National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (1)
- Cardiovascular Conditions (15)
- Children/Adolescents (2)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (3)
- Decision Making (1)
- Diabetes (1)
- (-) Diagnostic Safety and Quality (19)
- Electronic Health Records (EHRs) (2)
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- Healthcare Cost and Utilization Project (HCUP) (2)
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- Health Information Technology (HIT) (5)
- (-) Heart Disease and Health (19)
- Hospitalization (1)
- Human Immunodeficiency Virus (HIV) (1)
- Imaging (4)
- Intensive Care Unit (ICU) (1)
- Neurological Disorders (1)
- Patient-Centered Outcomes Research (1)
- Practice Patterns (1)
- Risk (2)
- Rural Health (1)
- Sex Factors (1)
- Stroke (1)
- Surgery (1)
- Telehealth (1)
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 19 of 19 Research Studies DisplayedSoares WE, Knee A, Gemme SR
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
The HEART score is a risk stratification aid that may safely reduce chest pain admissions for emergency department patients. However, differences in interpretation of subjective components potentially alters the performance of the score. In this study, the investigators compared agreement between HEART scores determined during clinical practice with research-generated scores and estimated their accuracy in predicting 30-day major adverse cardiac events.
AHRQ-funded; HS024815.
Citation: Soares WE, Knee A, Gemme SR .
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
Ann Emerg Med 2021 Aug;78(2):231-41. doi: 10.1016/j.annemergmed.2021.03.024..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Emergency Department, Diagnostic Safety and Quality, Clinical Decision Support (CDS), Health Information Technology (HIT)
Ganguli I, Cui J, Thakore N
Downstream cascades of care following high-sensitivity troponin test implementation.
This study sought to determine the association of high-sensitivity cardiac troponin (hs-cTn) assay implementation with cascade events. The investigators found that hs-cTn assay implementation was associated with more net upfront tests yet fewer net stress tests, percutaneous coronary interventions, cardiology evaluations, and hospital admissions in patients with chest pain relative to patients with other symptoms.
AHRQ-funded; toHS023812.
Citation: Ganguli I, Cui J, Thakore N .
Downstream cascades of care following high-sensitivity troponin test implementation.
J Am Coll Cardiol 2021 Jun 29;77(25):3171-79. doi: 10.1016/j.jacc.2021.04.049..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Huda A, Castaño A, Niyogi A
A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy.
Transthyretin amyloid cardiomyopathy, an often-unrecognized cause of heart failure, is now treatable with a transthyretin stabilizer. It is therefore important to identify at-risk patients who can undergo targeted testing for earlier diagnosis and treatment, prior to the development of irreversible heart failure. In this study, the investigators showed that a random forest machine learning model could identify potential wild-type transthyretin amyloid cardiomyopathy using medical claims data.
AHRQ-funded; HS026385.
Citation: Huda A, Castaño A, Niyogi A .
A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy.
Nat Commun 2021 May 11;12(1):2725. doi: 10.1038/s41467-021-22876-9..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Neurological Disorders, Diagnostic Safety and Quality, Risk
Shah NR, Eisman AS, Winchester DE
E-consult protocoling to improve the quality of cardiac stress tests.
Rarely appropriate cardiac stress tests remain prevalent in the range of 10% to 20% and unnecessarily prolong wait times. To address this ongoing problem, the investigators designed the EPIQ-Stress workflow, which included a structured electronic consult (“econsult”) with all outpatient stress test orders. In this study, the investigators assessed whether EPIQ-Stress implementation was associated with a reduction in rarely appropriate testing and in order-to-report wait times.
AHRQ-funded; HS022998.
Citation: Shah NR, Eisman AS, Winchester DE .
E-consult protocoling to improve the quality of cardiac stress tests.
JACC Cardiovasc Imaging 2021 Feb;14(2):512-14. doi: 10.1016/j.jcmg.2020.08.009..
Keywords: Telehealth, Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Dewan M, O'Halloran A, Kleinman M
eStablish and Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) electronic Delphi: development of a consensus framework for classifying and reviewing cardiac arrests within the PICU.
