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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 7620 Research Studies Displayed
Wolff C, Dowd WN, Ali MM
AHRQ Author: McClellan C
The impact of the abuse-deterrent reformulation of extended-release OxyContin on prescription pain reliever misuse and heroin initiation.
The introduction of abuse-deterrent OxyContin in 2010 was intended to reduce its misuse by making it more tamper resistant. However, some studies have suggested that this reformulation might have had unintended consequences, such as increases in heroin-related deaths. In this study, the investigators used the 2005-2014 cross-sectional U.S. National Survey on Drug Use and Health to explore the impact of this reformulation on intermediate outcomes that precede heroin-related deaths for individuals with a history of OxyContin misuse.
Citation: Wolff C, Dowd WN, Ali MM . The impact of the abuse-deterrent reformulation of extended-release OxyContin on prescription pain reliever misuse and heroin initiation. Addict Behav 2020 Jun;105:106268. doi: 10.1016/j.addbeh.2019.106268..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Prevention, Pain, Substance Abuse
Heneghan MB, Hussain T, Barrera L
Applying the COM-B model to patient-reported barriers to medication adherence in pediatric acute lymphoblastic leukemia.
This study examined parent- and patient-reported barriers to oral chemotherapy adherence with children with pediatric acute lymphoblastic leukemia (ALL). The medicine most often used was 6-mercaptopurine (6-MP). Forty-nine parents and 15 patients were surveyed and most reported at least one adherence barrier. Most of the barriers were about meeting other patients with ALL or meeting other parents. Patients also reported difficulty in finding out what their medications are, and what 6-MP does. These barriers can lead to relapse if they are not addressed.
Citation: Heneghan MB, Hussain T, Barrera L . Applying the COM-B model to patient-reported barriers to medication adherence in pediatric acute lymphoblastic leukemia. Pediatr Blood Cancer 2020 May;67(5):e28216. doi: 10.1002/pbc.28216..
Keywords: Children/Adolescents, Chemotherapy, Cancer, Medication, Patient Adherence/Compliance, Patient-Centered Outcomes Research
Chovatiya R, Silverberg JI
Association of pemphigus and pemphigoid with osteoporosis and pathological fractures.
Researchers sought to determine whether pemphigus and bullous pemphigoid (BP) are associated with osteoporosis and fractures in the US. Subjects for this cross-sectional study included adults with pemphigus or with BP from the 2006-2012 National Emergency Department Sample. The researchers found that, when compared to BP, pemphigus was associated with higher odds of osteopenia, osteoporosis, and fractures, particularly of the ulna and radius. Patients with pemphigus or BP as well as long-term systemic corticosteroid use had the highest odds of osteoporosis and fractures. The researchers suggested that patients with these conditions may benefit from increased screening for osteoporosis and interventions to prevent fractures.
Citation: Chovatiya R, Silverberg JI . Association of pemphigus and pemphigoid with osteoporosis and pathological fractures. Arch Dermatol Res 2020 May;312(4):263-71. doi: 10.1007/s00403-019-02010-y..
Keywords: Healthcare Cost and Utilization Project (HCUP), Osteoporosis, Fractures, Injuries and Wounds, Emergency Department
Mahorter SS, Knerr S, Bowles EJA
Prior breast density awareness, knowledge, and communication in a health system-embedded behavioral intervention trial.
This study examined knowledge of breast density as an important breast cancer risk factor among a set of women in a health system-embedded trial who had clinically elevated breast cancer risk 1 year before state-mandated density disclosure. The majority of the women (91%) had heard of breast density and were aware of its masking effect (87%). Only 60% had ever discussed their breast density with a provider.
Citation: Mahorter SS, Knerr S, Bowles EJA . Prior breast density awareness, knowledge, and communication in a health system-embedded behavioral intervention trial. Cancer 2020 Apr 15;126(8):1614-21. doi: 10.1002/cncr.32711..
Keywords: Cancer: Breast Cancer, Cancer, Women, Communications, Clinician-Patient Communication, Risk, Patient-Centered Outcomes Research
Analytic and data sharing options in real-world multi-database studies of comparative effectiveness and safety of medical products.
