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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
26 to 50 of 61 Research Studies DisplayedErtefaie A, Small D, Flory J
Selection bias when using instrumental variable methods to compare two treatments but more than two treatments are available.
The authors discuss how instrumental variable methods may result in biased treatment effects if applied on a data set in which subjects are preselected based on their received treatments. They applied their method on The Health Improvement Network (THIN) database to estimate the comparative effect of metformin and sulfonylureas on weight gain among patients with diabetes.
AHRQ-funded; HS023898.
Citation: Ertefaie A, Small D, Flory J .
Selection bias when using instrumental variable methods to compare two treatments but more than two treatments are available.
Int J Biostat 2016 May 1;12(1):219-32. doi: 10.1515/ijb-2015-0006.
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Keywords: Research Methodologies, Comparative Effectiveness, Patient-Centered Outcomes Research
Wang SV, Verpillat P, Rassen JA
Transparency and reproducibility of observational cohort studies using large healthcare databases.
The researchers explored the extent to which published pharmacoepidemiologic studies using commercially available databases could be reproduced by other investigators. Based on a nonsystematic sample of 38 descriptive or comparative safety/effectiveness cohort studies, they concludedc that an essential component of transparent and reproducible databases is more complete reporting of study implementation.
AHRQ-funded; HS022193.
Citation: Wang SV, Verpillat P, Rassen JA .
Transparency and reproducibility of observational cohort studies using large healthcare databases.
Clin Pharmacol Ther 2016 Mar;99(3):325-32. doi: 10.1002/cpt.329..
Keywords: Health Information Technology (HIT), Data, Research Methodologies, Comparative Effectiveness
Mehta HB, Dimou F, Adhikari D
Comparison of comorbidity scores in predicting surgical outcomes.
The purpose of this study was to compare diagnosis-based and prescription-based comorbidity scores for predicting surgical outcomes. It concluded that the Centers for Medicare and Medicaid Services-Hierarchical Condition Categories had superior performance in predicting surgical outcomes. Prescription-based scores, alone or in addition to diagnosis-based scores, were not better than any diagnosis-based scoring system.
AHRQ-funded; HS022134.
Citation: Mehta HB, Dimou F, Adhikari D .
Comparison of comorbidity scores in predicting surgical outcomes.
Med Care 2016 Feb;54(2):180-7. doi: 10.1097/mlr.0000000000000465..
Keywords: Comparative Effectiveness, Surgery, Research Methodologies, Diagnostic Safety and Quality, Adverse Events
Chen Y, Hong C, Ning Y
Meta-analysis of studies with bivariate binary outcomes: a marginal beta-binomial model approach.
In this paper, the researchers propose a marginal beta-binomial model for the meta-analysis of studies with binary outcomes. This model is based on the composite likelihood approach and has several attractive features compared with the existing models such as bivariate generalized linear mixed model (Chu and Cole, 2006) and Sarmanov beta-binomial model (Chen et al., 2012).
AHRQ-funded; HS022900.
Citation: Chen Y, Hong C, Ning Y .
Meta-analysis of studies with bivariate binary outcomes: a marginal beta-binomial model approach.
Stat Med 2016 Jan 15;35(1):21-40. doi: 10.1002/sim.6620.
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Keywords: Research Methodologies, Comparative Effectiveness
Chen Y, Chu H, Luo S
Bayesian analysis on meta-analysis of case-control studies accounting for within-study correlation.
In this article, the researchers first extend the published results on a single 2 x 2 table to allow within study prior correlation while retaining the advantage of closed-form posterior formula, and then extend the results to multiple 2 x 2 tables and regression setting. The hyperparameters, including within study correlation, are estimated via an empirical Bayes approach.
AHRQ-funded; HS020666.
Citation: Chen Y, Chu H, Luo S .
Bayesian analysis on meta-analysis of case-control studies accounting for within-study correlation.
Stat Methods Med Res 2015 Dec;24(6):836-55. doi: 10.1177/0962280211430889.
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Keywords: Comparative Effectiveness, Research Methodologies
Meeker D, Jiang X, Matheny ME
A system to build distributed multivariate models and manage disparate data sharing policies: implementation in the scalable national network for effectiveness research.
