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
51 to 75 of 132 Research Studies DisplayedHuguet N, Kaufmann J, O'Malley J
Using electronic health records in longitudinal studies: estimating patient attrition.
This study’s objective was to estimate overall and among adults with diabetes or hypertension: 1) patient attrition over a 3-year period at community health centers; and 2) the likelihood that patients with Medicaid switched their primary care source. Data was collected from the retrospective cohort study of 2012-2017 claims data Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Data Research Network of community health centers. This study focused on Oregon Medicaid enrollees with a total of 232,891 patients aged 19-64 with a gap of 6 months or more following a claim for a visit billed to a primary care source. The authors theorized the reason was due to patients with Medicaid permanently changing their primary care source. They found that attrition over 3 years averaged 33.5% but patients with diabetes or hypertension was lower (25% or less). Among Medicaid patients the attrition rate 12% for community health center patients compared with 39% for single-provider practice patients.
AHRQ-funded; HS025962.
Citation: Huguet N, Kaufmann J, O'Malley J .
Using electronic health records in longitudinal studies: estimating patient attrition.
Med Care 2020 Jun;58(Suppl 1):S46-S52. doi: 10.1097/mlr.0000000000001298...
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Blood Pressure, Chronic Conditions, Primary Care, Medicaid
Mefford MT, Goyal P, Howard G
The association of hypertension, hypertension duration, and control with incident heart failure in black and white adults.
Associations between hypertension and some cardiovascular diseases are stronger in black vs white adults. In this study, the investigators examined associations of hypertension, hypertension duration, and control with incident heart failure (HF) in black and white REasons for Geographic And Racial Differences in Stroke study participants (n = 25 770) who were followed for incident HF hospitalization (n = 947) from enrollment in 2003-2007 through 2015.
AHRQ-funded; HS013852.
Citation: Mefford MT, Goyal P, Howard G .
The association of hypertension, hypertension duration, and control with incident heart failure in black and white adults.
J Clin Hypertens 2020 May;22(5):857-66. doi: 10.1111/jch.13856..
Keywords: Blood Pressure, Heart Disease and Health, Cardiovascular Conditions, Racial and Ethnic Minorities
Ramirez M, Chen K, Follett RW
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
The aim of the study was to evaluate whether the implementation of the Best Practice Advisory (BPA) was associated with changes in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-receptor blocker (ARB) prescribing during primary care encounters for patients with diabetes. The investigators concluded that a BPA with a "chart closure" hard stop is a promising tool for the treatment of patients with comorbid diabetes and hypertension with an ACEI or ARB, especially when implemented within the context of team-based care, wherein clinical pharmacists support the work of primary care providers.
AHRQ-funded; HS00046.
Citation: Ramirez M, Chen K, Follett RW .
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
JMIR Med Inform 2020 Apr 17;8(4):e16421. doi: 10.2196/16421..
Keywords: Blood Pressure, Medication, Diabetes, Clinical Decision Support (CDS), Decision Making, Chronic Conditions
Rosenbloom JI, Lewkowitz AK, Lindley KJ
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
The purpose of this study was to test the hypothesis that a longer length of time between diagnosis of hypertensive disorders of pregnancy and delivery is associated with increased risk of cardiovascular morbidity in the years after delivery. The investigators concluded that prolonged expectant management of preterm hypertensive disorders of pregnancy was associated with an increased risk of maternal cardiac disease in the ensuing years.
AHRQ-funded; HS019455.
Citation: Rosenbloom JI, Lewkowitz AK, Lindley KJ .
Expectant management of hypertensive disorders of pregnancy and future cardiovascular morbidity.
Obstet Gynecol 2020 Jan;135(1):27-35. doi: 10.1097/aog.0000000000003567..
Keywords: Blood Pressure, Pregnancy, Cardiovascular Conditions, Labor and Delivery, Risk, Women
Tung EL, Chua RFM, Besser SA
Association of rising violent crime with blood pressure and cardiovascular risk: longitudinal evidence from Chicago, 2014-2016.
The purpose of this study was to examine the longitudinal association between rising violent crime and elevated blood pressure (BP). They analyzed 217,816 BP measurements from 17,783 adults during a temporal surge in violent crime in Chicago (2014-2016).The investigators concluded that rising violent crime was associated with increased BP during a temporal crime surge.
