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 47 Research Studies DisplayedMeiselbach MK, Drake C, Saloner B
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
This study examined variation in access to in-network buprenorphine-prescribing primary care providers that can treat opioid use disorder among Medicaid managed care enrollees. Approximately 32.2% of Medicaid enrollees had fewer than one in-network network buprenorphine-prescribing primary care providers per 100,000 county residents. There was on average a greater number of in-network buprenorphine-prescribing primary care providers in states with higher compared with lower overdose death rates, but most enrollees lived in areas with a shortage of these providers. The authors found that a 25 percent higher network participation rate by prescribers compared with nonprescribers could improve the probability that enrollees see a prescriber by approximately 25 percent.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Drake C, Saloner B .
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
Health Aff 2022 Jun;41(6):901-10. doi: 10.1377/hlthaff.2021.01719..
Keywords: Medicaid, Primary Care, Access to Care, Medication, Care Management, Opioids, Substance Abuse, Behavioral Health
Hollowell M, Hudmon KS, Perkins SM
Evaluation of a modified and abbreviated scale for assessing chronic illness care for medication therapy management practice.
The purpose of the study was to evaluate the validity and internal consistency of the Assessment of Chronic Illness Care (ACIC) abbreviated, 12-item scale as a novel instrument for measuring Medication Therapy Management (MTM) care delivery. Researchers administered the instrument to pharmacists employed at 27,560 community pharmacies. The study concluded that when applied to the measurement of chronic illness care within the MTM setting, the abbreviated ACIC showed acceptable validity and internal consistency, and could serve as a valuable tool.
AHRQ-funded; HS022119.
Citation: Hollowell M, Hudmon KS, Perkins SM .
Evaluation of a modified and abbreviated scale for assessing chronic illness care for medication therapy management practice.
Res Social Adm Pharm 2022 May;18(5):2804-10. doi: 10.1016/j.sapharm.2021.06.006..
Keywords: Chronic Conditions, Medication, Provider: Pharmacist, Care Management
Pestka DL, Brummel AR, Wong MT
Characterizing the reach of comprehensive medication management in a population health primary care model.
As care teams adopt team-based models of care, it is important to examine the reach of interdisciplinary services, such as pharmacists providing comprehensive medication management (CMM). This study examined the reach of pharmacist-delivered CMM in the first 10 months of a population health-focused primary care transformation (PCT). This study illustrated that pharmacists providing CMM see complex patients with a high propensity for medication therapy problems.
AHRQ-funded; HS026379.
Citation: Pestka DL, Brummel AR, Wong MT .
Characterizing the reach of comprehensive medication management in a population health primary care model.
J Am Coll Clin Pharm 2021 Nov;4(11):1410-19. doi: 10.1002/jac5.1525..
Keywords: Medication, Care Management, Provider: Pharmacist, Implementation
Hoffmann JA, Pergjika A, Konicek CE
Pharmacologic management of acute agitation in youth in the emergency department.
In this article, the authors reviewed the definition of agitation and pharmacologic management for youth with acute agitation, including common classes of medications, indications for use, and adverse effects. They also discussed the need to integrate the use of medications into a comprehensive strategy for agitation management that begins with proactive prevention of aggressive behavior, creation of a therapeutic treatment environment, and verbal de-escalation strategies.
AHRQ-funded; HS026385.
Citation: Hoffmann JA, Pergjika A, Konicek CE .
Pharmacologic management of acute agitation in youth in the emergency department.
Pediatr Emerg Care 2021 Aug;37(8):417-22. doi: 10.1097/pec.0000000000002510..
Keywords: Children/Adolescents, Emergency Department, Medication, Care Management
Stephens KA, Ike B, Baldwin LM
Challenges and approaches to population management of long-term opioid therapy patients.
Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. In this study, the investigators identified sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines.
AHRQ-funded; HS023750.
Citation: Stephens KA, Ike B, Baldwin LM .
Challenges and approaches to population management of long-term opioid therapy patients.
J Am Board Fam Med 2021 Jan-Feb;34(1):89-98. doi: 10.3122/jabfm.2021.01.190100..
