National Healthcare Quality and Disparities Report
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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 49 Research Studies DisplayedBrown-Johnson C, Calma J, Amano A
Evaluating the implementation of patient-reported outcomes in heart failure clinic: a qualitative assessment.
This study evaluated clinician perceptions of the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), a patient reported outcome (PRO) survey that captures symptom frequency, symptom burden, physical limitations, social limitations, and quality of life. The authors conducted interviews with cardiologists from 4 institutions across the United States and Canada (n=16) and observed clinic visits at 1 institution in Northern California (n=5). They conducted 2 rounds of interviews and did a qualitative analysis on (1) rapid analysis constructed around major themes related to the aims of the study and (2) content analysis with codes derived from the rapid analysis and implementation science. Most cardiologists reported the KCCQ-12 was acceptable, appropriate, and useful in clinical care. The survey was found to improve the consistency of patient history taking, focus patient-clinician conversations, collect a more accurate account of patient quality of life, track trends in patient well-being over time, and refine clinical decision-making.
AHRQ-funded; HS026128.
Citation: Brown-Johnson C, Calma J, Amano A .
Evaluating the implementation of patient-reported outcomes in heart failure clinic: a qualitative assessment.
Circ Cardiovasc Qual Outcomes 2023 May; 16(5):e009677. doi: 10.1161/circoutcomes.122.009677..
Keywords: Patient-Centered Outcomes Research, Outcomes, Heart Disease and Health, Cardiovascular Conditions
Bartels K, Howard-Quijano K, Prin M
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
This article summarized the background and objectives of the first Cardiovascular Outcomes Research in Perioperative Medicine (COR-PM) conference. It also described the conduct of the conference and outlined future directions for scientific meetings which are focused on the fostering of high-quality clinical research in the broader perioperative medicine community.
AHRQ-funded; HS027795.
Citation: Bartels K, Howard-Quijano K, Prin M .
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
Anesth Analg 2023 Feb; 136(2):418-20. doi: 10.1213/ane.0000000000006248..
Keywords: Cardiovascular Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Rastogi V, Marcaccio CL, Kim NH
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
The purpose of this study was to assess perioperative outcomes in patients in the Vascular Quality Initiative who underwent juxta-/pararenal FEVAR with supraceliac vs infraceliac sealing. 1,486 Patients who received an elective FEVAR for juxta-/pararenal aortic aneurysms in the Vascular Quality Initiative between 2014 and 2021were identified and included.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
AHRQ-funded; HS027285.
Citation: Rastogi V, Marcaccio CL, Kim NH .
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
J Vasc Surg 2023 Jan;77(1):9-19.e2. doi: 10.1016/j.jvs.2022.08.007..
Keywords: Cardiovascular Conditions, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Treatments
Marcaccio CL, Anjorin A, Patel PB
In-hospital outcomes after upper extremity versus transfemoral and transcarotid access for carotid stenting in the Vascular Quality Initiative.
This comparative study examined outcomes for treatment of patients at high risk of carotid endarterectomy using different approaches of carotid artery stenting (CAS). The study compared the effects of transradial or transbrachial (tr/tbCAS) versus more established transfemoral (tfCAS) or transcarotid (TCAR) CAS procedures. Patients were identified from the Quality Initiative registry from January 2016 to December 2021. Among 40,835 CAS identified patients, 962 underwent tr/tbCAS, 28,850 underwent tfCAS, and 21,033 underwent TCAR. Among matched patients who underwent tr/tbCAS versus tfCAS, there was no significant difference in the risk of stroke/death (4.1% vs 2.9), but tr/tbCAS was associated with a higher risk of death (2.4% vs 1.3). In the symptomatic subgroup, tr/tbCAS was associated with a higher risk of stroke/death (6.1% vs 3.9%) and death (3.6% vs 1.7%), but there were no differences in asymptomatic patients. After adjustment for Modified Rankin Scale in patients with preoperative stroke, there were no significant differences in stroke/death or death between groups.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Anjorin A, Patel PB .