The authors’ objective was to implement infrastructure that supports the functionality of some existing research networks (e.g., cohort discovery, workflow management, and estimation of multivariate analytic models on centralized data) while adding additional important new features. They were able to implement massively parallel (map-reduce) computation methods and a new policy management system to enable each study initiated by network participants to define the ways in which data may be processed, managed, queried, and shared.
AHRQ-funded; HS019913.
Citation: Meeker D, Jiang X, Matheny ME .
A system to build distributed multivariate models and manage disparate data sharing policies: implementation in the scalable national network for effectiveness research.
J Am Med Inform Assoc 2015 Nov;22(6):1187-95. doi: 10.1093/jamia/ocv017..
Keywords: Communication, Comparative Effectiveness, Data, Health Information Technology (HIT), Policy, Research Methodologies
Berkman ND, Lohr KN, Ansari MT, et al.
AHRQ Author: Chang S
Grading the strength of a body of evidence when assessing health care interventions: an EPC update.
The purpose of this article is to revise the 2010 guidance on grading the strength of evidence (SOE) of the effectiveness of drugs, devices, and other preventive and therapeutic interventions produced by AHRQ’s Evidence-based Practice Center program. It concluded that no single approach for grading SOE suits all reviews, but a more consistent and transparent approach to reporting summary information will make reviews more useful.
AHRQ authored; AHRQ-funded 290200710056I
Citation: Berkman ND, Lohr KN, Ansari MT, et al..
Grading the strength of a body of evidence when assessing health care interventions: an EPC update.
J Clin Epidemiol. 2015 Nov;68(11):1312-24. doi: 10.1016/j.jclinepi.2014.11.023..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Research Methodologies, Quality Measures
Berkman ND, Lohr KN, Ansari MT
Grading the strength of a body of evidence when assessing health care interventions: an EPC update.
The authors discussed the state of revision of 2010 guidance on grading the strength of evidence (SOE) of the effectiveness of drugs, devices, and other preventive and therapeutic interventions in systematic reviews produced by AHRQ's Evidence-based Practice Center (EPC) program. They concluded that EPC working groups will consider ongoing challenges and modify guidance as needed, on issues such as combining trials and observational studies in bodies of evidence, weighting domains, and combining qualitative and quantitative syntheses.
AHRQ-funded; 290200710056I.
Citation: Berkman ND, Lohr KN, Ansari MT .
Grading the strength of a body of evidence when assessing health care interventions: an EPC update.
J Clin Epidemiol 2015 Nov;68(11):1312-24. doi: 10.1016/j.jclinepi.2014.11.023.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Quality of Care, Patient-Centered Outcomes Research, Research Methodologies
Whicher DM, Miller JE, Dunham KM
Gatekeepers for pragmatic clinical trials.
The authors provided a framework to help guide gatekeepers' decision-making related to the use of resources for pragmatic clinical trials. They stated that recognition of the complex set of considerations that should inform decision-making will guide gatekeepers in making justifiable choices regarding the use of limited and valuable resources.
AHRQ-funded; HS000029.
Citation: Whicher DM, Miller JE, Dunham KM .
Gatekeepers for pragmatic clinical trials.
Clin Trials 2015 Oct;12(5):442-8. doi: 10.1177/1740774515597699.
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Keywords: Decision Making, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research, Research Methodologies
Wyss R, Ellis AR, Brookhart MA
Matching on the disease risk score in comparative effectiveness research of new treatments.
The researchers used simulations and an empirical example to evaluate the performance of disease risk score (DRS) matching compared with propensity score (PS) matching when controlling large numbers of covariates in settings involving newly introduced treatments. When PS distributions are separated, DRS matching can improve the precision of effect estimates and allow researchers to evaluate the treatment effect in a larger proportion of the treated population.
AHRQ-funded; HS017950.
Citation: Wyss R, Ellis AR, Brookhart MA .
Matching on the disease risk score in comparative effectiveness research of new treatments.
Pharmacoepidemiol Drug Saf 2015 Sep;24(9):951-61. doi: 10.1002/pds.3810.
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Keywords: Comparative Effectiveness, Research Methodologies, Blood Thinners, Medication
Fischer MA, Allen-Coleman C, Farrell SF
Stakeholder assessment of comparative effectiveness research needs for Medicaid populations.