A wide range of analytic and data sharing options are available in non-experimental multi-database studies designed to assess the real-world benefits and risks of medical products. This article reviewed available analytic and data sharing options and discussed key scientific and practical considerations when choosing among these options in multi-database studies of comparative effectiveness and safety of medical products.
Citation: Toh S . Analytic and data sharing options in real-world multi-database studies of comparative effectiveness and safety of medical products. Clin Pharmacol Ther 2020 Apr;107(4):834-42. doi: 10.1002/cpt.1754..
Keywords: Patient-Centered Outcomes Research, Research Methodologies, Comparative Effectiveness
Suda KJ, Zhou J, Rowan SA
Overprescribing of opioids to adults by dentists in the U.S., 2011-2015.
Dentists prescribe 1 in 10 opioid prescriptions in the U.S. When opioids are necessary, national guidelines recommend the prescription of low-dose opioids for a short duration. This study assessed the appropriate prescribing of opioids by dentists before guideline implementation. The investigators concluded that between 1 in 4 and 1 in 2 opioids prescribed to adult dental patients are overprescribed.
Citation: Suda KJ, Zhou J, Rowan SA . Overprescribing of opioids to adults by dentists in the U.S., 2011-2015. Am J Prev Med 2020 Apr;58(4):473-86. doi: 10.1016/j.amepre.2019.11.006..
Keywords: Opioids, Dental Health, Provider, Practice Patterns, Medication
Singer SJ, Kerrissey M, Friedberg M
A comprehensive theory of integration.
Efforts to transform health care delivery to improve care have increasingly focused on care integration. However, variation in how integration is defined has complicated efforts to design, synthesize, and compare studies of integration in health care. Drawing on previous work, in this study the investigators presented a comprehensive theoretical model of relationships between types of integration and proposed how to measure them.
Citation: Singer SJ, Kerrissey M, Friedberg M . A comprehensive theory of integration. Med Care Res Rev 2020 Apr;77(2):196-207. doi: 10.1177/1077558718767000..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Quality of Care
Schmutte TJ, Wilkinson ST
Suicide in older adults with and without known mental illness: results from the national violent death reporting system, 2003-2016.
Suicide risk increases with age, and evidence exists for the underdiagnosis and undertreatment of suicide risk in older adults. Recent data suggest that many U.S. adults who die from suicide do not have a known mental health condition. This study compared the characteristics and precipitating circumstances of geriatric suicide decedents with and without known mental illnesses.
Citation: Schmutte TJ, Wilkinson ST . Suicide in older adults with and without known mental illness: results from the national violent death reporting system, 2003-2016. Am J Prev Med 2020 Apr;58(4):584-90. doi: 10.1016/j.amepre.2019.11.001..
Keywords: Elderly, Mental Health
Sanghavi P, Pan S, Caudry D
Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare.
The purpose of this study was to assess the accuracy of nursing home self-report of major injury falls on the Minimum Data Set (MDS). They linked inpatient claims for major injury falls with MDS assessments. The investigators concluded that the nursing home-reported data used for the Nursing Home Compare (NHC) falls measure may be highly inaccurate.
Citation: Sanghavi P, Pan S, Caudry D . Assessment of nursing home reporting of major injury falls for quality measurement on nursing home compare. Health Serv Res 2020 Apr;55(2):201-10. doi: 10.1111/1475-6773.13247..
Keywords: Falls, Nursing Homes, Quality Measures, Quality Indicators (QIs), Quality of Care, Elderly, Public Reporting, Injuries and Wounds
Reeves SL, Madden B, Wu M
Performance of ICD-10-CM diagnosis codes for identifying children with sickle cell anemia.
The purpose of this study was to develop, test, and validate the performance of ICD-10-CM claims-based case definitions for identifying children with sickle cell anemia (SCA). The investigators concluded that children with SCA could be accurately identified in administrative claims using this straightforward case definition. They asserted that this methodology could be used to monitor trends and use of health services after transition to ICD-10-CM.
Citation: Reeves SL, Madden B, Wu M . Performance of ICD-10-CM diagnosis codes for identifying children with sickle cell anemia. Health Serv Res 2020 Apr;55(2):310-17. doi: 10.1111/1475-6773.13257..