In-hospital outcomes after upper extremity versus transfemoral and transcarotid access for carotid stenting in the Vascular Quality Initiative.
J Vasc Surg 2022 Dec;76(6):1603-14.e7. doi: 10.1016/j.jvs.2022.05.030..
Keywords: Stroke, Cardiovascular Conditions, Outcomes, Evidence-Based Practice, Comparative Effectiveness, Patient-Centered Outcomes Research
Amin AP, Rao SV, Seto AH
Transradial access for high-risk percutaneous coronary intervention: implications of the risk-treatment paradox.
The study’s objective was to examine whether the association between transradial percutaneous coronary intervention (PCI; TRI) use versus transfemoral PCI (TFI) and in-hospital outcomes is influenced by baseline risk. TRI was found to reduce adverse outcomes when compared with TFI. The authors analyzed 28,005 PCIs performed in a 7-hospital system between July 2009 and April 2018. TRI use increased over time. However a risk-treatment paradox for TRI use was observed not only for bleeding risk, but for acute kidney injury (AKI) and death. The absolute risk difference between TRI and TFI increased with increasing baseline risk.
AHRQ-funded; HS022481.
Citation: Amin AP, Rao SV, Seto AH .
Transradial access for high-risk percutaneous coronary intervention: implications of the risk-treatment paradox.
Circ Cardiovasc Interv 2021 Jul;14(7):e009328. doi: 10.1161/circinterventions.120.009328..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Adverse Events, Outcomes, Patient-Centered Outcomes Research
Cohen DJ, Sweeney SM, Miller WL
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
This study identified conditions and operational changes linked to improvements in smoking and blood pressure (BP) outcomes in primary care using samples and interviews from a subset of 104 practices participating in EvidenceNOW, a multisite cardiovascular disease prevention initiative. The authors calculated Clinical Quality Measure improvements, with targets of 10-point or greater absolute improvements in the proportion of patients with smoking screening, and if relevant, counseling and the proportion of hypertensive patients with adequately controlled BP. Primary care staff were surveyed and interviewed. In clinician-owned practices, implementing a workflow to routinely screen and counsel patients on smoking cessation resources, or implementing a documentation change or a referral to a resource alone led to an improvement of at least 10 points in the smoking outcome. These improvements did not occur though in health- or hospital system-owned practices or in Federally Qualified Health Centers. BP outcome improved by at least 10 points among solo practices after medical assistants learned how to take an accurate BP. Among larger, clinician-owned practices, BP outcomes improvement took place when staff took a second BP measurement after the first measurement was elevated and when staff learned where to document this information in the electronic health record. For larger and health- and hospital system-owned practices, 50 or more hours of facilitation was needed to improve BP outcomes.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Sweeney SM, Miller WL .
Improving smoking and blood pressure outcomes: the interplay between operational changes and local context.
Ann Fam Med 2021 May-Jun;19(3):240-48. doi: 10.1370/afm.2668..
Keywords: Blood Pressure, Tobacco Use, Primary Care, Quality Improvement, Cardiovascular Conditions, Quality of Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention, Outcomes
Brown CS, Osborne NH, Kim GY
Effect of concomitant deep venous reflux on truncal endovenous ablation outcomes in the Vascular Quality Initiative.
This study looked at outcomes for patients with varicose veins (C2 disease) undergoing truncal endovenous ablation with and without deep venous reflux. Data from the Vascular Quality Initiative was analyzed from 2015 to 2019. A total of 4881 patients were included, with 46.2% having combined deep and superficial reflux. Follow-up around a year later (median 336.5 days) was conducted after. Patients with deep reflux were less likely to be female, more likely to be Caucasian, and had no difference in BMI. Additionally, there were no differences in rates of prior varicose vein treatments, number of pregnancies, or history of deep venous thrombosis. However, patients without deep reflux were more likely to use anticoagulants at the time of the procedure. Patients without deep reflux had slightly higher median preprocedural Venous Clinician Severity Score (VCSS) scores as well as postprocedural VCSS scores. Total symptom score was higher for patients without deep reflux before and after the procedure, but there was no change in symptom score after the procedure. Patients with deep reflux had substantially higher rates of complications with a particular increase in proximal thrombus extension.