Keywords: Opioids, Pain, Chronic Conditions, Care Management, Medication, Primary Care, Ambulatory Care and Surgery
Militello LG, Hurley RW, Cook RL
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
Investigators sought a better understanding of primary care clinicians’ approaches to managing patients with chronic pain and explored implications for technological and administrative interventions. They found that primary care clinicians’ beliefs about opioid therapy generally align with the clinical evidence but may have some important gaps, suggesting the potential value of interventions that include improved access to research findings, organizational changes to support spending time with patients to develop rapport, and the need for innovative clinical cognitive support.
AHRQ-funded; HS023306.
Citation: Militello LG, Hurley RW, Cook RL .
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
J Gen Intern Med 2020 Dec;35(12):3542-48. doi: 10.1007/s11606-020-06178-2..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Provider: Physician, Provider: Clinician, Provider, Care Management
Flynn G, Jia H, Reynolds NR
Protocol of the randomized control trial: the WiseApp trial for improving health outcomes in PLWH (WiseApp).
This paper outlines the protocol for the WiseApp randomized control trial. The WiseApp contains real-time medication monitoring linking an electronic pill bottle and fitness tracker to the app, helping persons living with HIV (PLWH) self-manage their medication adherence and improve their overall quality of life. The primary objective of the trial is to test the effect of the WiseApp's medication adherence features on antiretroviral adherence in underserved PLWH in New York City. The real-time monitoring of the WiseApp has the potential to help providers initiate interventions to help patients resume treatment before drug resistance begins.
AHRQ-funded; HS025071.
Citation: Flynn G, Jia H, Reynolds NR .
Protocol of the randomized control trial: the WiseApp trial for improving health outcomes in PLWH (WiseApp).
BMC Public Health 2020 Nov 25;20(1):1775. doi: 10.1186/s12889-020-09688-0..
Keywords: Human Immunodeficiency Virus (HIV), Medication, Telehealth, Health Information Technology (HIT), Patient Adherence/Compliance, Patient Self-Management, Chronic Conditions, Care Management, Healthcare Delivery
Jones AE, King JB, Kim K
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.
The objective of this study was to describe direct oral anticoagulant (DOAC) management in patients who were and were not managed by an anticoagulation management service (AMS). Subjects were patients with atrial fibrillation at the University of Utah Health (UUH) who received DOAC therapy. Results showed that patients managed by AMS providers were more complex and had more frequent encounters regarding their DOAC therapy than those managed by non-AMS providers. However, there was evidence of duplicative DOAC therapy management efforts. No difference between AMS and non-AMS groups in the composite clinical endpoint was detected.
AHRQ-funded; HS026156.
Citation: Jones AE, King JB, Kim K .
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.
J Thromb Thrombolysis 2020 Oct;50(3):739-45. doi: 10.1007/s11239-020-02064-0..
Keywords: Blood Thinners, Medication, Provider: Pharmacist, Provider, Care Management, Healthcare Delivery
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Fishbein AB, Hamideh N, Lor J
Management of atopic dermatitis in children younger than two years of age by community pediatricians: a survey and chart review.
The authors characterized primary care providers' (PCPs) practice patterns for atopic dermatitis (AD) in children under 2 years of age and determined the need for AD guidelines for PCPs focused on this age group. They found that PCP management of AD in children under 2 years of age is different from that of older children, with possible underuse of medium/high-potency topical corticosteroids. They recommended clear guidelines for this age group.
AHRQ-funded; HS023011.
Citation: Fishbein AB, Hamideh N, Lor J .
Management of atopic dermatitis in children younger than two years of age by community pediatricians: a survey and chart review.
J Pediatr 2020 Jun;221:138-44.e3. doi: 10.1016/j.jpeds.2020.02.015..
Keywords: Children/Adolescents, Skin Conditions, Provider: Physician, Practice Patterns, Primary Care, Medication, Care Management
Shoemaker-Hunt SJ, Evans L, Swan H
Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices.
AHRQ-funded; 233201500013I.