The authors sought to develop a consensus framework to guide the process of classifying and reviewing pediatric in-hospital cardiac arrest in the PICU. A multidisciplinary group of pediatric resuscitation experts generated a consensus-based framework to classify and review pediatric in-hospital cardiac arrest in the PICU. The authors recommended that future work focus on the application of this framework and further validation of these definitions and contributing factors for in-hospital cardiac arrest both within and outside the PICU.
AHRQ-funded; HS026975.
Citation: Dewan M, O'Halloran A, Kleinman M .
eStablish and Formalize Expert Criteria for Avoidable Resuscitation Review (SAFECARR) electronic Delphi: development of a consensus framework for classifying and reviewing cardiac arrests within the PICU.
Pediatr Crit Care Med 2020 Nov;21(11):992-99. doi: 10.1097/pcc.0000000000002488..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Shah RU, Mutharasan RK, Ahmad FS
Development of a portable tool to identify patients with atrial fibrillation using clinical notes from the electronic medical record.
The electronic medical record contains a wealth of information buried in free text. In this study, the investigators created a natural language processing algorithm to identify patients with atrial fibrillation (AF) using text alone. The authors concluded that this approach allowed better use of the clinical narrative and created an opportunity for precise, high-throughput cohort identification.
AHRQ-funded; HS026385.
Citation: Shah RU, Mutharasan RK, Ahmad FS .
Development of a portable tool to identify patients with atrial fibrillation using clinical notes from the electronic medical record.
Circ Cardiovasc Qual Outcomes 2020 Oct;13(10):e006516. doi: 10.1161/circoutcomes.120.006516..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality
Mahtta D, Ahmed ST, Shah NR
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
The authors evaluate facility-level variation in cardiac stress test use among patients with diabetes mellitus (DM) across the Veterans Affairs (VA) health care system. Their results suggest that significant residual variation in overall stress test use exists among veterans with DM. They recommend future studies to assess system-wide appropriateness of stress testing, to assess patient-level symptom data, and to conduct qualitative analyses in order to understand individual provider-level drivers behind such variation.
AHRQ-funded; HS022998.
Citation: Mahtta D, Ahmed ST, Shah NR .
Facility-level variation in cardiac stress test use among patients with diabetes: findings from the Veterans Affairs national database.
Diabetes Care 2020 May;43(5):e58-e60. doi: 10.2337/dc19-2160..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Diabetes, Decision Making, Diagnostic Safety and Quality, Chronic Conditions
Pereira T, Gadhoumi K, Ma M
A supervised approach to robust photoplethysmography quality assessment.
In this paper, the investigators tested the performance of algorithms selected from a body of studies on photoplethysmogram (PPG) quality assessment using a dataset of PPG recordings from patients with AFib. They then proposed machine learning approaches for PPG quality assessment in 30-s segments of PPG recording from 13 stroke patients admitted to the University of California San Francisco (UCSF) neuro intensive care unit and another dataset of 3764 patients from one of the five UCSF general intensive care units.
AHRQ-funded; HS022860.
Citation: Pereira T, Gadhoumi K, Ma M .
A supervised approach to robust photoplethysmography quality assessment.
IEEE J Biomed Health Inform 2020 Mar;24(3):649-57. doi: 10.1109/jbhi.2019.2909065..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Stroke, Diagnostic Safety and Quality
Levy AE, Shah NR, Matheny ME
Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: implications for natural language processing tools.
The authors investigated whether Natural Language Processing (NLP) tools could potentially help estimate myocardial perfusion imaging (MPI) risk. Subjects were VA patients who underwent stress MPI and coronary angiography 2009-11; stress test reports were randomly selected for analysis. The authors found that post-test ischemic risk was determinable but rarely reported in this sample of stress MPI reports. They conclude that this supports the potential use of NLP to help clarify risk and recommend further study of NLP in this context.
AHRQ-funded; HS022998.
Citation: Levy AE, Shah NR, Matheny ME .
Determining post-test risk in a national sample of stress nuclear myocardial perfusion imaging reports: implications for natural language processing tools.
J Nucl Cardiol 2019 Dec;26(6):1878-85. doi: 10.1007/s12350-018-1275-y..
