National Healthcare Quality and Disparities Report
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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 54 Research Studies DisplayedGillespie EF, Panjwani N, Golden DW
Multi-institutional randomized trial testing the utility of an interactive three-dimensional contouring atlas among radiation oncology residents.
The present study reports on the efficacy and usability of a web-based contouring atlas compared with those of existing contouring resources in a randomized trial. Compared with the residents using currently available resources, the residents using eContour had improved contour agreement with both the consensus and the expert contours for the high-risk clinical target volume and greater agreement with the expert contour for the contralateral parotid gland.
AHRQ-funded; HS024321.
Citation: Gillespie EF, Panjwani N, Golden DW .
Multi-institutional randomized trial testing the utility of an interactive three-dimensional contouring atlas among radiation oncology residents.
Int J Radiat Oncol Biol Phys 2017 Jul 1;98(3):547-54. doi: 10.1016/j.ijrobp.2016.11.050.
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Keywords: Cancer, Diagnostic Safety and Quality, Education: Continuing Medical Education, Imaging, Web-Based
Hsu DY, Dalal P, Sable KA
Validation of International Classification of Disease Ninth Revision codes for atopic dermatitis.
This study sought to validate the use of ICD-9-CM codes for identifying atopic dermatitis. It found that in the outpatient setting, the ICD-9-CM codes 691.8 and 692.9 alone have poor positive predictive value (PPV). Incorporation of diagnoses of asthma, hay fever, and food allergy improves PPV and specificity. In the inpatient setting, a primary discharge diagnosis of 691.8 had excellent PPV.
AHRQ-funded; HS023011.
Citation: Hsu DY, Dalal P, Sable KA .
Validation of International Classification of Disease Ninth Revision codes for atopic dermatitis.
Allergy 2017 Jul;72(7):1091-95. doi: 10.1111/all.13113.
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Keywords: Data, Diagnostic Safety and Quality, Skin Conditions
Arnold S
AHRQ Author: Arnold S
The imperative to address diagnostic safety.
Diagnostic errors are likely to impact most of us in our lifetime. The author discusses two studies pointing to the vastness of the challenge and the urgency to act now. He also discusses other aspects of this issue and highlights two current AHRQ dedicated research opportunities on diagnostic safety: one to look at the incidence and causes of diagnostic errors in ambulatory care, and the second to look at improvement strategies and interventions.
AHRQ-authored.
Citation: Arnold S .
The imperative to address diagnostic safety.
Diagnosis 2017 Jun 27;4(2):55-56. doi: 10.1515/dx-2017-0017.
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Keywords: Diagnostic Safety and Quality, Medical Errors, Ambulatory Care and Surgery, Patient Safety, Quality Improvement
Bello JK, Mohanty N, Bauer V
Pediatric hypertension: provider perspectives.
The researchers aimed to gain insights into reasons for low rates of diagnosis and treatment from primary care providers. In interviews, providers reflected on numerous barriers to diagnosis, management, and follow-up; recommendations for educational content; and how community health center systems can be improved. Findings informed development of a multifaceted intervention.
AHRQ-funded; HS024100.
Citation: Bello JK, Mohanty N, Bauer V .
Pediatric hypertension: provider perspectives.
Glob Pediatr Health 2017 Jun 6;4:2333794x17712637. doi: 10.1177/2333794x17712637.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Healthcare Delivery, Blood Pressure, Obesity, Primary Care
Donnelly JP, Safford MM, Shapiro NI
Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study.
The Consensus Definitions present clinical criteria for the classification of patients with sepsis. Researchers investigated incidence and long-term outcomes of patients diagnosed with these classifications, which are currently unknown. Their findings support the use of the elevated sepsis-related organ failure assessment (SOFA) score from Sepsis-3, and elevated quick SOFA (qSOFA) score from Sepsis-3 classifications to identify patients with infection who are at elevated risk of poor outcomes.
AHRQ-funded; HS013852.
Citation: Donnelly JP, Safford MM, Shapiro NI .
Application of the Third International Consensus Definitions for Sepsis (Sepsis-3) Classification: a retrospective population-based cohort study.
