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Topics
- Anxiety (1)
- Blood Pressure (2)
- Cancer (1)
- Cancer: Lung Cancer (1)
- Cancer: Prostate Cancer (1)
- Children/Adolescents (1)
- Critical Care (1)
- Decision Making (4)
- Dementia (1)
- Diagnostic Safety and Quality (14)
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- Elderly (1)
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- Evidence-Based Practice (7)
- (-) Guidelines (14)
- Home Healthcare (1)
- Imaging (4)
- Influenza (1)
- Long-Term Care (1)
- Men's Health (1)
- Neurological Disorders (2)
- Nursing Homes (1)
- Nutrition (1)
- Patient-Centered Outcomes Research (1)
- Provider (2)
- Provider: Physician (1)
- Respiratory Conditions (2)
- Risk (1)
- Screening (1)
- Sepsis (1)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Urinary Tract Infection (UTI) (1)
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
1 to 14 of 14 Research Studies DisplayedKistler CE, Wretman Zimmerman, S S
Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline.
The purpose of this study was to examine the concordance between clinicians' diagnosis of suspected urinary tract infection (UTI) with a clinical guideline treated as the gold standard, in order to inform overprescribing and antibiotic stewardship in nursing homes. The authors conducted a cross-sectional web-based survey of a national convenience sample of nursing-home clinicians, including a discrete choice experiment with 19 randomly selected scenarios of nursing-home residents with possible UTIs. Responses were compared to the guideline. The results indicated that nursing-home clinicians tend to over-diagnose UTI. The authors concluded that this necessitates systems-based interventions to augment clinical decisionmaking.
AHRQ-funded; HS024519.
Citation: Kistler CE, Wretman Zimmerman, S S .
Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline.
J Am Geriatr Soc 2022 Apr;70(4):1070-81. doi: 10.1111/jgs.17638..
Keywords: Nursing Homes, Long-Term Care, Urinary Tract Infection (UTI), Guidelines, Diagnostic Safety and Quality, Decision Making
Bryant KB, Green MB, Shimbo D
Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go.
This analysis examined how historical use of home blood pressure monitoring (HBPM) aligns with current out-of-office BP monitoring recommendations for hypertensive US adults without a previous hypertension diagnosis and how HBPM use varies by patient characteristics. A cohort of 7185 adults aged 20 years or older without a diagnosis of hypertension or antihypertensive medication use and a high office BP (≥130/80 mm Hg) who participated in the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014 cycle were included. Participants who answered as having self-initiated or physician recommended HBPM were categorized as having used or having been told to use HBPM. The authors estimate that 31.4 million US adults did not have diagnosed hypertension, were not taking antihypertensive medications, and had an office BP ≥130/80 mm Hg. Out of that population, 95.3% would have met criteria to undergo out-of-office BP monitoring by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Only 3.6% (1.1 million) were told to use HBPM, and 15.7% had used HPBM. There were no differences in use by race/ethnicity, sex, health insurance status, or source of routine healthcare. The authors suggest the use of a telemonitoring system to improve ease of HBPM.
AHRQ-funded; HS024262.
Citation: Bryant KB, Green MB, Shimbo D .
Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go.
Hypertension 2022 Feb;79(2):e15-e17. doi: 10.1161/hypertensionaha.121.18463..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Home Healthcare, Guidelines, Evidence-Based Practice
Klompas M, Osborn TM, Rhee C
Who owns sepsis?
In this Ideas and Opinions article, the authors discuss applying to sepsis guidelines that are already in place for other conditions. They indicate that other time-critical diagnoses have evolved triaging systems to inform the urgency and intensity of therapy, and that sepsis can evolve similarly, where potentially infected patients with worrisome signs or comorbidities, such as hypotension, altered mental status, or immunosuppression, are managed with one level of urgency and intensity and less severely ill patients are managed with another.
AHRQ-funded; HS025008.
Citation: Klompas M, Osborn TM, Rhee C .
Who owns sepsis?
Ann Intern Med 2020 Feb 4;172(3):210-11. doi: 10.7326/m19-2966..
Keywords: Sepsis, Guidelines, Diagnostic Safety and Quality, Critical Care
Dugas AF, Hsieh YH, LoVecchio F
Derivation and validation of a clinical decision guideline for influenza testing in 4 US emergency departments.
