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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 149 Research Studies Displayed
Adams C, Wortley P, Chamberlain A
Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic?
This article examined whether declines in the crude US COVID-19 case fatality ratio is due to improved clinical care and/or other factors. The authors used multivariable logistic regression to examine associations between report month and mortality among confirmed and probable COVID-19 cases and hospitalized cases in Georgia from March 2020 through March 2021. Mortality risk was lowest in November 2020 compared to August 2020 and remained lower until March 2021. Among hospitalized cases, mortality risk increased in December 2020 and January 2021 before declining in March 2021. The authors concluded that improved clinical management may have contributed to lower mortality risk.
Citation: Adams C, Wortley P, Chamberlain A . Declining COVID-19 case-fatality in Georgia, USA, March 2020 to March 2021: a sign of real improvement or a broadening epidemic? Ann Epidemiol 2022 Aug;72:57-64. doi: 10.1016/j.annepidem.2022.05.008..
Keywords: COVID-19, Public Health, Mortality
Beeber AS, Hoben M, Leeman J
Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol.
This paper describes an AHRQ-funded study protocol (Engage) to develop a toolkit for increasing resident and family engagement in assisted living (AL) safety. The study goals are to engage AL residents and family caregivers, AL staff, and other AL stakeholders to (1) identify common AL safety problems; (2) prioritize safety problems and identify and evaluate existing PFE interventions with the potential to address safety problems in the AL setting; and (3) develop a testable toolkit to improve PFE in AL safety. Methods, including qualitative interviews, a scoping review of persona and family engagement (PFE) interventions, and stakeholder panel meetings are discussed. The authors also detail how the protocol was modified to address the unique challenges of the COVID-19 pandemic.
Citation: Beeber AS, Hoben M, Leeman J . Developing a toolkit to improve resident and family engagement in the safety of assisted living: Engage-A stakeholder-engaged research protocol. Res Nurs Health 2022 Aug;45(4):413-23. doi: 10.1002/nur.22232..
Keywords: Patient and Family Engagement, Patient Safety, Caregiving, Public Health, Long-Term Care
Keller SC, Caballero TM, Tamma PD
AHRQ Author: Miller MA
Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic.
This cohort study evaluated the effectiveness of the AHRQ Safety Program for Improving Antibiotic Use aimed to improve antibiotic prescribing in ambulatory practices by engaging clinicians and staff to incorporate antibiotic stewardship into practice culture, communication, and decision-making. The study ran from December 2019 through November 2020. A total of 389 ambulatory care practices with over 6.5 million visits to 5483 clinicians were compared from the baseline to completion of the program. Participants included 82 primary care practices, 103 urgent care practices, 34 federally supported practices, 21 pediatric-only practices, 39 pediatric urgent care practices, 21 pediatric-only practices, and 14 other practice types. Of the 389 practices who completed the program, 75% submitted completed data. Visits per practice per month decreased from a mean of 1624 at baseline to a nadir of 906 early in the COVID-19 pandemic (April 2020) and were 1797 at the end of the program. Total antibiotic prescribing decreased from 18.2% of visits at baseline to 9.5% at completion of the program. Acute respiratory infection (ARI) visits per practice per month decreased from a baseline of 321 to a nadir of 76 early in the pandemic (May 2020) and gradually increased through completion of the program (n = 239). Antibiotic prescribing for ARIs decreased from 39.2% at baseline to 24.7% at completion of the program.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Caballero TM, Tamma PD . Assessment of changes in visits and antibiotic prescribing during the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use and the COVID-19 pandemic. JAMA Netw Open 2022 Jul;5(7):e2220512. doi: 10.1001/jamanetworkopen.2022.20512..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, COVID-19, Public Health, Respiratory Conditions
Dube WC, Kellogg JT, Adams C
Quantifying risk for SARS-CoV-2 infection among nursing home workers for the 2020-2021 winter surge of the COVID-19 pandemic in Georgia, USA.
This study’s objective was to estimate incidence of risks for COVID-19 infection among nursing home staff in the state of Georgia during the 2020-2021 Winter surge in the US. Staff at fourteen nursing homes were given a survey and serologic testing at 2 time points with 3-month interval exposure assessment. At the first time point, 203 study eligible contracted or employed staff members from these participating nursing homes were seronegative. At the second time point, 72 (35.5%) had evidence of interval infection. Among unvaccinated staff, infection rates were significantly higher among nurses and certified nursing assistants accounting for race and interval infection incidence in both the community and facility.
