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
76 to 100 of 118 Research Studies DisplayedPhillips AZ, Rodriguez HP
Adults with diabetes residing in "food swamps" have higher hospitalization rates.
This study examined the relationship between ‘food swamps’ and hospitalization rates among adults with diabetes. Food Swamps are defined and measured by a ratio of fast food outlets to grocery stores within a given area. Data resources for this study included the Blue Cross Blue Shield Association Community Health Management Hub(R), AHRQ’s Health Care Cost and Utilization Project State Inpatient Databases, and HHS’s Area Health Resources File. The study concludes that higher hospitalization rates among adults with diabetes are significantly associated with food swamps, more so in rural than urban communities, and that improvements to local food environments may help to reduce this disparity.
AHRQ-funded; HS022241.
Citation: Phillips AZ, Rodriguez HP .
Adults with diabetes residing in "food swamps" have higher hospitalization rates.
Health Serv Res 2019 Feb;54(Suppl 1):217-25. doi: 10.1111/1475-6773.13102..
Keywords: Chronic Conditions, Diabetes, Disparities, Nutrition, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Social Determinants of Health
Elm JHL, Walls ML, Aronson BD
Sources of stress among Midwest American Indian adults with type 2 diabetes.
Investigators analyzed focus group transcripts of American Indian adults with type 2 diabetes from five tribal communities and classified stressors using an inductive/deductive analytical approach. They identified poverty, genocide, and colonization as fundamental causes of contemporary stress and health outcomes for American Indians and concluded that stressors are generally experienced as chronic, regardless of the duration of the stressor.
AHRQ-funded; HS024180.
Citation: Elm JHL, Walls ML, Aronson BD .
Sources of stress among Midwest American Indian adults with type 2 diabetes.
Am Indian Alsk Native Ment Health Res 2019;26(1):33-62. doi: 10.5820/aian.2601.2019.33..
Keywords: Diabetes, Chronic Conditions, Stress, Racial and Ethnic Minorities, Vulnerable Populations
Cherrington AL, Khodneva Y, Richman JS
Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial.
This study examined the impact of peer support on the number of acute care visits and hospitalizations for individuals with diabetes with and without depressive symptoms. This randomized controlled trial was conducted from 2010-2012. One year of peer support was given to intervention participants, and the usual care to control participants. A Patient Health Questionnaire (PHQ-8) was given to participants to assess depression symptoms at the beginning of the trial, at 6 months and then at 12 months. There was a lower rate of acute care visits and hospitalizations in those patients with depressive symptoms in the intervention group, but it made no difference for individuals without depressive symptoms.
AHRQ-funded; HS013852.
Citation: Cherrington AL, Khodneva Y, Richman JS .
Impact of peer support on acute care visits and hospitalizations for individuals with diabetes and depressive symptoms: a cluster-randomized controlled trial.
Diabetes Care 2018 Dec;41(12):2463-70. doi: 10.2337/dc18-0550..
Keywords: Ambulatory Care and Surgery, Chronic Conditions, Depression, Diabetes, Hospitalization, Behavioral Health, Patient Self-Management
Werner NE, Jolliff AF, Casper G, et al.
Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness.
Researchers combined distributed cognition theory and a patient work-system model to investigate how characteristics of the home interact with the cognitive work of personal health information management (PHIM) for chronic illness. A 3D cave automatic virtual-reality environment (CAVE) enabled participants diagnosed with diabetes to describe how they would perform PHIM within a home context. The researchers found that PHIM is ‘distinctly cognitive work,’ and that features of the physical environment - tasks, people, tools and technologies - continuously shape/are shaped by the PHIM process. They suggest that approaches in which the individual is considered relevant for analysis overlook the role of environment in shaping PHIM.
AHRQ-funded; HS022548.
Citation: Werner NE, Jolliff AF, Casper G, et al..
Home is where the head is: a distributed cognition account of personal health information management in the home among those with chronic illness.
Ergonomics 2018 Aug;61(8):1065-78. doi: 10.1080/00140139.2018.1435910..
Keywords: Chronic Conditions, Diabetes, Patient Self-Management
Andreae SJ, Andreae LJ, Cherrington AL
Development of a community health worker-delivered cognitive behavioral training intervention for individuals with diabetes and chronic pain.