This study looked at which patients should be tested for influenza among adult emergency department (ED) patients with fever or respiratory symptoms who met criteria for antiviral treatment per 2013 CDC guidelines. A prospective cohort study was conducted at 4 US EDs from November 2013 to April 2014. All 1941 enrolled participants were tested for influenza using polymerase chain reaction (PCR), and 183 patients (9.4%) had influenza. The CDC clinical decision guidelines (CDGs) for influenza testing includes new or increased cough (2 points), headache (1 point), subjective fever (1 point), and triage temperature >100.4F degrees. The CDG had a sensitivity and specificity of 94.1% and 36.6% respectively in the derivation set and the validation set.
AHRQ-funded; HS009699.
Citation: Dugas AF, Hsieh YH, LoVecchio F .
Derivation and validation of a clinical decision guideline for influenza testing in 4 US emergency departments.
Clin Infect Dis 2020 Jan;70(1):49-58. doi: 10.1093/cid/ciz171..
Keywords: Guidelines, Decision Making, Influenza, Respiratory Conditions, Emergency Department, Evidence-Based Practice, Diagnostic Safety and Quality
Armstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Crawford ED, Koo PJ, Shore N
A clinician's guide to next generation imaging in patients with advanced prostate cancer (RADAR III).
This paper reports on the convening of the Radiographic Assessments for Detection of Advanced Recurrence (RADAR III) Group to offer guidance on the use of next generation imaging to stage prostate cancer based on available data and clinical experience. The RADAR III Group recommends next generation imaging techniques in select patients in whom disease progression is suspected based on biomarker values, comorbidities and symptoms.
AHRQ-funded.
Citation: Crawford ED, Koo PJ, Shore N .
A clinician's guide to next generation imaging in patients with advanced prostate cancer (RADAR III).
J Urol 2019 Apr;201(4):682-92. doi: 10.1016/j.juro.2018.05.164..
Keywords: Men's Health, Cancer: Prostate Cancer, Cancer, Diagnostic Safety and Quality, Imaging, Evidence-Based Practice, Guidelines
Koziatek CA, Simon E, Horwitz LI
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
The objective of this study was to measure the performance of automated, structured data-only versions of the Wells and revised Geneva risk scores in emergency department encounters during which a computed tomography pulmonary angiography was ordered. The hypothesis was that such an automated method would classify a patient's pulmonary embolism risk with high accuracy compared to manual chart review.
AHRQ-funded; HS024376.
Citation: Koziatek CA, Simon E, Horwitz LI .
Automated pulmonary embolism risk classification and guideline adherence for computed tomography pulmonary angiography ordering.
Acad Emerg Med 2018 Sep;25(9):1053-61. doi: 10.1111/acem.13442..
Keywords: Respiratory Conditions, Risk, Diagnostic Safety and Quality, Emergency Department, Imaging, Guidelines
Greenhawt M, Bird JA, Nowak-Wegrzyn AH
Trends in provider management of patients with food protein-induced enterocolitis syndrome.
Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated food allergy. This study sought to better understand provider-level variation in FPIES knowledge and management. It found that nearly one-third of respondents reported poor familiarity with FPIES. Considerable variation exists in the use of diagnostic tests, management, and choice of "safe" nutrition, indicating a strong need for FPIES practice guidelines.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Bird JA, Nowak-Wegrzyn AH .
Trends in provider management of patients with food protein-induced enterocolitis syndrome.
J Allergy Clin Immunol Pract 2017 Sep - Oct;5(5):1319-24.e12. doi: 10.1016/j.jaip.2016.11.036.
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Keywords: Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Nutrition, Provider
Newberry SJ, FitzGerald JD, Motala A
Diagnosis of gout: a systematic review in support of an American College of Physicians clinical practice guideline.
This review summarized evidence regarding the accuracy of clinical tests and classification algorithms compared with that of a reference standard of monosodium urate crystals in joint aspirate for diagnosing gout. It concluded that multidimensional algorithms, which must be validated in primary and urgent care settings, may help clinicians make a provisional diagnosis of gout. Although dual-energy computed tomography and ultrasonography also show promise for gout diagnosis, accessibility to these methods may be limited.
AHRQ-funded; 290201200006I.
Citation: Newberry SJ, FitzGerald JD, Motala A .
Diagnosis of gout: a systematic review in support of an American College of Physicians clinical practice guideline.
Ann Intern Med 2017 Jan 3;166(1):27-36. doi: 10.7326/m16-0462.
