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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
26 to 50 of 312 Research Studies DisplayedMenez S, Coca Moledina, Moledina DG
Evaluation of plasma biomarkers to predict major adverse kidney events in hospitalized patients with COVID-19.
There is an increased risk for major adverse kidney events (MAKE) in patients hospitalized with COVID-19. The purpose of this prospective cohort study was to identify plasma biomarkers predictive of MAKE in patients hospitalized with COVID-19. The study found that in total, 95 patients (16%) experienced MAKE. Each 1 SD increase in soluble tumor necrosis factor receptor 1 (sTNFR1) and sTNFR2 was significantly associated with an increased risk of MAKE. A limitation of the study was a lack of control group of hospitalized patients without COVID-19.
AHRQ-funded; HS027626.
Citation: Menez S, Coca Moledina, Moledina DG .
Evaluation of plasma biomarkers to predict major adverse kidney events in hospitalized patients with COVID-19.
Am J Kidney Dis 2023 Sep; 82(3):322-32.e1. doi: 10.1053/j.ajkd.2023.03.010..
Keywords: COVID-19, Kidney Disease and Health, Inpatient Care
Chen JT, Mehrizi R, Aasman B
Long short-term memory model identifies ARDS and in-hospital mortality in both non-COVID-19 and COVID-19 cohort.
The objective of this study was to identify risk of acute respiratory distress syndrome (ARDS) and in-hospital mortality using a long short-term memory (LSTM) framework in mechanically ventilated (MV) COVID-19 and non-COVID-19 cohorts. The results indicated that the LSTM algorithm accurately identified the risk of ARDS or death in both non-COVID-19 and COVID MV patients. The researchers concluded that a tool that alerts to the risk of ARDS or death can improve the implementation of evidence-based ARDS management and facilitate goals-of-care discussions involving high-risk patients.
AHRQ-funded; HS026188.
Citation: Chen JT, Mehrizi R, Aasman B .
Long short-term memory model identifies ARDS and in-hospital mortality in both non-COVID-19 and COVID-19 cohort.
BMJ Health Care Inform 2023 Sep; 30(1). doi: 10.1136/bmjhci-2023-100782..
Keywords: COVID-19, Mortality, Hospitals, Inpatient Care
Kim D, Swaminathan S, Lee Y
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
COVID-19 resulted in clear racial/ethnic disparities in excess deaths among persons with kidney failure. It is not clear whether or how these disparities changed throughout the pandemic, especially after the deployment of COVID-19 vaccines. The purpose of this study was to examine disparities in excess mortality for the Medicare population with kidney failure from March 2020, through December 2021. The study found that there were 686,719 patients with kidney failure in January 2020. Researchers reported an increase in excess deaths beginning March 1, 2020, with a peak in January 2021. From March 1, 2020, through January 30, 2021, and there were substantial disparities in excess deaths across racial/ethnic groups. The number of excess deaths was 5582, 4303, and 2679 for non-Hispanic White, non-Hispanic Black, and Hispanic patients, respectively. The percent excess deaths was 31.9% for Hispanic patients, 27.5% for non-Hispanic Black patients, and 16.4% for non-Hispanic White patients. After the wide distribution of COVID-19 vaccines since the end of January 2021, the lowest percent excess deaths was observed among Hispanic patients, followed by Black patients, and White patients.
AHRQ-funded; HS028285.
Citation: Kim D, Swaminathan S, Lee Y .
Racial and ethnic disparities in excess deaths after COVID-19 vaccine deployment among persons with kidney failure.
Clin J Am Soc Nephrol 2023 Sep; 18(9):1207-09. doi: 10.2215/cjn.0000000000000226..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Vaccination, Kidney Disease and Health, Mortality
Rao S, Armistead I, Tyler A
Respiratory syncytial virus, influenza, and coronavirus disease 2019 hospitalizations in children in Colorado during the 2021-2022 respiratory virus season.