The investigators presented an iterative developmental approach to cognitive behavioral therapy (CBT) that combined program adaptation, pretesting, and community health workers (CHW) training processes for a CBT-based diabetes self-care program for individuals living with diabetes and chronic pain.
AHRQ-funded; HS019239.
Citation: Andreae SJ, Andreae LJ, Cherrington AL .
Development of a community health worker-delivered cognitive behavioral training intervention for individuals with diabetes and chronic pain.
Fam Community Health 2018 Jul/Sep;41(3):178-84. doi: 10.1097/fch.0000000000000197.
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Keywords: Behavioral Health, Chronic Conditions, Community-Based Practice, Diabetes, Rural Health
Dickens LT, Naylor RN
Clinical management of women with monogenic diabetes during pregnancy.
This study discusses clinical management of women with monogenic diabetes during pregnancy. Monogenic diabetes is rare and only accounts for 1-2% of all diabetes cases so it is frequently misdiagnoses as one of the other diabetes types. Diabetes treatment is different for this type of diabetes, and if untreated can cause fetal mutations. However, if treated there can be transplacental transfer of the medication (sulfonylurea). The study authors recommend large prospective studies be conducted to better define the need and timing of initiation of insulin treatment.
AHRQ-funded; HS023007.
Citation: Dickens LT, Naylor RN .
Clinical management of women with monogenic diabetes during pregnancy.
Curr Diab Rep 2018 Feb 15;18(3):12. doi: 10.1007/s11892-018-0982-8..
Keywords: Care Management, Chronic Conditions, Diabetes, Maternal Care, Pregnancy, Women
Magnan EM, Bolt DM, Greenlee RT
Stratifying patients with diabetes into clinically relevant groups by combination of chronic conditions to identify gaps in quality of care.
The purpose of this paper was to find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics. The researchers analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions based on condition co-occurrence. They found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. They concluded that patients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics.
AHRQ-funded; HS021899; HS018368.
Citation: Magnan EM, Bolt DM, Greenlee RT .
Stratifying patients with diabetes into clinically relevant groups by combination of chronic conditions to identify gaps in quality of care.
Health Serv Res 2018 Feb;53(1):450-68. doi: 10.1111/1475-6773.12607.
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Keywords: Cardiovascular Conditions, Chronic Conditions, Diabetes, Quality of Care, Quality Measures
Cooper LB, Lippmann SJ, Greiner MA
Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease.
Perceived risks of hyperkalemia and acute renal insufficiency may limit use of mineralocorticoid receptor antagonist (MRA) therapy in patients with heart failure, especially those with diabetes mellitus or chronic kidney disease. In their study, the investigators found that among patients with heart failure and diabetes mellitus or chronic kidney disease, MRA use was associated with lower risk of all-cause readmission despite greater risk of hyperkalemia and acute renal insufficiency.
AHRQ-funded; HS021092.
Citation: Cooper LB, Lippmann SJ, Greiner MA .
Use of mineralocorticoid receptor antagonists in patients with heart failure and comorbid diabetes mellitus or chronic kidney disease.
J Am Heart Assoc 2017 Dec 23;6(12):pii: e006540. doi: 10.1161/jaha.117.006540..
Keywords: Cardiovascular Conditions, Chronic Conditions, Diabetes, Evidence-Based Practice, Heart Disease and Health, Kidney Disease and Health, Outcomes, Patient-Centered Outcomes Research, Registries
Ratanawongsa N, Chan LL, Fouts MM
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, it presents evidence for the adoption of RxNorm and standardized naming and picklist options for high alert medications such as insulin.
AHRQ-funded; HS022561; HS023558.
Citation: Ratanawongsa N, Chan LL, Fouts MM .
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
J Diabetes Res 2017;2017:8983237. doi: 10.1155/2017/8983237.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations, Diabetes, Patient Safety, Chronic Conditions
Taylor HA, Morales C, Wilfond BS
A trial to test a novel approach to diabetes prevention.
This report presents a case introduction and summary in which the study under consideration planned to randomize patients at risk of diabetes (Type 2) to positive airway pressure (PAP) therapy to prevent the progression from prediabetes to diabetes (Type 2).
AHRQ-funded; HS000029.
