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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 312 Research Studies DisplayedSaldanha IJ, Adam GP, Kanaan G
Health insurance coverage and postpartum outcomes in the US: a systematic review.
The objective of this evidence review was to assess whether extension of health insurance coverage or improvements in health care access are associated with postpartum health care utilization and maternal outcomes. Findings with moderate strength of evidence suggested that more comprehensive association was likely to be related to greater postpartum visit attendance; findings with low strength of evidence indicated a possible association between more comprehensive insurance, fewer preventable readmissions, and emergency department visits. The authors concluded that these findings suggested that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate strength of evidence. They recommended that future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
AHRQ-funded; 75Q80120D00001.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Health insurance coverage and postpartum outcomes in the US: a systematic review.
JAMA Netw Open 2023 Jun; 6(6):e2316536. doi: 10.1001/jamanetworkopen.2023.16536..
Keywords: Health Insurance, Maternal Care, Women, Outcomes, Medicaid, Patient-Centered Outcomes Research, Evidence-Based Practice
Lindner SR, Balasubramanian B, Marino M
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
The purpose of this study was to estimate decreases in 10-year atherosclerotic cardiovascular disease (ASCVD) risk associated with EvidenceNOW, an initiative spanning multiple states that sought to improve cardiovascular preventive care by providing supportive interventions such as practice facilitation to address the “ABCS”: (A)spirin for high-risk patients, (B)lood pressure control for hypertensive people, (C)holesterol management, and (S)moking screening and cessation counseling. The researchers conducted an analytic modeling study that combined 1) data from 1,278 EvidenceNOW practices collected from 2015 to 2017; (2) patient-level information of 1,295 individuals who participated in the 2015 to 2016 National Health and Nutrition Examination Survey; and (3) 10-year ASCVD risk prediction equations. The study found the average 10-year ASCVD risk of these patients before intervention was 10.11%. Improvements in ABCS due to EvidenceNOW reduced their 10-year ASCVD risk to 10.03% which would prevent 3,169 ASCVD events over 10 years and $150 million in 90-day direct medical costs.
AHRQ-funded; HS023940.
Citation: Lindner SR, Balasubramanian B, Marino M .
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
J Am Board Fam Med 2023 May 8; 36(3):462-76. doi: 10.3122/jabfm.2022.220331R1..
Keywords: Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Blood Pressure
Cantor AG, Nelson HD, Pappas M
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
This comparative effectiveness review was conducted on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services. A literature search was conducted for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care for the period July 2016 to May 2022. Eight RCTs, 1 nonrandomized trial, and 7 observational studies were included (7 studies of contraceptive care and 9 of IPV services). Telehealth services demonstrated similar care as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]). Evidence on abortion was insufficient. Outcomes were also similar between telehealth and usual care interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). Telehealth barriers identified included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Safety strategies increased telehealth use for IPV services. Evidence lacked on access, health equity, or harms.
AHRQ-funded; 75Q80120D00006.
Citation: Cantor AG, Nelson HD, Pappas M .
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
J Gen Intern Med 2023 May; 38(7):1735-43. doi: 10.1007/s11606-023-08033-6..
Keywords: Telehealth, Health Information Technology (HIT), Women, Prevention, Domestic Violence, Evidence-Based Practice, Maternal Care, Sexual Health, Patient-Centered Outcomes Research, Comparative Effectiveness
McHugh M, Philbin S, Carroll AJ
An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care.
This study’s goal was to describe an approach for evaluating the development and effectiveness of a multisector partnership using data from the first year of the Healthy Hearts for Michigan (HH4M) Cooperative, a multisector partnership of nine organizations tasked with designing and implementing evidence-based QI strategies for hypertension management and tobacco cessation in 50 rural primary care practices. A 49-item survey focused on factors that facilitate or hinder multisector partnerships, drawing on implementation science and partnership, engagement, and collaboration research was developed. All 44 members of the HH4M Cooperative (79.5% response rate) were surveyed, interviews conducted with 14 members. Having a clear purpose and trust and respect among members were the strengths reported. A need for common terminology, clarification of roles and functions, and improvement in communication across workgroups were areas for improvement. The Cooperative’s biggest challenge was the lack of engagement from physician practices due to capacity constraints, exacerbated by the COVID-19 pandemic.