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Keywords: Guidelines, Diagnostic Safety and Quality, Evidence-Based Practice
Wang RC
Managing urolithiasis.
More than 1 million patients with suspected urolithiasis present to an emergency department (ED) each year in the United States. This review describes ED evaluation, therapies and the identification of patients who require urgent urologic intervention, with recommendations based on clinical trials; on guidelines from the American College of Emergency Physicians (ACEP), American College of Radiology, and American Urologic Association; and on anecdotal experience.
AHRQ-funded; HS021281.
Citation: Wang RC .
Managing urolithiasis.
Ann Emerg Med 2016 Apr;67(4):449-54. doi: 10.1016/j.annemergmed.2015.10.021.
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Keywords: Diagnostic Safety and Quality, Emergency Department, Guidelines
Nadpara P, Madhavan SS, Tworek C
Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: a population-based study.
This study evaluated the variations in guideline-concordant timely lung cancer care and prognosis among elderly in the US. It found that the time to diagnosis and treatment varied significantly among the elderly. However, 77.5 percent received guideline-concordant timely lung cancer care. The likelihood of receiving timely care significantly decreased with early stage diagnosis, increasing age, non-white race, higher comorbidity score, and lower income.
AHRQ-funded; HS018622.
Citation: Nadpara P, Madhavan SS, Tworek C .
Guideline-concordant timely lung cancer care and prognosis among elderly patients in the United States: a population-based study.
Cancer Epidemiol 2015 Dec;39(6):1136-44. doi: 10.1016/j.canep.2015.06.005.
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Keywords: Cancer: Lung Cancer, Elderly, Guidelines, Disparities, Diagnostic Safety and Quality
Callaghan BC, Kerber KA, Pace RJ
Headache neuroimaging: routine testing when guidelines recommend against them.
The aim of this article was to determine the patient-level factors associated with headache neuroimaging in outpatient practice. It concluded that neuroimaging is routinely ordered in outpatient headache patients including populations where guidelines specifically recommend against their use (migraines, chronic headaches, no red flags).
AHRQ-funded; HS017690.
Citation: Callaghan BC, Kerber KA, Pace RJ .
Headache neuroimaging: routine testing when guidelines recommend against them.
Cephalalgia 2015 Nov;35(13):1144-52. doi: 10.1177/0333102415572918.
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Keywords: Neurological Disorders, Imaging, Decision Making, Guidelines, Diagnostic Safety and Quality
Johnco CJ, Salloum A, Lewin AB
Refining clinical judgment of treatment response and symptom remission identification in childhood anxiety using a signal detection analysis on the pediatric anxiety rating scale.
The purpose of this study was to determine guidelines for delineating treatment response and symptom remission for children with anxiety disorder based on the five item Pediatric Anxiety Rating Scale (PARS5), and replicate guidelines using the six item PARS (PARS6). Optimal prediction of treatment response based on gold standard criteria was achieved at 15-20 percent reduction in symptoms on the PARS5 (with 20 percent reduction achieving marginally higher accuracy), and 20 percent reduction on the PARS6.
AHRQ-funded; HS018665.
Citation: Johnco CJ, Salloum A, Lewin AB .
Refining clinical judgment of treatment response and symptom remission identification in childhood anxiety using a signal detection analysis on the pediatric anxiety rating scale.
J Child Adolesc Psychopharmacol 2015 Nov;25(9):674-83. doi: 10.1089/cap.2015.0102.
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Keywords: Children/Adolescents, Anxiety, Diagnostic Safety and Quality, Guidelines
Piper MA, Evans CV, Burda BU
Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force.
The purpose of this paper is to update a systematic review on the benefits and harms of screening for high BP in adults and to summarize evidence on rescreening intervals and diagnostic and predictive accuracy of different BP methods for cardiovascular events. It concluded that evidence supports ambulatory blood pressure monitoring as the reference standard for confirming elevated office BP screening results to avoid misdiagnosis and overtreatment of persons with isolated clinic hypertension.
AHRQ-funded; 290201200151I.
Citation: Piper MA, Evans CV, Burda BU .
Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force.
Ann Intern Med 2015 Feb 3;162(3):192-204. doi: 10.7326/m14-1539..
Keywords: U.S. Preventive Services Task Force (USPSTF), Blood Pressure, Diagnostic Safety and Quality, Screening, Evidence-Based Practice, Guidelines