This study compared demographic characteristics, clinical features, and outcomes of children hospitalized with respiratory syncytial virus (RSV), influenza, or severe acute respiratory syndrome coronavirus 2 during their cocirculation 2021-2022 respiratory virus season. The authors conducted a retrospective cohort study using Colorado's hospital respiratory surveillance data comparing coronavirus disease 2019 (COVID-19)-, influenza-, and RSV-hospitalized cases < 18 years of age admitted and undergoing standardized molecular testing between October 1, 2021, and April 30, 2022. The cohort consisted of 847 hospitalized cases, of which 490 (57.9%) were RSV associated, 306 (36.1%) were COVID-19 associated, and 51 (6%) were influenza associated. Most RSV cases were children less than 4 years of age (92.9%), whereas influenza hospitalizations were observed in older children. RSV cases were more likely to require oxygen support higher than nasal cannula compared with COVID-19 and influenza cases, although COVID-19 cases were more likely to require invasive mechanical ventilation than influenza and RSV cases. Compared with children with COVID-19, the risk of intensive care unit admission was highest among children with influenza, whereas the risk of pneumonia, bronchiolitis, longer hospital length of stay, and need for oxygen were more likely among children with RSV.
AHRQ-funded; HS026512.
Citation: Rao S, Armistead I, Tyler A .
Respiratory syncytial virus, influenza, and coronavirus disease 2019 hospitalizations in children in Colorado during the 2021-2022 respiratory virus season.
J Pediatr 2023 Sep; 260:113491. doi: 10.1016/j.jpeds.2023.113491..
Keywords: Children/Adolescents, COVID-19, Respiratory Conditions, Influenza, Hospitalization, Infectious Diseases
Osmanlliu E, Kalwani NM, Parameswaran V
Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic.
Researchers examined adult cardiology visits at an academic and affiliated community practice in Northern California to assess the persistence sociodemographic disparities in telemedicine use before and during the COVID pandemic. Results indicated that sociodemographic characteristics of patients receiving cardiovascular care remained stable during both periods, but the modality of care diverged across groups. Observed disparities in the use of video-based telemedicine were greatest for patients 80 years or older, Black, with limited English proficiency, or on Medicaid. The researchers recommended that future studies examine barriers and outcomes in digital healthcare access across diverse patient groups.
AHRQ-funded; HS026128.
Citation: Osmanlliu E, Kalwani NM, Parameswaran V .
Sociodemographic disparities in the use of cardiovascular ambulatory care and telemedicine during the COVID-19 pandemic.
Am Heart J 2023 Sep; 263:169-76. doi: 10.1016/j.ahj.2023.06.011..
Keywords: COVID-19, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Disparities, Ambulatory Care and Surgery
Feldman AG, Beaty B, Everitt M
Survey of pediatric transplant center practices regarding COVID-19 vaccine mandates for transplant candidates and living donors and use of COVID-19-positive deceased organs.
This study’s objective was to assess COVID-19 policies at US pediatric solid organ transplant centers. A 79-item survey was created and emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID-19 vaccine policies for transplant candidates and living donors and use of grafts from COVID-19-positive deceased donors. The response rate was 77%. For children aged 5-15 years, 23% of centers have a COVID-19 vaccine mandate, 27% anticipate implementing a future mandate, and 47% have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% of centers have a COVID-19 vaccine mandate, 25% anticipate implementing a future mandate, and 40% have not considered or do not anticipate implementing a mandate. The top two reasons provided for not implementing a COVID-19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Almost a third of 85 (27/85) kidney and liver living donor centers require vaccinations of donors. Twenty percent of centers accept organs from COVID-19-positive deceased donors.
AHRQ-funded; HS026510.
Citation: Feldman AG, Beaty B, Everitt M .
Survey of pediatric transplant center practices regarding COVID-19 vaccine mandates for transplant candidates and living donors and use of COVID-19-positive deceased organs.