AHRQ-funded; HS027954.
Citation: McHugh M, Philbin S, Carroll AJ .
An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care.
Jt Comm J Qual Patient Saf 2023 Apr;49(4):199-206. doi: 10.1016/j.jcjq.2023.01.002.
Keywords: Quality Improvement, Evidence-Based Practice, Primary Care, Quality of Care, Patient-Centered Outcomes Research
JE Wallis, CJD Huang, LC
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Researchers evaluated the impact of compliance with nationally recognized radiation therapy quality measures on patient-reported health-related quality of life outcomes in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) population-based, prospective cohort study of men with localized prostate cancer. Eight quality measures were identified based on national guidelines. In multivariable analyses, no clinically significant associations were discovered between compliance with evaluated radiation therapy quality measures and patient-reported outcomes such as urinary irritation, urinary incontinence, bowel, sexual or hormonal function. The researchers concluded that further work would be needed to identify patient-centered quality measures of prostate cancer care.
AHRQ-funded; HS019356.
Citation: JE Wallis, CJD Huang, LC .
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Prostate Cancer Prostatic Dis 2023 Mar;26(1):80-87. doi: 10.1038/s41391-022-00518-5.
Keywords: Cancer: Prostate Cancer, Cancer, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Measures
Humbert-Droz M, Izadi Z, Schmajuk G
Development of a natural language processing system for extracting rheumatoid arthritis outcomes from clinical notes using the national rheumatology informatics system for effectiveness registry.
Researchers developed and evaluated a natural language processing pipeline for extracting outcome measures in rheumatology from free-text outpatient rheumatology notes within the ACR's Rheumatology Informatics System for Effectiveness (RISE) registry. All patients in RISE from 2015 to 2018 were included. The researchers found the pipeline to have good internal and external validity and they concluded that it could facilitate measurement of clinical and patient reported outcomes for use in both research and quality measurement.
AHRQ-funded; HS025638.
Citation: Humbert-Droz M, Izadi Z, Schmajuk G .
Development of a natural language processing system for extracting rheumatoid arthritis outcomes from clinical notes using the national rheumatology informatics system for effectiveness registry.
Arthritis Care Res 2023 Mar; 75(3):608-15. doi: 10.1002/acr.24869..
Keywords: Arthritis, Electronic Health Records (EHRs), Health Information Technology (HIT), Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Bierman AS, Burke BT, Comfort LN
From precision medicine to precision care: choosing and using precision medicine in the context of multimorbidity.
Swift progress in personalized medicine offers significant potential to decrease disease and death rates for numerous health issues. To maximize the advantages of personalized medicine and minimize negative outcomes, addressing real-world obstacles in applying this research to clinical practice is crucial. A primary challenge involves selecting and employing personalized medicine approaches in everyday practice, considering the care of a substantial portion of individuals with multiple coexisting conditions. Personalized medicine should be incorporated into a broader framework of individualized care, which takes into account factors that impact the efficacy of specific treatments. Individualized care combines a patient-focused approach with personalized medicine to guide decision-making and care plans, considering multiple health conditions, functional ability, personal values, goals, preferences, and social and societal contexts. Creating dissemination and implementation strategies for personalized medicine centered around individualized care can enhance patient-centric quality and health outcomes, direct interventions toward those who will benefit most, improve access to novel treatments, reduce the likelihood of treatment withdrawal due to unforeseen side effects, and promote health equity by customizing interventions and care for diverse individuals and communities. Delivering personalized medicine within the scope of individualized care supports respectful treatment that aligns with patient preferences, values, and objectives, fostering trust and offering necessary information for informed decision-making. Accelerating its adoption demands focus on the entire translational research continuum: devising innovative methods, proving their value, disseminating and implementing findings, and involving patients throughout the process. This includes basic science, preclinical and clinical research, and integration into practice, all aimed at enhancing health. This paper scrutinizes the challenges in adopting personalized medicine in the presence of multiple health conditions. The authors conclude that while the promise of personalized medicine is immense, proactive measures are essential to prevent unintended repercussions and ensure its equitable and efficient implementation.
AHRQ-authored: All.
Citation: Bierman AS, Burke BT, Comfort LN .
From precision medicine to precision care: choosing and using precision medicine in the context of multimorbidity.
