence-based Practice Center methods provide guidance on prioritization and selection of harms in systematic reviews.
J Clin Epidemiol 2018 Jun;98:98-104. doi: 10.1016/j.jclinepi.2018.01.007.
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Keywords: Adverse Events, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Adam GP, Springs S, Trikalinos T
AHRQ Author: Berliner E
Does information from ClinicalTrials.gov increase transparency and reduce bias? Results from a five-report case series.
The researchers investigated whether information in ClinicalTrials.gov would impact the conclusions of five ongoing systematic reviews. Of the 173 total ClinicalTrials.gov records identified across the five projects, between 11 and 43 percent did not have an associated publication. In the 14 percent of records that contained results, the new data provided in the ClinicalTrials.gov records did not change the results or conclusions of the reviews.
AHRQ-authored; AHRQ-funded; HS022998.
Citation: Adam GP, Springs S, Trikalinos T .
Does information from ClinicalTrials.gov increase transparency and reduce bias? Results from a five-report case series.
Syst Rev 2018 Apr 16;7(1):59. doi: 10.1186/s13643-018-0726-5.
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Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Armstrong MJ, Mullins CD, Gronseth GS
Impact of patient involvement on clinical practice guideline development: a parallel group study.
The aim of this study was to investigate the effect of patient and public involvement (PPI) on guideline question formation and validate a conceptual model of patient and public contributions to guidelines. The qualitative analysis of the discussions occurring during guideline question development demonstrated key differences in group conduct and validated the proposed conceptual model of patient and public contributions to guidelines.
AHRQ-funded; HS024159; HS022135.
Citation: Armstrong MJ, Mullins CD, Gronseth GS .
Impact of patient involvement on clinical practice guideline development: a parallel group study.
Implement Sci 2018 Apr 16;13(1):55. doi: 10.1186/s13012-018-0745-6.
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Keywords: Evidence-Based Practice, Guidelines, Patient and Family Engagement, Patient-Centered Outcomes Research, Research Methodologies
Kao LM, Greenhawt MJ, Warren CM
Parental and parent-perceived child interest in clinical trials for food allergen immunotherapy.
This investigation of the motivations and desires of caregivers related to enrolling their child in a clinical trial for food allergen immunotherapy found that the majority of respondents would consider enrolling their child in a trial, irrespective of most patient demographic and disease characteristics. Families earning ≥$100,000/ year reported significantly greater willingness to enroll in a trial.
AHRQ-funded; HS024599.
Citation: Kao LM, Greenhawt MJ, Warren CM .
Parental and parent-perceived child interest in clinical trials for food allergen immunotherapy.
Ann Allergy Asthma Immunol 2018 Mar;120(3):331-33.e1. doi: 10.1016/j.anai.2017.12.012.
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Keywords: Children/Adolescents, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Butler M, Epstein RA, Totten A
AHRQ series on complex intervention systematic reviews-paper 3: adapting frameworks to develop protocols.
This article identifies and describes elements of frameworks and how they can be adapted to inform the protocol and conduct of systematic reviews of complex interventions. Possible approaches to analytic frameworks for complex interventions that illustrate causal and associative linkages are outlined, including time elements, which systematic reviews of complex interventions may need to address.
AHRQ-funded; 290201200004C; 290201500008I; 290201500005I; 290201500006I; 290201500010I.
Citation: Butler M, Epstein RA, Totten A .
AHRQ series on complex intervention systematic reviews-paper 3: adapting frameworks to develop protocols.
J Clin Epidemiol 2017 Oct;90:19-27. doi: 10.1016/j.jclinepi.2017.06.013.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Guise JM, Butler ME, Chang C
AHRQ series on complex intervention systematic reviews-paper 6: PRISMA-CI extension statement and checklist.
This paper provides a stand-alone extension to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting tool for complex interventions-PRISMA-CI-to help authors, publishers, and readers understand and apply to systematic reviews of complex interventions. PRISMA-CI development followed the Enhancing the QUAlity and Transparency Of health Research Network guidance for extensions and focused on adding or modifying only essential items.
AHRQ-funded; 290201200004C; 290201200016I; 290201500011I.
Citation: Guise JM, Butler ME, Chang C .
AHRQ series on complex intervention systematic reviews-paper 6: PRISMA-CI extension statement and checklist.