Citation: Shoemaker-Hunt SJ, Evans L, Swan H .
Study protocol for evaluating Six Building Blocks for opioid management implementation in primary care practices.
Implement Sci Commun 2020 Feb 26;1:16. doi: 10.1186/s43058-020-00008-6..
Keywords: Opioids, Medication, Primary Care, Care Management, Pain, Chronic Conditions
Quintana Y, Fahy D, Abdelfattah AM
The design and methodology of a usability protocol for the management of medications by families for aging older adults.
Health research apps often do not focus on usability as a design priority. This is problematic when the population of interest is disproportionately underrepresented as users of mobile apps, especially observed with aging older adults (> = 75). Challenges with the adoption of health information technology (HIT) among this group are exacerbated by poor design and user interface/experience (UI/UX) choices. This protocol described the testing and evaluation process of one HIT app for the family-based collaboration platform InfoSAGE.
AHRQ-funded; HS021495; HS24869.
Citation: Quintana Y, Fahy D, Abdelfattah AM .
The design and methodology of a usability protocol for the management of medications by families for aging older adults.
BMC Med Inform Decis Mak 2019 Sep 5;19(1):181. doi: 10.1186/s12911-019-0907-8..
Keywords: Care Management, Caregiving, Elderly, Health Information Technology (HIT), Medication
Caram MEV, Kaufman SR, Modi PK
Adoption of abiraterone and enzalutamide by urologists.
The purpose of this study was to investigate the adoption of abiraterone and enzalutamide by urologists. Abiraterone and enzalutamide are oral therapies approved for the treatment of metastatic castration-resistant prostate cancer, a disease most commonly treated by medical oncologists. The investigators found that urologists are increasingly prescribing oral therapies for metastatic castration-resistant prostate cancer. They suggest that understanding the distribution of urologists specializing in castration-resistant prostate cancer therapeutics will help guide future interventions to optimize the care for this important patient population.
AHRQ-funded; HS025707.
Citation: Caram MEV, Kaufman SR, Modi PK .
Adoption of abiraterone and enzalutamide by urologists.
Urology 2019 Sep;131:176-83. doi: 10.1016/j.urology.2019.05.012..
Keywords: Cancer, Cancer: Prostate Cancer, Care Management, Medication, Men's Health
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Advanced Analytics Group of Pediatric Urology, ORC Personalized Medicine Group
Targeted workup after initial febrile urinary tract infection: using a novel machine learning model to identify children most likely to benefit from voiding cystourethrogram.
The authors sought to develop a model to predict the probability of recurrent urinary tract infection associated vesicoureteral reflux in children after an initial urinary tract infection. Their predictive model provided a promising performance to facilitate individualized treatment of children with an initial urinary tract infection and to identify those most likely to benefit from voiding cystourethrogram after the initial urinary tract infection. They conclude that this model would allow for more selective test application and increase yield while minimizing overuse.
AHRQ-funded; HS000063.
Citation: Advanced Analytics Group of Pediatric Urology, ORC Personalized Medicine Group .
Targeted workup after initial febrile urinary tract infection: using a novel machine learning model to identify children most likely to benefit from voiding cystourethrogram.
J Urol 2019 Jul;202(1):144-52. doi: 10.1097/ju.0000000000000186..
Keywords: Antibiotics, Care Management, Children/Adolescents, Guidelines, Medication, Urinary Tract Infection (UTI)
Newgard CD, Lin A, Eckstrom E
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.
In this study, the investigators evaluated the utility of comorbidities, anticoagulant use, and geriatric-specific physiologic measures to improve the sensitivity of the field triage guidelines for high-risk older adults in the out-of-hospital setting.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Eckstrom E .
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.
J Trauma Acute Care Surg 2019 May;86(5):829-37. doi: 10.1097/ta.0000000000002195
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Keywords: Elderly, Blood Thinners, Medication, Ambulatory Care and Surgery, Injuries and Wounds, Care Management
Balk EM, Rofeberg VN, Adam GP
Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes.