Cambridge Prisms: Precision Medicine 2023 Feb 21;1:e19. doi:10.1017/pcm.2023.8.
Keywords: Learning Health Systems, Patient-Centered Healthcare, Evidence-Based Practice, Patient-Centered Outcomes Research
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
Fishbein AB, Lor J, Penedo FJ
Patient-reported outcomes for measuring sleep disturbance in pediatric atopic dermatitis: cross-sectional study of the patient reported outcomes measurement information system pediatric sleep measures and actigraphy.
The purposes of this cross-sectional study were to test the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures in pediatric atopic dermatitis (AD) and to develop an algorithm to screen, evaluate, and intervene to reduce sleep disturbances. Participants were children with AD aged 5 to 17 and one parent who completed sleep, itch, and AD-specific questionnaires. Clinicians assessed disease severity. PROMIS sleep disturbance parent proxy reliability was high and was differentiated among Patient-Oriented Eczema Measure (POEM)-determined disease severity groups. The authors concluded that sleep disturbance in pediatric AD should be screened using the POEM sleep question, and further assessment using the PROMIS sleep disturbance measure or objective sleep monitoring if it is needed.
AHRQ-funded; HS023011.
Citation: Fishbein AB, Lor J, Penedo FJ .
Patient-reported outcomes for measuring sleep disturbance in pediatric atopic dermatitis: cross-sectional study of the patient reported outcomes measurement information system pediatric sleep measures and actigraphy.
J Am Acad Dermatol 2023 Feb; 88(2):348-56. doi: 10.1016/j.jaad.2020.05.138..
Keywords: Children/Adolescents, Sleep Problems, Skin Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice
Rizk S, Kaelin VC, Sim JGC
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
The study’s aim was to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. A mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were conducted and used to share quantitative trial results. All three stakeholder groups identified thematic supports and barriers across multiple constructs within each of four Consolidated Framework for Implementation Research (CFIR) domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) Three themes for "inner setting," and (4) Four themes for "outer setting." Priorities from stakeholders included prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Improving EI access (“outer setting”) using YC-PEM e-PRO results was also articulated by service coordinators and program leadership.
AHRQ-funded; HS027583.
Citation: Rizk S, Kaelin VC, Sim JGC .
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
Appl Clin Inform 2023 Jan; 14(1):91-107. doi: 10.1055/s-0042-1760631..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Children/Adolescents, Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
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
Kim HS, Hernaez R, Sansgiry S
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
The purpose of this study was to determine the comparative effectiveness of varying colonoscopy intervals on colorectal cancer (CRC) outcomes among patients with inflammatory bowel disease (IBD). Data was from the National Veterans Health Administration. Findings showed that, in a national cohort of patients with CRC-IBD, colonoscopy within 3 years prior to CRC diagnosis was associated with early tumor stage at diagnosis, and colonoscopy within 1 year was associated with a reduced all-cause mortality compared with no colonoscopy, supporting colonoscopy intervals of 1 to 3 years in patients with IBD in order to reduce late-stage CRC and all-cause mortality.
AHRQ-funded; HS024122.
Citation: Kim HS, Hernaez R, Sansgiry S .
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
Clin Gastroenterol Hepatol 2022 Dec;20(12):2848-57.e2. doi: 10.1016/j.cgh.2022.02.048..
Keywords: Cancer: Colorectal Cancer, Cancer, Digestive Disease and Health, Imaging, Screening, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research
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
De B, Pasalic D, Barocas DA
Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study.
The purpose of this study was to compare patient reported outcomes through 5 years following radical prostatectomy or external beam radiation therapy with low dose rate brachytherapy boost for localized prostate cancer. The researchers enrolled men 80 years of age or under who had localized prostate adenocarcinoma and followed them longitudinally from 2011 to 2012. The study found that when compared with radical prostatectomy, external beam radiation therapy with low dose rate brachytherapy boost was related with clinically meaningful worse urinary irritative/obstructive and better urinary incontinence function through 5 years. Urinary function bother was similar between groups. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with worse bowel function through 5 years compared to radical prostatectomy. Treatment with external beam radiation therapy with low dose rate brachytherapy boost was associated with better sexual function at 1 year compared to radical prostatectomy, but there was insufficient evidence to reject the supposition that no difference was seen at 3 or 5 years. The researcher concluded that external beam radiation therapy with low dose rate brachytherapy boost was related with clinically meaningful worse urinary irritative/obstructive and bowel functions but better urinary incontinence function through 5 years after treatment compared to radical prostatectomy.
