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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 161 Research Studies Displayed
Ma C, McDonald MV, Feldman PH
Continuity of nursing care in home health: impact on rehospitalization among older adults with dementia.
The objective of this retrospective cohort study was to examine the association between continuity of nursing care in home health care (HHC) and rehospitalization among persons with dementia (PWD). Multiple years of HHC assessment, administrative, and human resources data from a large urban not-for-profit home health agency was used. Findings showed that wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations.
Citation: Ma C, McDonald MV, Feldman PH . Continuity of nursing care in home health: impact on rehospitalization among older adults with dementia. Med Care 2021 Oct;59(10):913-20. doi: 10.1097/mlr.0000000000001599..
Keywords: Elderly, Home Healthcare, Dementia, Neurological Disorders, Hospital Readmissions
Hua CL, Thomas KS, Bunker J
Changes in the agreement between the Minimum Data Set and hospital Medicare claims measures of dementia.
The objective of this study was to examine the agreement between a clinical Minimum Data Set measure of dementia and a diagnosis of dementia documented on a hospital claim across three points in time. A second objective was to examine the extent to which the agreement varied by age, sex, and race/ethnicity. Findings showed that hospital claims for patients aged 66–75 were less likely to be accurate than those for other age groups and suggests that physicians do not always look for signs of dementia in younger adults. Additionally, Asian patients were less likely to have a diagnosis of dementia documented during hospitalization, which could be related to language barriers between patients and clinicians.
Citation: Hua CL, Thomas KS, Bunker J . Changes in the agreement between the Minimum Data Set and hospital Medicare claims measures of dementia. J Am Geriatr Soc 2021 Sep;69(9):2672-75. doi: 10.1111/jgs.17201..
Keywords: Elderly, Dementia, Neurological Disorders, Diagnosis, Medicare
Shepard V, Chou LN, Kuo YF, et al.
Characteristics associated with feeding tube placement: retrospective cohort study of Texas nursing home residents with advanced dementia.
The purpose of this retrospective cohort study was to investigate resident-level, provider-type, nursing home (NH), and regional factors associated with feeding tube (FT) placement in advanced dementia. The investigators concluded that regional, race, and ethnic variations in prevalence of FT use among NH residents suggested opportunities for clinicians and policy makers to improve the quality of end-of-life care by especially considering other palliative care measures for minorities living in border towns.
Citation: Shepard V, Chou LN, Kuo YF, et al.. Characteristics associated with feeding tube placement: retrospective cohort study of Texas nursing home residents with advanced dementia. J Am Med Dir Assoc 2021 Jul;22(7):1471-76.e4. doi: 10.1016/j.jamda.2020.10.033..
Keywords: Elderly, Nursing Homes, Long-Term Care, Dementia, Neurological Disorders
VanderPluym JH, Halker Singh RB, Urtecho M
Acute treatments for episodic migraine in adults: a systematic review and meta-analysis.
Migraine is common and can be associated with significant morbidity, and several treatment options exist for acute therapy. The objective of this study was to evaluate the benefits and harms associated with acute treatments for episodic migraine in adults. The investigators concluded that there are several acute treatments for migraine, with varying strength of supporting evidence. Use of triptans, nonsteroidal anti-inflammatory drugs, acetaminophen, dihydroergotamine, calcitonin gene-related peptide antagonists, lasmiditan, and some nonpharmacologic treatments were associated with improved pain and function.
Citation: VanderPluym JH, Halker Singh RB, Urtecho M . Acute treatments for episodic migraine in adults: a systematic review and meta-analysis. JAMA 2021 Jun 15;325(23):2357-69. doi: 10.1001/jama.2021.7939..
Keywords: Neurological Disorders, Pain, Chronic Conditions, Treatments
Naidech AM, Weaver B, Maas M
Early seizures are predictive of worse health-related quality of life at follow-up after intracerebral hemorrhage.
