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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
1 to 25 of 12392 Research Studies DisplayedBeck AF, Henize AW, Klein MD
A data-driven approach to optimizing medical-legal partnership performance and joint advocacy.
This paper discusses ways that medical-legal partnerships (MLPs) have facilitated advocacy at both patient (client) and population levels. MLPs address health-harming legal needs experienced by low-income families. In particular, the article discusses the work of the MLP Cincinnati Child Health-Law Partnership (Child HeLP), a joint initiative that bridges the primary care clinics at Cincinnati Children’s with the Legal Aid Society of Greater Cincinnati (LASGC). The authors found that Child HeLP referral was associated with a 38% reduction in hospitalizations. They discuss their use of quality improvement (QI) methods and statistical process (SPC) charts to optimize their partnership and facilitate identification of patterns amenable to population-level action and policy change. They also discuss how additional clinical-community partnerships have followed the Child HeLP model. There have been 10,190 referrals to legal partners for 7,801 children since Child HeLP’s inception in 2008. The most common reasons for referral are housing instability/adverse housing quality (~40%), public benefit denials or delays (~25%), and unmet educational needs (~20%). Referrals have resulted in an estimated $1,360,000 in recovered benefits and improvements in housing conditions, educational achievement, and other benefits.
AHRQ-funded; HS027996.
Citation: Beck AF, Henize AW, Klein MD .
A data-driven approach to optimizing medical-legal partnership performance and joint advocacy.
J Law Med Ethics 2023 Winter; 51(4):880-88. doi: 10.1017/jme.2023.158..
Keywords: Quality Improvement, Quality of Care, Policy
Frehn JL, Starn BE, Rodriguez HP
Care redesign to support telemedicine implementation during the COVID-19 pandemic: federally qualified health center personnel experiences.
During the COVID-19 pandemic, federally qualified health centers (FQHCs) swiftly adopted telemedicine. In-depth interviews with FQHC staff revealed that while telemedicine improved access and reduced no-shows, it also hindered the development of strong clinician-patient relationships due to limitations in building interpersonal connections. To overcome this, FQHCs employed various strategies, such as triaging appointment types, addressing social needs remotely, and establishing new protocols for ensuring patient privacy during virtual visits. Additionally, they emphasized the need to improve remote monitoring capabilities for marginalized populations. This study highlights the need for guidelines and evidence-based practices to enhance telemedicine use in FQHCs, focusing on strengthening interpersonal connections, addressing social needs, and protecting patient privacy. Future research should investigate how telemedicine can best complement in-person care to optimize patient outcomes and clinic efficiency in safety net settings.
AHRQ-funded; HS000046.
Citation: Frehn JL, Starn BE, Rodriguez HP .
Care redesign to support telemedicine implementation during the COVID-19 pandemic: federally qualified health center personnel experiences.
J Am Board Fam Med 2023 Oct 11; 36(5):712-22. doi: 10.3122/jabfm.2022.220370R2..
Keywords: Telehealth, Health Information Technology (HIT), COVID-19, Community-Based Practice, Clinician-Patient Communication, Patient and Family Engagement
Wright B, Brookman-Frazee I, Alegría M
Shared decision making between community therapists and Latinx caregivers during evidence-based practice delivery in publicly-funded children's mental health services.
This observational study examined shared decision-making (SDM) with caregivers of Latinx youth in community mental health services. The OPTION instrument was used to measure SDM in 210 audio-recorded therapy sessions with community therapists and Latinx caregivers. Objectives were to characterize therapist use of SDM strategies and to describe types of treatment decisions that were the focus of therapist use of SDM. Results indicated that community therapists serving Latinx families naturalistically engaged in at least one SDM step in most sessions at modest levels. These were divided into four superordinate categories of decisions: Treatment planning, Evidence-based Parenting Strategies, Addressing Youth Functioning, and Addressing Family Psychosocial Needs
AHRQ-funded; HS000046.
Citation: Wright B, Brookman-Frazee I, Alegría M .