The purpose of this study was to compare the effectiveness of pharmacologic and nonpharmacologic interventions to improve or cure stress, urgency, or mixed UI in nonpregnant women. The investigators concluded that most nonpharmacologic and pharmacologic interventions were more likely than no treatment to improve UI outcomes. They also concluded that behavioral therapy, alone or in combination with other interventions, was generally more effective than pharmacologic therapies alone in treating both stress and urgency UI.
AHRQ-funded; 290201500002I.
Citation: Balk EM, Rofeberg VN, Adam GP .
Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes.
Ann Intern Med 2019 Apr 2;170(7):465-79. doi: 10.7326/m18-3227..
Keywords: Care Management, Comparative Effectiveness, Evidence-Based Practice, Medication, Outcomes, Patient-Centered Outcomes Research, Women
Hung A, Mullins CD, Slejko JF
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
This study projected cost savings to the TRICARE program from changes to the antidiabetic formulary and utilization management (UM) policies. Budgetary impacts for 3 years as projected using a Microsoft Excel spreadsheet. This model projected a savings of up to $43 million in the third year from revisions to the payer’s formulary.
AHRQ-funded; HS024857.
Citation: Hung A, Mullins CD, Slejko JF .
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
J Manag Care Spec Pharm 2019 Mar;25(3):342-49. doi: 10.18553/jmcp.2019.25.3.342..
Keywords: Care Management, Elderly, Healthcare Costs, Medication, Policy
Parthipan A, Banerjee I, Humphreys K
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
Researchers employed a machine-learning approach to identify patients who were prescribed a combination of selective serotonin reuptake inhibitors (SSRIs) and prodrug opioids in order to examine the effect of this combination on postoperative pain control. They identified patients who received surgery over a 9-year period by using EHR data from an academic medical center, then developed and validated natural language processing (NLP) algorithms to extract depression-related information from both structured and unstructured data elements. The machine-learning algorithm accurately predicted the increase or decrease of the discharge, 3-week, and 8-week follow-up pain scores when compared to the pre-operative pain score; pre-operative pain, surgery type, and opioid tolerance were the strongest predictors of postoperative pain control. The researchers conclude that their study results provide the first direct clinical evidence that the known ability of SSRIs to inhibit prodrug opioid effectiveness is associated with worse pain control among depressed patients. They suggest that prescribers might choose direct acting opioids such as oxycodone or morphine for depressed patients on SSRIs instead of prodrug opioids.
AHRQ-funded; HS024096.
Citation: Parthipan A, Banerjee I, Humphreys K .
Predicting inadequate postoperative pain management in depressed patients: a machine learning approach.
PLoS One 2019 Feb 6;14(2):e0210575. doi: 10.1371/journal.pone.0210575..
Keywords: Care Management, Depression, Medication, Opioids, Pain, Surgery
Militello LG, Anders S, Downs SM
Understanding how primary care clinicians make sense of chronic pain.
This research explored how primary care clinicians manage their patients with chronic noncancer pain. They conducted Critical Decision Method interviews with 10 clinicians about 30 individual patients. Findings suggested that clinicians should focus on supporting sensemaking in the content of clinical evidence rather than trying to provide them with rules.
AHRQ-funded; HS023306.
Citation: Militello LG, Anders S, Downs SM .
Understanding how primary care clinicians make sense of chronic pain.
Cogn Technol Work 2018 Nov;20(4):575-84. doi: 10.1007/s10111-018-0491-1..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Decision Making, Primary Care, Care Management
Hall SF, Wright NC, Wolinsky FD
The prevalence of overtreatment of osteoporosis: results from the PAADRN trial.
There is a robust body of literature addressing undertreatment in osteoporosis, but limited data addressing overtreatment. In this study, the investigators sought to understand overtreatment as this understanding is important to minimizing harm and decrease costs. The investigators found that in their sample of older adults, overuse of osteoporosis pharmacotherapy was only 8.1%. Nevertheless, they concluded, overtreatment exposed patients to possible risk with negligible chance of benefit and should be minimized.
AHRQ-funded; HS023009.
Citation: Hall SF, Wright NC, Wolinsky FD .