Because children, pregnant women and people with mental illness have generally been underrepresented in research discussions, comparative effectiveness rsearch (CER) questions for these groups may be understudied. To address this problem, AHRQ commissioned a team to work with Medicaid Medical Directors and other stakeholders to identify relevant CER questions. Through an iterative process of topic identification and refinement, they developed relevant, feasible and actionable questions based on issues affecting Medicaid programs nationwide.
AHRQ-funded; 290200500161.
Citation: Fischer MA, Allen-Coleman C, Farrell SF .
Stakeholder assessment of comparative effectiveness research needs for Medicaid populations.
J Comp Eff Res 2015 Sep;4(5):465-71. doi: 10.2217/cer.15.26.
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Keywords: Comparative Effectiveness, Medicaid, Research Methodologies, Decision Making, Vulnerable Populations
Ross ME, Kreider AR, Huang YS
Propensity score methods for analyzing observational data like randomized experiments: challenges and solutions for rare outcomes and exposures.
The researchers expanded upon an approach to the analysis of observational data sets that mimics a sequence of randomized studies by implementing propensity score models within each trial to achieve covariate balance, using weighting and matching. Challenges included a rare outcome, a rare exposure, substantial and important differences between exposure groups, and a very large sample size.
AHRQ-funded; HS018550.
Citation: Ross ME, Kreider AR, Huang YS .
Propensity score methods for analyzing observational data like randomized experiments: challenges and solutions for rare outcomes and exposures.
Am J Epidemiol 2015 Jun 15;181(12):989-95. doi: 10.1093/aje/kwu469..
Keywords: Comparative Effectiveness, Data, Research Methodologies
Whicher D, Kass N, Faden R
Stakeholders' views of alternatives to prospective informed consent for minimal-risk pragmatic comparative effectiveness trials.
This paper reports on interviews with Institutional Review Board members and researchers and on focus groups with patients from Geisinger and Johns Hopkins health systems, with the objective of eliciting participants' views of the acceptability of four different disclosure and authorization models for low-risk pragmatic comparative effectiveness trials of widely-used therapies. Results suggested that many participants believed that it was acceptable to streamline information disclosure and to use an opt-out process for eligible individuals who would prefer not to participate.
AHRQ-funded; HS021064.
Citation: Whicher D, Kass N, Faden R .
Stakeholders' views of alternatives to prospective informed consent for minimal-risk pragmatic comparative effectiveness trials.
J Law Med Ethics 2015 Summer;43(2):397-409. doi: 10.1111/jlme.12256.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Brouwer ES, Napravnik S, Eron JJ, Jr.
Validation of Medicaid claims-based diagnosis of myocardial infarction using an HIV clinical cohort.
The investigators aimed to validate claims-based myocardial infarction (MI) algorithms in a Medicaid population using an HIV clinical cohort as the gold standard. Studying 1063 individuals over 2.5 years, 17 had an MI. Specificity ranged from 0.979 to 0.993 with the highest specificity obtained using the ICD-9 code 410.xx in the primary or secondary position and a length of stay greater than 3 days. Sensitivity of MI ascertainment varied from 0.588 to 0.824 depending on algorithm. They recommended that the type of algorithm used be prioritized based on study question and maximization of specific validation parameters that will minimize bias while also considering precision.
AHRQ-funded; HS018731.
Citation: Brouwer ES, Napravnik S, Eron JJ, Jr. .
Validation of Medicaid claims-based diagnosis of myocardial infarction using an HIV clinical cohort.
Med Care 2015 Jun;53(6):e41-8. doi: 10.1097/MLR.0b013e318287d6fd.
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Keywords: Comparative Effectiveness, Human Immunodeficiency Virus (HIV), Medicaid, Heart Disease and Health, Research Methodologies
Carman KL, Mallery C, Maurer M
Effectiveness of public deliberation methods for gathering input on issues in healthcare: results from a randomized trial.
The researchers conducted a 5-arm randomized controlled trial, assigning participants to one of four deliberative methods or to a reading materials only control group. They found that participating in deliberation increased participants' knowledge of evidence and comparative effectiveness research and shifted participants' attitudes regarding the role of evidence in decision-making.