Citation: Dube WC, Kellogg JT, Adams C . Quantifying risk for SARS-CoV-2 infection among nursing home workers for the 2020-2021 winter surge of the COVID-19 pandemic in Georgia, USA. J Am Med Dir Assoc 2022 Jun;23(6):942-46.e1. doi: 10.1016/j.jamda.2022.02.014..
Keywords: COVID-19, Nursing Homes, Provider: Health Personnel, Risk, Public Health
Usher MC, Tignanelli CJ, Hilliard B
Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation
Researchers sought to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. They found that, with standardized communication, interhospital transfers were a safe and effective method of cohorting COVID-19 patients, were well-received by health care providers, and had the potential to improve care quality.
AHRQ-funded; HS026379; HS026732.
Citation: Usher MC, Tignanelli CJ, Hilliard B . Responding to COVID-19 through interhospital resource coordination: a mixed-methods evaluation J Patient Saf 2022 Jun 1;18(4):287-94. doi: 10.1097/pts.0000000000000916..
Keywords: COVID-19, Hospitals, Healthcare Delivery, Public Health, Care Coordination, Transitions of Care
Michelson KA, Samuels-Kalow ME
Association of elementary school reopening status and county COVID-19 incidence.
This study examined the association between elementary school opening status (ESOS) and pediatric COVID-19 incidence. The authors conducted a cross-sectional study of US counties with school districts with ≥500 elementary school students. The main exposure was ESOS in September 2020 and outcome was county incidence of COVID-19. Among 3220 US counties, 19.2% were remote, 12.1% were hybrid, and 62.8% were in person. In unadjusted models, COVID-19 incidence after school started was higher among children in hybrid or in-person counties compared with remote only counties. After adjusting for local COVID-19 incidence, the incidence rate ratio compared with remote counties was 1.01 in hybrid counties and 0.79 in in-person counties.
Citation: Michelson KA, Samuels-Kalow ME . Association of elementary school reopening status and county COVID-19 incidence. Acad Pediatr 2022 May-Jun;22(4):667-70. doi: 10.1016/j.acap.2021.09.006..
Keywords: Children/Adolescents, COVID-19, Public Health, Education
Kranz AM, Steiner ED, Mitchell JM
School-based health services in Virginia and the COVID-19 pandemic.
The purpose of this study was to examine how the COVID-19 pandemic may have impacted the provision of school health services and related student needs. In May 2021, all 1178 Virginia public elementary schools received a web-based survey regarding the impact of the pandemic on school-based health services, with 65% of schools responding (N=767). Schools reported providing fewer school-based health services during the pandemic than before, with dental screenings declining the most (51% before vs 15% after). The study also reported that mental health as a top concern for students increased from 15% before the pandemic to 27% during the pandemic. The study concluded that schools reported providing fewer health services to students during pandemic in the 2020-2021 school year and increased concern about students' mental health.
Citation: Kranz AM, Steiner ED, Mitchell JM . School-based health services in Virginia and the COVID-19 pandemic. J Sch Health 2022 May;92(5):436-44. doi: 10.1111/josh.13147..
Keywords: COVID-19, Children/Adolescents, Public Health, Healthcare Delivery, Community-Based Practice
Murray E, Roosevelt GE, Vogel JA
Screening for health-related social needs in the emergency department: adaptability and fidelity during the COVID-19 pandemic.
Researchers sought to evaluate a screening and referral program for health-related social needs (HRSN) in an emergency department. Using the Accountable Health Communities Screening Tool, they found that, during the COVID-19 pandemic, HRSN doubled, likely reflecting the economic impact of the pandemic.
Citation: Murray E, Roosevelt GE, Vogel JA . Screening for health-related social needs in the emergency department: adaptability and fidelity during the COVID-19 pandemic. Am J Emerg Med 2022 Apr;54:323.e1-23.e4. doi: 10.1016/j.ajem.2021.09.071..
Keywords: COVID-19, Social Determinants of Health, Emergency Department, Screening, Public Health
Bartsch SM, O'Shea KJ, Chin KL
Maintaining face mask use before and after achieving different COVID-19 vaccination coverage levels: a modelling study.
This study’s objective was to assess the value of maintaining face mask use indoors according to different COVID-19 vaccination coverage levels in the US. This computational simulation-model study used a Monte Carlo simulation model representing the US population and SARS CoV-2 spread. The investigation found that maintaining face mask use until and a short time after achieving various final vaccination coverage levels can not only be cost-effective, but even cost saving. In all scenarios, it was estimated cost-effective to maintain face mask use for about 2-10 weeks beyond the date of target vaccination coverage achievement.