AHRQ-funded; HS023007.
Citation: Tung EL, Chua RFM, Besser SA .
Association of rising violent crime with blood pressure and cardiovascular risk: longitudinal evidence from Chicago, 2014-2016.
Am J Hypertens 2019 Nov 15;32(12):1192-98. doi: 10.1093/ajh/hpz134..
Keywords: Blood Pressure, Social Determinants of Health, Risk
Shahu A, Herrin J, Dhruva SS
Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in ALLHAT.
This study used data from the randomized clinical trial ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to study the effect of socioeconomics and blood pressure control and cardiovascular outcomes. The study sites were stratified by their county-level median household income into income quintiles. The lowest income sites (quintile 1) were most likely to be women, black or Hispanic, have less education, to live in the South and to have fewer cardiovascular risk factors. Despite standardized treatment protocols, quintile 1 participants were less likely to have blood pressure control, and all greater all-cause mortality, heart failure hospitalizations/mortality and end-stage renal disease than the highest income participants (quintile 5).
AHRQ-funded; HS023000.
Citation: Shahu A, Herrin J, Dhruva SS .
Disparities in socioeconomic context and association with blood pressure control and cardiovascular outcomes in ALLHAT.
J Am Heart Assoc 2019 Aug 6;8(15):e012277. doi: 10.1161/jaha.119.012277..
Keywords: Blood Pressure, Cardiovascular Conditions, Disparities, Patient-Centered Outcomes Research, Medication, Prevention, Outcomes
Fabiyi CA, Reid LD, Mistry KB
AHRQ Author: Fabiyi CA, Mistry KB
Postpartum health care use after gestational diabetes and hypertensive disorders of pregnancy.
The objective of this study was to examine postpartum health care utilization after a pregnancy complicated by gestational diabetes (GD) and hypertensive disorders of pregnancy (HDP) using nationally representative data. The investigators found that women with GD/HDP did not differ from women with neither complication on postpartum utilization outcomes. Less educated women with GD/HDP were more likely to miss an office visit within 1 year postpartum than less educated women with neither complication. Certain subgroups of women were more likely to forego timely and appropriate postpartum care.
AHRQ-authored.
Citation: Fabiyi CA, Reid LD, Mistry KB .
Postpartum health care use after gestational diabetes and hypertensive disorders of pregnancy.
J Womens Health 2019 Aug;28(8):1116-23. doi: 10.1089/jwh.2018.7198..
Keywords: Medical Expenditure Panel Survey (MEPS), Maternal Care, Pregnancy, Diabetes, Blood Pressure, Women, Healthcare Utilization
Tajeu GS, Kent ST, Huang L
Antihypertensive medication nonpersistence and low adherence for adults <65 years initiating treatment in 2007-2014.
Previous evidence suggests modest improvements in antihypertensive medication adherence occurred from 2007 to 2012 among US adults >/=65 years of age. Whether adherence improved over time among adults <65 years of age is unknown. In this study, the investigators assessed trends in antihypertensive medication nonpersistence and low adherence among 379 658 commercially insured adults <65 years of age initiating treatment in 2007-2014 using MarketScan claims.
AHRQ-funded; HS024262; HS013852.
Citation: Tajeu GS, Kent ST, Huang L .
Antihypertensive medication nonpersistence and low adherence for adults <65 years initiating treatment in 2007-2014.
Hypertension 2019 Jul;74(1):35-46. doi: 10.1161/hypertensionaha.118.12495..
Keywords: Blood Pressure, Patient Adherence/Compliance, Medication, Cardiovascular Conditions
Lor M, Koleck TA, Bakken S
Association between health literacy and medication adherence among Hispanics with hypertension.
This study examined the association between health literacy and medication adherence among Hispanic adults with hypertension. A cross-sectional survey of 1355 Hispanic adults, mostly Dominicans who self-report hypertension was conducted. After controlling for age, sex, birth country, education level, recruitment location, depression, anxiety, and sleep disturbance inadequate health literacy was associated with a lower adherence score.
AHRQ-funded; HS019853; HS022961.
Citation: Lor M, Koleck TA, Bakken S .