AHRQ-funded; HS000053.
Citation: Brown CS, Osborne NH, Kim GY .
Effect of concomitant deep venous reflux on truncal endovenous ablation outcomes in the Vascular Quality Initiative.
J Vasc Surg Venous Lymphat Disord 2021 Mar;9(2):361-68.e3. doi: 10.1016/j.jvsv.2020.04.031..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Brown CS, Obi AT, Cronenwett JL
Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease).
This study looked outcomes of patients with varicose veins (C2 disease) who were treated with venous ablation alone or ablation plus phlebectomy using the Vascular Quality Initiative Varicose Vein Registry. Data between January 2015 and March 2015 was used to investigate postoperative as well as long-term clinical and patient-reported outcomes among patients with documented symptomatic C2 disease undergoing truncal endovenous ablations alone and combined ablation and phlebectomy. Out of 3375 patients, 40.1% underwent isolated truncal ablation and the rest had the combined procedure of ablation and phlebectomy. Complications were low for both procedures (8.4% and 8.7%). Overall, improvement in symptoms was experienced by 94.4% of patients with more increases in patients undergoing ablation and phlebectomy than ablation alone. Both procedures are recommended by the authors to be covered by insurance.
AHRQ-funded; HS000053.
Citation: Brown CS, Obi AT, Cronenwett JL .
Outcomes after truncal ablation with or without concomitant phlebectomy for isolated symptomatic varicose veins (C2 disease).
J Vasc Surg Venous Lymphat Disord 2021 Mar;9(2):369-76. doi: 10.1016/j.jvsv.2020.05.016..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Thompson MP, Yaser JM, Hou H
Determinants of hospital variation in cardiac rehabilitation enrollment during coronary artery disease episodes of care.
Cardiac rehabilitation (CR) is associated with improved outcomes for patients with coronary artery disease (CAD). However, CR enrollment remains low and there is a dearth of real-world data on hospital-level variation in CR enrollment. In this study, the investigators sought to explore determinants of hospital variability in CR enrollment during CAD episodes of care: medical management of acute myocardial infarction (AMI-MM), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG).
AHRQ-funded; HS026003.
Citation: Thompson MP, Yaser JM, Hou H .
Determinants of hospital variation in cardiac rehabilitation enrollment during coronary artery disease episodes of care.
Circ Cardiovasc Qual Outcomes 2021 Feb;14(2):e007144. doi: 10.1161/circoutcomes.120.007144..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Rehabilitation, Outcomes, Patient-Centered Outcomes Research, Hospitals
Bayliss WS, Bushnell CD, Halladay JR
The cost of implementing and sustaining the COMprehensive Post-Acute Stroke Services model.
This study compares the outcomes of using the COMprehensive Post-Acute Stroke Services (COMPASS) model, a transitional care intervention for stroke patients discharged to home against status quo postacute stroke care in a cluster-randomized trial in 40 hospitals in North Carolina. Hospital-level costs associated with implementing and sustaining COMPASS were examined during a 1-year period. Out of 40 hospitals, 22 hospitals were actively engaged in COMPASS. A 10% higher stroke patient volume was associated with 5.1% lower COMPASS costs per patient. About half of hospitals (N = 10) reported postacute clinic visits as their highest cost activity, while 7 hospitals reported case ascertainment as their highest cost activity. The authors estimated that based on average costs of COMPASS and readmissions, COMPASS could lower net costs if the model can prevent about 6 readmissions per year.
AHRQ-funded; HS025723.
Citation: Bayliss WS, Bushnell CD, Halladay JR .
The cost of implementing and sustaining the COMprehensive Post-Acute Stroke Services model.
Med Care 2021 Feb;59(2):163-68. doi: 10.1097/mlr.0000000000001462..