Keywords: Children/Adolescents, Sickle Cell Disease, Diagnosis
Popejoy LL, Wakefield BJ, Vogelsmeier AA
Reengineering skilled nursing facility discharge: analysis of reengineered discharge implementation.
There is a need to adopt evidence-based approaches to discharge planning in the skilled nursing facility (SNF) short stay population. This article describes implementation of the Reengineered Discharge (RED) process in SNFs and makes recommendations for its future implementation. The investigators concluded that their research revealed that discharge processes are similar across settings and that evidence-based programs such as RED can be adapted to the SNF setting.
Citation: Popejoy LL, Wakefield BJ, Vogelsmeier AA . Reengineering skilled nursing facility discharge: analysis of reengineered discharge implementation. J Nurs Care Qual 2020 Apr/Jun;35(2):158-64. doi: 10.1097/ncq.0000000000000413..
Keywords: Nursing Homes, Evidence-based Practice, Patient-Centered Healthcare
Niedzwiecki MJ, Machta RM, Reschovsky JD
Characteristics of academic-affiliated health systems.
Changing market forces increasingly are leading academic medical centers (AMCs) to form or join health systems. But it is unclear how this shift is affecting the tripartite academic mission of education, research, and high-quality patient care. To explore this topic, the authors identified and characterized the types of health systems that owned or managed AMCs in the United States in 2016.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Niedzwiecki MJ, Machta RM, Reschovsky JD . Characteristics of academic-affiliated health systems. AHRQ-authored; AHRQ-funded; 290201600001C..
Keywords: Healthcare Systems, Hospitals
Nadkarni MA, Maas MB, Batra A
Elevated cerebrospinal fluid protein is associated with unfavorable functional outcome in spontaneous subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) is a devastating neurologic event for which markers to assess poor outcome are needed. Elevated cerebrospinal fluid (CSF) protein may result from inflammation and blood-brain barrier (BBB) disruption that occurs during SAH. In this study, the investigators sought to determine if CSF protein level is associated with functional outcome after SAH.
Citation: Nadkarni MA, Maas MB, Batra A . Elevated cerebrospinal fluid protein is associated with unfavorable functional outcome in spontaneous subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2020 Apr;29(4):104605. doi: 10.1016/j.jstrokecerebrovasdis.2019.104605..
Keywords: Stroke, Cardiovascular Conditions, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
Griffey RT, Schneider RM, Todorov AA
Adverse events present on arrival to the emergency department: the ED as a dual safety net.
This study examined the prevalence of adverse events due to medication-related or patient care-related events that present on arrival (POA) to the emergency department (ED). This retrospective observation study tested the ED Trigger Tool from data at an urban academic medical center. Adults who completed an ED visit were eligible (N=92,859). A total of 5,582 visits gave a trigger. The majority of AEs (1,181) identified were from patients who were white and older. In total, POA AEs accounted for an estimated 7.65% of ED visits.
Citation: Griffey RT, Schneider RM, Todorov AA . Adverse events present on arrival to the emergency department: the ED as a dual safety net. Jt Comm J Qual Patient Saf 2020 Apr;46(4):192-98. doi: 10.1016/j.jcjq.2019.12.003..
Keywords: Adverse Events, Adverse Drug Events (ADE), Emergency Department, Medication, Patient Safety, Quality of Care
Fahrenbach J, Chin MH, Huang ES
Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program.
This study examined the relationship between neighborhood social risk factors (SRFs) and hospital ratings in Medicare's Hospital Compare Program. Results showed that lower hospital summary scores were associated with caring for neighborhoods with higher social risk. Associations between neighborhood SRFs and hospital ratings were largest in the timeliness of care, patient experience, and hospital readmission groups and smallest in the safety, efficiency, and effectiveness of care groups. Failing to account for neighborhood social risk in hospital rating systems may reinforce hidden disincentives to care for medically underserved areas in the United States.
Citation: Fahrenbach J, Chin MH, Huang ES . Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program. Med Care 2020 Apr;58(4):376-83. doi: 10.1097/mlr.0000000000001283..
