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
151 to 175 of 364 Research Studies DisplayedSimpson KR, Lyndon A, Spetz J
Adherence to the AWHONN staffing guidelines as perceived by labor nurses.
Labor and delivery nurses were surveyed to determine if their units adhere to Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) staffing guidelines. Labor nurses in selected hospitals in California, Michigan and New Jersey were invited via email to participate in the study. Their nurse leaders facilitated the invitations. A total of 615 labor nurses from 67 hospitals participated. Most nurses did report that staffing guidelines were adhered to. The hospitals with smaller annual birth volumes (500-999 range) were significantly more like to be perceived as compliant than hospitals with 2,500 or more annual births.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Adherence to the AWHONN staffing guidelines as perceived by labor nurses.
Nurs Womens Health 2019 Jun;23(3):217-23. doi: 10.1016/j.nwh.2019.03.003..
Keywords: Care Management, Guidelines, Labor and Delivery, Maternal Care, Patient Safety, Pregnancy, Provider, Provider: Nurse, Women
Krist AH, Davidson KW, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q
What evidence do we need before recommending routine screening for social determinants of health?
This editorial, co-written by two members of the U.S. Preventive Services Task Force (USPSTF), and a member of the Agency for Healthcare Research and Quality (AHRQ) discusses the need to determine if social determinants of health (SDOH) should be discussed during a primary care visit. At the present time only 2 USPSTF recommendations are social determinants (intimate partner violence, elder abuse, and abuse of vulnerable adults; and child maltreatment). However, there are recommendations for nine health behaviors and three mental health behaviors that are included in SDOH. There is an absence of evidence of benefit for routine screening for many of the social determinants, and the USPSTF is currently conducting an evaluation to understand the state of screening for SDOH.
AHRQ-authored.
Citation: Krist AH, Davidson KW, Ngo-Metzger Q .
What evidence do we need before recommending routine screening for social determinants of health?
Am Fam Physician 2019 May 15;99(10):602-05..
Keywords: Evidence-Based Practice, Guidelines, Primary Care, Screening, Social Determinants of Health, U.S. Preventive Services Task Force (USPSTF)
Armstrong MJ
Developing the disorders of consciousness guideline and challenges of integrating shared decision-making into clinical practice.
The purpose of this study was to review methodology informing evidence-based guideline development and integration of guidelines into clinical care through shared decision-making (SDM) and to highlight challenges to SDM in disorders of consciousness. Recently published disorders of consciousness guideline recommendations provide strategies for clinicians to enhance quality care for these individuals and also to provide details helping clinicians partner with individuals with disorders of consciousness and their surrogates. Further research is recommended into many aspects of caring for individuals with disorders of consciousness and optimal strategies for partnering with surrogates in decision-making.
AHRQ-funded; HS024159.
Citation: Armstrong MJ .
Developing the disorders of consciousness guideline and challenges of integrating shared decision-making into clinical practice.
J Head Trauma Rehabil 2019 May/Jun;34(3):199-204. doi: 10.1097/htr.0000000000000496.
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Keywords: Decision Making, Guidelines, Evidence-Based Practice, Neurological Disorders, Patient-Centered Outcomes Research
Simon KC, Munson R, Ong A
Design and implementation of structured clinical documentation support tools for treating stroke patients.
This article describes the development of a customized structured clinical documentation toolkit that standardizes patient data collection to conform to Best Practices for treating patients with stroke. The toolkit collects demographic information for patients, relevant score test measures, and information on disability, treatment, and outcomes. Basic descriptive data gathered via the toolkits is provided and their utility in collecting patient data in a manner that supports both quality clinical care and research initiatives demonstrated. Quality improvement projects and current research initiatives using the toolkit are also discussed.
AHRQ-funded; HS024057.
Citation: Simon KC, Munson R, Ong A .
Design and implementation of structured clinical documentation support tools for treating stroke patients.
J Stroke Cerebrovasc Dis 2019 May;28(5):1229-35. doi: 10.1016/j.jstrokecerebrovasdis.2019.01.011..
Keywords: Electronic Health Records (EHRs), Evidence-Based Practice, Guidelines, Health Information Technology (HIT), Stroke, Tools & Toolkits
Trent SA, Havranek EP, Ginde AA
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
This study examined the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for patients with severe sepsis. A quasi-experiment was conducted with attending physicians randomized into 6 clusters at a single urban safety net hospital. Feedback with blinded peer comparison significantly improved guideline adherence from 52% to 65% with feedback.