Citation: Bartsch SM, O'Shea KJ, Chin KL . Maintaining face mask use before and after achieving different COVID-19 vaccination coverage levels: a modelling study. Lancet Public Health 2022 Mar 8;7(4):e356-e65. doi: 10.1016/s2468-2667(22)00040-8..
Keywords: COVID-19, Public Health
Riviello ED, Dechen T, O'Donoghue AL
Assessment of a crisis standards of care scoring system for resource prioritization and estimated excess mortality by race, ethnicity, and socially vulnerable area during a regional surge in COVID-19.
Researchers analyzed the association of a crisis standards of care (CSOC) scoring system with resource prioritization and estimated excess mortality by race, ethnicity, and residence in a socially vulnerable area during the COVID-19 pandemic. Using data from 6 hospitals in greater Boston, Massachusetts, they found that a CSOC priority score resulted in lower prioritization of Black patients to receive scarce resources. Also, a model using a random lottery resulted in more estimated excess deaths overall without improving equity by race.
Citation: Riviello ED, Dechen T, O'Donoghue AL . Assessment of a crisis standards of care scoring system for resource prioritization and estimated excess mortality by race, ethnicity, and socially vulnerable area during a regional surge in COVID-19. JAMA Netw Open 2022 Mar;5(3):e221744. doi: 10.1001/jamanetworkopen.2022.1744..
Keywords: COVID-19, Racial / Ethnic Minorities, Mortality, Public Health, Vulnerable Populations
Shao CC, McLeod MC, Gleason L
Effect of COVID-19 pandemic restructuring on surgical volume and outcomes of non-COVID patients undergoing surgery.
The authors sought to assess changes in surgical case mix and outcomes due to restructuring during the pandemic. Institutional ACS-NSQIP data was used to identify patients undergoing surgery at a single tertiary care institution in the Deep South. They found that surgeries during the COVID-19 pandemic were more often outpatient without differences in post-operative outcomes. They recommended additional analysis to determine the impact of duration of operative delay on surgical outcomes with restructuring focusing more on outpatient surgeries.
Citation: Shao CC, McLeod MC, Gleason L . Effect of COVID-19 pandemic restructuring on surgical volume and outcomes of non-COVID patients undergoing surgery. Am Surg 2022 Mar;88(3):489-97. doi: 10.1177/00031348211054528..
Keywords: COVID-19, Surgery, Public Health, Outcomes
Auty SG, Griffith KN
Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States.
This study examined trends in overdose mortality nationally and by state Medicaid expansion status from 2013 to 2020. Using data from the CDC’s WONDER database, findings showed that the increase in drug or opioid overdose deaths experienced during the first year of the COVID-19 pandemic was similar in states with and without Medicaid expansion.
Citation: Auty SG, Griffith KN . Medicaid expansion and drug overdose mortality during the COVID-19 pandemic in the United States. Drug Alcohol Depend 2022 Mar 1;232:109340. doi: 10.1016/j.drugalcdep.2022.109340..
Keywords: COVID-19, Medicaid, Opioids, Substance Abuse, Behavioral Health, Mortality, Public Health
Li Y, Cheng Z, Cai X
State social distancing restrictions and nursing home outcomes.
This study examined how state orders for social distancing to curb COVID-19 morbidity and mortality affected nursing home patients and what potential negative health consequences they may have had. The authors examined state social distancing restrictions from June to August of 2020 and their associations with the weekly numbers of new COVID cases, new COVID deaths, and new non-COVID deaths in nursing homes across the US. They found that stronger state social distancing measures were associated with improved outcomes, reduced across-facility disparities in COVID outcomes, and somewhat increased non-COVID-19 death rates. The estimates for non-COVID-19 deaths were sensitive to alternative model specifications.
AHRQ-funded; HS026893; HS024923.
Citation: Li Y, Cheng Z, Cai X . State social distancing restrictions and nursing home outcomes. Sci Rep 2022 Jan 20;12(1):1058. doi: 10.1038/s41598-022-05011-6..
Keywords: COVID-19, Nursing Homes, Prevention, Public Health
Michelson KA, Rees CA, Sarathy J
Interregional transfers for pandemic surges.
Hospital inpatient and intensive care unit (ICU) bed shortfalls may arise due to regional surges in volume. In this study, the investigators sought to determine how interregional transfers could alleviate bed shortfalls during a pandemic, using estimates of past and projected inpatient and ICU cases of coronavirus disease 2019 (COVID-19) from 4 February 2020 to 1 October 2020.
Citation: Michelson KA, Rees CA, Sarathy J . Interregional transfers for pandemic surges. Clin Infect Dis 2021 Dec 6;73(11):e4103-e10. doi: 10.1093/cid/ciaa1549..