Association between health literacy and medication adherence among Hispanics with hypertension.
J Racial Ethn Health Disparities 2019 Jun;6(3):517-24. doi: 10.1007/s40615-018-00550-z..
Keywords: Blood Pressure, Health Literacy, Patient Adherence/Compliance, Medication, Racial and Ethnic Minorities
Anstey DE, Moise N, Kronish I
Masked hypertension: whom and how to screen?
The purpose of this study was to review issues regarding the practical implementation of screening strategies for masked hypertension. In this review, challenges to screening strategies for masked hypertension, and factors that should be considered when deciding to screen using ambulatory or home blood pressure monitoring were highlighted.
AHRQ-funded; HS024262.
Citation: Anstey DE, Moise N, Kronish I .
Masked hypertension: whom and how to screen?
Curr Hypertens Rep 2019 Apr 4;21(4):26. doi: 10.1007/s11906-019-0931-1..
Keywords: Blood Pressure, Screening
Shaffer VA, Wegier P, Valentine KD
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
Uncontrolled hypertension is a significant health problem in the United States, even though multiple drugs exist to effectively treat this chronic disease. As part of a larger project developing data visualizations to support shared decision making about hypertension treatment, the investigators conducted a series of studies to understand how perceptions of hypertension control were impacted by data variations inherent in the visualization of blood pressure (BP) data.
AHRQ-funded; HS023328.
Citation: Shaffer VA, Wegier P, Valentine KD .
Patient judgments about hypertension control: the role of variability, trends, and outliers in visualized blood pressure data.
J Med Internet Res 2019 Mar 26;21(3):e11366. doi: 10.2196/11366..
Keywords: Blood Pressure, Decision Making, Patient-Centered Healthcare, Medication, Chronic Conditions
Liyanage-Don N, Fung D, Phillips E
Implementing home blood pressure monitoring into clinical practice.
The purpose of this study was to review data that supports the use of home blood pressure monitoring (HBPM) and to provide practical guidance to clinicians who wish to incorporate HBPM into their practice. Home blood pressure monitoring more accurately reflects the risk of cardiovascular events than office blood pressure measurements, and evidence supports the hypothesis that HBPM combined with clinical support improves blood pressure control. In spite of this, HBPM use remains low due to barriers between patients, clinicians, and healthcare system levels; understanding these barriers is crucial for the development of strategies to implement HBPM. This article considers how recommended best practices can facilitate the successful and effective implementation of HBPM.
AHRQ-funded; HS024262.
Citation: Liyanage-Don N, Fung D, Phillips E .
Implementing home blood pressure monitoring into clinical practice.
Curr Hypertens Rep 2019 Feb 12;21(2):14. doi: 10.1007/s11906-019-0916-0..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Primary Care, Screening
Goldberg EM, Wilson T, Jambhekar B
Emergency department-provided home blood pressure devices can help detect undiagnosed hypertension.
This study researched the value of giving home blood pressure devices to patients in emergency departments (EDs) with a triage blood pressure (BP) of >= 120/80 mmHg and no history of hypertension. About 68% of the participants used the device at least 4 times. Those participants with elevated BP had follow-up with their primary care doctor 46% of the time.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Wilson T, Jambhekar B .
Emergency department-provided home blood pressure devices can help detect undiagnosed hypertension.
High Blood Press Cardiovasc Prev 2019 Feb;26(1):45-53. doi: 10.1007/s40292-019-00300-0..
Keywords: Blood Pressure, Emergency Department, Diagnostic Safety and Quality
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
Fink JT, Magnan EM, Johnson HM
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
In this observational population-based cohort study, the investigators sought to examine the relationship between the extent of obesity and the achievement of guideline-recommended blood pressure goals and other quality of care metrics among patients with diabetes. The investigators suggest that although the cardiovascular risk for patients with obesity and diabetes is greater than for non-obese patients with diabetes, they found that patients with obesity are even further behind in achieving blood pressure control.
AHRQ-funded; HS021899.
Citation: Fink JT, Magnan EM, Johnson HM .
Blood pressure control and other quality of care metrics for patients with obesity and diabetes: a population-based cohort study.
High Blood Press Cardiovasc Prev 2018 Dec;25(4):391-99. doi: 10.1007/s40292-018-0284-x..
