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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 25 Research Studies DisplayedFareed N, Swoboda C, Singh P
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
The objective of this study was to develop user specifications for a tailored and integrated technology, patient application (mHealth) and provider dashboard, that provides a complete view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy and to develop prototypes based on users’ needs. Participating patients and providers stated a core set of expectations for the mHealth and dashboard applications. Participants then provided feedback to improve these applications. The authors concluded that digital health tools could transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels. Refining the stated needs and preferences of patients and providers to develop applications holds potential for tackling complicated health care issues.
AHRQ-funded; HS028822.
Citation: Fareed N, Swoboda C, Singh P .
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
Digit Health 2023 Jan-Dec; 9:20552076221144181. doi: 10.1177/20552076221144181..
Keywords: Patient-Centered Healthcare, Telehealth, Diabetes, Pregnancy, Chronic Conditions, Women, Health Information Technology (HIT)
Kunneman M, Branda ME, Ridgeway JL
Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
The purpose of this trial was to determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Findings showed that using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence, or improved diabetes control in patients with type 2 diabetes.
AHRQ-funded; HS018339.
Citation: Kunneman M, Branda ME, Ridgeway JL .
Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
Endocrine 2022 Feb;75(2):377-91. doi: 10.1007/s12020-021-02861-4..
Keywords: Diabetes, Medication, Decision Making, Patient-Centered Healthcare, Clinician-Patient Communication, Chronic Conditions
Howland C, Despins L, Sindt J
Primary care clinic nurse activities with a telehealth monitoring system.
The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients using a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those assuming usual care. Significant differences were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up, providing evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.
AHRQ-funded; HS017035.
Citation: Howland C, Despins L, Sindt J .
Primary care clinic nurse activities with a telehealth monitoring system.
West J Nurs Res 2021 Jan;43(1):5-12. doi: 10.1177/0193945920923082..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Primary Care, Clinician-Patient Communication, Communication, Patient Self-Management, Nursing, Patient-Centered Healthcare, Diabetes
Pantalone KM, Misra-Hebert AD, Hobbs TM
The probability of a1c goal attainment in patients with uncontrolled type 2 diabetes in a large integrated delivery system: a prediction model.
Researchers assessed patient characteristics and treatment factors associated with uncontrolled type 2 diabetes and the probability of hemoglobin A(1c) (A1C) goal attainment. Using electronic health record data at Cleveland Clinic, they found that a minority of patients with an A1C >9% achieved an A1C <8% at 1 year. While most identified predictive factors are nonmodifiable by the clinician, pursuit of frequent patient engagement and tailored drug regimens may help to improve A1C goal attainment.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
The probability of a1c goal attainment in patients with uncontrolled type 2 diabetes in a large integrated delivery system: a prediction model.
Diabetes Care 2020 Aug;43(8):1910-19. doi: 10.2337/dc19-0968..
Keywords: Diabetes, Patient-Centered Healthcare, Patient and Family Engagement, Chronic Conditions
Poon BY, Shortell SM, Rodriguez HP
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
Shared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed. In this study, the investigators examined the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship.
AHRQ-funded; HS022241.
Citation: Poon BY, Shortell SM, Rodriguez HP .
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
J Gen Intern Med 2020 Mar;35(3):732-42. doi: 10.1007/s11606-019-05351-6.
Keywords: Decision Making, Diabetes, Cardiovascular Conditions, Chronic Conditions, Patient-Centered Healthcare, Patient and Family Engagement
McCoy RG, Lipska KJ, Van Houten HK
Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes.
Researchers examined contemporary patterns of glycemic control and use of medications known to cause hypoglycemia among adults with diabetes across age and multimorbidity. They found that the proportion of patients achieving low HbA1c levels was highest among older and multimorbid patients. Older patients and patients with higher comorbidity burden were more likely to be treated with insulin to achieve these HbA1c levels despite the potential for hypoglycemia and uncertain long-term benefit.
AHRQ-funded; HS024075.
Citation: McCoy RG, Lipska KJ, Van Houten HK .
Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes.
BMJ Open Diabetes Res Care 2020 Feb;8(1). doi: 10.1136/bmjdrc-2019-001007..
Keywords: Diabetes, Medication, Patient-Centered Outcomes Research, Patient-Centered Healthcare, Evidence-Based Practice, Risk, Chronic Conditions
Barry-Menkhaus SA, Wagner DV, Riley AR
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
In this article, the authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions among youth with type 1 diabetes.