Pediatr Transplant 2023 Sep; 27(6):e14513. doi: 10.1111/petr.14513..
Keywords: COVID-19, Children/Adolescents, Transplantation
Overhage L, Hailu R, Busch AB
Trends in acute care use for mental health conditions among youth during the COVID-19 pandemic.
This study’s objective was to examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic. This cross-sectional analysis used data from national, deidentified commercial health insurance claims of youth mental health ED and hospital care that took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17,614 in the baseline year (March 2019-February 2020) and 16,815 youth in pandemic year 2 (March 2021-February 2022) had at least 1 mental health ED visit. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits. Among adolescent females, there was a larger increase (22.1%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4%. Mean length of inpatient psychiatric stay increased 3.8%. The fraction of episodes with prolonged boarding increased 76.4%.
AHRQ-funded; HS026503.
Citation: Overhage L, Hailu R, Busch AB .
Trends in acute care use for mental health conditions among youth during the COVID-19 pandemic.
JAMA Psychiatry 2023 Sep; 80(9):924-32. doi: 10.1001/jamapsychiatry.2023.2195..
Keywords: COVID-19, Behavioral Health, Children/Adolescents
Hua Y, Temkin-Greener H, Cai S
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
The purpose of this study was to explore primary care telemedicine use among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) who resided in Assisted Living Facilities (Als) during the early stage of the COVID-19 pandemic, with a focus on possible racial and socioeconomic differences. The study found that at the start of the pandemic in quarter 2 of 2020, Black residents were less likely to have telemedicine visits than their White counterparts. In the following two quarters, Black residents were more likely to receive primary care via telemedicine than White residents; a similar difference was observed between Hispanic and White residents, but with smaller effect sizes. Compared with nondual residents, dual residents were more likely to receive primary care via telemedicine in Q3. In addition, residents in AL communities with a higher proportion of dual residents, compared with those in low-dual ALs, were less likely to receive primary care via telemedicine throughout the study period. However, the difference in telemedicine use between higher vs lower dual ALs narrowed over time.
AHRQ-funded; HS026893.
Citation: Hua Y, Temkin-Greener H, Cai S .
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
J Am Med Dir Assoc 2023 Aug; 24(8):1157-58.e3. doi: 10.1016/j.jamda.2023.05.005..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Racial and Ethnic Minorities, Elderly
Eliason E, Admon LK, Steenland MW
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
The purpose of this study was to explore the loss of Medicaid coverage in toward the end of the postpartum period prior to COVID-19 and describe the implications for Medicaid unwinding. The researchers utilized unique Pregnancy Risk Assessment Monitoring System follow-up data from prior to the COVID-19 pandemic. The study found that only 68% of enrollees in prenatal Medicaid maintained continuous Medicaid coverage through 9 or 10 months postpartum. Of the total prenatal Medicaid enrollees who lost their coverage in the early postpartum period, two-thirds continued to be uninsured 9 to 10 months postpartum. The researchers concluded that extensions to state postpartum Medicaid could prevent a return to postpartum coverage loss rates similar to the level in the prepandemic period.
AHRQ-funded; HS027464; HS000011.
Citation: Eliason E, Admon LK, Steenland MW .
Late postpartum coverage loss before COVID-19: implications for Medicaid unwinding.
Health Aff 2023 Jul; 42(7):966-72. doi: 10.1377/hlthaff.2022.01659..
Keywords: COVID-19, Maternal Care, Medicaid, Women, Access to Care, Uninsured, Health Insurance
Titus AR, Mezuk B, Hirschtick JL
Patterns and predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan.
Researchers examined the intersection of demographic, economic, and illness-related predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan. Data were taken from a population-based survey of Michigan adults who experienced a COVID-19 diagnosis prior to August 2020. Results indicated that relative risks for experiencing poor mental health outcomes varied by race/ethnicity, sex, age, and income. Symptom severity was associated with a higher burden of comorbid depressive/anxiety symptoms. "Long COVID" was associated with all outcomes. The researchers concluded that because of overlapping risk factors, integrated approaches to treating depressive/anxiety symptoms among COVID-19 survivors is warranted.