AHRQ-funded; HS022400.
Citation: Trent SA, Havranek EP, Ginde AA .
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
Am J Med Qual 2019 May/Jun;34(3):217-25. doi: 10.1177/1062860618796947..
Keywords: Antibiotics, Emergency Department, Guidelines, Infectious Diseases, Inpatient Care, Medication, Pneumonia, Provider, Provider: Physician, Sepsis
Monsees EA, Tamma PD, Cosgrove SE
AHRQ Author: Miller MA
Integrating bedside nurses into antibiotic stewardship: a practical approach.
This study looked into a framework for nurses to integrate antibiotic stewardship (AS) into their clinical work with patients. The practices that nurses can take include improving antibiotic prescribing practices through appropriate obtainment of Cloistridioides difficile tests, appropriate urine culturing practices, optimal antibiotic administration, accurate and detailed documentation of antibiotic allergy histories, and through the prompting of antibiotic time outs. Barriers were also identified to engagement of nurses in AS and offered potential solutions.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Monsees EA, Tamma PD, Cosgrove SE .
Integrating bedside nurses into antibiotic stewardship: a practical approach.
Infect Control Hosp Epidemiol 2019 May;40(5):579-84. doi: 10.1017/ice.2018.362..
Keywords: Antibiotics, Antimicrobial Stewardship, Guidelines, Healthcare-Associated Infections (HAIs), Medication, Nursing, Patient Safety
Jue JJ, Cunningham S, Lohr K
AHRQ Author: Nix M
Developing and testing the Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) Instrument.
In 2011, the Institute of Medicine (IOM) (now the National Academy of Medicine) published standards for trustworthy guidelines and recommended that the National Guideline Clearinghouse (NGC) of the Agency for Healthcare Research and Quality clearly indicate the extent to which guidelines adhere to these standards. To accomplish this, the authors developed and tested the NGC Extent of Adherence to Trustworthy Standards (NEATS) instrument which they discuss in this paper.
AHRQ-authored; AHRQ-funded; 290-2013-00006C.
Citation: Jue JJ, Cunningham S, Lohr K .
Developing and testing the Agency for Healthcare Research and Quality's National Guideline Clearinghouse Extent of Adherence to Trustworthy Standards (NEATS) Instrument.
Ann Intern Med 2019 Apr 2. doi: 10.7326/m18-2950..
Keywords: Implementation, Evidence-Based Practice, Guidelines
Crawford ED, Koo PJ, Shore N
A clinician's guide to next generation imaging in patients with advanced prostate cancer (RADAR III).
This paper reports on the convening of the Radiographic Assessments for Detection of Advanced Recurrence (RADAR III) Group to offer guidance on the use of next generation imaging to stage prostate cancer based on available data and clinical experience. The RADAR III Group recommends next generation imaging techniques in select patients in whom disease progression is suspected based on biomarker values, comorbidities and symptoms.
AHRQ-funded.
Citation: Crawford ED, Koo PJ, Shore N .
A clinician's guide to next generation imaging in patients with advanced prostate cancer (RADAR III).
J Urol 2019 Apr;201(4):682-92. doi: 10.1016/j.juro.2018.05.164..
Keywords: Men's Health, Cancer: Prostate Cancer, Cancer, Diagnostic Safety and Quality, Imaging, Evidence-Based Practice, Guidelines
Tracer H, Welch R
AHRQ Author: Tracer H
Screening for atrial fibrillation with electrocardiography.
This case study describes a 67-year-old woman with hypertension who neither drinks nor smokes and is moderately physically active. Her brother has recently been diagnosed with atrial fibrillation and she requests an electrocardiograph (ECG) to be screened herself for this condition. The case study questions are based on USPSTF recommendations for screening for atrial fibrillation with electrocardiography.
AHRQ-authored.
Citation: Tracer H, Welch R .
Screening for atrial fibrillation with electrocardiography.
Am Fam Physician 2019 Mar 15;99(6):383-84..