J Clin Epidemiol 2017 Oct;90:43-50. doi: 10.1016/j.jclinepi.2017.06.016.
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Keywords: Evidence-Based Practice, Guidelines, Patient-Centered Outcomes Research, Research Methodologies
Braun D, Gorfine M, Parmigiani G
Propensity scores with misclassified treatment assignment: a likelihood-based adjustment.
The researchers show that misclassification of treatment assignment can impact three distinct stages of a propensity score analysis. They examine how error in the treatment assignment impacts each stage in the context of three common propensity score implementations: subclassification, matching, and inverse probability of treatment weighting (IPTW). They propose a two-step likelihood-based approach which fully adjusts for treatment misclassification bias under subclassification
AHRQ-funded; HS021991.
Citation: Braun D, Gorfine M, Parmigiani G .
Propensity scores with misclassified treatment assignment: a likelihood-based adjustment.
Biostatistics 2017 Oct 1;18(4):695-710. doi: 10.1093/biostatistics/kxx014.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Landsittel DP, Kessler L, Schmid CH
Training in patient-centered outcomes research for specific researcher communities.
A number of publications have discussed approaches to training the scientific workforce in comparative effectiveness research (CER) and patient-centered outcomes research (PCOR). To extend these efforts into specific researcher communities, the AHRQ developed a Funding Opportunity Announcement that called for training for a specific researcher community in collaboration with associated program partners. This paper describes the strategies developed by the 5 subsequently funded programs, and the challenges associated with developing in-person and online programs.
AHRQ-funded; HS023214; HS023199; HS023299; HS023207; HS023185.
Citation: Landsittel DP, Kessler L, Schmid CH .
Training in patient-centered outcomes research for specific researcher communities.
J Clin Transl Sci 2017 Oct;1(5):278-84. doi: 10.1017/cts.2017.307.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies, Training
Kim MO, Wang X, Liu C
Random-effects meta-analysis for systematic reviews of phase I clinical trials: rare events and missing data.
The researchers use a systematic review of pediatric phase I oncology trials to illustrate the utility of advanced Bayesian analysis. Outcomes are rarely entirely missing in clinical trials. They utilize available information and conduct Bayesian incomplete data analysis. Their advanced Bayesian analyses, although illustrated with the specific example, are generally applicable.
AHRQ-funded; HS022437.
Citation: Kim MO, Wang X, Liu C .
Random-effects meta-analysis for systematic reviews of phase I clinical trials: rare events and missing data.
Res Synth Methods 2017 Jun;8(2):124-35. doi: 10.1002/jrsm.1209.
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Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Patel HD, Iyoha E, Pierorazio PM
A systematic review of research gaps in the evaluation and management of localized renal masses.
The authors conducted a systematic review to summarize research gaps for the evaluation of composite models for predicting malignancy; use of percutaneous renal sampling for diagnosis; and comparative effectiveness of surgery, thermal ablation, and active surveillance. They recommended incorporation of emerging biomarkers into validated composite models, standardization of biopsy protocols, standard reporting of clinical stage, and performance of prospective studies with objective selection criteria.
AHRQ-funded; 290201200007I.
Citation: Patel HD, Iyoha E, Pierorazio PM .
A systematic review of research gaps in the evaluation and management of localized renal masses.
Urology 2016 Dec;98:14-20. doi: 10.1016/j.urology.2016.08.013.
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Keywords: Cancer, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Indicators (QIs), Research Methodologies
Cohen DJ, Balasubramanian BA, Gordon L
A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.
This paper describes the study protocol for the EvidenceNOW national evaluation, which is called Evaluating System Change to Advance Learning and Take Evidence to Scale (ESCALATES). Quantitative, qualitative, and mixed methods analyses will be conducted to examine how Cooperatives organize to provide external support to practices, to compare effectiveness of the dissemination and implementation approaches they implement, and to examine how regional variations and other organization and contextual factors influence implementation and effectiveness.
AHRQ-funded; HS022981; HS023940.
Citation: Cohen DJ, Balasubramanian BA, Gordon L .
A national evaluation of a dissemination and implementation initiative to enhance primary care practice capacity and improve cardiovascular disease care: the ESCALATES study protocol.
Implement Sci 2016 Jun 29;11(1):86. doi: 10.1186/s13012-016-0449-8.
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Keywords: Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention, Primary Care, Research Methodologies