Keywords: Imaging, Risk, Clinical Decision Support (CDS), Health Information Technology (HIT), Diagnostic Safety and Quality, Cardiovascular Conditions, Heart Disease and Health
Shah NR, Ahmed ST, Winchester DE
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
The aim of this study was to quantify variation in cardiac stress test utilization across the Veterans Health Administration (VA) in patients with established ischemic heart disease (IHD). The investigators used VA datasets to identify adults with IHD (myocardial infarction, percutaneous coronary intervention, and/or coronary artery bypass grafting) with a primary care clinic visit at the VA in fiscal year 2014.
AHRQ-funded; HS022998.
Citation: Shah NR, Ahmed ST, Winchester DE .
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
JACC Cardiovasc Imaging 2019 Jul;12(7 Pt 1):1292-93. doi: 10.1016/j.jcmg.2019.02.020..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality, Healthcare Utilization, Practice Patterns, Imaging
Strom JB, Shen C, Yeh RW
SCOT-HEART: does it live up to the PROMISE?
This paper examines the Scottish Computed Tomography of the Heart (SCOT-HEART) trial which was a prospective, openlabel, parallel group, multicenter trial that randomized 4146 adults (ages 18–75), referred for suspected angina to 12 cardiology clinics across Scotland between November 18, 2010 and September 24, 2014, to an initial strategy of computed tomographic Angiography (CTA) plus standard care or standard care alone in a 1:1 fashion.
AHRQ-funded; R01 HS024520.
Citation: Strom JB, Shen C, Yeh RW .
SCOT-HEART: does it live up to the PROMISE?
J Cardiovasc Comput Tomogr 2019 May - Jun;13(3):48-50. doi: 10.1016/j.jcct.2019.01.008..
Keywords: Imaging, Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Gadhoumi K, Do D, Badilini F
Wavelet leader multifractal analysis of heart rate variability in atrial fibrillation.
Accurate and timely detection of atrial fibrillation (AF) episodes is important in primary and secondary prevention of ischemic stroke and heart-related problems. In this work, heart rate regularity of ECG inter-beat intervals was investigated in episodes of AF and other rhythms using a wavelet leader based multifractal analysis. The investigators’ aim was to improve the detectability of AF episodes.
AHRQ-funded; HS022860.
Citation: Gadhoumi K, Do D, Badilini F .
Wavelet leader multifractal analysis of heart rate variability in atrial fibrillation.
J Electrocardiol 2018 Nov - Dec;51(6s):S83-s87. doi: 10.1016/j.jelectrocard.2018.08.030..
Keywords: Heart Disease and Health, Diagnostic Safety and Quality, Cardiovascular Conditions
Blecker S, Sontag D, Horwitz LI
Early identification of patients with acute decompensated heart failure.
The purpose of this study was to develop and test accuracies of various approaches to identify patients with acute decompensated heart failure (ADHF) with the use of data derived from the electronic health record. The authors concluded that machine learning algorithms with unstructured notes had the best performance for identification of ADHF and can improve provider efficiency for delivery of quality improvement interventions.
AHRQ-funded; HS023683.
Citation: Blecker S, Sontag D, Horwitz LI .
Early identification of patients with acute decompensated heart failure.
J Card Fail 2018 Jun;24(6):357-62. doi: 10.1016/j.cardfail.2017.08.458..
Keywords: Cardiovascular Conditions, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Heart Disease and Health
Bravo PE, Bergmark BA, Vita T
Diagnostic and prognostic value of myocardial blood flow quantification as non-invasive indicator of cardiac allograft vasculopathy.
Cardiac allograft vasculopathy (CAV) is a leading cause of death in orthotopic heart transplant (OHT) survivors. Effective non-invasive screening methods are needed. The aim of this study was to investigate the added diagnostic and prognostic value of myocardial blood flow (MBF) to standard myocardial perfusion imaging (MPI) with positron emission tomography (PET) for CAV detection.
AHRQ-funded; HS022998.
Citation: Bravo PE, Bergmark BA, Vita T .
Diagnostic and prognostic value of myocardial blood flow quantification as non-invasive indicator of cardiac allograft vasculopathy.
Eur Heart J 2018 Jan 21;39(4):316-23. doi: 10.1093/eurheartj/ehx683..