Keywords: U.S. Preventive Services Task Force (USPSTF), Heart Disease and Health, Cardiovascular Conditions, Screening, Prevention, Evidence-Based Practice, Case Study, Guidelines
Callaghan BC, Reynolds E, Banerjee M
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
The authors of this article investigated the pattern and utilization of neuropathic pain medications in peripheral neuropathy patients. They found that opioid initiation and transition to chronic opioid therapy were frequent in the studied population despite few patients receiving more than one guideline-recommended medication. They concluded that efforts are needed to decrease opioid utilization and to increase guideline-recommended medication use in order to improve current neuropathic pain treatment.
AHRQ-funded; HS017690.
Citation: Callaghan BC, Reynolds E, Banerjee M .
Longitudinal pattern of pain medication utilization in peripheral neuropathy patients.
Pain 2019 Mar;160(3):592-99. doi: 10.1097/j.pain.0000000000001439..
Keywords: Chronic Conditions, Guidelines, Healthcare Utilization, Medication, Neurological Disorders, Opioids, Pain, Practice Patterns
Guirguis-Blake JM, Evans CV, Rushkin M
Ocular prophylaxis for gonococcal ophthalmia neonatorum: updated evidence report and systematic review for the US Preventive Services Task Force.
This evidence report and systematic review was commissioned for the U.S. Preventive Services Task Force to update the evidence of using prophylactic ocular topic medication for all newborns to prevent gonococcal ophthalmia neonatorum (GON) which can cause blindness if not treated immediately. Many articles were screened for inclusion, and of those included the recommendations remained an “A” grade recommendation, which is to apply the topical medication on all newborns due to an increase in syphilis prevalence.
AHRQ-funded; 290201500007I.
Citation: Guirguis-Blake JM, Evans CV, Rushkin M .
Ocular prophylaxis for gonococcal ophthalmia neonatorum: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Jan 29;321(4):404-06. doi: 10.1001/jama.2018.17847..
Keywords: Evidence-Based Practice, Eye Disease and Health, Guidelines, Newborns/Infants, Prevention, U.S. Preventive Services Task Force (USPSTF)
Carnahan RM, Daly JM, Minion S
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
The authors assessed the needs and preferred resources of Iowa physicians to inform the development of educational resources for best practice dementia care and compared the responses of nursing home medical directors with nonmedical directors. They found that medical directors and nonmedical directors had similar preferences for resources used and information needs, with preference for online resources, pocket guides, a handbook, consulting pharmacists, and facility in-services being the most commonly preferred sources of new information. Medical directors were significantly more aware of the FDA warning on antipsychotic use in dementia and treated more nursing home patients. No differences were observed between groups related to confidence in and use of nondrug strategies instead of antipsychotics to manage behavioral symptoms of dementia.
AHRQ-funded; HS019355.
Citation: Carnahan RM, Daly JM, Minion S .
A needs assessment of family physicians to inform development of educational resources on antipsychotic use in dementia.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719840113. doi: 10.1177/2150132719840113..
Keywords: Education: Continuing Medical Education, Medication, Dementia, Neurological Disorders, Elderly, Evidence-Based Practice, Guidelines, Long-Term Care
Livingston CJ, Freeman RJ, Costales VC
AHRQ Author: Niebuhr DW
Electronic nicotine delivery systems or e-cigarettes: American College of Preventive Medicine's practice statement.
E-cigarettes or or electronic nicotine delivery systems (ENDS) have rapidly gained popularity in the U.S. Controversy exists about the safety and efficacy of ENDS. This paper describes the American College of Preventive Medicine's Prevention Practice Committee’s consensus-based evidence review process to develop a practice statement for the American College of Preventive Medicine.
AHRQ-authored
Citation: Livingston CJ, Freeman RJ, Costales VC .
Electronic nicotine delivery systems or e-cigarettes: American College of Preventive Medicine's practice statement.
Am J Prev Med 2019 Jan;56(1):167-78. doi: 10.1016/j.amepre.2018.09.010.
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Keywords: Guidelines, Prevention, Substance Abuse, Tobacco Use
Patil SJ, Koopman RJ, Belden J
The role of home BP monitoring: answers to 10 common questions.
This review examines what role home blood-pressure monitoring (HBPM) should take in the management of patients with hypertension. The answers to ten evidence-based questions, with reference to USPSTF recommendations, are used to provide insight. These questions include: Can HPBM be used to confirm a hypertension diagnosis? What are the diagnostic and treatment targets for HBPM? Does HBPM improve control of hypertension? Does HBPM help improve medication adherence? Does HBPM improve BP outcomes?
AHRQ-funded; HS023328.