AHRQ-funded; HS019356; HS022640.
Citation: De B, Pasalic D, Barocas DA .
Patient-reported outcomes after external beam radiotherapy with low dose rate brachytherapy boost vs radical prostatectomy for localized prostate cancer: five-year results from a prospective comparative effectiveness study.
J Urol 2022 Dec;208(6):1226-39. doi: 10.1097/ju.0000000000002902..
Keywords: Cancer: Prostate Cancer, Cancer, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Treatments
Schroeder MC, Chapman CG, Chrischilles EA
Generating practice-based evidence in the use of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction.
This study’s goal was to determine if variation in real-world practice of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction (AMI) reflects poor quality-of-care or a balance of outcome tradeoffs among patients. Medicare fee-for-service beneficiaries hospitalized 2007-2008 for AMI were included. Treatment within 30-days post-discharge was grouped into one of eight possible combinations for the three drug classes: beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers, and statins. Outcomes looked at included one-year overall survival, one-year cardiovascular-event-free survival, and 90-day adverse events. Results were found that each drug combination was observed in the final sample (N = 124,695), with 35.7% having all three, and 13.5% having none. There were both treatment benefits and harms in patients with AMIs with higher rates of guideline-recommended treatment.
AHRQ-funded; HS018381.
Citation: Schroeder MC, Chapman CG, Chrischilles EA .
Generating practice-based evidence in the use of guideline-recommended combination therapy for secondary prevention of acute myocardial infarction.
Pharmacy 2022 Nov 3;10(6). doi: 10.3390/pharmacy10060147..
Keywords: Evidence-Based Practice, Guidelines, Heart Disease and Health, Cardiovascular Conditions, Comparative Effectiveness, Patient-Centered Outcomes Research, Prevention
Ko H, Pelt CE, Martin BI
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
The purpose of this study was to compare baseline and early post-operative global and condition-specific patient reported outcomes (PROs) between patients undergoing cemented versus cementless total knee arthroplasty (TKA). The researchers prospectively collected PROs through the Comparative Effectiveness Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) trial using the short-form of the Knee Injury and Osteoarthritis Outcome Score (KOOS-Jr.), the Patient-Reported Outcomes Measurement Information System Physical Health (PROMIS-PH), and the Numeric Pain Rating Scale (NPRS). Pre- and post-operative outcomes in 5,961 patients undergoing primary TKA between December 2016 and August 2021 were examined. The study found that significant pre to- post-operative were observed in both groups. The researchers concluded that patients with cemented TKA reported early benefit in KOOS-Jr. over those with cementless TKA.
AHRQ-funded; HS024714.
Citation: Ko H, Pelt CE, Martin BI .
Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching.
BMC Musculoskelet Disord 2022 Oct 27;23(1):934. doi: 10.1186/s12891-022-05899-1..
Keywords: Orthopedics, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Kuzel AJ, Cuellar A, Nichols L
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
The purpose of this study was for The Heart of Virginia Health care (HVH) collaborative (one of the Agency for Healthcare Research and Quality's (AHRQ) Evidence Now project’s 7 collaboratives) to test different ways to improve performance and outcomes on ABCS clinical quality measures (appropriate Aspirin use, Blood pressure control, Cholesterol control, and Smoking cessation counseling) within small primary care practices. The researchers recruited 264 eligible practices and randomized them to 3 cohorts in a stepped wedge design, with 173, utilizing 16 different EHRs, participated through the entire initiative. Trained coaches delivered the practice support curriculum to improve performance on the ABCS measures. The program included an initial kickoff meeting, 3 months of focused support, 9 months of continued support, and access to online materials and faculty. The intervention phase was shortened due to difficulty in recruiting a sufficient number of practices. The study found that the short HVH intervention had a small but statistically significant positive average effects on appropriate use of aspirin and other anti-thrombotics, small negative effects on blood pressure control, except for those practices which did not attend the kickoff, and small negative effects on smoking cessation counseling. The researchers concluded that the truncation of the intervention contributed to the lack of substantial improvements in the ABCS.