AHRQ-funded; HS022981.
Citation: Barry-Menkhaus SA, Wagner DV, Riley AR .
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
Curr Diab Rep 2020 Jan 30;20(1):3. doi: 10.1007/s11892-020-1290-7..
Keywords: Diabetes, Patient-Centered Healthcare, Patient Self-Management, Patient Adherence/Compliance, Care Management, Patient-Centered Outcomes Research, Healthcare Delivery, Children/Adolescents
Mayberry LS, Lyles CR, Oldenburg B
mHealth interventions for disadvantaged and vulnerable people with type 2 diabetes.
The authors evaluate the impact of diabetes self-management interventions delivered via mobile device and/or Internet on glycemic control of disadvantaged/vulnerable adults with type 2 diabetes. They found evidence suggesting that digital interventions can improve diabetes control, healthcare utilization, and healthcare costs. More research to substantiate these early findings is recommended; the authors suggest that many issues remain in order to optimize the impact of digital interventions on the health outcomes of disadvantaged/vulnerable persons with diabetes.
AHRQ-funded; HS022408; HS025429.
Citation: Mayberry LS, Lyles CR, Oldenburg B .
mHealth interventions for disadvantaged and vulnerable people with type 2 diabetes.
Curr Diab Rep 2019 Nov 25;19(12):148. doi: 10.1007/s11892-019-1280-9.
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Keywords: Diabetes, Vulnerable Populations, Patient Self-Management, Telehealth, Health Information Technology (HIT), Patient-Centered Healthcare, Low-Income, Chronic Conditions
Rosas LG, Lv N, Lewis MA
A Latino patient-centered, evidence-based approach to diabetes prevention.
Cultural tailoring of evidence-based diabetes prevention program (DPP) interventions is needed to effectively address obesity and its related chronic diseases among Latinos in primary care. This article described the patient-centered process used to adapt the DPP and reported cultural adaptations. The investigators concluded that the 2-stage approach actively engaging patients, family members, providers, and health care system leaders reinforced the cultural congruence of the existing intervention while further strengthening it with adaptations promoting Latino family and community support.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Lewis MA .
A Latino patient-centered, evidence-based approach to diabetes prevention.
J Am Board Fam Med 2018 May-Jun;31(3):364-74. doi: 10.3122/jabfm.2018.03.170280..
Keywords: Cultural Competence, Diabetes, Evidence-Based Practice, Patient and Family Engagement, Patient-Centered Healthcare, Racial and Ethnic Minorities
Pantalone KM, Misra-Hebert AD, Hobbs TM
Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease.
The researchers evaluated real-world patient characteristics, medication use, and health care utilization patterns in patients with type 2 diabetes with established cardiovascular disease (CVD). Their data indicated underutilization of specialists and antidiabetic medications reported to confer CV benefit in patients with type 2 diabetes and CVD. The impact of recently updated guidelines and cardiovascular outcome trial results on management patterns in such patients remains to be seen.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
Antidiabetic treatment patterns and specialty care utilization among patients with type 2 diabetes and cardiovascular disease.
Cardiovasc Diabetol 2018 Apr 10;17(1):54. doi: 10.1186/s12933-018-0699-7.
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Keywords: Cardiovascular Conditions, Diabetes, Healthcare Utilization, Patient-Centered Healthcare
McCreedy EM, Kane RL, Gollust SE
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explored how patient characteristics associated with a high risk-to-benefit ratio with hypoglycemia medications affected decision making by primary care clinicians. The investigators found that primary care clinicians often chose to intensify glycemic control despite individual patient factors that warranted higher glycemic targets based on existing guidelines.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Kane RL, Gollust SE .
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
J Am Board Fam Med 2018 Mar-Apr;31(2):192-200. doi: 10.3122/jabfm.2018.02.170141..
Keywords: Diabetes, Elderly, Patient-Centered Healthcare, Guidelines, Evidence-Based Practice, Decision Making, Medication, Primary Care, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Taira DA, Seto BK, Davis JW
Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups.
This study examined racial/ethnic and regional differences in medication adherence in patients with diabetes taking oral anti-diabetic, anti-hypertensive, and cholesterol lowering medications and to identify the pharmacies and prescribers who serve these communities. After adjustment for other factors, Filipinos, Native Hawaiians, and people of other race were significantly less adherent to anti-diabetic and anti-hypertensive medications than Japanese.
AHRQ-funded; HS023185.
Citation: Taira DA, Seto BK, Davis JW .