Shared decision making between community therapists and Latinx caregivers during evidence-based practice delivery in publicly-funded children's mental health services.
Patient Educ Couns 2023 Oct; 115:107867. doi: 10.1016/j.pec.2023.107867..
Keywords: Shared Decision Making, Racial and Ethnic Minorities, Evidence-Based Practice, Children/Adolescents, Behavioral Health
Solberg LI, Ziegenfuss JY, Rivard RL
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
The goal of this study was to test the feasibility of collecting qualitative patient-preferred goals and its feasibility as an addition to a standardized process for collecting quantitative composite patient-reported outcome measures (PROMs) from patients undergoing knee joint replacement. The study found that joint replacement patients who responded to quantitative PROMS were willing to report on their other preferred outcomes.
AHRQ-funded; HS025618.
Citation: Solberg LI, Ziegenfuss JY, Rivard RL .
Is there room for individual patient-specified preferences in the patient-reported outcome measurement revolution?
J Patient Cent Res Rev 2023 Fall; 10(4):210-18. doi: 10.17294/2330-0698.2017..
Keywords: Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Xiao Y, Miller K, Werner N
Co-design with patients for improving patient safety: strategies, barriers and pitfalls.
The purpose of this paper was to review discussion from a panel conducted to explore the spectrum of inclusion, engagement, and strategies with patients and family members in patient safety research. Strategies and barriers are included as a springboard for exploration of how to engage patients and family members in co-design of "work systems" and patient-professional collaborative work.
AHRQ-funded; HS028409.
Citation: Xiao Y, Miller K, Werner N .
Co-design with patients for improving patient safety: strategies, barriers and pitfalls.
Proc Hum Factors Ergon Soc Annu Meet 2023 Sep; 67(1):633-38. doi: 10.1177/21695067231192416..
Keywords: Patient Safety, Patient and Family Engagement
Isbell LM, Graber ML, Rovenpor DR
Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.
The purpose of this randomized experiment study was to investigate the influence of comorbid depression on diagnostic accuracy. The researchers utilized an interactive vignette that described a patient with a complex presentation of pernicious anemia. Fifty-nine physician participants were randomized to diagnose either a patient with or without (control) comorbid depression and related behaviors. All other clinical information was identical. Physicians recorded a differential diagnosis, ordered tests, and rated patient likeability. The study found that the patient with comorbid depression was less likeable than the control patient. Accuracy of diagnosis was lower in the depression condition compared to the control condition, but this difference was not statistically significant. Accuracy was lower in the depression condition (vs. control) when physicians ordered less tests, but there was no variation for physicians who ordered more tests.
AHRQ-funded; HS025752.
Citation: Isbell LM, Graber ML, Rovenpor DR .
Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.
Diagnosis 2023 Aug; 10(3):257-66. doi: 10.1515/dx-2020-0106..
Keywords: Depression, Behavioral Health
McGuier EA, Kolko DJ, Stadnick NA
Advancing research on teams and team effectiveness in implementation science: an application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
This article described the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, a flexible tool that can facilitate the application of team effectiveness approaches in implementation science. The authors provided an overview of key constructs in team effectiveness research. They also described ways to conceptualize different types of teams and team constructs relevant to implementation within the EPIS framework, and identify future directions for research. Three case examples are used to illustrate the application of EPIS to implementation studies involving teams.
AHRQ-funded; HS026862.
Citation: McGuier EA, Kolko DJ, Stadnick NA .
Advancing research on teams and team effectiveness in implementation science: an application of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
Implement Res Pract 2023 Jan-Dec; 4:26334895231190855. doi: 10.1177/26334895231190855..
Keywords: Teams, Implementation, Health Services Research (HSR)
Catchpole K, Cohen T, Alfred M
Human factors integration in robotic surgery.