Keywords: Stroke, Cardiovascular Conditions, Healthcare Costs, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Brown CS, Osborne NH, Kim GY
Comparison of unilateral vs bilateral and staged bilateral vs concurrent bilateral truncal endovenous ablation in the Vascular Quality Initiative.
This study compares outcomes in patients who have undergone unilateral vs bilateral venous ablation procedures or between staged and concurrent bilateral procedures. Data from the Vascular Quality Initiative from 2015 to 2019 was used to investigate immediate postoperative as well as long-term clinical and patient-reported outcomes. A total of 5029 patients were included, of whom 75.2% underwent unilateral procedures. Follow-up was conducted with a median of 227 days after. Unilateral patients were less likely to be female and white and had lower BMI compared with patients undergoing bilateral procedures. In addition, unilateral patients had fewer prior varicose vein treatments and had higher Venous Clinical Severity Scores (VCSS). There were no differences in complications in patients undergoing unilateral vs bilateral procedures. Systemic complications were rare in both groups.
AHRQ-funded; HS000053.
Citation: Brown CS, Osborne NH, Kim GY .
Comparison of unilateral vs bilateral and staged bilateral vs concurrent bilateral truncal endovenous ablation in the Vascular Quality Initiative.
J Vasc Surg Venous Lymphat Disord 2021 Jan;9(1):113-21.e3. doi: 10.1016/j.jvsv.2020.05.008..
Keywords: Cardiovascular Conditions, Chronic Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Kostelanetz S, Di Gravio C, Schildcrout JS
Should we implement geographic or patient-reported social determinants of health measures in cardiovascular patients.
The authors compared patient-reported social determinants of health (SDOH) to the Brokamp Area Deprivation Index (ADI) and then evaluated the association of patient-reported SDOH and ADI with mortality in patients with cardiovascular disease (CVD). They found that the Brokamp ADI is associated with mortality in hospitalized patients with CVD. They recommended that, in the absence of available patient-reported data, hospitals implement the Brokamp ADI as an approximation for patient-reported data to enhance risk stratification of patients with CVD.
AHRQ-funded; HS026122.
Citation: Kostelanetz S, Di Gravio C, Schildcrout JS .
Should we implement geographic or patient-reported social determinants of health measures in cardiovascular patients.
Ethn Dis 2021 Winter;31(1):9-22. doi: 10.18865/ed.31.1.9..
Keywords: Social Determinants of Health, Cardiovascular Conditions, Mortality, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Hextrum S, Minhas JS, Liotta EM
Hypocapnia, ischemic lesions, and outcomes after intracerebral hemorrhage.
This research evaluated the relationship between early pCO(2) changes, ischemic lesions and outcomes in patients with intracerebral hemorrhage (ICH). This observational cohort study ran from 2006 to 2019. Arterial blood gas (ABG) measurements and mechanical ventilation settings in the first 72 hours after admission were collected. ABG data was analyzed from 220 patients. Hyperventilation occurred in 52 (28%) of cases and was not associated with clinical severity. Lower initial pCO(2) was associated with greater risk of in-hospital death. MRI images from 33 patients was used to measure the risk of developing ischemic lesions with lower pCO(2). Lower pCO(2) was also associated with a higher risk, except in patients with low initial systolic blood pressure.
AHRQ-funded; HS023437.
Citation: Hextrum S, Minhas JS, Liotta EM .
Hypocapnia, ischemic lesions, and outcomes after intracerebral hemorrhage.
J Neurol Sci 2020 Nov 15;418:117139. doi: 10.1016/j.jns.2020.117139..
Keywords: Stroke, Cardiovascular Conditions, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Yao X, Inselman JW, Ross JS
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Patients with atrial fibrillation and severely decreased kidney function were excluded from the pivotal non-vitamin K antagonist oral anticoagulants (NOAC) trials, thereby raising questions about comparative safety and effectiveness in patients with reduced kidney function. This study aimed to compare oral anticoagulants across the range of kidney function in patients with atrial fibrillation.