Investigators tested the hypothesis that health-related quality of life at follow-up is different between patients with and without early seizures (and secondarily, with nonconvulsive status epilepticus) after intracerebral hemorrhage. Subjects were 33 patients whose quality of life was assessed 3 months after intracerebral hemorrhage onset. The researchers found that early seizures and nonconvulsive status epilepticus were associated with lower health-related quality of life at follow-up in survivors of intracerebral hemorrhage.
Citation: Naidech AM, Weaver B, Maas M . Early seizures are predictive of worse health-related quality of life at follow-up after intracerebral hemorrhage. Crit Care Med 2021 Jun;49(6):e578-e84. doi: 10.1097/ccm.0000000000004936..
Keywords: Neurological Disorders, Quality of Life
Bradbury KR, Williams C, Leonard S
Emotional aspects of pediatric post-intensive care syndrome following traumatic brain injury.
This study assessed parent-reported emotional functioning in children with traumatic brain injury (TBI) and identified risk factors for emotional sequelae in the acute recovery phase. Results from logistic regression indicated that only elevated parent PTSD symptoms were a significant predictor for child anxiety and depressive symptoms. Anxiety and depressive symptoms were prevalent in the acute recovery phase of TBI. Consistent with previous research, elevations in anxiety and depressive symptoms were more related to psychosocial factors than to injury severity.
Citation: Bradbury KR, Williams C, Leonard S . Emotional aspects of pediatric post-intensive care syndrome following traumatic brain injury. J Child Adolesc Trauma 2021 Jun;14(2):177-87. doi: 10.1007/s40653-020-00332-y..
Keywords: Children/Adolescents, Brain Injury, Trauma, Neurological Disorders
Chen HF, Rose AM, Waisbren S
Newborn screening and treatment of phenylketonuria: projected health outcomes and cost-effectiveness.
This study’s objective was to evaluate the cost-effectiveness of newborn screening and treatment for phenylketonuria (PKU) in the context of new data on adherence to a recommended diet treatment and a newly available drug (sapropterin dihydrochloride). A computer simulation model was developed to project outcomes for a hypothetical cohort of newborns which compared four strategies. The strategies compared were: 1) clinical identification (CI) with diet treatment; 2) newborn screening (NBS) with diet treatment; 3) CI with diet and medication; and 4) NBS with diet and medication. The range of incremental cost-effectiveness ratio went from $6400/QALY for newborn screening with diet treatment compared to clinical identification with diet treatment up to $16,000,000/QALY for adding medication to NBS with diet treatment. Future research is needed to consider conditions under which sapropterin dihydrochloride would be more economically attractive.
Citation: Chen HF, Rose AM, Waisbren S . Newborn screening and treatment of phenylketonuria: projected health outcomes and cost-effectiveness. Children 2021 May 12;8(5). doi: 10.3390/children8050381..
Keywords: Newborns/Infants, Neurological Disorders, Screening, Value, Healthcare Costs
Huda A, Castaño A, Niyogi A
A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy.
Transthyretin amyloid cardiomyopathy, an often-unrecognized cause of heart failure, is now treatable with a transthyretin stabilizer. It is therefore important to identify at-risk patients who can undergo targeted testing for earlier diagnosis and treatment, prior to the development of irreversible heart failure. In this study, the investigators showed that a random forest machine learning model could identify potential wild-type transthyretin amyloid cardiomyopathy using medical claims data.
Citation: Huda A, Castaño A, Niyogi A . A machine learning model for identifying patients at risk for wild-type transthyretin amyloid cardiomyopathy. Nat Commun 2021 May 11;12(1):2725. doi: 10.1038/s41467-021-22876-9..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Neurological Disorders, Diagnosis, Risk
Srivastava S, Clark B, Landy-Schmitt C
Repetitive and self-injurious behaviors in children with Cornelia de Lange syndrome.
Citation: Srivastava S, Clark B, Landy-Schmitt C . Repetitive and self-injurious behaviors in children with Cornelia de Lange syndrome. J Autism Dev Disord 2021 May;51(5):1748-58. doi: 10.1007/s10803-020-04617-x..
Keywords: Children/Adolescents, Neurological Disorders, Diagnosis
Cavallaro SC, Monuteaux MC, Chaudhari PP
Use of neuroimaging for children with seizure in general and pediatric emergency departments.
Investigators sought to compare rates of head computed tomography (CT) scans for pediatric seizure between general and pediatric emergency departments (EDs). Subjects were patients 21 years of age or less who presented to an ED with a chief complaint or diagnosis of seizure. They investigators found that general EDs obtained CT scans of the head more often in patients with epilepsy, without fever, and without trauma. They concluded that children with seizure were more likely to undergo CT scans of the head at general EDs compared with pediatric EDs.
Citation: Cavallaro SC, Monuteaux MC, Chaudhari PP . Use of neuroimaging for children with seizure in general and pediatric emergency departments. J Emerg Med 2021 Apr;60(4):478-84. doi: 10.1016/j.jemermed.2020.10.044..
Keywords: Children/Adolescents, Emergency Department, Imaging, Neurological Disorders
Berry JG, Difazio RL, Melvin P
Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions.
This study assessed how co-occurring conditions influence recovery after hip reconstruction surgery in children with neurological complex chronic conditions (CCCs). This retrospective analysis of 4058 children age 4 years or older was conducted from 2015 to 2018 in 49 children’s hospitals. The presence of CCCs was assessed using the AHRQ Chronic Condition Indicator system. Outcomes looked for included postoperative hospital length of stay (LOS), 30 -day readmission rates, and median hospital costs. The most common co-occurring conditions were digestive (60.1%) and respiratory (37.9%). Median LOS increased 67% as co-existing conditions increased from one to four or more. Median hospital costs increased 41% and readmission rates increased 250%. Malnutrition was associated with the greatest increase in postoperative hospital use.
Citation: Berry JG, Difazio RL, Melvin P . Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions. Dev Med Child Neurol 2021 Feb;63(2):204-10. doi: 10.1111/dmcn.14712..
Keywords: Children/Adolescents, Chronic Conditions, Surgery, Hospital Readmissions, Hospitals, Neurological Disorders
Roberts AC, Rafferty MR, Wu SS
Patterns and predictors of referrals to allied health services for individuals with Parkinson's disease: a Parkinson's foundation (PF) QII study.
Rehabilitation therapies are critical for optimizing quality-of-life and daily functions for individuals living with Parkinson's disease (PD). Thus, understanding the patterns of and under what conditions physicians make rehabilitation referrals is important for optimizing care. In this study, the investigators analyzed data from 5020 participants (4 countries) collected from 1/3/2016 to 4/20/2018 as part of the Parkinson's Foundation Quality Improvement Initiative (PF QII).
Citation: Roberts AC, Rafferty MR, Wu SS . Patterns and predictors of referrals to allied health services for individuals with Parkinson's disease: a Parkinson's foundation (PF) QII study. Parkinsonism Relat Disord 2021 Feb;83:115-22. doi: 10.1016/j.parkreldis.2020.11.024..
Keywords: Neurological Disorders, Rehabilitation
Azadani EN, Townsend J, Peng J
The association between traumatic dental and brain injuries in American children.
This study examined the association between dento-alveolar trauma (DAT) and traumatic brain injuries (TBIs) among children ages 0-18 years. The Nationwide Emergency Department Sample (NEDS), an HCUP dataset, was analyzed using ICD-9-CM codes for the 2010-2014 NEDS data. Out of 6,281,658 emergency department (ED) visits, DAT was recorded in 93,408 (1.5%) visits and TBI was recorded in 996,334 (15.9%) visits. Of the DAT-positive encounters, 7.5% had codes associated with TBI. Patients with DAT had 0.20 odds of having TBI compared with patients who did not DAT when all confounding variables were kept constant. Multiple injuries, being involved in motor vehicle crashes, and injuries due to assault were associated with higher odds of concomitant TBI in patients who sustained DAT.
Citation: Azadani EN, Townsend J, Peng J . The association between traumatic dental and brain injuries in American children. Dent Traumatol 2021 Feb;37(1):114-22. doi: 10.1111/edt.12611..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Emergency Department, Trauma, Neurological Disorders, Dental Health
Ing C, Jackson WM, Zaccariello MJ
Prospectively assessed neurodevelopmental outcomes in studies of anaesthetic neurotoxicity in children: a systematic review and meta-analysis.
This systematic review and meta-analysis tried to answer the question whether exposure to a single general anesthetic (GA) in early childhood causes long-term neurodevelopmental problems. Databases searched from inception to October 2019 were PubMed/MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library. Outcomes common to at least three studies were evaluated using a random-effects meta-analyses. A total of 841 out of 1644 children who had a single exposure to GA were evaluated. Findings were that there were statistically significant increases in parent reports of behavioral problems but no difference in general intelligence.
Citation: Ing C, Jackson WM, Zaccariello MJ . Prospectively assessed neurodevelopmental outcomes in studies of anaesthetic neurotoxicity in children: a systematic review and meta-analysis. Br J Anaesth 2021 Feb;126(2):433-44. doi: 10.1016/j.bja.2020.10.022..
Keywords: Children/Adolescents, Neurological Disorders, Medication, Adverse Drug Events (ADE), Adverse Events, Evidence-Based Practice, Outcomes
Thomson J, Hall M, Nelson K
Timing of co-occurring chronic conditions in children with neurologic impairment.
Children with neurologic impairment (NI) are at risk for developing co-occurring chronic conditions, increasing their medical complexity and morbidity. In this study, the authors assessed the prevalence and timing of onset for those conditions in children with NI. They concluded that children with NI enrolled in Medicaid had substantial multimorbidity that developed early in life.
Citation: Thomson J, Hall M, Nelson K . Timing of co-occurring chronic conditions in children with neurologic impairment. Pediatrics 2021 Feb;147(2):e2020009217. doi: 10.1542/peds.2020-009217..
Keywords: Children/Adolescents, Neurological Disorders, Chronic Conditions, Medicaid, Health Status
Xu H, Li X, Shi Y
Hospital bed height influences biomechanics during bed egress: a comparative controlled study of patients with Parkinson disease.
Although a significant proportion of patient falls occur during egress from the hospital bed, the biomechanical adaptations during egress from different bed heights are still largely unknown. The purpose of this study was to evaluate the effect of hospital bed height on natural transition during egress in patients with Parkinson disease (PD). The investigators found that low bed height increased demands of balance and postural control during egress which exacerbated the risk of falls for patients with PD.
AHRQ-funded; HS018953; HS025606.
Citation: Xu H, Li X, Shi Y . Hospital bed height influences biomechanics during bed egress: a comparative controlled study of patients with Parkinson disease. J Biomech 2021 Jan 22;115:110116. doi: 10.1016/j.jbiomech.2020.110116..
Keywords: Falls, Neurological Disorders, Hospitals
Hill CE, Reynolds EL, Burke JF
Increasing out-of-pocket costs for neurologic care for privately insured patients.
This study examined out-of-pocket (OOP) costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients. Patients with a neurologist visit or diagnostic test from 2001 to 2016 were identified from a large, privately insured health care claims database. Inflation-adjusted OOP costs were assessed. The database identified 3,724,342 patients. The most frequent services used were E/M (78.5%), EMG/nerve conduction studies (NCS) (7.7%), MRIs (5.3%), and EEGs (4.5%). Mean OOP cost increased over time, most substantially for EEG, MRI, and E/M. The range of OOP costs in 2016 varied considerably. For example, for an MRI, the 50th percentile paid $103.10 and the 95th percentile paid $875.40.
Citation: Hill CE, Reynolds EL, Burke JF . Increasing out-of-pocket costs for neurologic care for privately insured patients. Neurology 2021 Jan 19;96(3):e322-e32. doi: 10.1212/wnl.0000000000011278..
Keywords: Healthcare Costs, Health Insurance, Neurological Disorders
Zmora R, Zmora LL, Bustamante G
Dementia caregivers' experiences and reactions to remote activity monitoring system alerts.
Technology-based tools, including remote activity monitoring (RAM) systems, have been proposed as valuable aids for family caregivers of people with dementia. Previous analyses have shown limited effects of these systems and highlighted a number of barriers, including false alarms. In this study, the investigators used data from an ongoing embedded mixed method randomized controlled intervention to describe patterns of alerts and their association with receipt of the RAM system and caregiver outcomes.
Citation: Zmora R, Zmora LL, Bustamante G . Dementia caregivers' experiences and reactions to remote activity monitoring system alerts. J Gerontol Nurs 2021 Jan;47(1):13-20. doi: 10.3928/00989134-20201208-03.
Keywords: Elderly, Dementia, Neurological Disorders, Caregiving, Telehealth
Armstrong Armstrong, Irwin DJ, Leverenz JB
Biomarker use for dementia with Lewy body diagnosis: survey of US experts.
Researchers investigated clinical practice patterns of dementia with Lewy body (DLB) diagnostic criteria. An anonymous survey was sent to 38 center of excellence investigators inquiring about clinical use of diagnostic tests/biomarkers. They found that neuropsychological testing and MRI remained the most widely used diagnostic tests by DLB specialists. Other tests, particularly, indicative biomarkers, are used only selectively. They recommended research to validate existing potential DLB biomarkers, to develop new biomarkers, and to investigate mechanisms to improve DLB diagnosis.
Citation: Armstrong Armstrong, Irwin DJ, Leverenz JB . Biomarker use for dementia with Lewy body diagnosis: survey of US experts. Alzheimer Dis Assoc Disord 2021 Jan-Mar;35(1):55-61. doi: 10.1097/wad.0000000000000414..
Keywords: Dementia, Neurological Disorders, Diagnosis
Munger Clary HM, Croxton RD, Snively BM
Neurologist prescribing versus psychiatry referral: examining patient preferences for anxiety and depression management in a symptomatic epilepsy clinic sample.
The objective of this study was to determine patient preference for anxiety and/or depression prescribing by neurologists versus psychiatry referral among an adult epilepsy clinic sample of symptomatic patients. Findings showed that most patients indicated a preference for neurologists to prescribe for anxiety or depression symptoms in the epilepsy clinic. Care models involving neurologist prescribing for anxiety and depression symptoms merit further investigation and potential adoption in clinical practice.
Citation: Munger Clary HM, Croxton RD, Snively BM . Neurologist prescribing versus psychiatry referral: examining patient preferences for anxiety and depression management in a symptomatic epilepsy clinic sample. Epilepsy Behav 2021 Jan;114(Pt A):107543. doi: 10.1016/j.yebeh.2020.107543..
Keywords: Anxiety, Depression, Behavioral Health, Neurological Disorders
Fritz JM, Lane E, McFadden M
Physical therapy referral from primary care for acute back pain with sciatica : a randomized controlled trial.
This study examined whether early physical therapy (EPT) use in sciatica patients of less than 90 days duration reduces disability compared to usual care (UC) alone. A cohort of 220 adult sciatica patients ages 18 to 60 at two healthcare systems in Salt Lake City, Utah were randomly assigned to the control or EPT. Half (110) were given EPT, 1 education session, and then referred to 4 weeks of physical therapy including exercise and manual therapy. The other 110 were provided usual care. Outcomes were measured using the Oswestry Disability Index (OSW) after 6 months. Secondary outcomes were pain intensity, patient-reported treatment success, health care use or missed workdays. The EPT group were more likely to self-report less back pain after 5 weeks as well as treatment success after 1 year than the UC care group. There were no significant differences in health care use or missed workdays with the 2 groups.
Citation: Fritz JM, Lane E, McFadden M . Physical therapy referral from primary care for acute back pain with sciatica : a randomized controlled trial. Ann Intern Med 2021 Jan;174(1):8-17. doi: 10.7326/m20-4187..