AHRQ-funded; 290201000005C.
Citation: Carman KL, Mallery C, Maurer M .
Effectiveness of public deliberation methods for gathering input on issues in healthcare: results from a randomized trial.
Soc Sci Med 2015 May;133:11-20. doi: 10.1016/j.socscimed.2015.03.024..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Research Methodologies, Decision Making
Cottrell EK, Whitlock EP, Kato E
AHRQ Author: Kato E
Defining the benefits and challenges of stakeholder engagement in systematic reviews.
The researchers examined the following questions: 1) what are the expected benefits of involving stakeholders in systematic reviews, and 2) what are the perceived challenges of involving stakeholders in systematic reviews? Using a literature scan and series of key informant interviews, they identified expected benefits such as establishing credibility and anticipating controversy. Challenges included time, training, resources and finding the right people.
AHRQ-authored; AHRQ-funded; 290201200004C
Citation: Cottrell EK, Whitlock EP, Kato E .
Defining the benefits and challenges of stakeholder engagement in systematic reviews.
Comp Eff Rev. 2015 Apr;5:13-19..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Research Methodologies
Whicher D, Kass N, Saghai Y
The views of quality improvement professionals and comparative effectiveness researchers on ethics, IRBs, and oversight.
The authors conducted a series of semi-structured focus groups with quality improvement (QI) and comparative effectiveness research (CER) professionals to understand their experiences and views of the ethical and regulatory challenges that exist. They found that most participants have experienced challenges related to the ethical oversight of QI and CER activities, and many believe that current regulatory criteria for distinguishing clinical practice from clinical research requiring ethical oversight are confusing.
AHRQ-funded; HS000029.
Citation: Whicher D, Kass N, Saghai Y .
The views of quality improvement professionals and comparative effectiveness researchers on ethics, IRBs, and oversight.
J Empir Res Hum Res Ethics 2015 Apr;10(2):132-44. doi: 10.1177/1556264615571558.
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Keywords: Comparative Effectiveness, Healthcare Delivery, Quality Improvement, Research Methodologies
Brouwer ES, Moga DC, Eron JJ
Evaluating the incident user design in the HIV population: incident use versus naive?
Through linkage to a comprehensive HIV clinical cohort, the researchers aimed to quantify and describe the truly naïve patients in an incident use population identified in Medicaid administrative claims. In their sample, they found that 34 percent of the Medicaid incident users were naïve based on medical record abstraction of antiretroviral use.
AHRQ-funded; HS018731.
Citation: Brouwer ES, Moga DC, Eron JJ .
Evaluating the incident user design in the HIV population: incident use versus naive?
Pharmacoepidemiol Drug Saf 2015 Mar;24(3):297-300. doi: 10.1002/pds.3705..
Keywords: Human Immunodeficiency Virus (HIV), Research Methodologies, Comparative Effectiveness, Data, Medicaid
Neugebauer R, Schmittdiel JA, Zhu Z
High-dimensional propensity score algorithm in comparative effectiveness research with time-varying interventions.
The authors described the application and performance of the hdPS algorithm to improve covariate selection in CER with time-varying interventions based on inverse probability weighting estimation and explored stabilization of the resulting estimates using Super Learning. Their evaluation was based on both the analysis of electronic health records data in a real-world CER study of adults with type 2 diabetes and a simulation study.
AHRQ-funded; 29020050016I.
Citation: Neugebauer R, Schmittdiel JA, Zhu Z .
High-dimensional propensity score algorithm in comparative effectiveness research with time-varying interventions.
Stat Med 2015 Feb 28;34(5):753-81. doi: 10.1002/sim.6377..
Keywords: Comparative Effectiveness, Data, Research Methodologies
Li T, Vedula SS, Hadar N
Innovations in data collection, management, and archiving for systematic reviews.
The authors provide a step-by-step tutorial for collecting, managing, and archiving data for systematic reviews and suggest steps for developing rigorous data collection forms in the Systematic Review Data Repository to facilitate implementation of the methodological standards and expectations of the Institute of Medicine and other organizations.
AHRQ-funded; 290200710055I; 290201200012I.
Citation: Li T, Vedula SS, Hadar N .
Innovations in data collection, management, and archiving for systematic reviews.