The prevalence of overtreatment of osteoporosis: results from the PAADRN trial.
Arch Osteoporos 2018 Sep 28;13(1):103. doi: 10.1007/s11657-018-0517-6..
Keywords: Osteoporosis, Decision Making, Medication, Elderly, Patient-Centered Healthcare, Patient and Family Engagement, Care Management
Ramirez M, Maranon R, Fu J
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
The purpose of this study was to evaluate provider responses to a narrowly targeted Best Practice Advisory (BPA) alert regarding the intensification of blood pressure medications for persons with diabetes before and after implementation of a ‘chart closure’ hard stop. Researchers designed a BPA that sent alerts via an electronic health record system during outpatient encounters when patients with diabetes had elevated blood pressures and were not on angiotensin receptor blocking medications. These alerts were implemented in eight primary care practices within UCLA Health. Data on provider responses to the alerts was compared before and after implementing a ‘chart closure’ hard stop. Providers responded to alerts more often after the ‘chart closure’ hard stop was implemented. The researchers conclude that targeting specific omitted medication classes can produce specific alerts that may reduce alert fatigue, and that using a ‘chart closure’ hard stop may prompt providers to take action without major disruptions to their workflow.
AHRQ-funded; HS000046.
Citation: Ramirez M, Maranon R, Fu J .
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
J Am Med Inform Assoc 2018 Sep;25(9):1167-74. doi: 10.1093/jamia/ocy073..
Keywords: Blood Pressure, Diabetes, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Care Management
Desai K, Carroll I, Asch SM
Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management.
In this study, the investigators sought to assess the association between discharge multimodal analgesia and postoperative pain outcomes in two diverse health care settings. They evaluated patients undergoing four common surgeries associated with high pain in electronic health records from an academic hospital (AH) and Veterans Health Administration (VHA). The investigators found that a majority of surgical patients received a multimodal pain approach at discharge yet many received only opioids. Multimodal regimen at discharge was associated with better follow-up pain and all-cause readmissions compared to the opioid-only regimen.
AHRQ-funded; HS024096.
Citation: Desai K, Carroll I, Asch SM .
Utilization and effectiveness of multimodal discharge analgesia for postoperative pain management.
J Surg Res 2018 Aug;228:160-69. doi: 10.1016/j.jss.2018.03.029..
Keywords: Care Management, Medication, Opioids, Pain, Surgery
Turner TE, Saeed MJ, Novak E
Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality.
Despite the absence of data from randomized clinical trials, professional societies recommend inferior vena cava (IVC) filters for patients with venous thromboembolic disease (VTE) and a contraindication to anticoagulation therapy. Prior observational studies of IVC filters have suggested a mortality benefit associated with IVC filter insertion but have often failed to adjust for immortal time bias. The purpose of this study was to determine the association of IVC filter placement with 30-day mortality after adjustment for immortal time bias.
AHRQ-funded; HS019455.
Citation: Turner TE, Saeed MJ, Novak E .
Association of inferior vena cava filter placement for venous thromboembolic disease and a contraindication to anticoagulation with 30-day mortality.
JAMA Netw Open 2018 Jul 6;1(3):e180452. doi: 10.1001/jamanetworkopen.2018.0452.
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Keywords: Blood Thinners, Cardiovascular Conditions, Care Management, Heart Disease and Health, Healthcare Cost and Utilization Project (HCUP), Medication, Outcomes
Spellberg B
The maturing antibiotic mantra: "Shorter is still better."
The proper duration of antibiotic therapy for various infections is a matter of long-standing consternation. This article discusses the evidence supporting the idea that shorter courses of antibiotic therapy are as effective as longer courses. It asserts that shorter courses are better due to reduced exposure which intrinsically reduces the risk of adverse events and of selective pressure that drives resistance in our microbiomes.
AHRQ-funded; HS025690.
Citation: Spellberg B .
The maturing antibiotic mantra: "Shorter is still better."
J Hosp Med 2018 May;13(5):361.62. doi: 10.12788/jhm.2904.
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Keywords: Antibiotics, Care Management, Medication