AHRQ-funded; HS026120.
Citation: Titus AR, Mezuk B, Hirschtick JL .
Patterns and predictors of depressive and anxiety symptoms within a population-based sample of adults diagnosed with COVID-19 in Michigan.
Soc Psychiatry Psychiatr Epidemiol 2023 Jul; 58(7):1099-108. doi: 10.1007/s00127-023-02453-9..
Keywords: COVID-19, Depression, Anxiety, Behavioral Health
Amaefule AQ, Litvintchouk A, de Cordova P
Reevaluating the significance of infection preventionists and infection prevention and control departments in the post-COVID-19 era.
Infection preventionists are specialized health care professionals responsible for infection control policy development and implementation, prevention education for staff and patients, and investigation of outbreaks. The role of infection preventionists in creating effective methods for infection prevention and control became even more critical during the COVID-19 pandemic. The purpose of this paper was to increase awareness of the importance for health care systems and health care institutions to integrate lessons learned, improve infection prevention and control resources, and increase the workforce of infection preventionists to better prepare for pandemic events in the future.
AHRQ-funded; HS029023.
Citation: Amaefule AQ, Litvintchouk A, de Cordova P .
Reevaluating the significance of infection preventionists and infection prevention and control departments in the post-COVID-19 era.
Am J Med Qual 2023 Jul-Aug; 38(4):206-08. doi: 10.1097/jmq.0000000000000132..
Keywords: COVID-19, Infectious Diseases, Public Health
Hatch BA, Kenzie E, Ramalingam N
Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making.
The purpose of this cross-sectional study was to determine how vaccine mandates affect the healthcare workforce. Between October 28, 2021- November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel, the researchers conducted a survey of Oregon primary care clinic staff. The survey included 19 questions that assessed the clinic-level effects of the vaccination mandate. Study outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. The study found that clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) used medical and/or religious vaccination waivers (71% vs 33%) and reported significant impact on clinic staffing (45% vs 21%). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%). Qualitative analysis revealed a decrease in clinic morale and mixed opinions of the vaccination mandate.
AHRQ-funded; HS027080.
Citation: Hatch BA, Kenzie E, Ramalingam N .
Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making.
PLoS One 2023 Jun 27; 18(6):e0287553. doi: 10.1371/journal.pone.0287553..
Keywords: COVID-19, Vaccination, Primary Care, Policy, Rural Health, Urban Health, Rural/Inner-City Residents
Patel M, Berlin H, Rajkumar A
Barriers to telemedicine use: qualitative analysis of provider perspectives during the COVID-19 pandemic.
The objective of this study was to describe perceived barriers and facilitators to the use of web-based visits to inform quality improvement efforts and promote sustainability. Medical providers at a large, midwestern academic institution were surveyed. Four overarching categories of provider experience with web-based visits emerged: quality of care, patient rapport, visit flow, and equity. The authors concluded that their findings demonstrated key barriers to the maintenance of telemedicine services following the COVID pandemic, and that these findings might help to prioritize impactful methods of sustaining and expanding telemedicine availability for patients.
AHRQ-funded; HS027632.
Citation: Patel M, Berlin H, Rajkumar A .
Barriers to telemedicine use: qualitative analysis of provider perspectives during the COVID-19 pandemic.
JMIR Hum Factors 2023 Jun 26; 10:e39249. doi: 10.2196/39249..
Keywords: Telehealth, COVID-19, Public Health, Health Information Technology (HIT), Provider: Health Personnel
Paglino E, Lundberg, DJ, Zhou Z
Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022.