Ann Intern Med. 2015 Feb 17;162(4):287-94. doi: 10.7326/M14-1603..
Keywords: Data, Comparative Effectiveness, Outcomes, Research Methodologies
Roberts AW, Dusetzina SB, Farley JF
Revisiting the washout period in the incident user study design: why 6-12 months may not be sufficient.
The purpose of this study was to describe how washout period duration affects the size and accuracy of retrospective incident user cohorts. It found that the 6- and 12-month washouts excluded 75 and 85% of the samples, respectively. Half of subjects in the 6-month washout cohorts were actually prevalent users, and the 12-month washout period resulted in 30% misclassified.
AHRQ-funded; HS000032.
Citation: Roberts AW, Dusetzina SB, Farley JF .
Revisiting the washout period in the incident user study design: why 6-12 months may not be sufficient.
J Comp Eff Res 2015 Jan;4(1):27-35. doi: 10.2217/cer.14.53..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Research Methodologies
Gerber DE, Pruitt SL, Halm EA
Should criteria for inclusion in cancer clinical trials be expanded?
The authors argue that the time is right to take a more evidence-based approach to assessing the validity of many traditional exclusion criteria for cancer clinical trials. Furthermore, for investigators, it is critically important that their selection of inclusion and exclusion criteria be thoughtful, deliberate and justified. To accomplish this, they will need to use an array of methodological approaches to assess their validity and impact.
AHRQ-funded; HS022418.
Citation: Gerber DE, Pruitt SL, Halm EA .
Should criteria for inclusion in cancer clinical trials be expanded?
J Comp Eff Res 2015;4(4):289-91. doi: 10.2217/cer.15.27..
Keywords: Evidence-Based Practice, Research Methodologies, Cancer, Comparative Effectiveness, Patient-Centered Outcomes Research
Fleurence R, Whicher D, Dunham K
The Patient-centered Outcomes Research Institute's role in advancing methods for Patient-centered Outcomes Research.
The authors described PCORI’s legislatively mandated Methodology Committee and its Methodology Report; discussed PCORI’s current slate of CER methods projects; and shared some initial thoughts about future areas where further methods development is needed.
AHRQ-funded; HS000029.
Citation: Fleurence R, Whicher D, Dunham K .
The Patient-centered Outcomes Research Institute's role in advancing methods for Patient-centered Outcomes Research.
Med Care 2015 Jan;53(1):2-8. doi: 10.1097/mlr.0000000000000244.
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Keywords: Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Research Methodologies
Grijalva CG, Roumie CL, Murff HJ
The role of matching when adjusting for baseline differences in the outcome variable of comparative effectiveness studies.
The aim of this study was to evaluate performance of analytical strategies commonly used to adjust for baseline differences in continuous outcome variables for comparative effectiveness studies. It found that with increasing HbA1c baseline differences between groups, bias in effect estimates and suboptimal confidence interval coverage probabilities increased in all approaches. These issues were further compounded by measurement error. Matching on baseline HbA1c, substantially mitigated these issues.
AHRQ-funded; 2902010000161.
Citation: Grijalva CG, Roumie CL, Murff HJ .
The role of matching when adjusting for baseline differences in the outcome variable of comparative effectiveness studies.
J Comp Eff Res 2015;4(4):341-9. doi: 10.2217/cer.15.16..
Keywords: Comparative Effectiveness, Research Methodologies, Diabetes
Boland MR, Rusanov A, So Y
From expert-derived user needs to user-perceived ease of use and usefulness: a two-phase mixed-methods evaluation framework.
This paper presents a two-phase evaluation framework involving usability experts (phase 1) and end-users (phase 2). In phase 1, a cross-system functionality alignment between expert-derived user needs and system functions was performed to inform the choice of ‘‘the best available’’ comparison system to enable a cognitive walkthrough in phase 1 and a comparative effectiveness evaluation in phase 2.
AHRQ-funded; HS019853.
Citation: Boland MR, Rusanov A, So Y .
From expert-derived user needs to user-perceived ease of use and usefulness: a two-phase mixed-methods evaluation framework.
J Biomed Inform 2014 Dec;52:141-50. doi: 10.1016/j.jbi.2013.12.004..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Research Methodologies