Citation: Patil SJ, Koopman RJ, Belden J .
The role of home BP monitoring: answers to 10 common questions.
J Fam Pract 2019 Jan/Feb;68(1):29-33..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Home Healthcare, Evidence-Based Practice, Care Management, Guidelines
Li SA, Alexander PE, Reljic T
Evidence to decision framework provides a structured "roadmap" for making GRADE guidelines recommendations.
It is unclear how guidelines panelists discuss and consider factors (criteria) that are formally and not formally included in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. To describe the use of decision criteria, the investigators explored how panelists adhered to GRADE criteria and sought to identify any emerging non-GRADE criteria when the panelists used the Evidence to Decision (EtD) framework as part of GRADE application.
AHRQ-funded; HS024917.
Citation: Li SA, Alexander PE, Reljic T .
Evidence to decision framework provides a structured "roadmap" for making GRADE guidelines recommendations.
J Clin Epidemiol 2018 Dec;104:103-12. doi: 10.1016/j.jclinepi.2018.09.007..
Keywords: Evidence-Based Practice, Guidelines, Decision Making
Vermandere M, Kuijpers T, Burgers JS
Alpha-Blockers for uncomplicated ureteric stones: a clinical practice guideline.
This paper develops an evidence-based recommendation for the use of alpha-blockers for treating uncomplicated ureteric stones. It is based on an up-to-date Cochran review and applies the Rapid Recommendations approach to guideline development. An international panel of clinicians, researchers, methodologists and patient representatives was created and a recommendation was created. There is only low-quality evidence for using alpha-blockers and the net benefit was found to be small.
AHRQ-funded; HS025701.
Citation: Vermandere M, Kuijpers T, Burgers JS .
Alpha-Blockers for uncomplicated ureteric stones: a clinical practice guideline.
BJU Int 2018 Dec;122(6):924-31. doi: 10.1111/bju.14457..
Keywords: Evidence-Based Practice, Guidelines, Medication
Neal JL, Lowe NK, Phillippi JC
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
The goals of this study were: Determine the proportions of women admitted to the hospital before or in active labor per the leading National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines; Compare associations of labor status at admission with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. Active labor diagnostic guidelines were applied retrospectively to cervical examination data. The authors conclude that many parous women with spontaneous labor onset are admitted to the hospital before active labor, and these women are more likely to receive oxytocin augmentation during labor and to have a cesarean birth. Implications for practice are discussed.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Phillippi JC .
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
Midwifery 2018 Dec;67:64-69. doi: 10.1016/j.midw.2018.09.007..
Keywords: Decision Making, Guidelines, Hospitalization, Labor and Delivery, Pregnancy, Women
Magrath M, Yang E, Ahn C
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). Results showed that an EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.
AHRQ-funded; HS022418.
Citation: Magrath M, Yang E, Ahn C .
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
J Natl Compr Canc Netw 2018 Nov;16(11):1321-28. doi: 10.6004/jnccn.2018.7050..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Colonoscopy, Cancer: Colorectal Cancer, Screening, Cancer, Guidelines, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention
Wolff T, Jadotte YJ
AHRQ Author: Wolff T
Screening for prostate cancer.
This case study describes a 57-year-old black man, non-smoker, who has a history of diabetes mellitus, currently well-controlled. He would like to discuss the prostate-specific antigen (PSA) test even though he has no family history of prostate cancer. The case study questions are based on USPSTF recommendations for prostate cancer screening.
AHRQ-authored.
Citation: Wolff T, Jadotte YJ .
Screening for prostate cancer.
Am Fam Physician 2018 Oct 15;98(8):537-38..
Keywords: Cancer: Prostate Cancer, Case Study, Guidelines, Prevention, Screening
Admon AJ, Gupta A, Williams M
Appraising the evidence supporting Choosing Wisely(R) recommendations.
This study’s objective was to appraise the evidence supporting the Choosing Wisely® campaign initiated by the American Board of Internal Medicine (ABIM) Foundation to advance dialogue on prevention of unnecessary medical tests, treatments, and procedures. The authors extracted all 320 recommendations that were published through August 2014. The recommendations were then categorized by evidence strength and then a sample of referenced clinical practice guidelines (CPGs) using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Overall, 70.3% of recommendations cited CPGs, whereas 22.2% cited primary research as their highest evidence level. Hospital medicine recommendations cited CPGs 90% of the time. However, the median overall score using AGREE II was 54.2% and even for hospital medicine-referenced CPGs was 58.3%.