Researchers estimated all-cause excess mortality for the US by county and month by using a Bayesian hierarchical model focused on data from 2015-2019. Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. The researchers concluded that their results highlight the need for investments in rural health as the pandemic's rural impact increases.
AHRQ-funded; HS013853.
Citation: Paglino E, Lundberg, DJ, Zhou Z .
Monthly excess mortality across counties in the United States during the COVID-19 pandemic, March 2020 to February 2022.
Sci Adv 2023 Jun 23; 9(25):eadf9742. doi: 10.1126/sciadv.adf9742..
Keywords: COVID-19, Mortality
Mahmud A, Cushing-Haugen K, Wellman R
Understanding the relationship between social risk factors and COVID-19 contacts.
The purpose of this study was to facilitate researchers’ understanding of the prevalence of patients' social risk factors during the pandemic and recognize how social risks may intensify COVID-19. Between January and September 2020, the researchers conducted a national survey of Kaiser Permanente members and analyzed only the data from those who responded to a set of COVID-19 survey items. The survey included questions on their experiences with social risks, whether they knew of people with COVID-19, if COVID-19 affected their emotional and mental health, and their preferred type of assistance. The study found that 62% of respondents reported social risks, with 38% reporting having 2 or more social risks. The most common response was financial strain (45%). One third of respondents reported one or more contact types with COVID-19. respondents with 2 or more COVID-19 contact types reported higher rates of housing instability, financial strain, food insecurity, and social isolation than those with fewer contacts. Fifty percent of respondents reported that COVID-19 affected their emotional, mental health negatively, and 19% of respondents noted that it affected their ability to maintain a job.
AHRQ-funded; HS013853.
Citation: Mahmud A, Cushing-Haugen K, Wellman R .
Understanding the relationship between social risk factors and COVID-19 contacts.
Perm J 2023 Jun 15; 27(2):18-22. doi: 10.7812/tpp/22.146..
Keywords: COVID-19, Risk, Public Health, Infectious Diseases
Mooney AC, Jackson KE, Hamad R
Experiences of distress and gaps in government safety net supports among parents of young children during the COVID-19 pandemic: a qualitative study.
This study examined the experiences and challenges of families with low incomes caring for young children during the COVID-19 pandemic. The authors conducted semi-structured qualitative interviews from August 2020 to January 2021 with 34 parents of young children in California that were then analyzed using thematic analysis. They identified three key themes related to parents' experiences during the pandemic: (1) positive experiences with government support programs, (2) challenging experiences with government support programs, and (3) distress resulting from insufficient support for childcare disruptions. Program expansions helped alleviate food insecurity, and those attending community colleges reported accessing a range of supports through supportive counselors. However, there were many reported gaps in childcare and distance learning support, pre-existing housing instability, and parenting stressors.
AHRQ-funded; HS022241.
Citation: Mooney AC, Jackson KE, Hamad R .
Experiences of distress and gaps in government safety net supports among parents of young children during the COVID-19 pandemic: a qualitative study.
BMC Public Health 2023 Jun 7; 23(1):1099. doi: 10.1186/s12889-023-16037-4..
Keywords: Children/Adolescents, COVID-19, Public Health
Ranard BL, Chow CC, Megjhani M
A mathematical model of SARS-CoV-2 immunity predicts paxlovid rebound.
Researchers used a parsimonious mathematical model of immunity to SARS-CoV-2 infection to model the effect of nirmatrelvir/ritonavir (Paxlovid), an oral antiviral medication, in unvaccinated and vaccinated patients. Model simulations showed that viral rebound after treatment occurred only in vaccinated patients; unvaccinated treated with Paxlovid did not experience rebound in viral load. The researchers concluded that an approach combining parsimonious models of the immune system could be used to gain important insights in the context of emerging pathogens.
AHRQ-funded; HS026121.
Citation: Ranard BL, Chow CC, Megjhani M .
A mathematical model of SARS-CoV-2 immunity predicts paxlovid rebound.