Keywords: Quality of Care, Hospitals, Medicare, Quality Indicators (QIs), Patient Experience, Socioeconomic Factors
Chen J, Sadasivam R, Blok AC
The association between patient-reported clinical factors and 30-day acute care utilization in chronic heart failure.
The purpose of this study was to identify post-discharge patient-reported clinical factors associated with repeat acute care use. Through phone surveys with patients with chronic heart failure, findings indicated that patient-reported poor health status, pain, and poor appetite were positively associated with 30-day acute care utilization. Recommendations included further study before incorporation into risk prediction to drive quality improvement efforts.
Citation: Chen J, Sadasivam R, Blok AC . The association between patient-reported clinical factors and 30-day acute care utilization in chronic heart failure. Med Care 2020 Apr;58(4):336-43. doi: 10.1097/mlr.0000000000001258..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Emergency Department, Chronic Conditions
Chen DW, Reyes-Gastelum D, Wallner LP
Disparities in risk perception of thyroid cancer recurrence and death.
The authors studied risk perception among survivors of thyroid cancer. Patients diagnosed with differentiated thyroid cancer from the Surveillance, Epidemiology, and End Results registries were surveyed and an analytic cohort defined by a 5% or greater risk of disease recurrence and mortality. The authors found that less educated patients and Hispanic patients were more likely to report inaccurate risk perceptions, which were associated with worry and a decreased quality of life.
Citation: Chen DW, Reyes-Gastelum D, Wallner LP . Disparities in risk perception of thyroid cancer recurrence and death. Cancer 2020 Apr 1;126(7):1512-21. doi: 10.1002/cncr.32670..
Keywords: Disparities, Cancer, Risk, Quality of Life, Socioeconomic Factors, Racial / Ethnic Minorities
Bucholz EM, Toomey SL, Butala NM
Suitability of elderly adult hospital readmission rates for profiling readmissions in younger adult and pediatric populations.
Investigators sought to determine the correlation between hospital 30-day risk-standardized readmission rates in elderly adults and those in nonelderly adults and children. Data from U.S. hospitals in the 2013-2014 Nationwide Readmissions Database were used. The researchers found that hospital readmission rates in elderly adults may reflect broader hospital readmission performance in middle-aged and young adult populations, but they are not reflective of hospital performance in pediatric populations.
AHRQ-funded; HS020513; HS025299.
Citation: Bucholz EM, Toomey SL, Butala NM . Suitability of elderly adult hospital readmission rates for profiling readmissions in younger adult and pediatric populations. Health Serv Res 2020 Apr;55(2):277-87. doi: 10.1111/1475-6773.13269..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Health Services Research (HSR), Research Methodologies, Children/Adolescents
Armstrong MJ, Gronseth GS, Gagliardi AR
Participation and consultation engagement strategies have complementary roles: a case study of patient and public involvement in clinical practice guideline development.
guideline question development. Using a clinical practice guideline in development by the American Academy of Neurology, they found that participation and consultation PPI strategies have different advantages. Congruence between strategies increases the strength of the patient voice. They recommended that guideline developers prioritize using both strategies for successful PPI.
Citation: Armstrong MJ, Gronseth GS, Gagliardi AR . Participation and consultation engagement strategies have complementary roles: a case study of patient and public involvement in clinical practice guideline development. Health Expect 2020 Apr;23(2):423-32. doi: 10.1111/hex.13018..
Keywords: Evidence-based Practice, Guidelines, Patient and Family Engagement
Kohut MR, Keller SC, Linder JA
AHRQ Author: Miller MA
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Researchers conducted semi-structured interviews with clinicians to determine how they perceive demand for antibiotics in the outpatient setting. They conducted interviews with 25 clinicians from nine practices across three states. Patient demand was the most common reason why non-indicated antibiotics were prescribed. Clinicians felt that if they didn’t prescribe them they would experience repercussions in their reputation and practice and that certain patients are impossible to please without an antibiotic prescription regardless of the diagnosis.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Kohut MR, Keller SC, Linder JA . The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting. Fam Pract 2020 Mar 25;37(2):276-82. doi: 10.1093/fampra/cmz066..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Outpatient Care, Provider: Clinician, Provider: Physician, Provider
Rathi VK, McWilliams JM, Roberts ET
Rathi VK, McWilliams JM, Roberts ET. Getting incentives right in payment reform: thinking beyond financial risk.