Citation: Taylor HA, Morales C, Wilfond BS .
A trial to test a novel approach to diabetes prevention.
Am J Bioeth 2017 Oct;17(10):74-75. doi: 10.1080/15265161.2017.1366200..
Keywords: Diabetes, Prevention, Chronic Conditions
Ndefo UA, Moultry AM, Davis PN
Provision of medication therapy management by pharmacists to patients with type-2 diabetes mellitus in a federally qualified health center.
This article describes a medication therapy management (MTM) pilot program that was implemented at a federally qualified health center. This program was implemented at three clinics involving patients with uncontrolled diabetes, defined as hemoglobin A1c (HbA1c) greater than 8 percent. Fifty-seven patients met the established criteria and were enrolled in the six-month program. Thirty-seven patients completed the program and had an average 15 percent reduction in HbA1c.
AHRQ-funded; 290201100001C.
Citation: Ndefo UA, Moultry AM, Davis PN .
Provision of medication therapy management by pharmacists to patients with type-2 diabetes mellitus in a federally qualified health center.
P&T 2017 Oct;42(10):632-37.
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Keywords: Diabetes, Medication, Chronic Conditions, Patient-Centered Healthcare, Provider: Pharmacist
Shortell SM, Poon BY, Ramsay PP
A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of accountable care organizations.
For adult primary care practices seeing patients with diabetes and/or cardiovascular disease, researchers examined the relationship between selected practice characteristics, patient engagement, and patient-reported outcomes of care. They found that having a patient-centered culture was positively associated with fewer depression symptoms and better physical function scores. Patient activation was positively associated with fewer depression symptoms.
AHRQ-funded; HS024075.
Citation: Shortell SM, Poon BY, Ramsay PP .
A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of accountable care organizations.
J Gen Intern Med 2017 Jun;32(6):640-47. doi: 10.1007/s11606-016-3980-z.
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Keywords: Patient and Family Engagement, Patient-Centered Outcomes Research, Primary Care, Chronic Conditions, Diabetes, Cardiovascular Conditions
Waldfogel JM, Nesbit SA, Dy SM
Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: a systematic review.
This review systematically assessed the effect of pharmacologic treatments of diabetic peripheral neuropathy (DPN) on pain and quality of life. It concluded that for reducing pain, duloxetine and venlafaxine, pregabalin and oxcarbazepine, tricyclic antidepressants, atypical opioids, and botulinum toxin were more effective than placebo. However, quality of life was poorly reported, studies were short-term, drugs had substantial dropout rates, and opioids have significant risks.
AHRQ-funded; 2902015000061.
Citation: Waldfogel JM, Nesbit SA, Dy SM .
Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: a systematic review.
Neurology 2017 May 16;88(20):1958-67. doi: 10.1212/wnl.0000000000003882.
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Keywords: Diabetes, Chronic Conditions, Medication, Quality of Life, Patient-Centered Outcomes Research
Karter AJ, Lipska KJ, O'Connor PJ
High rates of severe hypoglycemia among African American patients with diabetes: the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.
This seven-year surveillance study (2005-2011) evaluated race/ethnic differences in the trends in rates of severe hypoglycemia (SH) in a population of insured, at-risk adults with diabetes. Annual SH rates ranged from 1.8 percent to 2.1 percent during this 7-year observation period. African Americans had consistently higher SH rates compared with Whites, while Latinos and Asians had consistently lower rates compared with Whites in each of the 7 years.
AHRQ-funded; HS019859.
Citation: Karter AJ, Lipska KJ, O'Connor PJ .
High rates of severe hypoglycemia among African American patients with diabetes: the Surveillance, Prevention, and Management of Diabetes Mellitus (SUPREME-DM) network.
J Diabetes Complications 2017 May;31(5):869-73. doi: 10.1016/j.jdiacomp.2017.02.009.
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Keywords: Chronic Conditions, Diabetes, Healthcare Delivery, Health Status, Racial and Ethnic Minorities
Gunter KE, Nocon RS, Gao Y
Medical home characteristics and quality of diabetes care in safety net clinics.
The researchers examined associations between patient-centered medical home (PCMH) characteristics and quality of diabetes care in 15 safety net clinics in five states. They found that PCMH characteristics had mixed, inconsistent associations with the quality of diabetes care. The PCMH model may require refinement in design and implementation to improve diabetes care among vulnerable populations.