J Med Virol 2023 Jun; 95(6):e28854. doi: 10.1002/jmv.28854..
Keywords: COVID-19, Medication
Acolin J, Fishman P
Beyond the biomedical, towards the agentic: a paradigm shift for population health science.
Life expectancy in the United States is decreasing. Health disparities are widening. Growing evidence for and integration of social and structural determinants into theory and practice has not yet improved outcomes. The COVID-19 pandemic reinforced the fact. The purpose of this paper was to contend that the biomedical model and its core scientific paradigm of causal determinism, is unable to meet population health needs. The researchers offer that this paper advances the field of medicine by transcending criticism to recognize the need for a paradigm shift. The authors apply the experience of the COVID-19 pandemic to exemplify the practical applications of their framework.
AHRQ-funded; HS013853.
Citation: Acolin J, Fishman P .
Beyond the biomedical, towards the agentic: a paradigm shift for population health science.
Soc Sci Med 2023 Jun; 326:115950. doi: 10.1016/j.socscimed.2023.115950..
Keywords: COVID-19, Public Health
Jenkins JL, Hsu EB, Zhang A
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
This study’s aim was to summarize current evidence from the United States on the effectiveness of practices and interventions for preventing, recognizing, and controlling occupationally acquired infectious diseases in Emergency Medical Service (EMS) clinicians. A database search was conducted for literature published January 2006 through March 15, 2022 to search for studies in the United States that involved EMS clinicians and firefighters, reported on one or more workplace practices or interventions that prevented or controlled infectious diseases, and included outcome measures. Eleven observational studies reported on infection prevention and control (IPC) practices providing evidence that hand hygiene, standard precautions, mandatory vaccine policies, and on-site vaccine clinics are effective. Less frequent handwashing and less frequent hand hygiene after glove use were positively correlated with nasal colonization of Methicillin-resistant Staphylococcus aureus (MRSA). Lack of personal protective equipment (PPE) or PPE breach were correlated with higher severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity and virus 2 (SARS-CoV-2) seropositivity. Workers were more likely to be vaccinated against influenza if their employer offered the vaccine. Vaccination rates for H1N1 influenza increased with the use of active, targeted education modules.
AHRQ-funded; 75Q80120D00003.
Citation: Jenkins JL, Hsu EB, Zhang A .
Current evidence for infection prevention and control interventions in emergency medical services: a scoping review.
Prehosp Disaster Med 2023 Jun; 38(3):371-77. doi: 10.1017/s1049023x23000389..
Keywords: COVID-19, Emergency Department, Evidence-Based Practice, Prevention, Public Health, Infectious Diseases
Anderson NW, Halfon N, Eisenberg D
Mixed signals in child and adolescent mental health and well-being indicators in the United States: a call for improvements to population health monitoring.
The authors of this paper suggest that policies targeting social indicators of youth status may not have improved overall mental health and well-being. They contend this absence of impact is evidenced by the divergence between social indicators which are improving, such as high school graduation, food insecurity, and smoking, and those which are worsening, such as mental health and well-being. The researchers report that available data indicates that one or more common exposures may be to blame, including those inadequately captured by existing social indicators.
AHRQ-funded; HS000046.
Citation: Anderson NW, Halfon N, Eisenberg D .
Mixed signals in child and adolescent mental health and well-being indicators in the United States: a call for improvements to population health monitoring.
Milbank Q 2023 Jun; 101(2):259-86. doi: 10.1111/1468-0009.12634..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Ambulatory Care and Surgery, Cardiovascular Conditions
Auerbach AD, Astik GJ, O'Leary KJ
Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19.