This study used the example of robotic-assisted surgery (RAS) to explore the methodological and practical challenges of technology integration in surgery, provide examples of evidence-based improvements, and discuss the importance of systems engineering and clinical human factors research and practice. The authors reviewed studies on workload, communication, workflow, workspace, and coordination in robotic surgery, and then discuss the potential for improvement that these studies suggest within the wider healthcare system. They concluded that there is a growing need to understand and develop approaches to safety and quality improvement through human-systems integration at the frontline of care.
AHRQ-funded; HS026491.
Citation: Catchpole K, Cohen T, Alfred M .
Human factors integration in robotic surgery.
Hum Factors 2024 Mar; 66(3):683-700. doi: 10.1177/00187208211068946..
Keywords: Surgery
Ghule P, Panic J, Malone DC P, Panic J, Malone DC
Risk of bleeding with concomitant use of oral anticoagulants and aspirin: a systematic review and meta-analysis.
The purpose of this study was to compare bleeding risks associated with the combined use of oral anticoagulants (OACs) and aspirin versus their individual use. The study involved a systematic review of literature from MEDLINE and Web of Science, focusing on both randomized controlled trials (RCTs) and observational studies that reported bleeding events in patients using OAC plus aspirin compared to those using either medication alone. The analysis included 42 studies in total. When examining the combination of OAC and aspirin versus OAC alone, a significant increase in bleeding risk was observed in both RCTs and observational studies. The odds of bleeding were approximately 1.4 times higher with the combination therapy in both types of studies. Comparing OAC plus aspirin to aspirin alone, RCTs showed a substantial increase in bleeding risk with the combination therapy, with the odds of bleeding being more than twice as high. However, observational studies did not demonstrate a statistically significant difference in bleeding risk between these groups, although there was a trend toward increased risk with combination therapy.
AHRQ-funded; HS025984.
Citation: Ghule P, Panic J, Malone DC P, Panic J, Malone DC .
Risk of bleeding with concomitant use of oral anticoagulants and aspirin: a systematic review and meta-analysis.
Am J Health Syst Pharm 2024 Jun 11; 81(12):494-508. doi: 10.1093/ajhp/zxae010..
Keywords: Blood Thinners, Medication, Adverse Drug Events (ADE), Adverse Events
Henderson JT, Webber EM, Weyrich MS
Screening for breast cancer: evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this study was to review research on various breast cancer screening strategies for the US Preventive Services Task Force. The researchers analyzed randomized clinical trials and nonrandomized studies, focusing on different screening approaches and their associated outcomes. The review encompassed seven randomized clinical trials and 13 nonrandomized studies, with only two nonrandomized studies reporting mortality outcomes. A nonrandomized trial emulation study found no significant mortality difference for screening beyond age 74 years. Advanced cancer detection rates were similar for annual and biennial screening intervals in a nonrandomized study. Three trials comparing digital breast tomosynthesis (DBT) mammography screening with digital mammography alone showed that DBT detected more invasive cancers at the first screening round, but there were no significant differences in interval cancers or risk of advanced cancer at subsequent screenings. Limited evidence suggested lower recall rates with DBT. For individuals with dense breasts, supplemental screening with magnetic resonance imaging reduced interval cancer risk but increased false-positive recalls and biopsies. Supplemental ultrasound screening showed no differences in interval cancers but increased false-positives.
AHRQ-funded; 75Q80120D00004.
Citation: Henderson JT, Webber EM, Weyrich MS .
Screening for breast cancer: evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2024 Jun 11; 331(22):1931-46. doi: 10.1001/jama.2023.25844..
Keywords: U.S. Preventive Services Task Force (USPSTF), Cancer: Breast Cancer, Women, Screening, Evidence-Based Practice, Guidelines, Prevention, Cancer
Grigoryan L, Trautner BW
Antibiotic stewardship interventions for urinary tract infections in outpatient settings: a narrative review.
Antibiotic misuse in treating urinary tract infections (UTIs) in outpatients is widespread, contributing significantly to antibiotic overuse. While multifaceted interventions involving pre- or post-design strategies have shown promise in improving antibiotic use for UTIs, the long-term sustainability of audit and feedback, a common approach, remains uncertain. Future investigations into outpatient antibiotic stewardship for UTIs should focus on assessing both the effectiveness of interventions and the feasibility of their implementation.