Keywords: Blood Pressure, Diabetes, Quality of Care, Obesity
Goldberg EM, Marks SJ, Merchant RC
National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015.
This study researched treatment trends for emergency department (ED) visits for hypertension from 2005 to 2015. The study found that there is still room for improvement, and disparities still exist for Blacks and uninsured patients.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Marks SJ, Merchant RC .
National trends in the emergency department management of adult patients with elevated blood pressure from 2005 to 2015.
J Am Soc Hypertens 2018 Dec;12(12):858-66. doi: 10.1016/j.jash.2018.09.010..
Keywords: Blood Pressure, Emergency Department
Anstey DE, Muntner P, Bello NA
Diagnosing masked hypertension using ambulatory blood pressure monitoring, home blood pressure monitoring, or both?
The aim of this study was to determine the overlap between ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) for the detection of masked hypertension (MHT). The investigators asserted that their data suggested that conducting ABPM will detect many individuals with MHT who have an increased cardiovascular disease risk.
AHRQ-funded; HS024262.
Citation: Anstey DE, Muntner P, Bello NA .
Diagnosing masked hypertension using ambulatory blood pressure monitoring, home blood pressure monitoring, or both?
Hypertension 2018 Nov;72(5):1200-07. doi: 10.1161/hypertensionaha.118.11319..
Keywords: Blood Pressure, Diagnostic Safety and Quality
Sterling MR, Silva AF, Robbins L
Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.
This qualitative study examined the role of numeracy (basic number skills) in the management of patients with heart failure (HF). Thirty men and women aged 47-89 years with a history of HF were recruited from an urban academic primary care practice. Participants all had a history of HF within the past year, were seen at the practice within the last year, and had been hospitalized for HF within the last 6 months. They were interviewed about their numeracy to help manage monitoring weight, maintaining a low-salt diet, and monitoring blood pressure. A wide range of knowledge and understanding was found and fear served as a barrier and facilitator to carrying out HF self-care tasks involving numbers. If the patient has a caregiver who also lacks those skills or does not have HF care training, patients may not be managing their HF as well as they should.
AHRQ-funded; HS000066.
Citation: Sterling MR, Silva AF, Robbins L .
Let's talk numbers: a qualitative study of community-dwelling US adults to understand the role of numeracy in the management of heart failure.
BMJ Open 2018 Sep 19;8(9):e023073. doi: 10.1136/bmjopen-2018-023073..
Keywords: Patient Self-Management, Education: Patient and Caregiver, Care Management, Heart Disease and Health, Nutrition, Lifestyle Changes, Obesity: Weight Management, Obesity, Blood Pressure, Cardiovascular Conditions
Rao G, Naureckas S, Datta A
Pediatric hypertension: diagnostic patterns derived from electronic health records.
This study examined the rates of diagnostic for pediatric hypertension using electronic health records (EHRs). The rates of diagnosis were very low (6.1%) among 1478 children identified as hypertensive. Rates of diagnosis improved in children aged 12 and above but was very low for children aged 6 and under. Underdiagnosis can lead to organ failure and increased risk for adult hypertension.
AHRQ-funded; HS024100.
Citation: Rao G, Naureckas S, Datta A .
Pediatric hypertension: diagnostic patterns derived from electronic health records.
Diagnosis 2018 Sep;5(3):157-60. doi: 10.1515/dx-2018-0010..
Keywords: Children/Adolescents, Blood Pressure, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Ramirez M, Maranon R, Fu J
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
The purpose of this study was to evaluate provider responses to a narrowly targeted Best Practice Advisory (BPA) alert regarding the intensification of blood pressure medications for persons with diabetes before and after implementation of a ‘chart closure’ hard stop. Researchers designed a BPA that sent alerts via an electronic health record system during outpatient encounters when patients with diabetes had elevated blood pressures and were not on angiotensin receptor blocking medications. These alerts were implemented in eight primary care practices within UCLA Health. Data on provider responses to the alerts was compared before and after implementing a ‘chart closure’ hard stop. Providers responded to alerts more often after the ‘chart closure’ hard stop was implemented. The researchers conclude that targeting specific omitted medication classes can produce specific alerts that may reduce alert fatigue, and that using a ‘chart closure’ hard stop may prompt providers to take action without major disruptions to their workflow.