Lancet Infect Dis 2017 Jun;17(6):661-70. doi: 10.1016/s1473-3099(17)30117-2.
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Keywords: Sepsis, Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Outcomes
McGrath SP, Pyke J, Taenzer AH
Assessment of continuous acoustic respiratory rate monitoring as an addition to a pulse oximetry-based patient surveillance system.
This study explored the technical and logistical aspects of augmenting pulse oximetry-based patient surveillance systems with continuous respiratory rate monitoring and offers some insight into the impact on patient deterioration detection that may result.
AHRQ-funded; HS024403.
Citation: McGrath SP, Pyke J, Taenzer AH .
Assessment of continuous acoustic respiratory rate monitoring as an addition to a pulse oximetry-based patient surveillance system.
J Clin Monit Comput 2017 Jun;31(3):561-69. doi: 10.1007/s10877-016-9884-y..
Keywords: Diagnostic Safety and Quality, Respiratory Conditions
Meyer AND, Singh H
Calibrating how doctors think and seek information to minimise errors in diagnosis.
This editorial discusses a study by Sheringham et al., published in 2017 in BMJ Quality and Safety, and entitled “Variations in GPs’ decisions to investigate suspected lung cancer: a factorial experiment using multimedia vignettes” in which they used simulated patient vignettes to understand the role that patient characteristics (including demographics and symptomatology) play in physicians’ decisions to investigate for possible diagnosis of lung cancer.
AHRQ-funded; HS022087; HS023602.
Citation: Meyer AND, Singh H .
Calibrating how doctors think and seek information to minimise errors in diagnosis.
BMJ Qual Saf 2017 Jun;26(6):436-38. doi: 10.1136/bmjqs-2016-006071..
Keywords: Cancer: Lung Cancer, Shared Decision Making, Diagnostic Safety and Quality
Henriksen K, Dymek C, Harrison MI
AHRQ Author: Henriksen K, Dymek C, Harrison MI, Brady PJ, Arnold SB
Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on improving diagnosis: a proceedings review.
AHRQ held a research summit in the fall of 2016, inviting members from a diverse collection of organizations, both inside and outside of government, to share their suggestions regarding what is known about diagnosis and the challenges that need to be addressed. Among the goals of the summit were to learn from the insights of participants and examine issues associated with definitions of diagnostic error and gaps in the evidence base.
AHRQ-authored.
Citation: Henriksen K, Dymek C, Harrison MI .
Challenges and opportunities from the Agency for Healthcare Research and Quality (AHRQ) research summit on improving diagnosis: a proceedings review.
Diagnosis 2017 Jun;4(2):57-66.
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Keywords: Diagnostic Safety and Quality, Medical Errors, Evidence-Based Practice, Quality of Care
Sudduth CL, Overton EC, Lyu PF
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
Using administrative codes and minimal physiologic and laboratory data, researchers sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay. They concluded that selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94 percent authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay.
AHRQ-funded; HS000055.
Citation: Sudduth CL, Overton EC, Lyu PF .
Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
J Crit Care 2017 Jun;39:220-24. doi: 10.1016/j.jcrc.2017.01.012.
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Keywords: Diagnostic Safety and Quality, Intensive Care Unit (ICU), Hospitalization, Sepsis
Bowen ME, Xuan L, Lingvay I
Performance of a random glucose case-finding strategy to detect undiagnosed diabetes.
This study describes a case-finding approach using non-diagnostic random glucose values to identify individuals in need of diabetes testing and compares its performance to current screening guidelines. Using random glucose >/=100 mg/dL to identify individuals in need of diabetes, it determined that screening is highly sensitive and specific, performing better than current screening guidelines. Case-finding strategies informed by random glucose data may improve diabetes detection.
AHRQ-funded; HS022418.
Citation: Bowen ME, Xuan L, Lingvay I .
Performance of a random glucose case-finding strategy to detect undiagnosed diabetes.
Am J Prev Med 2017 Jun;52(6):710-16. doi: 10.1016/j.amepre.2017.01.023.