AHRQ-funded; HS029489.
Citation: Grigoryan L, Trautner BW .
Antibiotic stewardship interventions for urinary tract infections in outpatient settings: a narrative review.
Infect Dis Clin North Am 2024 Jun; 38(2):277-94. doi: 10.1016/j.idc.2024.03.006..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Urinary Tract Infection (UTI), Ambulatory Care and Surgery
Barbash IJ, Davis BS, Saul M
Association Between Medicare's sepsis reporting Policy (SEP-1) and the documentation of a sepsis diagnosis in the clinical record.
An interrupted time series analysis examined the impact of Medicare's sepsis reporting measure (SEP-1) on sepsis diagnosis rates in 11 hospitals over 5 years. The study found that SEP-1 implementation was associated with a modest increase in sepsis diagnoses documented in clinical notes, rising from 32.2% just before implementation to 37.3% by the end of the study period. This increase was statistically significant and more pronounced in patients who did not require vasopressors. While the overall effect was relatively small, these findings suggest that policy measures like SEP-1 can influence sepsis diagnosis rates, particularly in less severe cases.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Davis BS, Saul M .
Association Between Medicare's sepsis reporting Policy (SEP-1) and the documentation of a sepsis diagnosis in the clinical record.
Med Care 2024 Jun; 62(6):388-95. doi: 10.1097/mlr.0000000000001997..
Keywords: Sepsis, Medicare
Bardia A, Michel G, Farela A
Association of adherence to individual components of Society of Thoracic Surgeons cardiac surgery antibiotic guidelines and postoperative infections.
This retrospective observation study examined the association between the 4 components of the Society of Thoracic Surgeons antibiotic guidelines and postoperative complications in a cohort of patients undergoing valve or coronary artery bypass grafting requiring cardiopulmonary bypass. The incidence of nonadherence to the 4 individual components was 7.9% for timing of first dose, 22.6% for antibiotic choice, 5.8% for weight-based dose adjustment, and 6.8% for intraoperative redosing. Failure to adhere to first dose timing guidelines was directly associated with Society of Thoracic Surgeons-adjudicated postoperative infection (odds ratio, 1.9). Failure of weight-adjusted dosing was associated with both postoperative sepsis and 30-day mortality. There were no significant associations among the 4 Society of Thoracic Surgeons metrics individually or as a combination that were observed with postoperative infection, sepsis, or 30-day mortality.
AHRQ-funded; HS029172.
Citation: Bardia A, Michel G, Farela A .
Association of adherence to individual components of Society of Thoracic Surgeons cardiac surgery antibiotic guidelines and postoperative infections.
J Thorac Cardiovasc Surg 2024 Jun; 167(6):2170-76.e5. doi: 10.1016/j.jtcvs.2023.03.031..
Keywords: Cardiovascular Conditions, Surgery, Antibiotics, Guidelines, Medication
Bartsch SM, Weatherwax C, Martinez MF
Cost-effectiveness of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing and isolation strategies in nursing homes.
This study examined the question when and how often nursing homes should test staff for COVID-19 and how this may change as severe acute respiratory coronavirus virus 2 (SARS-CoV-2) evolves. In winter 2023-2024, when the SARS-CoV-2 omicron variant was prevalent, symptom-based antigen testing averted 4.5 COVID-19 cases compared to no testing, saving $191 in direct medical costs. Testing implementation costs far outweighed these savings, resulting in net costs of $990 from the CMS perspective, $1,545 from the third-party payer perspective, and $57,155 from the societal perspective. Testing did not return sufficient positive health effects to make it cost-effective, but it exceeded this threshold in ≥59% of simulation trials. However, if conditions changed to make a severe outcome risk ≥3 times higher than that of current omicron variants, all antigen testing strategies became cost-effective (≤$31,906 per QALY) or cost saving (saving ≤$18,372).
AHRQ-funded; HS028165.