AHRQ-funded; HS023913.
Citation: Kuzel AJ, Cuellar A, Nichols L .
The EvidenceNOW practice support initiative: the Heart of Virginia Healthcare.
J Am Board Fam Med 2022 Oct 18;35(5):979-89. doi: 10.3122/jabfm.2022.05.210021..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Primary Care, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Healthcare Delivery
Lozano PM, Lane-Fall M, Franklin PD
Training the next generation of learning health system scientists.
The purpose of this paper was to describe the approaches developed by 11 Agency for Healthcare Research and Quality (AHRQ)- and Patient-Centered Outcomes Research Institute- funded Centers of Excellence (COEs) to grow the number of learning health systems (LHS) scientists. Program directors for each COE have provided descriptive program data since 2018. The authors found that since the program began, the 11 COEs have partnered with health systems to train 110 scholars. Nine programs partner with a Veterans Affairs health system and 9 partner with safety net providers. Clinically trained scholars include 70 physicians and 17 scholars in other clinical disciplines. Non-clinicians represent diverse fields, with most representing population health sciences. Challenges include guiding scholars through issues that can disrupt or delay projects during already-limited program time, such as delays in accessing data, organizational changes, pandemic impacts and others. The researchers concluded that the program documentation provides evidence of scholars' academic accomplishments and career-trajectory achievements.
AHRQ-authored; AHRQ-funded; HS026369; HS026370; HS026372; HS026379; HS026383; HS026385; HS026390; HS026393; HS026395; HS026396; HS026407
Citation: Lozano PM, Lane-Fall M, Franklin PD .
Training the next generation of learning health system scientists.
Learn Health Syst 2022 Oct;6(4):e10342. doi: 10.1002/lrh2.10342..
Keywords: Learning Health Systems, Health Systems, Patient-Centered Outcomes Research, Evidence-Based Practice, Training, Workforce
Oatis 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
Israni AK, Schladt D, Bruin MJ
Deconstructing silos of knowledge around lung transplantation to support patients: a patient-specific search of scientific registry of transplant recipients data.
This article describes the development of the web site www.transplantcentersearch.org intended to support lung transplant patients by providing program-level data from the Scientific Registry of Transplant Recipients (SRTR) on each program in the United States. There is a high level of variation in selection criteria and although nearly half of recipients reside within 50 miles of their transplant program, >30% travel 100 miles or more. The web site allows patients to search for programs in the area of their choosing and receive information on the number of transplants and program factors that are most predictive of recipient survival after listing. Patients can also review information on recipients and donors at each program to further differentiate program options. This feature is patient-specific, allowing the patient to enter information about their clinical background and indicate general preferences for their treatment before receiving counts on recipients and donors matching their entries. The development of the site involved 2 phases. In Phase I the authors examined variations between programs using data on waitlist and transplant outcomes from the SRTR. Phase II involved interviews and focus groups with transplant candidates, recipients, and family members to gain insight into the decision-making process, barriers, and knowledge groups. In the future randomized trials will be conducted to evaluate the efficacy of the web site.
AHRQ-funded; HS026379.
Citation: Israni AK, Schladt D, Bruin MJ .
Deconstructing silos of knowledge around lung transplantation to support patients: a patient-specific search of scientific registry of transplant recipients data.
Transplantation 2022 Aug;106(8):1517-19. doi: 10.1097/tp.0000000000004051..
Keywords: Transplantation, Registries, 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
Korthuis PT, Cook RR, Lum PJ
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Opioid Use Disorder (OUD) treatment medications can improve outcomes for human immunodeficiency virus (HIV) and also reduce opioid use. The purpose of the study was to determine if outpatient naltrexone treatment could also reduce opioid use and improve outcomes for HIV. The researchers reported that enrollment was stopped early because of slower than expected recruitment, resulting in 114 final participants with untreated OUD and HIV, with 62% positive for fentanyl, 60% positive for cocaine, and 47% positive for other opioids at the baseline. The intervention compared treatment as usual (TAU) of methadone or buprenorphine with extended-release naltrexone (XR-NTX) on group differences in viral suppression at 24 weeks and past 30-day use of opioids at 24 weeks. The study reported that at 24 weeks the outcome of viral suppression was similar for TAU and XR-NTX, and that fewer XR-NTX participants initiated medication than TAU participants. The outcome of previous 30-day use of opioids was similar for TAU as compared to XR-NTX. Of those participants who did initiate medication, those administered XR-NTX experienced less days of opioid use when compared with TAU in the prior 30 days. The researchers reported that the study evidence was not conclusive but did support that XR-NTX is not inferior to TAU for HIV viral suppression, and that study participants who started XR-NTX used less opioids at 24 weeks than participants who were administered TAU.