AHRQ-funded; HS000084.
Citation: Gunter KE, Nocon RS, Gao Y .
Medical home characteristics and quality of diabetes care in safety net clinics.
J Community Health 2017 Apr;42(2):303-11. doi: 10.1007/s10900-016-0256-9.
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Keywords: Diabetes, Patient-Centered Healthcare, Quality of Care, Chronic Conditions
Brennan MB, Hess TM, Bartle B
Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes.
Diabetic foot ulcers are associated with an increased risk of death. This study evaluated whether ulcer severity at presentation predicts mortality. It concluded that initial diabetic foot ulcer severity is a more significant predictor of subsequent mortality than coronary artery disease, peripheral arterial disease, or stroke.
AHRQ-funded; HS018542.
Citation: Brennan MB, Hess TM, Bartle B .
Diabetic foot ulcer severity predicts mortality among veterans with type 2 diabetes.
J Diabetes Complications. 2017 Mar;31(3):556-561. doi: 10.1016/j.jdiacomp.2016.11.020..
Keywords: Diabetes, Mortality, Chronic Conditions, Pressure Ulcers
Saeed MJ, Olsen MA, Powderly WG
Diabetes mellitus is associated with higher risk of developing decompensated cirrhosis in chronic hepatitis C patients.
This study investigated the association of diabetes with risk of decompensated cirrhosis in patients with chronic hepatitis C (CHC). In a privately insured US population with CHC, the rates of decompensated cirrhosis per 1000 person-years were: 185.5 for persons with baseline cirrhosis and diabetes, 119.8 for persons with cirrhosis and no diabetes, 35.3 for persons with no cirrhosis and diabetes, and 17.1 for persons with no cirrhosis and no diabetes.
AHRQ-funded; HS019455.
Citation: Saeed MJ, Olsen MA, Powderly WG .
Diabetes mellitus is associated with higher risk of developing decompensated cirrhosis in chronic hepatitis C patients.
J Clin Gastroenterol 2017 Jan;51(1):70-76. doi: 10.1097/mcg.0000000000000566.
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Keywords: Chronic Conditions, Diabetes, Hepatitis, Risk
Sohn MW, Epstein N, Huang ES
Visit-to-visit systolic blood pressure variability and microvascular complications among patients with diabetes.
This study examined the relationship between systolic blood pressure (SBP) variability and the risk of microvascular complications in a non-elderly diabetic population. Compared to individuals with the least SBP variability (Quartile 1), those with most variability (Quartile 4) had 81 percent and 19 percent higher incidence of nephropathy, retinopathy, neuropathy, and any complication, respectively, after adjusting for mean SBP, demographic and clinical factors.
AHRQ-funded; HS018542.
Citation: Sohn MW, Epstein N, Huang ES .
Visit-to-visit systolic blood pressure variability and microvascular complications among patients with diabetes.
J Diabetes Complications 2017 Jan;31(1):195-201. doi: 10.1016/j.jdiacomp.2016.09.003.
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Keywords: Blood Pressure, Diabetes, Risk, Chronic Conditions
Smith MA, Bednarz L, Nordby PA
Increasing consumer engagement by tailoring a public reporting website on the quality of diabetes care: a qualitative study.
The goal of this study was to determine if tailoring quality reports to persons with diabetes mellitus and co-occurring chronic conditions would increase user engagement with a website that publicly reports the quality of diabetes care. It concluded that tailoring can be used to improve public reporting sites for individuals with chronic conditions, ultimately allowing consumers to make more informed health care decisions.
AHRQ-funded; HS021899.
Citation: Smith MA, Bednarz L, Nordby PA .
Increasing consumer engagement by tailoring a public reporting website on the quality of diabetes care: a qualitative study.
J Med Internet Res 2016 Dec 21;18(12):e332. doi: 10.2196/jmir.6555.
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Keywords: Chronic Conditions, Decision Making, Diabetes, Patient and Family Engagement, Web-Based
Sohn MW, Kang H, Park JS
Disparities in recommended preventive care usage among persons living with diabetes in the Appalachian region.
