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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results1 to 8 of 8 Research Studies Displayed
Rao BR, Merchant FM, Abernethy ER
The impact of government-mandated shared decision-making for implantable defibrillators: a natural experiment.
This study examined the impact of the 2018 Centers for Medicare and Medicaid Services (CMS) mandate that patients considering implantation of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death undergo shared decision-making (SDM) using a decision-aid. The authors surveyed patients who underwent implantation of a primary prevention ICD within the Emory Healthcare system between 2017-2019 (pre and post SDM mandate). Survey domains included decisional conflict, knowledge about the ICD, values-choice concordance, and engagement in decision-making. Of 101 patients who completed the survey, 45 had an ICD placed before the mandate and 56 placed after. No major differences were found between any of the survey domains. Patients with ICDs after the mandate were more likely to subjectively feel more informed about the benefits of the procedure but were less likely to be able to correctly identify the frequency of complications.
Citation: Rao BR, Merchant FM, Abernethy ER . The impact of government-mandated shared decision-making for implantable defibrillators: a natural experiment. Pacing Clin Electrophysiol 2022 Feb; 45(2):274-80. doi: 10.1111/pace.14414..
Keywords: Decision Making, Medical Devices, Policy, Cardiovascular Conditions
Rao BR, Merchant FM, Howard DH
Shared decision-making for implantable cardioverter-defibrillators: policy goals, metrics, and challenges.
Researchers discussed shared decision-making for implantable cardioverter-defibrillators (ICDs), including the results from a case study implementing the shared decision-making mandate for ICDs, which involved providing patients with decision aids prior to or following the doctor consultation.
Citation: Rao BR, Merchant FM, Howard DH . Shared decision-making for implantable cardioverter-defibrillators: policy goals, metrics, and challenges. J Law Med Ethics 2021 Win;49(4):622-29. doi: 10.1017/jme.2021.85..
Keywords: Decision Making, Medical Devices, Policy, Cardiovascular Conditions
Blecker S, Herrin J, Li L
Trends in hospital readmission of Medicare-covered patients with heart failure.
This study sought to compare trends in Medicare risk-adjusted, 30-day readmissions following principal heart failure (HF) hospitalizations and other hospitalizations with HF. The investigators found that patients with HF are often hospitalized for other causes, and these hospitalizations have high readmission rates. Policy changes led to decreases in readmission rates for both principal and secondary HF hospitalizations. Readmission rates in both groups remained high, suggesting that initiatives targeting all hospitalized patients with HF continue to be warranted.
AHRQ-funded; HS022882; HS023683.
Citation: Blecker S, Herrin J, Li L . Trends in hospital readmission of Medicare-covered patients with heart failure. J Am Coll Cardiol 2019 Mar 12;73(9):1004-12. doi: 10.1016/j.jacc.2018.12.040..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Hospital Readmissions, Hospitalization, Medicare, Policy
Chui PW, Parzynski CS, Ross JS
Association of statewide certificate of need regulations with percutaneous coronary intervention appropriateness and outcomes.
This study sought to characterize the association between state certificate of need (CON) regulations and percutaneous coronary interventions (PCI) appropriateness. The investigators found that states with CON had lower proportions of rarely appropriate PCI s, but the absolute differences were small. The investigators note that the findings suggest that CON regulations alone may not limit rarely appropriate PCI among patients with and without acute coronary syndrome.
Citation: Chui PW, Parzynski CS, Ross JS . Association of statewide certificate of need regulations with percutaneous coronary intervention appropriateness and outcomes. J Am Heart Assoc 2019 Jan 22;8(2):e010373. doi: 10.1161/jaha.118.010373..
Keywords: Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research, Heart Disease and Health, Policy, Surgery
Desai NR, Bourdillon PM, Parzynski CS
Association of the US Department of Justice Investigation of Implantable Cardioverter-Defibrillators and
The US Department of Justice (DOJ) conducted an investigation into implantable cardioverter-defibrillators (ICDs) not meeting the Centers for Medicare & Medicaid Services National Coverage Determination (NCD) criteria. To examine changes in the proportion of initial primary prevention ICDs that did not meet NCD criteria following the announcement of the DOJ investigation at hospitals that reached settlements (settlement hospitals) and those that did not (nonsettlement hospitals).
Citation: Desai NR, Bourdillon PM, Parzynski CS . Association of the US Department of Justice Investigation of Implantable Cardioverter-Defibrillators and JAMA 2018 Jul 3;320(1):63-71. doi: 10.1001/jama.2018.8151..
Keywords: Cardiovascular Conditions, Medical Devices, Medical Devices, Medicare, Policy
Charles EJ, Johnston LE, Herbert MA
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. It concluded that Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving health care financing, Medicaid expansion may positively affect patient care and outcomes.
Citation: Charles EJ, Johnston LE, Herbert MA . Impact of Medicaid expansion on cardiac surgery volume and outcomes. Ann Thorac Surg 2017 Oct;104(4):1251-58. doi: 10.1016/j.athoracsur.2017.03.079.
Keywords: Patient-Centered Outcomes Research, Medicaid, Surgery, Cardiovascular Conditions, Policy
Webb M, Fahimi S, Singh GM
Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations.
This study quantified the cost effectiveness of a government policy combining targeted industry agreements and public education to reduce sodium intake in 183 countries worldwide. It concluded that a government "soft regulation" strategy combining targeted industry agreements and public education to reduce dietary sodium is projected to be highly cost effective worldwide, even without accounting for potential healthcare savings.
Citation: Webb M, Fahimi S, Singh GM . Cost effectiveness of a government supported policy strategy to decrease sodium intake: global analysis across 183 nations. BMJ 2017 Jan 10;356:i6699. doi: 10.1136/bmj.i6699.
Keywords: Healthcare Costs, Nutrition, Cardiovascular Conditions, Blood Pressure, Policy
Shih T, Chen LM, Nallamothu BK
Will bundled payments change health care? Examining the evidence thus far in cardiovascular care.
The authors explore bundled payment initiatives and their potential advantages and disadvantages, focusing their review on previous and current bundled payment programs for cardiovascular conditions. They conclude by discussing what implications these programs might have as healthcare reform takes further shape in the coming years.
Citation: Shih T, Chen LM, Nallamothu BK . Will bundled payments change health care? Examining the evidence thus far in cardiovascular care. Circulation 2015 Jun 16;131(24):2151-8. doi: 10.1161/circulationaha.114.010393..
Keywords: Healthcare Costs, Evidence-Based Practice, Cardiovascular Conditions, Policy