AHRQ-funded; HS026370.
Citation: Korthuis PT, Cook RR, Lum PJ .
HIV clinic-based extended-release naltrexone versus treatment as usual for people with HIV and opioid use disorder: a non-blinded, randomized non-inferiority trial.
Addiction 2022 Jul;117(7):1961-71. doi: 10.1111/add.15836..
Keywords: Human Immunodeficiency Virus (HIV), Opioids, Substance Abuse, Behavioral Health, Medication, Treatments, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Ivlev I, Beil TL, Haynes JS
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
This rapid evidence review was conducted to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents. An extensive literature review was done through December 6, 2021 for controlled trials conducted in settings highly applicable to the US. Additionally, the authors searched relevant systematic reviews for eligible studies. They identified 12 trials that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to other therapies in improving depression symptoms immediately, but not at a longer follow-up. There did not appear to be an increased risk for suicidal attempts or ideation with dCBT, however the number of events was very small. Potential barriers to implementing and maintaining dCBT included challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. No data on harms or unintended negative consequences were reported in the included studies.
AHRQ-funded; HS026370.
Citation: Ivlev I, Beil TL, Haynes JS .
Rapid evidence review of digital cognitive-behavioral therapy for adolescents with depression.
J Adolesc Health 2022 Jul;71(1):14-19. doi: 10.1016/j.jadohealth.2022.01.220..
Keywords: Children/Adolescents, Depression, Behavioral Health, Evidence-Based Practice, Patient-Centered Outcomes Research
Saldanha IJ, Cao W, Bhuma MR
Systematic reviews can guide clinical practice and new research on primary headaches in pregnancy: an editorial on the 2022 American Headache Society Members' Choice Award paper.
This article describes the systematic review paper that was done on management of primary headaches during pregnancy, postpartum, and breastfeeding, which won the 2021 American Headache Society’s Member’s Choice Award. The findings are summarized in this paper, which discusses different pharmacologic interventions and their possible effects on the fetus/child and mother. Evidence was summarized for prevention and treatment of primary headache. The authors did not find a lot of evidence for harms or benefits but called for more studies to be done.
AHRQ-funded; 290201500002I.
Citation: Saldanha IJ, Cao W, Bhuma MR .
Systematic reviews can guide clinical practice and new research on primary headaches in pregnancy: an editorial on the 2022 American Headache Society Members' Choice Award paper.
Headache 2022 Jul;62(7):774-76. doi: 10.1111/head.14332..
Keywords: Neurological Disorders, Pregnancy, Evidence-Based Practice, Guidelines, Patient-Centered Outcomes Research
Dullabh P, Sandberg SF, Heaney-Huls K
Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.
This AHRQ-authored horizon scan identified challenges and opportunities for advancing patient-centered clinical decision support (PC CDS) and future directions for PC CDS. The authors engaged a technical expert panel, conducted a scoping literature review, and interviewed key informants. They quantitatively analyzed literature and interview transcripts and mapped the findings to the 4 phases translating evidence into PC CDS interventions (Prioritizing, Authoring, Implementing, and Measuring) and to external factors. Twelve challenges were identified for PC CDS development with lack of patient input identified as a critical challenge. Lack of patient-centered terminology standards was viewed as a challenge in authoring PC CDS. They also found a dearth of CDS studies that measured clinical outcomes, creating significant gaps in the understanding of PC CDS’ impact.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dullabh P, Sandberg SF, Heaney-Huls K .
Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.
J Am Med Inform Assoc 2022 Jun 14;29(7):1233-43. doi: 10.1093/jamia/ocac059.
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Keywords: Clinical Decision Support (CDS), Patient-Centered Healthcare, Health Information Technology (HIT), Decision Making, Patient-Centered Outcomes Research, Evidence-Based Practice