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Keywords: Diabetes, Diagnostic Safety and Quality, Risk, Screening
O'Neil ME, Callahan M, Carlson KF
Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder.
This study examined symptom reporting related to the 10th Edition of the International Statistical Classification of Diseases (ICD-10) criteria for postconcussional syndrome (PCS) in veterans. One aim was to examine relationships among PCS symptoms by using the British Columbia Postconcussion Symptom Inventory (BC-PSI). BC-PSI factors were interpreted as cognitive, vestibular, affective, anger, and somatic. Items and factor scores were highest for veterans with blast exposure plus mTBI, and lowest for controls.
AHRQ-funded; HS022981.
Citation: O'Neil ME, Callahan M, Carlson KF .
Postconcussion symptoms reported by Operation Enduring Freedom/Operation Iraqi Freedom veterans with and without blast exposure, mild traumatic brain injury, and posttraumatic stress disorder.
J Clin Exp Neuropsychol 2017 Jun;39(5):449-58. doi: 10.1080/13803395.2016.1232699.
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Keywords: Brain Injury, Diagnostic Safety and Quality, Behavioral Health, Trauma
Singh H, Schiff GD, Graber ML
The global burden of diagnostic errors in primary care.
In this narrative review, the authors discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. They then synthesize available literature to discuss the types of presenting symptoms and conditions most commonly affected. Finally, they summarize interventions based on available data and suggest next steps to reduce the global burden of diagnostic errors.
AHRQ-funded; HS022087; HS023602.
Citation: Singh H, Schiff GD, Graber ML .
The global burden of diagnostic errors in primary care.
BMJ Qual Saf 2017 Jun;26(6):484-94. doi: 10.1136/bmjqs-2016-005401.
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Keywords: Diagnostic Safety and Quality, Health Information Technology (HIT), Medical Errors, Patient Safety, Primary Care
Goldberg EM, Wilson T, Saucier C
Achieving the BpTRUth: emergency department hypertension screening and the Centers for Medicare & Medicaid Services quality measure.
The aims of this study were to (1) assess the reliability of ED triage blood pressure (BP) as a metric to establish when the CMS threshold (>/=120/80 mm Hg), and other clinically relevant BP thresholds (>/=140/90 and >/=160/100 mm Hg) have been met; and (2) determine whether correct identification varies by gender, race, or triage acuity. At the three suggested BP thresholds, 66.1 percent, 74.0 percent, and 88.8 percent of patients were confirmed to meet the CMS threshold, respectively. There were no differences by gender, race, or triage acuity.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Wilson T, Saucier C .
Achieving the BpTRUth: emergency department hypertension screening and the Centers for Medicare & Medicaid Services quality measure.
J Am Soc Hypertens 2017 May;11(5):290-94. doi: 10.1016/j.jash.2017.03.003.
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Keywords: Blood Pressure, Emergency Department, Quality Measures, Screening, Diagnostic Safety and Quality, Quality of Care
Kwa MC, Ardalan K, Laumann AE
Validation of International Classification of Diseases codes for the epidemiologic study of dermatomyositis.
The authors assessed the validity of using ICD-9-CM code 710.3 to identify adult patients with dermatomyositis in outpatient and inpatient settings. They found that one or more occurrences of ICD-9 code 710.3 is insufficient to support the diagnosis of dermatomyositis in the outpatient setting, but that ICD-9 710.3 codes appear to be valid in the inpatient setting.
AHRQ-funded; HS023011.
Citation: Kwa MC, Ardalan K, Laumann AE .
Validation of International Classification of Diseases codes for the epidemiologic study of dermatomyositis.
Arthritis Care Res 2017 May;69(5):753-57. doi: 10.1002/acr.23010.
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Keywords: Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Skin Conditions
Fu Y, Liu S, Li H
Automatic and hierarchical segmentation of the human skeleton in CT images.
In this study, a novel and automatic method is proposed to segment all the major individual bones of the human skeleton above the upper legs in CT images based on an articulated skeleton atlas. The reported method is capable of automatically segmenting 62 major bones, including 24 vertebrae and 24 ribs, by traversing a hierarchical anatomical tree and by using both rigid and deformable image registration.