Examining factors associated with nonadherence and identifying providers caring for nonadherent subgroups.
J Pharm Health Serv Res 2017 Dec;8(4):247-53. doi: 10.1111/jphs.12193.
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Keywords: Diabetes, Medication, Patient Adherence/Compliance, Patient-Centered Healthcare, Racial and Ethnic Minorities
Oakes AH, Garmo VS, Bone LR
Identifying and prioritizing the barriers and facilitators to the self-management of type 2 diabetes mellitus: a community-centered approach.
The researchers sought to develop and test an instrument to identify and quantify the barriers and facilitators to self-management of type 2 diabetes. The study concluded that factors impacting self-management can be quantified and categorized as barriers and facilitators. Further refinement to some factors and investigation into alternative prioritization methods is necessary.
AHRQ-funded; HS000029.
Citation: Oakes AH, Garmo VS, Bone LR .
Identifying and prioritizing the barriers and facilitators to the self-management of type 2 diabetes mellitus: a community-centered approach.
Patient 2017 Dec;10(6):773-83. doi: 10.1007/s40271-017-0248-6..
Keywords: Diabetes, Health Services Research (HSR), Patient-Centered Healthcare, Patient Self-Management
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
Bowen ME, Merchant Z, Abdullah K
Patient, provider, and system factors associated with failure to follow-up elevated glucose results in patients without diagnosed diabetes.
Patient, provider, and system factors associated with failure to follow-up elevated glucose values in electronic medical records (EMRs) are not well described. The researchers conducted a chart review in a comprehensive EMR with a patient portal and results management features but found no associations between patient characteristics, diabetes risk factors, or provider characteristics and follow-up failures.
AHRQ-funded; HS022418.
Citation: Bowen ME, Merchant Z, Abdullah K .
Patient, provider, and system factors associated with failure to follow-up elevated glucose results in patients without diagnosed diabetes.
Health Serv Res Manag Epidemiol 2017 Aug 29;4:2333392817721647. doi: 10.1177/2333392817721647.
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Keywords: Diabetes, Electronic Health Records (EHRs), Web-Based, Patient-Centered Healthcare, Diagnostic Safety and Quality
Olesiuk WJ, Farley JF, Domino ME
Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia?
The purpose of this study was to determine whether Medicaid recipients with co-occurring diabetes and schizophrenia that are medical-home-enrolled are more likely to receive guideline-concordant diabetes care than those who are not medical-home-enrolled, controlling for confounders. The study concluded that medical-home enrollment is generally associated with greater likelihood of receiving guideline-concordant diabetes care for Medicaid enrollees with diabetes and schizophrenia.
AHRQ-funded; HS023099; HS019659; HS000032.
Citation: Olesiuk WJ, Farley JF, Domino ME .
Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia?
J Health Care Poor Underserved 2017;28(3):1030-41. doi: 10.1353/hpu.2017.0094..
Keywords: Care Management, Diabetes, Medicaid, Behavioral Health, Patient-Centered Healthcare
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
Smith JJ, Johnston JM, Hiratsuka VY
Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
The researchers investigated changes in trend for type 2 diabetes mellitus (DM-II) quality indicators after patient-centered medical home (PCMH) implementation at Southcentral Foundation, a tribal health organization in Alaska. They found that rates of new DM-II diagnoses were stable prior to but increased after implementation. DM-II rates of HbA1c screening increased, though not significantly before and remained stable after implementation.
AHRQ-funded; HS019154.
Citation: Smith JJ, Johnston JM, Hiratsuka VY .
Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
Prim Care Diabetes 2015 Apr;9(2):120-6. doi: 10.1016/j.pcd.2014.06.005..
Keywords: Diabetes, Patient-Centered Healthcare, Primary Care, Quality Measures, Racial and Ethnic Minorities
McCoy RG, Lipska KJ, Yao X
Intensive treatment and severe hypoglycemia among adults with type 2 diabetes.
The objectives of this study were to estimate the prevalence of intensive treatment and the association between intensive treatment, clinical complexity, and incidence of severe hypoglycemia among adults with type 2 diabetes who are not using insulin. The researchers found that over 20% of patients with type 2 diabetes received intensive treatment that might have been unnecessary and that among patients with high clinical complexity, intensive treatment nearly doubled the risk of severe hypoglycemia.
AHRQ-funded; HS018339.
Citation: McCoy RG, Lipska KJ, Yao X .
Intensive treatment and severe hypoglycemia among adults with type 2 diabetes.