AHRQ-funded; HS025517; HS025164; HS025402; HS022882; HS024075.
Citation: Yao X, Inselman JW, Ross JS .
Comparative effectiveness and safety of oral anticoagulants across kidney function in patients with atrial fibrillation.
Circ Cardiovasc Qual Outcomes 2020 Oct;13(10):e006515. doi: 10.1161/circoutcomes.120.006515..
Keywords: Kidney Disease and Health, Cardiovascular Conditions, Blood Thinners, Medication, Medication: Safety, Patient Safety, Comparative Effectiveness, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Capo-Lugo CE, Askew RL, Muldoon K
Longer time before acute rehabilitation therapy worsens disability after intracerebral hemorrhage.
This study examines the association of time to initiation of acute rehabilitation therapy to increases in disability after intracerebral hemorrhage (ICH), and identifies predictors of time to initiation of rehabilitation therapy. Retrospective data analysis was conducted using ICH patients from a large comprehensive stroke center in a metropolitan area. Disability was assessed using a modified Rankin Scale (mRS) with poor outcome defined as mRS 4-6. There was a median time of 3 days from hospital admission and the first consult by any rehabilitation therapy specialist. Each additional day between admission and initiation of acute rehabilitation therapy was associated with odds of poor outcome at 30 days and at 90 days. Predictors of later initiation of acute rehabilitation therapy included heavy drinking (>5 drinks per day), premorbid mRS<4, presence of pulmonary embolism and longer length of stay in the intensive care unit.
AHRQ-funded; HS024366; HS023437; HS000078.
Citation: Capo-Lugo CE, Askew RL, Muldoon K .
Longer time before acute rehabilitation therapy worsens disability after intracerebral hemorrhage.
Arch Phys Med Rehabil 2020 May;101(5):870-76. doi: 10.1016/j.apmr.2019.11.006..
Keywords: Rehabilitation, Disabilities, Stroke, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research
Nadkarni MA, Maas MB, Batra A
Elevated cerebrospinal fluid protein is associated with unfavorable functional outcome in spontaneous subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) is a devastating neurologic event for which markers to assess poor outcome are needed. Elevated cerebrospinal fluid (CSF) protein may result from inflammation and blood-brain barrier (BBB) disruption that occurs during SAH. In this study, the investigators sought to determine if CSF protein level is associated with functional outcome after SAH.
AHRQ-funded; HS023437.
Citation: Nadkarni MA, Maas MB, Batra A .
Elevated cerebrospinal fluid protein is associated with unfavorable functional outcome in spontaneous subarachnoid hemorrhage.
J Stroke Cerebrovasc Dis 2020 Apr;29(4):104605. doi: 10.1016/j.jstrokecerebrovasdis.2019.104605..
Keywords: Stroke, Cardiovascular Conditions, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
Bath J, Kruse RL, Smith JB
Association of postoperative glycemic control with outcomes after carotid procedures.
This study evaluated the relationship between suboptimal glucose control and adverse outcomes after carotid procedures. Patients admitted for elective carotid procedures from 2008-2015 were identified from the Cerner Healthfacts VR database using ICD-9-CM codes. Out of 4287 patients, 87% had optimal postoperative glucose control (80-180 mg/dL). Patients with suboptimal glucose control experienced higher stroke rates, more cardiac complications, longer hospital stays, higher rates of infection, and more complications overall than patients with optimal glucose control.
AHRQ-funded; HS022140.
Citation: Bath J, Kruse RL, Smith JB .
Association of postoperative glycemic control with outcomes after carotid procedures.
Vascular 2020 Feb;28(1):16-24. doi: 10.1177/1708538119866528..
Keywords: Adverse Events, Cardiovascular Conditions, Surgery, Patient-Centered Outcomes Research, Outcomes
Hay CC, Graham JE, Pappadis MR
The impact of one's sex and social living situation on rehabilitation outcomes after a stroke.