AHRQ-funded; HS000046.
Citation: Ramirez M, Maranon R, Fu J .
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
J Am Med Inform Assoc 2018 Sep;25(9):1167-74. doi: 10.1093/jamia/ocy073..
Keywords: Blood Pressure, Diabetes, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Care Management
Carter EJ, Moise N, Alcantara C
Patient barriers and facilitators to ambulatory and home blood pressure monitoring: a qualitative study.
Guidelines recommend that patients with newly elevated office blood pressure undergo ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) to rule-out white coat hypertension before being diagnosed with hypertension. This study explored patients' perspectives of the barriers and facilitators to undergoing ABPM or HBPM.
AHRQ-funded; HS024262.
Citation: Carter EJ, Moise N, Alcantara C .
Patient barriers and facilitators to ambulatory and home blood pressure monitoring: a qualitative study.
Am J Hypertens 2018 Jul 16;31(8):919-27. doi: 10.1093/ajh/hpy062..
Keywords: Blood Pressure, Diagnostic Safety and Quality
Lakshminarayan K, Westberg S, Northuis C
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Hypertension (HTN) is significantly under-treated in stroke survivors. The study authors examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control. They concluded that a mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors.
AHRQ-funded; HS021794.
Citation: Lakshminarayan K, Westberg S, Northuis C .
A mHealth-based care model for improving hypertension control in stroke survivors: pilot RCT.
Contemp Clin Trials 2018 Jul;70:24-34. doi: 10.1016/j.cct.2018.05.005..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Stroke, Cardiovascular Conditions
Egan BM, Li J, Davis RA
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
The US Preventive Services Task Force cholesterol guideline recommended statins for fewer adults than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline by setting a higher 10-year atherosclerotic cardiovascular disease threshold and requiring concomitant diabetes mellitus, hypertension, dyslipidemia, or cigarette smoking. The 2017 ACC/AHA hypertension guideline lowered the hypertension threshold, increasing 2016 guideline statin-eligible adults. This article discusses differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
AHRQ-funded; P30 HS021667.
Citation: Egan BM, Li J, Davis RA .
Differences in primary cardiovascular disease prevention between the 2013 and 2016 cholesterol guidelines and impact of the 2017 hypertension guideline in the United States.
J Clin Hypertens 2018 Jun;20(6):991-1000. doi: 10.1111/jch.13314..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Guidelines, Blood Pressure, Medication, Prevention, Primary Care, U.S. Preventive Services Task Force (USPSTF)
Myerson RM, Colantonio LD, Safford MM
Does identification of previously undiagnosed conditions change care-seeking behavior?
The purpose of the study was to determine whether identification of previously undiagnosed high cholesterol, hypertension, and/or diabetes during an in-home assessment impacts care seeking among Medicare beneficiaries. The study concluded that in-home assessment of cholesterol, blood pressure, and blood glucose can increase doctor visits for individuals with previously undiagnosed conditions. However, biomarker assessment may have more limited impact among individuals with low access to care.
AHRQ-funded; HS000084.
Citation: Myerson RM, Colantonio LD, Safford MM .
Does identification of previously undiagnosed conditions change care-seeking behavior?
Health Serv Res 2018 Jun;53(3):1517-38. doi: 10.1111/1475-6773.12644..
Keywords: Blood Pressure, Diabetes, Home Healthcare, Cardiovascular Conditions
Chaddha A, Smith MA, Palta M
Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: a multidisciplinary group practice observational study.
The objective of the study was to determine rates and predictors of achieving hypertension control among Medicare patients with diabetes and uncontrolled hypertension after hospital discharge for an initial cardiac event. A retrospective analysis of linked electronic health record and Medicare data was performed. The study findings demonstrated the importance of implementing guideline-directed multidisciplinary care in this population.
AHRQ-funded; HS018368; HS017646.
Citation: Chaddha A, Smith MA, Palta M .
Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: a multidisciplinary group practice observational study.
J Clin Hypertens 2018 May;20(5):891-901. doi: 10.1111/jch.13282..
Keywords: Cardiovascular Conditions, Diabetes, Blood Pressure