Keywords: COVID-19, Hospitals, Public Health, Intensive Care Unit (ICU), Critical Care
Pollack CE, Leifheit KM, McGinty EE
Public support for policies to increase housing stability during the COVID-19 pandemic.
The COVID-19 pandemic has exacerbated longstanding housing precarity. This study measured the public support for policies designed to increase housing stability and gauged whether support levels were associated with views about the role of evictions in COVID-19 transmission and the existence of racial inequities in the housing market. The investigators concluded that support for housing stability policies was strong among U.S. adults, particularly among those who agreed that preventing evictions slowed COVID-19 transmission and among those who acknowledged racial inequities in the housing market.
Citation: Pollack CE, Leifheit KM, McGinty EE . Public support for policies to increase housing stability during the COVID-19 pandemic. Am J Prev Med 2021 Dec;61(6):919-22. doi: 10.1016/j.amepre.2021.05.006..
Keywords: COVID-19, Policy, Public Health
Jones K, Mantey J, Washer L
When planning meets reality: COVID-19 interpandemic survey of Michigan nursing homes.
This survey examined conditions at Michigan nursing homes (NHs) during the COVID-19 pandemic period. This survey evaluated preparedness, staffing, testing, and adaptations made due to COVID. Of 452 Michigan NHs contacted via email, 145 opened the survey of those,143 responded from May 1-12, 2020. Two-thirds reported shortages of personal protective equipment. Half lacked sufficient testing resources with only 36% able to test residents and staff when needed. A majority (55%) experienced staffing shortages, with 63% experiencing resignations with front-line clinical staff more likely to resign. Facilities showed rapid adaptation, with 78% creating COVID-19 units to care for patients on site. To reduce isolation, most NHs facilitated communication via phone calls, videoconferencing, and window visits. The majority continued to provide normal required therapies (90%).
Citation: Jones K, Mantey J, Washer L . When planning meets reality: COVID-19 interpandemic survey of Michigan nursing homes. Am J Infect Control 2021 Nov;49(11):1343-49. doi: 10.1016/j.ajic.2021.03.016..
Keywords: COVID-19, Nursing Homes, Public Health, Emergency Preparedness
Vranas KC, Golden SE, Mathews KS
The influence of the COVID-19 pandemic on ICU organization, care processes, and frontline clinician experiences: a qualitative study.
The COVID-19 pandemic resulted in unprecedented adjustments to intensive care unit (ICU) organization and care processes globally. The investigators examined if hospital emergency responses to the COVID-19 pandemic differed depending on hospital setting and explored which strategies worked well to mitigate strain as perceived by intensivists. The investigators concluded that their study demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
Citation: Vranas KC, Golden SE, Mathews KS . The influence of the COVID-19 pandemic on ICU organization, care processes, and frontline clinician experiences: a qualitative study. Chest 2021 Nov;160(5):1714-28. doi: 10.1016/j.chest.2021.05.041..
Keywords: COVID-19, Intensive Care Unit (ICU), Critical Care, Healthcare Delivery, Workforce, Public Health
Santana S, Brach C, Harris L
AHRQ Author: Brach C
Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health.
The US Department of Health & Human Services (HHS) updates the Healthy People objectives each decade based on the most current science. For the development of HP2030, the HHS drew on recommendations from the Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 (Secretary's Advisory Committee), an independent advisory committee of national health experts, to update the 20-year old individual-focused Healthy People definition of health literacy. This paper discusses that process.
Citation: Santana S, Brach C, Harris L . Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract 2021 Nov-Dec;27(Suppl 6):S258-S64. doi: 10.1097/phh.0000000000001324..
Keywords: Health Literacy, Public Health, Health Promotion
Anesi GL, Kerlin MP
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Researchers discuss the impact of resource limitations on care delivery and outcomes. They conclude that the interaction between resource limitation and care delivery and outcomes is complex and incompletely understood. Further, the COVID-19 pandemic provides a learning opportunity for strain response during both pandemic and non-pandemic times.
Citation: Anesi GL, Kerlin MP . The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage. Curr Opin Crit Care 2021 Oct 1;27(5):513-19. doi: 10.1097/mcc.0000000000000859..
Keywords: COVID-19, Public Health, Healthcare Delivery, Intensive Care Unit (ICU), Outcomes
Bartsch SM, Wedlock PT, O'Shea KJ
Lives and costs saved by expanding and expediting coronavirus disease 2019 vaccination.
The authors developed a computational model representing the United States population, COVID-19 coronavirus spread (February 2020-December 2022), and vaccination to determine the impact of increasing coverage and expediting time to achieve coverage. They concluded that their study quantified the potential value of decreasing vaccine hesitancy and increasing vaccination coverage and how this value may decrease with the time it takes to achieve coverage, emphasizing the need to reach high coverage levels as soon as possible, especially before the fall/winter.