The goal of this retrospective observational study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. Subjects were Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities after a stroke. Results showed that when sociodemographic and clinical factors were controlled, females were more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who lived alone before their stroke had higher odds of discharging at a supervision level or better.
AHRQ-funded; HS022134.
Citation: Hay CC, Graham JE, Pappadis MR .
The impact of one's sex and social living situation on rehabilitation outcomes after a stroke.
Am J Phys Med Rehabil 2020 Jan;99(1):48-55. doi: 10.1097/phm.0000000000001276..
Keywords: Stroke, Rehabilitation, Elderly, Patient-Centered Outcomes Research, Sex Factors, Cardiovascular Conditions, Outcomes
Bath J, Smith JB, Kruse RL
Association of neutrophil-to-lymphocyte ratio with outcomes after elective abdominal aortic aneurysm repair.
This study investigated postoperative outcomes from elective abdominal aortic aneurysm surgery (AAA) repair using neutrophil-to-lymphocyte ratio as the predictor. Inpatients from the Cerner Health Facts database undergoing elective AAA repair from 2008 to 2015 were selected using ICD-9 procedure codes. Patients with a high postoperative NLR experienced longer hospital stays; higher rates of in-hospital death; high rates of renal failure, cardiac problems, respiratory problems, and infection compared to patients with a low postoperative NLR. The authors recommend future study of NLR to help provide clinically important risk profiles.
AHRQ-funded; HS022140.
Citation: Bath J, Smith JB, Kruse RL .
Association of neutrophil-to-lymphocyte ratio with outcomes after elective abdominal aortic aneurysm repair.
J Vasc Nurs 2019 Sep;37(3):213-20. doi: 10.1016/j.jvn.2019.06.001..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Surgery, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Shahu A, Herrin J, Dhruva SS
Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in ALLHAT.
This study used data from the randomized clinical trial ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to study the effect of socioeconomics and blood pressure control and cardiovascular outcomes. The study sites were stratified by their county-level median household income into income quintiles. The lowest income sites (quintile 1) were most likely to be women, black or Hispanic, have less education, to live in the South and to have fewer cardiovascular risk factors. Despite standardized treatment protocols, quintile 1 participants were less likely to have blood pressure control, and all greater all-cause mortality, heart failure hospitalizations/mortality and end-stage renal disease than the highest income participants (quintile 5).
AHRQ-funded; HS023000.
Citation: Shahu A, Herrin J, Dhruva SS .
Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in ALLHAT.
J Am Heart Assoc 2019 Aug 6;8(15):e012277. doi: 10.1161/jaha.119.012277..
Keywords: Blood Pressure, Cardiovascular Conditions, Disparities, Patient-Centered Outcomes Research, Medication, Prevention, Outcomes
Parchman ML, Anderson ML, Coleman K
Assessing quality improvement capacity in primary care practices.
The Healthy Hearts Northwest (H2N) Study is part of an AHRQ initiative to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors. The three main risk factors are appropriate aspirin use, blood pressure control, and tobacco screening/cessation. A practice facilitator (PF) met with clinicians and staff in the participating practices to discuss the results for each item on the Quality Improvement Capacity Assessment (QICA) scale. The score was associated with prior experience managing change and moderately associated with two of the three risk factors: aspirin use and blood pressure control. The QICA was found to be a useful assessment tool to measure QI capacity within a practice.
AHRQ-funded; HS023908.
Citation: Parchman ML, Anderson ML, Coleman K .
Assessing quality improvement capacity in primary care practices.
BMC Fam Pract 2019 Jul 25;20(1):103. doi: 10.1186/s12875-019-1000-1.
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Keywords: Cardiovascular Conditions, Evidence-Based Practice, Heart Disease and Health, Outcomes, Patient-Centered Outcomes Research, Primary Care, Quality of Care, Quality Improvement
Shah S, Xian Y, Olson DM
Home-time is a patient-centered outcome variable for stroke: an executive summary.