This study examined disparities in the receipt of preventive care recommended by the American Diabetes Association (ADA) between Appalachian and non-Appalachian counties and within Appalachian counties. It concluded that there are significant disparities in the uptake of many recommended preventive services between less and more affluent counties in the Appalachian region.
AHRQ-funded; HS018542.
Citation: Sohn MW, Kang H, Park JS .
Disparities in recommended preventive care usage among persons living with diabetes in the Appalachian region.
BMJ Open Diabetes Res Care 2016 Dec;4(1):e000284. doi: 10.1136/bmjdrc-2016-000284.
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Keywords: Diabetes, Disparities, Prevention, Chronic Conditions, Social Determinants of Health
Zullo AR, Dore DD, Gutman R
National glucose-lowering treatment complexity is greater in nursing home residents than community-dwelling adults.
This letter describes common glucose-lowering medication usage patterns for a national cross-section of U.S. adults aged 65 and older residing in nursing home (NH) and community settings from 2007 to 2010. The study results suggest that continued efforts are warranted to improve glucose-lowering medication management and simplify treatment regimens in the NH; that the relative importance of CER questions regarding specific glucose-lowering treatments may differ according to the care setting; and that CER studies of glucose-lowering treatments in older adults must address the combination use of medications, especially in NH residents.
AHRQ-funded; HS022998.
Citation: Zullo AR, Dore DD, Gutman R .
National glucose-lowering treatment complexity is greater in nursing home residents than community-dwelling adults.
J Am Geriatr Soc 2016 Nov;64(11):e233-e35. doi: 10.1111/jgs.14485.
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Keywords: Care Management, Chronic Conditions, Diabetes, Elderly, Medication, Nursing Homes
Rivera-Hernandez M
Religiosity, social support and care associated with health in older Mexicans with diabetes.
This study examined the relationships between religiosity, social support, diabetes care and control, and self-rated health of people living in Mexico who have been diagnosed with diabetes. The author found that emotional support from one's spouse/partner directly affects diabetes care and control and health. No direct relationship between religiosity and health was found, but religiosity was positively associated with diabetes care and control.
AHRQ-funded; HS000011.
Citation: Rivera-Hernandez M .
Religiosity, social support and care associated with health in older Mexicans with diabetes.
J Relig Health 2016 Aug;55(4):1394-410. doi: 10.1007/s10943-015-0105-7.
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Keywords: Chronic Conditions, Diabetes, Elderly
Huang ES
Management of diabetes mellitus in older people with comorbidities.
Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments). Very few studies have attempted to study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population.
AHRQ-funded; HS018542.
Citation: Huang ES .
Management of diabetes mellitus in older people with comorbidities.
BMJ 2016 Jun 15;353:i2200. doi: 10.1136/bmj.i2200.
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Keywords: Diabetes, Elderly, Patient-Centered Outcomes Research, Chronic Conditions
Budiman-Mak E, Epstein N, Brennan M
Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.
This study's objective is to examine whether systolic blood pressure has any prognostic value for lower-extremity amputations. The authors concluded that this study showed a significant graded relationship between systolic blood pressure variability and risk of major amputation among non-elderly persons with diabetes.
AHRQ-funded; HS018542.
Citation: Budiman-Mak E, Epstein N, Brennan M .
Systolic blood pressure variability and lower extremity amputation in a non-elderly population with diabetes.
Diabetes Res Clin Pract 2016 Apr;114:75-82. doi: 10.1016/j.diabres.2016.01.010.
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Keywords: Diabetes, Blood Pressure, Risk, Chronic Conditions
McCoy RG, Van Houten HK, Ross JS
HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study.
The researchers sought to determine the extent and effect of excessive testing for glycated hemoglobin (HbA1c) among adults with controlled type 2 diabetes. They found that in a US cohort of adults with stable and controlled type 2 diabetes, more than 60% received too many HbA1c tests, a practice associated with potential overtreatment with hypoglycemic drugs.
AHRQ-funded; HS018339.
Citation: McCoy RG, Van Houten HK, Ross JS .
HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study.
BMJ 2015 Dec 8;351:h6138. doi: 10.1136/bmj.h6138..
Keywords: Chronic Conditions, Diabetes, Healthcare Utilization, Medication, Patient-Centered Outcomes Research