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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 11 of 11 Research Studies Displayed
Patterson BW, Johnson J, Ward MD
Effect of a split-flow physician in triage model on abdominal CT ordering rate and yield.
The objective of this study was to compare the rate and clinical yield of computed tomography (CT) imaging between patients presenting with abdominal pain initially seen by a physician in triage (PIT) versus those seen only by physicians working in the main emergency department (ED). For patients with abdominal pain, the investigators found no significant differences in rates of CT ordering or CT yield for patients seen in a PIT vs. traditional models.
Citation: Patterson BW, Johnson J, Ward MD . Effect of a split-flow physician in triage model on abdominal CT ordering rate and yield. Am J Emerg Med 2021 Aug;46:160-64. doi: 10.1016/j.ajem.2020.05.119..
Keywords: Imaging, Emergency Department, Practice Patterns, Diagnostic Safety and Quality
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
Citation: Westafer LM, Kunz A, Bugajska P . Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study. Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Shah NR, Ahmed ST, Winchester DE
Facility-level variation in stress test utilization in veterans with ischemic heart disease.
The aim of this study was to quantify variation in cardiac stress test utilization across the Veterans Health Administration (VA) in patients with established ischemic heart disease (IHD). The investigators used VA datasets to identify adults with IHD (myocardial infarction, percutaneous coronary intervention, and/or coronary artery bypass grafting) with a primary care clinic visit at the VA in fiscal year 2014.
Citation: Shah NR, Ahmed ST, Winchester DE . Facility-level variation in stress test utilization in veterans with ischemic heart disease. JACC Cardiovasc Imaging 2019 Jul;12(7 Pt 1):1292-93. doi: 10.1016/j.jcmg.2019.02.020..
Keywords: Veterans, Heart Disease and Health, Cardiovascular Conditions, Diagnostic Safety and Quality, Healthcare Utilization, Practice Patterns, Imaging
Yun BJ, Borczuk P, Zachrison KS
Utilization of head CT during injury visits to United States emergency departments: 2012-2015.
This study examined national trends in utilization of head computed tomography (CT) imaging in emergency department (ED) patients presenting with an injury-related visit. Data from the US National Hospital Ambulatory Medical Care Survey from 2012 to 2015 was used to find ED patients who had at least one head CT. Overall there was an increase (11.7-13.23%) but it was not statistically significant.
Citation: Yun BJ, Borczuk P, Zachrison KS . Utilization of head CT during injury visits to United States emergency departments: 2012-2015. Am J Emerg Med 2018 Aug;36(8):1463-66. doi: 10.1016/j.ajem.2018.05.018..
Keywords: Healthcare Utilization, Emergency Department, Imaging, Injuries and Wounds, Practice Patterns
Henry MK, Zonfrillo MR, French B
Hospital variation in cervical spine imaging of young children with traumatic brain injury.
The authors sought to identify child-level and hospital-level factors associated with performance of cervical imaging of children with traumatic brain injury from falls and abusive head trauma. They found no association between annual hospital volume of injured children and cervical imaging performance.
Citation: Henry MK, Zonfrillo MR, French B . Hospital variation in cervical spine imaging of young children with traumatic brain injury. Acad Pediatr 2016 Sep-Oct;16(7):684-91. doi: 10.1016/j.acap.2016.01.017.
Keywords: Brain Injury, Children/Adolescents, Imaging, Hospitals, Practice Patterns
Melnick ER, O'Brien EG, Kovalerchik O
The association between physician empathy and variation in imaging use.
This paper's objective was to describe empathy in a cohort of emergency physicians and evaluate its association with CT utilization. The authors found that, on the four psychometric scales used, performance was not predictive of risk-adjusted CT utilization in the emergency department. They concluded that the underlying physician-based factors that mediate interphysician variation remain to be clearly identified.
Citation: Melnick ER, O'Brien EG, Kovalerchik O . The association between physician empathy and variation in imaging use. Acad Emerg Med 2016 Aug;23(8):895-904. doi: 10.1111/acem.13017.
Keywords: Decision Making, Emergency Medical Services (EMS), Healthcare Utilization, Imaging, Practice Patterns
Wang RC, Rodriguez RM, Moghadassi M
External validation of the STONE score, a clinical prediction rule for ureteral stone: an observational multi-institutional study.
The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. The researchers evaluated the STONE score compared with physician gestalt. They concluded that in its present form, the STONE score lacks sufficient accuracy to allow clinicians to defer CT scan for suspected ureteral stone.
AHRQ-funded; HS021281; HS019312.
Citation: Wang RC, Rodriguez RM, Moghadassi M . External validation of the STONE score, a clinical prediction rule for ureteral stone: an observational multi-institutional study. Ann Emerg Med 2016 Apr;67(4):423-32.e2. doi: 10.1016/j.annemergmed.2015.08.019.
Keywords: Decision Making, Diagnostic Safety and Quality, Imaging, Kidney Disease and Health, Practice Patterns
Tan A, Zhou J, Kuo YF
Variation among primary care physicians in the use of imaging for older patients with acute low back pain.
The authors sought to estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. They used Texas Medicare claims data and tracked whether each patient received lumbar imaging within 4 weeks of the initial visit. They found that the specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed and that the use of imaging by individual physicians was stable over time.
Citation: Tan A, Zhou J, Kuo YF . Variation among primary care physicians in the use of imaging for older patients with acute low back pain. J Gen Intern Med 2016 Feb;31(2):156-63. doi: 10.1007/s11606-015-3475-3.
Keywords: Back Health and Pain, Elderly, Imaging, Primary Care, Practice Patterns
Kruger JF, Chen AH, Rybkin A
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
The authors examined outpatient clinician attitudes towards considering radiation exposure when ordering CT scans and clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry. They found that displaying clinically relevant radiation exposure information at order entry may improve clinician knowledge and inform patient-clinician discussions regarding risks and benefits of imaging.
Citation: Kruger JF, Chen AH, Rybkin A . Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study. BMJ Qual Saf 2014 Nov;23(11):893-901. doi: 10.1136/bmjqs-2013-002773.
Keywords: Decision Making, Provider: Health Personnel, Imaging, Patient Safety, Practice Patterns
Hollingsworth JM, Sakshaug JW, Zhang Y
In-office imaging capabilities among procedure-based specialty practices.
The authors sought to determine whether arrangements tailored to fit Stark law spur utilization. They found that the availability of in-office advanced imaging is associated with increased imaging use.
AHRQ-funded; HS020927; HS018726.
Citation: Hollingsworth JM, Sakshaug JW, Zhang Y . In-office imaging capabilities among procedure-based specialty practices. Surg Innov 2014 Aug;21(4):403-8. doi: 10.1177/1553350613505715.
Keywords: Ambulatory Care and Surgery, Quality of Care, Imaging, Practice Patterns
Johnson EK, Graham DA, Chow JS
Nationwide emergency department imaging practices for pediatric urolithiasis: room for improvement.
The researchers describe the national use of computed tomography (CT) versus ultrasound imaging for pediatric patients seen at emergency departments (EDs) for suspected urolithiasis (SU) during the period 2006-2010. Use of CT was much higher than use of ultrasound, although it dropped off after 2007. Lowest CT use was seen at EDs that care for more children.
Citation: Johnson EK, Graham DA, Chow JS . Nationwide emergency department imaging practices for pediatric urolithiasis: room for improvement. J Urol. 2014 Jul;192(1):200-6. doi: 10.1016/j.juro.2014.01.028..
Keywords: Children/Adolescents, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Imaging, Children/Adolescents, Practice Patterns