JAMA Intern Med 2016 Jul;176(7):969-78. doi: 10.1001/jamainternmed.2016.2275.
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Keywords: Adverse Drug Events (ADE), Diabetes, Medication, Patient-Centered Healthcare, Risk
Schmittdiel JA, Desai J, Schroeder EB
Methods for engaging stakeholders in comparative effectiveness research: a patient-centered approach to improving diabetes care.
This article presents ways to engage stakeholders in comparative effectiveness research, including patient community surveys, stakeholder meetings with substantial patient representation, and patient stakeholder deciding votes in selecting pilot research topics. Researchers and health care leaders should continue to develop best-practices and strategies for increasing patient involvement in comparative effectiveness and delivery science research.
AHRQ-funded; HS022963; HS019859.
Citation: Schmittdiel JA, Desai J, Schroeder EB .
Methods for engaging stakeholders in comparative effectiveness research: a patient-centered approach to improving diabetes care.
Healthc (Amst) 2015 Jun;3(2):80-8. doi: 10.1016/j.hjdsi.2015.02.005.
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Keywords: Comparative Effectiveness, Diabetes, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient and Family Engagement
Van der Wees PJ, Friedberg MW, Guzman EA
Comparing the implementation of team approaches for improving diabetes care in community health centers.
The researchers sought to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. They found that CHW and MA responsibilities converged over time to focus on health coaching of diabetic patients, with the MA health coaches experiencing difficulty in allocating dedicated time due to other responsibilities. Time constraints also limited the personal introduction of patients to health coaches by clinicians. Participants highlighted the importance of a supportive team climate and proactive leadership as important enablers for MAs and CHWs to implement their health coaching responsibilities. This study suggests that a flexible approach to implementing health coaching is more important than fidelity to rigid models that do not allow for variable allocation of responsibilities across team members.
AHRQ-funded; HS020120.
Citation: Van der Wees PJ, Friedberg MW, Guzman EA .
Comparing the implementation of team approaches for improving diabetes care in community health centers.
BMC Health Serv Res 2014 Dec 3;14:608. doi: 10.1186/s12913-014-0608-z.
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Keywords: Community-Based Practice, Diabetes, Patient-Centered Healthcare, Quality Improvement, Teams
Everett CM, Thorpe CT, Palta M
The roles of primary care PAs and NPs caring for older adults with diabetes.
The investigators proposed a multidimensional characterization of PA and NP roles on panels of primary care patients with diabetes. They found that PAs and NPs in primary care perform a variety of roles and frequently perform multiple roles within a clinic.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett CM, Thorpe CT, Palta M .
The roles of primary care PAs and NPs caring for older adults with diabetes.
Jaapa 2014 Apr;27(4):45-9. doi: 10.1097/01.jaa.0000444736.16669.76.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams
Taliani CA, Bricker PL, Adelman AM
Implementing effective care management in the patient-centered medical home.
The investigators explored how a disparate group of patient-centered medical homes (PCMHs) embedded care management in their team care environment to identify best practices. They concluded that PCMHs may want to ensure that care managers are available to meet with patients during visits, support patient self-management, fully leverage the electronic medical record for team messaging and patient tracking, and ensure integration into the care team with office huddles and ongoing communication.
AHRQ-funded; HS019150.
Citation: Taliani CA, Bricker PL, Adelman AM .
Implementing effective care management in the patient-centered medical home.
Am J Manag Care 2013 Dec;19(12):957-64.
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Keywords: Care Management, Diabetes, Healthcare Delivery, Patient-Centered Healthcare, Quality Improvement, Teams
Everett C, Thorpe C, Palta M
Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.
The investigators compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. They found that outcomes were generally equivalent in thirteen comparisons but mixed in seven others, so that no role was best for all outcomes. They concluded that patient characteristics, as well as patients' and organizations' goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett C, Thorpe C, Palta M .
Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.
Health Aff 2013 Nov;32(11):1942-8. doi: 10.1377/hlthaff.2013.0506.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams
Everett CM, Thorpe CT, Palta M
Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes.
The investigators described the division of patients and services between primary care providers for older diabetes patients on panels with varying levels of PA/NP involvement. They concluded that understanding how patients and services are divided between PA/NPs and physicians will assist in defining provider roles on primary care teams.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett CM, Thorpe CT, Palta M .
Division of primary care services between physicians, physician assistants, and nurse practitioners for older patients with diabetes.
Med Care Res Rev 2013 Oct;70(5):531-41. doi: 10.1177/1077558713495453.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams
