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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
76 to 100 of 225 Research Studies DisplayedPossin KL, Merrilees JJ, Dulaney S
Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial.
Few health systems have adopted effective dementia care management programs. The Care Ecosystem is a model for delivering care from centralized hubs across broad geographic areas to caregivers and persons with dementia (PWDs) independently of their health system affiliations. The purpose of this study was to determine whether the Care Ecosystem was effective in improving outcomes important to PWDs, their caregivers, and payers beyond those achieved with usual care.
AHRQ-funded; HS022241.
Citation: Possin KL, Merrilees JJ, Dulaney S .
Effect of collaborative dementia care via telephone and internet on quality of life, caregiver well-being, and health care use: the Care Ecosystem randomized clinical trial.
JAMA Intern Med 2019 Sep 30;179(12):1658-67. doi: 10.1001/jamainternmed.2019.4101..
Keywords: Dementia, Neurological Disorders, Telehealth, Health Information Technology (HIT), Care Management, Healthcare Delivery, Caregiving, Quality of Life
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Schroeder AD, Tubre DJ, Fitzgibbons RJ
Watchful waiting for inguinal hernia.
In this article, the authors examine the available evidence regarding nonoperative treatment or ‘‘watchful waiting’’ of inguinal hernias. The goal was to develop evidence-based recommendations to provide patients with inguinal hernia the treatment strategy that will maximize benefit while minimizing potential risks.
AHRQ-funded; HS009860.
Citation: Schroeder AD, Tubre DJ, Fitzgibbons RJ .
Watchful waiting for inguinal hernia.
Adv Surg 2019 Sep;53:293-303. doi: 10.1016/j.yasu.2019.04.014.
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Keywords: Care Management, Evidence-Based Practice, Decision Making
Biener AI, Decker SL, Rohde F
AHRQ Author: Decker SL, Rohde F
Prevalence and treatment of chronic obstructive pulmonary disease (COPD) in the United States.
This infographic depicts MEPS data concerning the prevalence and treatment of chronic obstructive pulmonary disease, including information on costs, medications and other chronic conditions.
AHRQ-authored.
Citation: Biener AI, Decker SL, Rohde F .
Prevalence and treatment of chronic obstructive pulmonary disease (COPD) in the United States.
JAMA 2019 Aug 20;322(7):602. doi: 10.1001/jama.2019.10241..
Keywords: Medical Expenditure Panel Survey (MEPS), Respiratory Conditions, Care Management, Chronic Conditions, Healthcare Costs
Zachrison KS, Dhand A, Schwamm LH
A network approach to stroke systems of care.
This study provided a network analysis of stroke systems of care. Stroke patients are increasing transferred between hospitals to receive higher levels of care, but coordination and triage of these patients remains a challenge. The network analysis provides an understanding of the central hubs, the change of network structure over time, and the dissemination of innovations.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Dhand A, Schwamm LH .
A network approach to stroke systems of care.
Circ Cardiovasc Qual Outcomes 2019 Aug;12(8):e005526. doi: 10.1161/circoutcomes.119.005526..
Keywords: Stroke, Care Coordination, Transitions of Care, Care Management, Cardiovascular Conditions, Hospitals
Harle CA, DiIulio J, Downs SM
Decision-centered design of patient information visualizations to support chronic pain care.
The objective of this study was to describe a decision-centered design process, and resultant interactive patient information displays, to support key clinical decision requirements in chronic noncancer pain care. Through critical decision method interviews and a half-day multidisciplinary design workshop, researchers designed an interactive prototype, the Chronic Pain Treatment Tracker. This prototype summarizes the current treatment plan, past treatment history, potential future treatments, and treatment options that require caution. The researchers concluded that the Chronic Pain Treatment Tracker presents clinicians with the information they need in a structure that promotes quick uptake, understanding, and action.
AHRQ-funded; HS023306.
Citation: Harle CA, DiIulio J, Downs SM .
Decision-centered design of patient information visualizations to support chronic pain care.
Appl Clin Inform 2019 Aug;10(4):719-28. doi: 10.1055/s-0039-1696668..
Keywords: Pain, Chronic Conditions, Decision Making, Health Information Technology (HIT), Clinical Decision Support (CDS), Care Management, Healthcare Delivery
Ouayogode MH, Mainor AJ, Meara E
Association between care management and outcomes among patients with complex needs in Medicare accountable care organizations.
This study compared the performance of accountable care organizations (ACOS) for prevention quality indicator admissions and 30-day all-cause readmissions including hospitalization and emergency department visits, evaluation and management visits in ambulatory settings, median annual spending, lower median health care contact days and lower continuity-of-care-index for Medicare patients. This cross-sectional study surveyed 244 Medicare Shared Savings Program ACOs in the 2017-2018 National Survey of ACOs (of 351 Medicare ACO respondents conducted from July 20, 2017, to February 15, 2018 that was linked to 2016 Medicare administrative claims data. The study population included Medicare beneficiaries 66 years or older who were defined as having complex needs with higher costs because of frailty or 2 or more chronic conditions. There was not found to be much difference in quality between the lowest and top tertiles for care management and coordination activities.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Mainor AJ, Meara E .
Association between care management and outcomes among patients with complex needs in Medicare accountable care organizations.
JAMA Netw Open 2019 Jul 3;2(7):e196939. doi: 10.1001/jamanetworkopen.2019.6939..
Keywords: Care Management, Elderly, Medicare, Outcomes, Patient-Centered Outcomes Research, Quality of Care, Quality Indicators (QIs)
Advanced Analytics Group of Pediatric Urology, ORC Personalized Medicine Group
Targeted workup after initial febrile urinary tract infection: using a novel machine learning model to identify children most likely to benefit from voiding cystourethrogram.
The authors sought to develop a model to predict the probability of recurrent urinary tract infection associated vesicoureteral reflux in children after an initial urinary tract infection. Their predictive model provided a promising performance to facilitate individualized treatment of children with an initial urinary tract infection and to identify those most likely to benefit from voiding cystourethrogram after the initial urinary tract infection. They conclude that this model would allow for more selective test application and increase yield while minimizing overuse.
AHRQ-funded; HS000063.
Citation: Advanced Analytics Group of Pediatric Urology, ORC Personalized Medicine Group .
Targeted workup after initial febrile urinary tract infection: using a novel machine learning model to identify children most likely to benefit from voiding cystourethrogram.
J Urol 2019 Jul;202(1):144-52. doi: 10.1097/ju.0000000000000186..
Keywords: Antibiotics, Care Management, Children/Adolescents, Guidelines, Medication, Urinary Tract Infection (UTI)
Befus DR, Hull S
Nonpharmacological self-management of migraine across social locations: an equity-oriented, qualitative analysis.
The authors conducted focus groups to explore patients’ desires and recommendations for migraine clinicians and researchers. They identified 4 themes: a more holistic, collaborative, long-term treatment approach; medication as a short-term solution; high personal and economic costs of medication; and desire for more information about and access to natural approaches. The authors concluded that holistic and integrative approaches were preferred over medication as long-term migraine management strategies; however, people in marginalized social locations, while disproportionately disabled by migraine, did not feel as comfortable accessing integrative approaches through currently available channels.
AHRQ-funded; HS0224430.
Citation: Befus DR, Hull S .
Nonpharmacological self-management of migraine across social locations: an equity-oriented, qualitative analysis.
Glob Adv Health Med 2019 Jun 13;8:2164956119858034. doi: 10.1177/2164956119858034..
Keywords: Care Management, Chronic Conditions, Complementary and Alternative Medicine, Neurological Disorders, Patient Self-Management
Quinn CC, Chard S, Roth EG
The Telemedicine for Patients With Inflammatory Bowel Disease (TELE-IBD) clinical trial: qualitative assessment of participants' perceptions.
This qualitative clinical trial examined the use of telemedicine for managing patients with inflammatory bowel disease (IBD). The study called TELE-IBD, enrolled 348 patients, with 259 completing the study. Patients completing the study were interviewed after and results were positive in improving quality of life (QOL) by improving patient education and self-management.
AHRQ-funded; HS018975.
Citation: Quinn CC, Chard S, Roth EG .
The Telemedicine for Patients With Inflammatory Bowel Disease (TELE-IBD) clinical trial: qualitative assessment of participants' perceptions.
J Med Internet Res 2019 Jun 3;21(6):e14165. doi: 10.2196/14165..
Keywords: Telehealth, Digestive Disease and Health, Health Information Technology (HIT), Care Management
Fraze TK, Beidler LB, Briggs ADM
'Eyes in the home': ACOs use home visits to improve care management, identify needs, and reduce hospital use.
Researchers used national survey data from physician practices and accountable care organizations (ACOs), paired with qualitative interviews, to learn about home visiting programs. They found that interviewed ACOs reported using home visits as part of care management and care transitions programs as well as to evaluate patients' home environments and identify needs, most often using nonphysician staff. Further, home visit implementation for some types of patients can be challenging because of barriers related to reimbursement, staffing, and resources.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Briggs ADM .
'Eyes in the home': ACOs use home visits to improve care management, identify needs, and reduce hospital use.
Health Aff 2019 Jun;38(6):1021-27. doi: 10.1377/hlthaff.2019.00003..
Keywords: Transitions of Care, Home Healthcare, Healthcare Delivery, Care Management
Soffin EM, Gibbons MM, Wick EC
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
This evidence review was conducted as part of AHRQ’s Safety Program for Improving Surgical Care and Recovery. An evidence review of interventions was conducted to create an enhanced recovery after surgery (ERAS) protocol for anesthesiology for hip fracture repair surgery. The researchers identified anesthesiology components of care and evaluated them across the perioperative continuum. They created ERAS protocols for the preoperative, intraoperative, and postoperative phases.
AHRQ-funded; 233201500020I.
Citation: Soffin EM, Gibbons MM, Wick EC .
Evidence review conducted for the Agency for Healthcare Research and Quality Safety Program for I
Anesth Analg 2019 Jun;128(6):1107-17. doi: 10.1213/ane.0000000000003925..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Surgery, Orthopedics, Quality Improvement, Quality of Care, Outcomes, Care Management
Boltey EM, Iwashyna TJ, Hyzy RC
Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.
In order to support coordination among ICU team members, researchers developed a shared mental model (SMM). After administering a survey at the 2016 MHA Keystone Center ICU workshop, different components of SMMs were measured using five items from a validated survey, each on a 5-point Likert scale. Self-reported routine ABCDE implementation was measured using a single item 4-point Likert scale, and the relationship between SMMs and routine ABCDE implementation measured using logistic regression. The majority of survey respondents reported using the ABCDE bundle routinely. Odds of reporting routine ABCDE implementation significantly decreased when clinicians agreed it was difficult to predict team members' behaviors. The researchers conclude that increased awareness of team members' behaviors may be a mechanism to improve the implementation of complex care bundles such as ABCDE.
AHRQ-funded; HS024552.
Citation: Boltey EM, Iwashyna TJ, Hyzy RC .
Ability to predict team members' behaviors in ICU teams is associated with routine ABCDE implementation.
J Crit Care 2019 Jun;51:192-97. doi: 10.1016/j.jcrc.2019.02.028..
Keywords: Care Management, Critical Care, Hospitals, Intensive Care Unit (ICU), Healthcare Delivery, Teams
Simpson KR, Lyndon A, Spetz J
Adherence to the AWHONN staffing guidelines as perceived by labor nurses.
Labor and delivery nurses were surveyed to determine if their units adhere to Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) staffing guidelines. Labor nurses in selected hospitals in California, Michigan and New Jersey were invited via email to participate in the study. Their nurse leaders facilitated the invitations. A total of 615 labor nurses from 67 hospitals participated. Most nurses did report that staffing guidelines were adhered to. The hospitals with smaller annual birth volumes (500-999 range) were significantly more like to be perceived as compliant than hospitals with 2,500 or more annual births.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Adherence to the AWHONN staffing guidelines as perceived by labor nurses.
Nurs Womens Health 2019 Jun;23(3):217-23. doi: 10.1016/j.nwh.2019.03.003..
Keywords: Care Management, Guidelines, Labor and Delivery, Maternal Care, Patient Safety, Pregnancy, Provider, Provider: Nurse, Women
Pandian V, Zhen G, Stanley S
Management of difficult airway among patients with oropharyngeal angioedema.
This study assessed the impact of a quality improvement program to manage patients with difficult airway associated with oropharyngeal angioedema patients called DART (difficult airway response team). This retrospective review compared patient charges from July 2003 to June 2008 (pre-DART) to charges from July 2008 to June 2013 (post-DART). Patient characteristics, airway evaluation, and interventions were compared. There was a higher incidence of patients requiring intubation in the post-DART cohort (67%) versus the pre-DART cohort (39%). The results showed the approach offers adequate time and resources for airway evaluation prior to intervention and allows fewer numbers of attempts to secure an airway.
AHRQ-funded; HS024547.
Citation: Pandian V, Zhen G, Stanley S .
Management of difficult airway among patients with oropharyngeal angioedema.
Laryngoscope 2019 Jun;129(6):1360-67. doi: 10.1002/lary.27622..
Keywords: Care Management, Quality of Care, Quality Improvement, Respiratory Conditions, Teams
Newgard CD, Lin A, Eckstrom E
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.
In this study, the investigators evaluated the utility of comorbidities, anticoagulant use, and geriatric-specific physiologic measures to improve the sensitivity of the field triage guidelines for high-risk older adults in the out-of-hospital setting.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Eckstrom E .
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.
J Trauma Acute Care Surg 2019 May;86(5):829-37. doi: 10.1097/ta.0000000000002195
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Keywords: Elderly, Blood Thinners, Medication, Ambulatory Care and Surgery, Injuries and Wounds, Care Management
Ellis CT, Cole AL, Sanoff HK
Evaluating surveillance patterns after chemoradiation-only compared with conventional management for older patients with rectal cancer.
This study examined surveillance patterns for elderly patients who were treated only with chemoradiation (CR) as opposed to traditional treatment (chemoradiation and protectomy). In the cohort study, a total of 2,482 individuals met the inclusion criteria, with 21% receiving CR-only treatment, and 79% had conventional treatment. In comparison to patients who had traditional treatment, patients with CR-only treatment had far less follow-up during the first 2 years post-treatment. Adherence to guideline-recommended surveillance was poor for all Medicare patients, but especially for CR-only treated patients.
AHRQ-funded; HS000032.
Citation: Ellis CT, Cole AL, Sanoff HK .
Evaluating surveillance patterns after chemoradiation-only compared with conventional management for older patients with rectal cancer.
J Am Coll Surg 2019 May;228(5):782-91.e2. doi: 10.1016/j.jamcollsurg.2019.01.010..
Keywords: Cancer, Cancer: Colorectal Cancer, Care Management, Treatments, Elderly, Patient-Centered Outcomes Research
Nakamura ZM, Nash RP, Quillen LJ
Psychiatric care in hematopoietic stem cell transplantation.
An overview of literature in PubMed and PsychInfo was conducted to identify articles describing psychiatric symptoms and care for adult cancer patients undergoing hematopoietic stem transplantation (HSCT). Neuropsychiatric symptoms included depression, anxiety, distress, post-traumatic stress disorder, delirium, and cognitive impairment. The researchers concluded that consulting psychiatrists should be familiar with the treatment basics of HSCT and the neuropsychiatric outcomes that may follow to guide their treatment plan.
AHRQ-funded; HS000032.
Citation: Nakamura ZM, Nash RP, Quillen LJ .
Psychiatric care in hematopoietic stem cell transplantation.
Psychosomatics 2019 May - Jun;60(3):227-37. doi: 10.1016/j.psym.2019.01.005..
Keywords: Cancer, Care Management, Behavioral Health, Transplantation
Vizer LM, Eschler j, KOO BM
"It's not just technology, it's people": constructing a conceptual model of shared health informatics for tracking in chronic illness management.
To inform development of effective technologies that aid tracking of health indicators to support chronic illness management, this study aimed to construct a health informatics model that accurately describes the work and social context of that tracking work. The investigators concluded that the resulting CoMSHI yielded a more detailed and nuanced viewpoint of tracking in support of chronic illness management and could inform technology design to improve tracking tools to support people in more confident and capable chronic illness management.
AHRQ-funded; HS021590.
Citation: Vizer LM, Eschler j, KOO BM .
"It's not just technology, it's people": constructing a conceptual model of shared health informatics for tracking in chronic illness management.
J Med Internet Res 2019 Apr 29;21(4):e10830. doi: 10.2196/10830..
Keywords: Care Management, Chronic Conditions, Health Information Technology (HIT), Patient Self-Management
Balk EM, Rofeberg VN, Adam GP
Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes.
The purpose of this study was to compare the effectiveness of pharmacologic and nonpharmacologic interventions to improve or cure stress, urgency, or mixed UI in nonpregnant women. The investigators concluded that most nonpharmacologic and pharmacologic interventions were more likely than no treatment to improve UI outcomes. They also concluded that behavioral therapy, alone or in combination with other interventions, was generally more effective than pharmacologic therapies alone in treating both stress and urgency UI.
AHRQ-funded; 290201500002I.
Citation: Balk EM, Rofeberg VN, Adam GP .
Pharmacologic and nonpharmacologic treatments for urinary incontinence in women: a systematic review and network meta-analysis of clinical outcomes.
Ann Intern Med 2019 Apr 2;170(7):465-79. doi: 10.7326/m18-3227..
Keywords: Care Management, Comparative Effectiveness, Evidence-Based Practice, Medication, Outcomes, Patient-Centered Outcomes Research, Women
Wu SS, Chan KS, Bae J
Electronic clinical reminder and quality of primary diabetes care.
The goal of this retrospective cohort study was to examine the association of EMR's clinical reminder use with a comprehensive set of diabetes quality metrics in office-based physicians and within solo- versus multi-physician practices. Data on visits made by adults with diabetes were identified from the National Ambulatory Medical Care Survey and a multiple logistic regression was used to test for associations between clinical reminder use and recommended services by the American Diabetes Association. The researchers found no statistically significant relationship that suggests clinical reminder use improves diabetes process guidelines for solo practices, and they conclude that other resource efforts are needed to reduce gaps in primary diabetes care.
AHRQ-funded; HS000029.
Citation: Wu SS, Chan KS, Bae J .
Electronic clinical reminder and quality of primary diabetes care.
Prim Care Diabetes 2019 Apr;13(2):150-57. doi: 10.1016/j.pcd.2018.08.007..
Keywords: Care Management, Chronic Conditions, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Quality of Care
Santosa KB, Keller M, Olsen MA
Negative-pressure wound therapy in infants and children: a population-based study.
Although the safety and benefits of negative-pressure wound therapy (NPWT) have been clearly demonstrated in the adult population, studies evaluating the safety and describing the use of NPWT in the pediatric population have been limited. In this study, the investigators performed a literature review and analyzed the Truven Health Analytics MarketScan Commercial Claims Databases from 2006 to 2014 to identify infants and children treated with NPWT.
AHRQ-funded; HS019455.
Citation: Santosa KB, Keller M, Olsen MA .
Negative-pressure wound therapy in infants and children: a population-based study.
J Surg Res 2019 Mar;235:560-68. doi: 10.1016/j.jss.2018.10.043..
Keywords: Children/Adolescents, Newborns/Infants, Pressure Ulcers, Injuries and Wounds, Care Management, Patient Safety
Kilbourne AM, Prenovost KM, Liebrecht C
Randomized controlled trial of a collaborative care intervention for mood disorders by a national commercial health plan.
This study investigated the outcomes of a collaborative care intervention for patients with mood disorders. The randomized controlled trial was conducted with Aetna insurance enrollees who were recently hospitalized for unipolar major depression or bipolar disorder. An evidence-based chronic care model (CCM) program was developed that included 10 sessions of a Life Goals self-management program and brief contacts were also made by a care manager. Outcomes measured were changes over 12 months in depression symptoms and mental health-related quality of life through two different short questionnaires. Clinical outcomes improved for patients receiving CCM although there was substantial attrition in the program.
AHRQ-funded; HS021425.
Citation: Kilbourne AM, Prenovost KM, Liebrecht C .
Randomized controlled trial of a collaborative care intervention for mood disorders by a national commercial health plan.
Psychiatr Serv 2019 Mar;70(3):219-24. doi: 10.1176/appi.ps.201800336..
Keywords: Depression, Behavioral Health, Health Insurance, Care Management, Teams, Healthcare Delivery
Childers CP, Dworsky JQ, Maggard-Gibbons M
The contemporary appendectomy for acute uncomplicated appendicitis in adults.
Epidemiologic data related to the surgical management of appendicitis are out of date. In this study, the authors contemplated the role of nonoperative therapy in uncomplicated appendicitis and developed a contemporary profile of the risks and benefits of operative appendectomy by merging the 2016 National Surgical Quality Improvement Program essential and appendectomy-targeted participant use files.
AHRQ-funded; HS025079.
Citation: Childers CP, Dworsky JQ, Maggard-Gibbons M .
The contemporary appendectomy for acute uncomplicated appendicitis in adults.
Surgery 2019 Mar;165(3):593-601. doi: 10.1016/j.surg.2018.09.009..
Keywords: Care Management, Quality Improvement, Surgery, Treatments
Hung A, Mullins CD, Slejko JF
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
This study projected cost savings to the TRICARE program from changes to the antidiabetic formulary and utilization management (UM) policies. Budgetary impacts for 3 years as projected using a Microsoft Excel spreadsheet. This model projected a savings of up to $43 million in the third year from revisions to the payer’s formulary.
AHRQ-funded; HS024857.
Citation: Hung A, Mullins CD, Slejko JF .
Using a budget impact model framework to evaluate antidiabetic formulary changes and utilization management tools.
J Manag Care Spec Pharm 2019 Mar;25(3):342-49. doi: 10.18553/jmcp.2019.25.3.342..
Keywords: Care Management, Elderly, Healthcare Costs, Medication, Policy