Citation: Bartsch SM, Wedlock PT, O'Shea KJ . Lives and costs saved by expanding and expediting coronavirus disease 2019 vaccination. J Infect Dis 2021 Sep 17;224(6):938-48. doi: 10.1093/infdis/jiab233..
Keywords: COVID-19, Vaccination, Public Health
Smulowitz PB, O'Malley AJ, Khidir H
National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic.
Concerns about avoidance or delays in seeking emergency care during the COVID-19 pandemic are widespread, but national data on emergency department (ED) visits and subsequent rates of hospitalization and outcomes are lacking. In this study, the investigators examined trends in ED visits and rates of hospitalization and thirty-day mortality conditional on an ED visit for non-COVID-19 conditions during several stages of the pandemic and for areas that were considered COVID-19 hot spots versus those that were not.
Citation: Smulowitz PB, O'Malley AJ, Khidir H . National trends In ED visits, hospital admissions, and mortality for Medicare patients during the COVID-19 pandemic. Health Aff 2021 Sep;40(9):1457-64. doi: 10.1377/hlthaff.2021.00561..
Keywords: COVID-19, Public Health, Emergency Department, Hospitalization
Chelen JSC, White DB, Zaza S
US ventilator allocation and patient triage policies in anticipation of the COVID-19 surge.
Researchers assessed policy preparedness and substantive triage criteria within existing policies using a cross-sectional survey distributed to public health personnel and healthcare providers between March 23 and April 23, 2020. They found that their sample of policies reflected organizational strategies of exemplar-based policy development and the use of objective criteria in triage decisions, either before or instead of clinical judgment, to support ethical distribution of resources.
Citation: Chelen JSC, White DB, Zaza S . US ventilator allocation and patient triage policies in anticipation of the COVID-19 surge. Health Secur 2021 Sep-Oct;19(5):459-67. doi: 10.1089/hs.2020.0166..
Keywords: COVID-19, Public Health, Emergency Preparedness, Policy
Bartsch SM, Wong KF, Mueller LE
Modeling interventions to reduce the spread of multidrug-resistant organisms between health care facilities in a region.
The objective of this study was to identify a group of target facilities and to assess which multidrug-resistant organism (MDRO) intervention would be best to implement in the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, a large regional public health collaborative in Orange County, California. Findings suggested that decolonization would be the best strategy for the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County.
AHRQ-funded; HS023317; HS028165.
Citation: Bartsch SM, Wong KF, Mueller LE . Modeling interventions to reduce the spread of multidrug-resistant organisms between health care facilities in a region. JAMA Netw Open 2021 Aug 2;4(8):e2119212. doi: 10.1001/jamanetworkopen.2021.19212..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Public Health
Santos T, Lee SD, East C
Can collaboration between nonprofit hospitals and local health departments influence population health investments by nonprofit hospitals?
The Patient Protection and Affordable Care Act (ACA) sought to improve population health by requiring nonprofit hospitals (NFPs) to conduct triennial community health needs assessments and address the identified needs. In this context, some states have encouraged collaboration between hospitals and local health department (LHD) to increase the focus of community benefit spending onto population health. The aim of the study was to examine whether a 2012 state law that required NFPs to collaborate with LHDs in local health planning influenced hospital population health improvement spending.
AHRQ-funded; HS024959; HS026116.
Citation: Santos T, Lee SD, East C . Can collaboration between nonprofit hospitals and local health departments influence population health investments by nonprofit hospitals? Med Care 2021 Aug;59(8):687-93. doi: 10.1097/mlr.0000000000001561..
Keywords: Hospitals, Public Health
Johnson CL, Schwartz H, Greenberg A
Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic.
The onset of the COVID-19 pandemic led to the postponement of low-acuity surgical procedures in an effort to conserve resources and ensure patient safety. This study aimed to characterize patient-reported concerns about undergoing surgical procedures during the pandemic. The investigators concluded that eliciting patients' perspectives, adapting processes to address potential barriers, and effectively educating patients about institutional measures to minimize in-hospital transmission of COVID-19 should be integrated into surgical care.
Citation: Johnson CL, Schwartz H, Greenberg A . Patient perceptions on barriers and facilitators to accessing low-acuity surgery during COVID-19 pandemic. J Surg Res 2021 Aug;264:30-36. doi: 10.1016/j.jss.2021.01.028..
Keywords: COVID-19, Surgery, Access to Care, Patient Experience, Public Health