AHRQ-funded; HS022888.
Citation: Fu Y, Liu S, Li H .
Automatic and hierarchical segmentation of the human skeleton in CT images.
Phys Med Biol 2017 Apr 7;62(7):2812-33. doi: 10.1088/1361-6560/aa6055.
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Keywords: Diagnostic Safety and Quality, Imaging
Bhattacharjee P, Churpek MM, Snyder A
Detecting sepsis: are two opinions better than one?
Researchers conducted a study to characterize the agreement between different providers' suspicion of infection and the correlation with patient outcomes using prospective data from a general medicine ward. They concluded that provider disagreement regarding suspected infection is common, with RNs suspecting infection more often, suggesting that a collaborative model for sepsis detection may improve timing and accuracy.
AHRQ-funded; HS000078.
Citation: Bhattacharjee P, Churpek MM, Snyder A .
Detecting sepsis: are two opinions better than one?
J Hosp Med 2017 Apr;12(4):256-58. doi: 10.12788/jhm.2721.
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Keywords: Diagnostic Safety and Quality, Nursing, Risk, Sepsis
Bhattacharjee P, Edelson DP, Churpek MM
Identifying patients with sepsis on the hospital wards.
The goal of this review was to discuss recent advances in the detection of sepsis in patients on the hospital wards. The investigators discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening patients with sepsis, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick sepsis-related organ failure assessment (qSOFA) score.
AHRQ-funded; HS000078.
Citation: Bhattacharjee P, Edelson DP, Churpek MM .
Identifying patients with sepsis on the hospital wards.
Chest 2017 Apr;151(4):898-907. doi: 10.1016/j.chest.2016.06.020..
Keywords: Clinical Decision Support (CDS), Diagnostic Safety and Quality, Hospitalization, Sepsis
Wright NC, Saag KG, Dawson-Hughes B
The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA.
This study evaluated the prevalence of osteoporosis using the osteoporosis diagnostic criteria developed by the National Bone Health Alliance (NBHA), which includes qualified fractures, FRAX score in addition to bone mineral density (BMD). The study found that 16% of men and 29.9% of women 50+ have osteoporosis based on the NBHA diagnostic criteria.
AHRQ-funded; HS023009.
Citation: Wright NC, Saag KG, Dawson-Hughes B .
The impact of the new National Bone Health Alliance (NBHA) diagnostic criteria on the prevalence of osteoporosis in the USA.
Osteoporos Int 2017 Apr;28(4):1225-32. doi: 10.1007/s00198-016-3865-3..
Keywords: Diagnostic Safety and Quality, Injuries and Wounds, Osteoporosis
Murphy DR, Meyer AN, Vaghani V
Application of electronic algorithms to improve diagnostic evaluation for bladder cancer.
The researchers evaluated the performance of electronic trigger algorithms to detect delays in hematuria follow-up. They concluded that triggers offer a promising method to detect delays in care of patients with high-grade hematuria and warrant further evaluation in clinical practice as a means to reduce delays in bladder cancer diagnosis.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer AN, Vaghani V .
Application of electronic algorithms to improve diagnostic evaluation for bladder cancer.
Appl Clin Inform 2017 Mar 22;8(1):279-90. doi: 10.4338/aci-2016-10-ra-0176.
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Keywords: Cancer, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Dabbous FM, Dolecek TA, Berbaum ML
Impact of a false-positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis.
Researchers sought to examine the impact of a false positive (FP) screening mammogram on the subsequent screening mammography behavior. They found that experiencing a FP mammogram increases the risk of late stage at diagnosis compared with prior true negative (TN) mammogram Also, women with a FP mammogram were more likely to delay their subsequent screening compared with women with a TN mammogram.
AHRQ-funded; HS018366.
Citation: Dabbous FM, Dolecek TA, Berbaum ML .
Impact of a false-positive screening mammogram on subsequent screening behavior and stage at breast cancer diagnosis.
Cancer Epidemiol Biomarkers Prev 2017 Mar;26(3):397-403. doi: 10.1158/1055-9965.epi-16-0524.