Keywords: Adverse Events, Cardiovascular Conditions, Diagnostic Safety and Quality, Evidence-Based Practice, Heart Disease and Health, Imaging, Patient-Centered Outcomes Research, Surgery
Smith MW, Owens PL, Andrews RM
AHRQ Author: Owens PL, Andrews RM, Steiner CA
Differences in severity at admission for heart failure between rural and urban patients: the value of adding laboratory results to administrative data.
This study’s main objective was to examine the role of laboratory test results in measuring disease severity at the time of admission for inpatients who reside in rural and urban areas. It concluded that heart failure patients from rural areas are hospitalized at lower severity levels than their urban counterparts. Laboratory test data provide insight on clinical severity and practice patterns beyond what is available in administrative discharge data.
AHRQ-authored; AHRQ-funded; 29020060009.
Citation: Smith MW, Owens PL, Andrews RM .
Differences in severity at admission for heart failure between rural and urban patients: the value of adding laboratory results to administrative data.
BMC Health Serv Res 2016 Apr 18;16(1):133. doi: 10.1186/s12913-016-1380-z.
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Keywords: Heart Disease and Health, Hospitalization, Healthcare Cost and Utilization Project (HCUP), Diagnostic Safety and Quality, Rural Health
Spatz ES, Curry LA, Masoudi FA
The variation in recovery: role of gender on outcomes of young AMI Patients (VIRGO) classification system: a taxonomy for young women with acute myocardial infarction.
The authors developed a novel taxonomy among adults up to age 55 with acute myocardial infarction (AMI) enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study. They found that approximately 1 in 8 young women with AMI is unclassified by the Universal Definition of MI. They proposed a more inclusive taxonomy that could serve as a framework for understanding biological disease mechanisms, therapeutic efficacy, and prognosis in this population.
AHRQ-funded; HS023000.
Citation: Spatz ES, Curry LA, Masoudi FA .
The variation in recovery: role of gender on outcomes of young AMI Patients (VIRGO) classification system: a taxonomy for young women with acute myocardial infarction.
Circulation 2015 Nov 3;132(18):1710-8. doi: 10.1161/circulationaha.115.016502.
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Keywords: Diagnostic Safety and Quality, Heart Disease and Health, Sex Factors
Burns KM, Encinosa WE, Pearson GD
AHRQ Author: Encinosa WE
Electrocardiogram in preparticipation athletic evaluations among insured youths.
The researchers retrospectively characterized electrocardiogram (ECG) use among preparticipation history and examinations (PPEs). They found that thirteen percent of PPEs with ECG and 0.5 percent of PPEs alone led to a cardiology referral. After PPEs with ECG, cardiac disease was identified in 18 percent (2 percent sports-limiting); after PPEs alone, cardiac disease was identified in 0.5 percent (0.03 percent sports-limiting).
AHRQ-authored.
Citation: Burns KM, Encinosa WE, Pearson GD .
Electrocardiogram in preparticipation athletic evaluations among insured youths.
J Pediatr 2015 Oct;167(4):804-09.e1. doi: 10.1016/j.jpeds.2015.06.011..
Keywords: Children/Adolescents, Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality
Moy E, Barrett M, Coffey R
AHRQ Author: Moy E
Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics.
The purpose of this study is to estimate the frequency of missed heart attacks or their precursors (e.g., unstable angina) in the emergency department (ED) by examining use of EDs in the week prior to hospitalization for heart attack. This study of 111,973 patients found an overall rate of 0.9 percent for missed diagnoses of heart attacks.
AHRQ-authored; AHRQ-funded; 290201300002C
Citation: Moy E, Barrett M, Coffey R .
Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics.
Diagn. 2015 Feb;2(1):29-40..
Keywords: Diagnostic Safety and Quality, Heart Disease and Health, Emergency Department, Emergency Medical Services (EMS), Healthcare Cost and Utilization Project (HCUP)
Crane HM, Heckbert SR, Drozd DR
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
In this study, a team of researchers developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. They found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half the events ultimately determined to be MIs were not identified by clinical diagnoses.
AHRQ-funded; HS019515
Citation: Crane HM, Heckbert SR, Drozd DR .
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
Am J Epidemiol. 2014 Apr 15;179(8):996-1005. doi: 10.1093/aje/kwu010..
Keywords: Human Immunodeficiency Virus (HIV), Heart Disease and Health, Clinical Decision Support (CDS), Diagnostic Safety and Quality