During the COVID-19 pandemic, clinicians were required to address a disease with continuously changing traits while simultaneously complying with changes in care (e.g., physical distancing) that could contribute to diagnostic errors (DEs). The purpose of this study was to examine the frequency of DEs and their causes in patients hospitalized under investigation (PUI) for COVID-19. The researchers randomly selected up to 8 cases per site per month for evaluation, with each case evaluated by two clinicians to determine whether a DE occurred, and whether any diagnostic process faults took place. The study found that wo hundred and fifty-seven patient charts were evaluated, of which 14% contained a DE. Patients with and without DE were statistically similar in socioeconomic factors, comorbidities, risk factors for COVID-19, and COVID-19 test turnaround time and eventual positivity. The most common diagnostic process issues contributing to DE were problems with clinical assessment, testing choices, history taking, and physical examination. Diagnostic process issues related with COVID-19 policies and procedures were not related with DE risk. 35.9% of patients with errors and 5.4% of patients overall suffered harm or death due to diagnostic error.
AHRQ-funded; HS027369.
Citation: Auerbach AD, Astik GJ, O'Leary KJ .
Prevalence and causes of diagnostic errors in hospitalized patients under investigation for COVID-19.
J Gen Intern Med 2023 Jun; 38(8):1902-10. doi: 10.1007/s11606-023-08176-6..
Keywords: COVID-19, Diagnostic Safety and Quality, Hospitals, Inpatient Care, Quality of Care
Feyman Y, Avila CJ, Auty S
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
This study examined whether minority veterans experienced higher rates of all-cause mortality than White veterans during the COVID-19 pandemic. The authors used administrative data from the Veterans Health Administration’s Corporate Data Warehouse. Veterans were excluded in the analysis if they were missing county of residence or race-ethnicity data. Overall, veteran mortality rates were 16% above normal during March-December 2020 which equates to 42,348 excess deaths. Non-Hispanic White veterans experienced the smallest relative increase in mortality (17%), while Native American veterans had the highest increase (40%). Black Veterans (32%) and Hispanic Veterans (26%) had somewhat lower excess mortality, although these changes were significantly higher compared to White veterans. Disparities were smaller compared to the general population.
AHRQ-funded; HS026395.
Citation: Feyman Y, Avila CJ, Auty S .
Racial and ethnic disparities in excess mortality among U.S. veterans during the COVID-19 pandemic.
Health Serv Res 2023 Jun; 58(3):642-53. doi: 10.1111/1475-6773.14112..
Keywords: COVID-19, Mortality, Racial and Ethnic Minorities, Disparities
McDaniel CE, Leyenaar JK, Bryan MA
Urban-rural disparities in interfacility transfers for children during COVID-19.
This study’s goal was to identify temporal trends and differences in urban and rural pediatric interfacility transfers (IFTs) before and during the COVID-19 pandemic. The authors conducted a cross-sectional analysis of IFT among children <18 years from January 2019 to June 2022 using the Pediatric Health Information System. They calculated observed-to-expected (O-E) ratios of pre-pandemic (March 2019-Feb 2020) transfers compared to pandemic year 1 (March 2020-Feb 2021) and year 2 (March 2021-February 2022) using Poisson modeling. The O-E ratio of IFT in year 1 for urban children was 14.0% and 14.8% for rural children compared to pre-pandemic. In year 2, transfers rebounded with IFTs for rural-residing children increasing more than urban-residing children (101.7%) compared to 90.7%. For mental-health indications in year 2, rural transfer ratios were higher than urban, 126% compared to 113.7%.
AHRQ-funded; HS028683.
Citation: McDaniel CE, Leyenaar JK, Bryan MA .
Urban-rural disparities in interfacility transfers for children during COVID-19.
J Rural Health 2023 Jun; 39(3):611-16. doi: 10.1111/jrh.12746..
Keywords: COVID-19, Children/Adolescents, Disparities, Rural Health, Urban Health, Rural/Inner-City Residents
Jacobs PD, Moriya AS
AHRQ Author: Jacobs PD, Moriya AS
Changes in health coverage during the COVID-19 pandemic.