AHRQ-funded; HS020672.
Citation: Admon AJ, Gupta A, Williams M .
Appraising the evidence supporting Choosing Wisely(R) recommendations.
J Hosp Med 2018 Oct;13(10):688-91. doi: 10.12788/jhm.2964..
Keywords: Decision Making, Evidence-Based Practice, Guidelines, Prevention, Quality of Care, Quality Improvement
Tracer H, Jadotte YT
AHRQ Author: Tracer H
Screening for cardiovascular disease risk with electrocardiography.
This paper presents a case study, along with questions and answers, related to the U.S. Preventive Services Task Force (USPSTF) recommendations for screening for cardiovascular disease risk with electrocardiography.
AHRQ-authored.
Citation: Tracer H, Jadotte YT .
Screening for cardiovascular disease risk with electrocardiography.
Am Fam Physician 2018 Sep 15;98(6):375-76..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cardiovascular Conditions, Screening, Risk, Prevention, Guidelines, Evidence-Based Practice, Case Study
Koziatek CA, Simon E, Horwitz LI
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
The objective of this study was to measure the performance of automated, structured data-only versions of the Wells and revised Geneva risk scores in emergency department encounters during which a computed tomography pulmonary angiography was ordered. The hypothesis was that such an automated method would classify a patient's pulmonary embolism risk with high accuracy compared to manual chart review.
AHRQ-funded; HS024376.
Citation: Koziatek CA, Simon E, Horwitz LI .
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
Acad Emerg Med 2018 Sep;25(9):1053-61. doi: 10.1111/acem.13442..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality, Emergency Department, Imaging, Guidelines
Durkin MJ, Keller M, Butler AM
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
In 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). This study assessed whether the CPG had an impact on national antibiotic prescribing practices. The study found that CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs.
AHRQ-funded; HS019455.
Citation: Durkin MJ, Keller M, Butler AM .
An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections.
Open Forum Infect Dis 2018 Sep;5(9):ofy198. doi: 10.1093/ofid/ofy198..
Keywords: Antibiotics, Decision Making, Guidelines, Practice Patterns, Urinary Tract Infection (UTI)
Lee DJ, Barocas DA, Zhao Z
Contemporary prostate cancer radiation therapy in the United States: patterns of care and compliance with quality measures.
This study measured compliance with quality measures for radiation therapy treatment of prostate cancer. The Comparative Effectiveness Analysis of Surgery and Radiation Study enrolled men who were treated for localized prostate cancer from 2011 and 2012. Medical records were reviewed, and patients completed surveys. Researchers concluded that men who received external beam radiation therapy (EBRT) were treated more appropriately than those treated with brachytherapy (BT). White men were also more likely to receive appropriate treatment than African-American and other minorities.
AHRQ-funded; HS019356; HS022640.
Citation: Lee DJ, Barocas DA, Zhao Z .
Contemporary prostate cancer radiation therapy in the United States: patterns of care and compliance with quality measures.
Pract Radiat Oncol 2018 Sep-Oct;8(5):307-16. doi: 10.1016/j.prro.2018.04.009..
Keywords: Cancer, Cancer: Prostate Cancer, Comparative Effectiveness, Evidence-Based Practice, Guidelines, Patient-Centered Outcomes Research, Practice Patterns, Quality Measures
Jonas DE, Kahwati LC, Yun JDY
Screening for atrial fibrillation with electrocardiography: evidence report and systematic review for the US Preventive Services Task Force.
The objective of this study was to review the evidence on screening for nonvalvular atrial fibrillation with electrocardiography (ECG) and stroke prevention treatment in asymptomatic adults 65 years or older to inform the US Preventive Services Task Force. The authors concluded that although screening with ECG can detect previously unknown cases of atrial fibrillation, it has not been shown to detect more cases than screening focused on pulse palpation.
AHRQ-funded; 290201500011I.
Citation: Jonas DE, Kahwati LC, Yun JDY .
Screening for atrial fibrillation with electrocardiography: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2018 Aug 7;320(5):485-98. doi: 10.1001/jama.2018.4190..
Keywords: U.S. Preventive Services Task Force (USPSTF), Heart Disease and Health, Cardiovascular Conditions, Screening, Evidence-Based Practice, Guidelines, Prevention