An outcome measure to assess functional recovery after stroke that is easily obtainable and meaningful to the patient can be very useful for assessing risks and benefits of therapeutic strategies. Home-time, which is defined as the total number of days spent alive by the patient at home, outside healthcare institutions after discharge from an index stroke event, is such a measure, and is discussed in this paper.
AHRQ-funded.
Citation: Shah S, Xian Y, Olson DM .
Home-time is a patient-centered outcome variable for stroke: an executive summary.
J Neurosci Nurs 2019 Jun;51(3):110-12. doi: 10.1097/jnn.0000000000000437..
Keywords: Patient-Centered Outcomes Research, Stroke, Cardiovascular Conditions, Outcomes
Sharma A, Sun JL, Lokhnygina Y
Patient phenotypes, cardiovascular risk, and ezetimibe treatment in patients after acute coronary syndromes (from IMPROVE-IT).
The authors of this article performed a hierarchical cluster analysis to identify acute coronary syndrome (ACS) patients at high risk for adverse clinical events. Post-ACS patients were randomized to ezetimibe+simvastatin or placebo+simvastatin. Ezetimibe's impact on outcomes across clusters; the ability of the cluster analysis to discriminate for outcomes was compared with the Global Registry of Acute Coronary Events (GRACE) score. Outcomes included cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina, or coronary revascularization at least 30 days after randomization. Compared with GRACE, cluster analysis did not provide superior outcome discrimination. Consistent ezetimibe treatment effect was identified across clusters. The authors conclude that cluster analysis identified significant difference in risk of outcomes across cluster groups.
AHRQ-funded; HS023000.
Citation: Sharma A, Sun JL, Lokhnygina Y .
Patient phenotypes, cardiovascular risk, and ezetimibe treatment in patients after acute coronary syndromes (from IMPROVE-IT).
Am J Cardiol 2019 Apr 15;123(8):1193-201. doi: 10.1016/j.amjcard.2019.01.034..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Outcomes, Patient-Centered Outcomes Research, Risk
Zullo AR, Mogul A, Corsi K
Association between secondary prevention medication use and outcomes in frail older adults after acute myocardial infarction.
In order to examine the effect of using more guideline-recommended medications after myocardial infarction on mortality, rehospitalization, and functional decline in the frailest and oldest segment of long-stay nursing home residents, researchers conducted a retrospective cohort study of U.S. nursing home residents aged 65 years or older. Exposure was the number of secondary prevention medications initiated after myocardial infarction; outcomes were 90-day death, rehospitalization, or functional decline. The results of the study indicate that the use of more guideline-recommended medications after myocardial infarction was associated with decreased mortality in older, predominantly frail adults, but there was no difference in rehospitalization. Functional decline outcomes were discordant and the researchers note that this does not rule out an increased risk associated with more medication use.
AHRQ-funded; HS022998.
Citation: Zullo AR, Mogul A, Corsi K .
Association between secondary prevention medication use and outcomes in frail older adults after acute myocardial infarction.
Circ Cardiovasc Qual Outcomes 2019 Apr;12(4):e004942. doi: 10.1161/circoutcomes.118.004942..
Keywords: Cardiovascular Conditions, Elderly, Heart Disease and Health, Medication, Nursing Homes, Outcomes, Patient-Centered Outcomes Research, Prevention
Inohara T, Kim S, Pieper K
B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation.
In this study, the investigators evaluated the association between B-type natriuretic peptide (BNP) levels and outcomes, including atrial fibrillation (AF) progression, composite outcome of major adverse cardiovascular or neurological events (MACNE) and major bleeding, via pooled logistic regression and Cox frailty models in Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry.
AHRQ-funded; HS021092.
Citation: Inohara T, Kim S, Pieper K .
B-type natriuretic peptide, disease progression and clinical outcomes in atrial fibrillation.
Heart 2019 Mar;105(5):370-77. doi: 10.1136/heartjnl-2018-313642..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Patient-Centered Outcomes Research, Outcomes, Registries