In this paper the authors discuss payment reform, global budget models and why incentives differ for health system versus physician group ACO’s. They indicate that incentives in new payment models are closely connected to the structure of the health care delivery system and that policies that ignore this relationship and focus only on the risk terms of payment contracts may miss opportunities for progress.
Citation: Rathi VK, McWilliams JM, Roberts ET . Rathi VK, McWilliams JM, Roberts ET. Getting incentives right in payment reform: thinking beyond financial risk. Ann Intern Med 2020 Mar 17;172(6):423-24. doi: 10.7326/m19-3178..
Keywords: Healthcare Costs, Policy, Payment
Garcia-Albeniz X, Hernan MA, Logan RW
Continuation of annual screening mammography and breast cancer mortality in women older than 70 years.
This study examined whether discontinuing annual screening mammographies in women older than 70 years results in an increased 8-year breast cancer mortality. The researchers used data from the Medicare program and looked at over 1 million beneficiaries aged 70 to 84 who had no previous breast cancer diagnosis, and who underwent screening mammography from 2000 to 20008. The 8-year risk difference for women aged 70 to 74 years was -1.0 death per 1000 women and for women aged 75 to 84 years it was 0.07. Neither of these show substantial reductions in 8-year breast cancer mortality compared with stopping screening.
Citation: Garcia-Albeniz X, Hernan MA, Logan RW . Continuation of annual screening mammography and breast cancer mortality in women older than 70 years. Ann Intern Med 2020 Mar 17;172(6):381-89. doi: 10.7326/m18-1199..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Mammogram, Prevention, Women, Elderly, Mortality
Dobler CC, Morrow AS, Beuschel B
Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis.
The authors evaluated the comparative effectiveness and adverse events of pharmacologic interventions for adults with exacerbation of COPD. Sixty-eight randomized controlled trials were selected for evaluation and data extraction. They found that antibiotics and systemic corticosteroids reduced treatment failure in adults with mild to severe exacerbation of COPD.
Citation: Dobler CC, Morrow AS, Beuschel B . Pharmacologic therapies in patients with exacerbation of chronic obstructive pulmonary disease: a systematic review with meta-analysis. Ann Intern Med 2020 Mar 17;172(6):413-23. doi: 10.7326/m19-3007..
Keywords: Respiratory Conditions, Chronic Conditions, Evidence-based Practice, Patient-Centered Outcomes Research, Comparative Effectiveness, Medication, Antibiotics, Treatments, Adverse Drug Events (ADE), Adverse Events
Fan T, Fakolade A
AHRQ Author: Fan T
Medication use to reduce risk of breast cancer.
In this case study, a 40-year-old woman comes to her doctor’s office for a routine gynecologic visit. She is not taking any medications and is generally healthy. She is sexually active, and her last menstrual period started 10 days ago. She states that her mother was diagnosed with bilateral breast cancer at 49 years of age and that she would like to discuss her options for reducing the risk of breast cancer. Three questions are posed about risk-reducing medications.
Citation: Fan T, Fakolade A . Medication use to reduce risk of breast cancer. Am Fam Physician 2020 Mar 15;101(6):373-74..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Breast Cancer, Cancer, Medication, Risk, Prevention, Case Study, Women
Wilson N, Jehn M, Kisana H
Nurses' perceptions of implant barcode scanning in surgical services.
Health policy changes have prompted hospital systems to assess implementation of implant barcode scanning systems to capture unique device identifiers. The aims of this project were to assess predictors of operating room nurses' acceptance of a new implant barcode scanning system, describe operating room nurses' perceptions of the system value, and identify operating room nurses' perceived gaps in system implementation.
Citation: Wilson N, Jehn M, Kisana H . Nurses' perceptions of implant barcode scanning in surgical services. Comput Inform Nurs 2020 Mar;38(3):131-38. doi: 10.1097/cin.0000000000000579..
Keywords: Provider: Nurse, Provider, Surgery, Health Information Technology (HIT)