This AHRQ-authored paper used data from MEPS to examine patterns of health insurance coverage during the COVID-19 pandemic. The authors compared the proportion of people whose source of coverage changed from 2019 to 2020 with the proportion of people whose source changed from 2018 to 2019. The sample was limited to those who were interviewed in both 2018 and 2019 or in both 2019 and 2020. The analysis looked at people aged 63 or younger in the first year of the sample. The authors found increased stability for children and nonelderly adults during the first year of the pandemic. Fewer people who had Medicaid in 2019 became uninsured in 2020 (4.3%) than in 2018-19 (7.8%). Residents of Medicaid expansion states who were enrolled in 2019 were less likely to become uninsured in 2020 (3.6%) than was the case in the 2018-2019 period (6.0%). This was also true in non-Medicaid expansion states (6.6% vs 12.4%). However, residents of expansion states were more likely to become enrolled in Medicaid in 2020 if they were previously uninsured in 2019 (21.5%) compared with 2018-2019 (15.3%). For nonexpansion states, there was no detectable change in the percentage transitioning from uninsured to Medicaid over the two time periods (8.5% compared with 6.9%).
AHRQ-authored.
Citation: Jacobs PD, Moriya AS .
Changes in health coverage during the COVID-19 pandemic.
Health Affairs 2023 May; 42(5):721-26. doi: 10.1377/hlthaff.2022.01469..
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Health Insurance, Medicaid, Access to Care
Lundberg DJ, Wrigley-Field E, Cho A
COVID-19 mortality by race and ethnicity in US metropolitan and nonmetropolitan areas, March 2020 to February 2022.
Previous research has determined that Hispanic and non-Hispanic Black residents in the United States experienced significantly higher COVID-19 mortality rates in 2020 than non-Hispanic White residents due to structural racism. In 2021, these disparities were observed to decrease. The purpose of this study was to evaluate the extent to which national decreases in racial and ethnic disparities in COVID-19 mortality between the initial pandemic wave and the subsequent Omicron wave reflect decreases in mortality vs other factors, such as the changing geography of the pandemic. The researchers conducted this cross-sectional study using data from the United States Centers for Disease Control and Prevention for COVID-19 deaths from March 1, 2020, through February 28, 2022, in U.S. resident adults aged 25 years and older. Deaths were examined by race and ethnicity across metropolitan and nonmetropolitan areas, and the national decrease in racial and ethnic disparities between the initial wave and Omicron waves was decomposed. The study included death certificates for 977, 018 U.S. that included a mention of COVID-19. The rate of COVID-19 deaths among adults residing in nonmetropolitan areas increased 5.4% during the initial wave to a peak of 23.4% during the Delta wave; the proportion was 21.5% during the Omicron wave. The national disparity in age-standardized COVID-19 death rates per 100,000 person-years for non-Hispanic Black compared with non-Hispanic White adults decreased by 293 deaths. After standardizing for age and racial and ethnic differences by metropolitan vs nonmetropolitan residence, increases in death rates among non-Hispanic White adults explained 40.7% of the decrease (40.7%); 19.6% of the decrease was explained by shifts in mortality to nonmetropolitan areas, where a disproportionate share of non-Hispanic White adults resided. The remaining 39.6% of the decrease was explained by decreases in death rates in non-Hispanic Black adults. The researchers concluded that the majority of the national decrease in racial and ethnic disparities in COVID-19 mortality between the initial wave and Omicron waves was explained by increased mortality among non-Hispanic White adults and changes in the geographic distribution of the pandemic.
AHRQ-funded; HS013853.
Citation: Lundberg DJ, Wrigley-Field E, Cho A .
COVID-19 mortality by race and ethnicity in US metropolitan and nonmetropolitan areas, March 2020 to February 2022.
JAMA Netw Open 2023 May; 6(5):e2311098. doi: 10.1001/jamanetworkopen.2023.11098..
Keywords: COVID-19, Mortality, Racial and Ethnic Minorities