Keywords: Back Health and Pain, Neurological Disorders, Pain, Rehabilitation, Primary Care, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Sangal RB, Fodeh S, Taylor A
Identification of patients with nontraumatic intracranial hemorrhage using administrative claims data.
Nontraumatic intracranial hemorrhage (ICH) is a neurological emergency of research interest; however, unlike ischemic stroke, has not been well studied in large datasets due to the lack of an established administrative claims-based definition. In this study, the investigators aimed to evaluate both explicit diagnosis codes and machine learning methods to create a claims-based definition for this clinical phenotype.
Citation: Sangal RB, Fodeh S, Taylor A . Identification of patients with nontraumatic intracranial hemorrhage using administrative claims data. J Stroke Cerebrovasc Dis 2020 Dec;29(12):105306. doi: 10.1016/j.jstrokecerebrovasdis.2020.105306..
Keywords: Cardiovascular Conditions, Neurological Disorders, Diagnosis, Data
Bajaj JS, Duarte-Rojo A, Xie JJ
Minimal hepatic encephalopathy and mild cognitive impairment worsen quality of life in elderly patients with cirrhosis.
Researchers investigated the performance of elderly patients with cirrhosis on tests for minimal hepatic encephalopathy (MHE) and predementia mild cognitive impairment (MCI) and their effects on quality of life (QOL). They found that, in a multicenter study of elderly patients with cirrhosis and controls, the presence of MHE, regardless of MCI, was associated with poor cognition and QOL. They created adjusted norms that defined the high sensitivity of EncephalApp for the detection of MHE in older individuals and validated it in a separate cohort.
Citation: Bajaj JS, Duarte-Rojo A, Xie JJ . Minimal hepatic encephalopathy and mild cognitive impairment worsen quality of life in elderly patients with cirrhosis. Clin Gastroenterol Hepatol 2020 Dec;18(13):3008-16.e2. doi: 10.1016/j.cgh.2020.03.033..
Keywords: Elderly, Chronic Conditions, Quality of Life, Dementia, Neurological Disorders
Perioperative management of aneurysmal subarachnoid hemorrhage.
This article discusses aneurysmal subarachnoid hemorrhage, an acute neurologic emergency. Extracranial manifestations of aneurysmal subarachnoid hemorrhage include cardiac dysfunction, neurogenic pulmonary edema, fluid and electrolyte imbalances, and hyperglycemia. The author indicates that prompt definitive treatment of the aneurysm by craniotomy and clipping or endovascular intervention with coils and/or stents is needed to prevent rebleeding. The author also notes that data on the impact of anesthesia on long-term neurologic outcomes of aneurysmal subarachnoid hemorrhage do not exist.
Citation: Sharma D . Perioperative management of aneurysmal subarachnoid hemorrhage. Anesthesiology 2020 Dec;133(6):1283-305. doi: 10.1097/aln.0000000000003558..
Keywords: Cardiovascular Conditions, Neurological Disorders, Surgery, Care Management
Jacobs M, Briley P, Ellis C
Quantifying experiences with telepractice for aphasia therapy: a text mining analysis of client response data.
The investigators’ goal was to use content analysis (CA) to measure posttreatment satisfaction with a telepractice approach for aphasia treatment. Seventeen persons with aphasia (PWA) received 12 treatment sessions over a 6-week period, after which CA was utilized to explore patient satisfaction with this treatment approach. The investigators concluded that their study demonstrated that CA can be an effective approach for determining satisfaction with aphasia treatment, particularly among PWA with limited verbal abilities.
Citation: Jacobs M, Briley P, Ellis C . Quantifying experiences with telepractice for aphasia therapy: a text mining analysis of client response data. Semin Speech Lang 2020 Nov;41(5):414-32. doi: 10.1055/s-0040-1716887..
Keywords: Telehealth, Health Information Technology (HIT), Patient Experience, Neurological Disorders