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Keywords: Cancer: Breast Cancer, Cancer, Imaging, Screening, Diagnostic Safety and Quality, Women, Prevention
Eifler JB, Alvarez J, Koyama T
More judicious use of expectant management for localized prostate cancer during the last 2 decades.
Urologists have been criticized for overtreating men with low risk prostate cancer and for passively observing older men with higher risk disease. Proponents of active surveillance for low risk disease and critics of watchful waiting for higher risk disease have advocated for more judicious use of observation. In this study, the investigator compared 2 population based cohorts to determine how expectant management has evolved during the last 2 decades.
AHRQ-funded; HS019356; HS022640.
Citation: Eifler JB, Alvarez J, Koyama T .
More judicious use of expectant management for localized prostate cancer during the last 2 decades.
J Urol 2017 Mar;197(3 Pt 1):614-20. doi: 10.1016/j.juro.2016.10.067..
Keywords: Cancer, Cancer: Prostate Cancer, Care Management, Diagnostic Safety and Quality, Men's Health
Farvardin S, Patel J, Khambaty M
Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis.
This study characterized the association between hepatocellular carcinoma (HCC) surveillance receipt and patient knowledge, attitudes, and perceived barriers in a racially diverse and socioeconomically disadvantaged cohort of patients with cirrhosis. It found that patients with cirrhosis are knowledgeable and interested in HCC surveillance; however, patient-reported barriers are associated with lower surveillance rates in clinical practice and represent potential intervention targets to improve HCC surveillance effectiveness.
AHRQ-funded; HS022418.
Citation: Farvardin S, Patel J, Khambaty M .
Patient-reported barriers are associated with lower hepatocellular carcinoma surveillance rates in patients with cirrhosis.
Hepatology 2017 Mar;65(3):875-84. doi: 10.1002/hep.28770.
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Keywords: Cancer, Education: Patient and Caregiver, Social Determinants of Health, Diagnostic Safety and Quality
Vaughn VM, Chopra V
Revisiting the panculture.
In this paper, the authors discuss the term the ‘panculture’ – microbiological culture of blood, urine, sputum or stool in search of an offending pathogen- as well as the pros and cons of the practice.
AHRQ-funded; HS022835.
Citation: Vaughn VM, Chopra V .
Revisiting the panculture.
BMJ Qual Saf 2017 Mar;26(3):236-39. doi: 10.1136/bmjqs-2015-004821..
Keywords: Shared Decision Making, Diagnostic Safety and Quality, Education: Continuing Medical Education
Issaka RB, Singh MH, Oshima SM
Inadequate utilization of diagnostic colonoscopy following abnormal FIT results in an integrated safety-net system.
The effectiveness of stool-based colorectal cancer (CRC) screening is contingent on colonoscopy completion in patients with an abnormal fecal immunochemical test (FIT). This study found that FIT positive patients never referred to gastroenterology or who missed their appointment after referrals were more likely to have comorbid conditions and documented illicit substance use compared with patients who completed a colonoscopy.
AHRQ-funded; HS023558.
Citation: Issaka RB, Singh MH, Oshima SM .
Inadequate utilization of diagnostic colonoscopy following abnormal FIT results in an integrated safety-net system.
Am J Gastroenterol 2017 Feb;112(2):375-82. doi: 10.1038/ajg.2016.555.
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Keywords: Colonoscopy, Cancer: Colorectal Cancer, Cancer, Diagnostic Safety and Quality
Gephart SM, Fleiner M, Kijewski A
The ConNECtion between abdominal signs and necrotizing enterocolitis in infants 501 to 1500 g.
Necrotizing enterocolitis (NEC) can become severe quickly, making early recognition a priority and understanding the occurrence of abdominal and clinical signs of impending NEC important. The purpose of this study was to examine relationships of abdominal signs up to 36 hours before diagnosis of NEC within subgroups treated medically, surgically, or those who died.
AHRQ-funded; HS022908.
Citation: Gephart SM, Fleiner M, Kijewski A .
The ConNECtion between abdominal signs and necrotizing enterocolitis in infants 501 to 1500 g.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Newborns/Infants