Citation: Bartsch SM, Weatherwax C, Martinez MF .
Cost-effectiveness of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing and isolation strategies in nursing homes.
Infect Control Hosp Epidemiol 2024 Jun; 45(6):754-61. doi: 10.1017/ice.2024.9..
Keywords: COVID-19, Healthcare Costs, Nursing Homes, Diagnostic Safety and Quality
Ellenbogen MI, Weiner JP, Zhu Y
Development of a hospital coding intensity measure based on sepsis diagnoses.
This study’s goal was to develop a hospital coding intensity measure based on sepsis diagnoses. The authors hypothesized that coded sepsis rates among patients hospitalized with common infections may serve as a useful surrogate for coding intensity and derived a hospital-level sepsis coding intensity measure using prevalence of "sepsis" primary diagnoses among patients hospitalized with urinary tract infection, cellulitis, and pneumonia. This was well correlated with the hospital mean number of discharge diagnoses, which has historically been used to quantify hospital-level coding intensity. It also has the advantage of inferring hospital coding intensity without the strong association with comorbidity that the mean number of discharge diagnoses has.
AHRQ-funded; HS028673; HS029350.
Citation: Ellenbogen MI, Weiner JP, Zhu Y .
Development of a hospital coding intensity measure based on sepsis diagnoses.
J Hosp Med 2024 Jun; 19(6):505-07. doi: 10.1002/jhm.13351..
Keywords: Sepsis, Hospitals
Ehmann MR, Klein EY, Zhao X
Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study.
This retrospective cohort study’s objective was to describe the epidemiology of community-acquired acute kidney injury (CA-AKI) in the United States and the associated clinical outcomes. CA-AKI was identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine (Scr)-based criteria. Outcomes for encounters resulting in hospitalization included the in-hospital trajectory of AKI severity, dialysis initiation, intensive care unit (ICU) admission, and death. Outcomes for all encounters included occurrence over 180 days of hospitalization, ICU admission, new or progressive chronic kidney disease, dialysis initiation, and death. For all encounters, 10.4% of patients met the criteria for any stage of AKI on arrival to the ED, with 16.6% of patients admitted to the hospital from the ED having CA-AKI on arrival to the ED. The likelihood of AKI recovery was inversely related to the CA-AKI stage on arrival to the ED. Among encounters for hospitalized patients, CA-AKI was associated with in-hospital dialysis initiation, ICU admission, and death compared with patients without CA-AKI. Among all encounters, CA-AKI was associated with new or progressive chronic kidney disease, dialysis initiation, subsequent hospitalization including ICU admission, and death during the subsequent 180 days.
AHRQ-funded; HS027793; HS026640.
Citation: Ehmann MR, Klein EY, Zhao X .
Epidemiology and clinical outcomes of community-acquired acute kidney injury in the emergency department: a multisite retrospective cohort study.
Am J Kidney Dis 2024 Jun; 83(6):762-71.e1. doi: 10.1053/j.ajkd.2023.10.009..
Keywords: Community-Acquired Infections, Kidney Disease and Health, Emergency Department, Outcomes
Harrison MI, Borsky AE
AHRQ Author: Harrison MI
Funding learning health system research: challenges and strategies.
The purpose of this study was to explore the challenges and strategies associated with funding learning health system (LHS) research programs. The researchers conducted qualitative case studies of LHS initiatives in five health systems, gathering data through 38 semi-structured interviews with 35 diverse participants over an 18-month period. The analysis revealed that while external funding for LHS research facilitated some internal improvements, scientific advancements, and enhanced reputation, it also created challenges in responding to the immediate needs of health system stakeholders. Discrepancies between external funding requirements and internally focused projects were identified in various areas, including objectives, practical applicability, target audiences, timelines, routines, required skill sets, and researchers' career paths. To contribute more effectively to system improvement, LHS researchers needed to collaborate with clinicians and other non-researchers, and adapt to both long-term research studies and shorter, dynamic improvement projects. The study found that support from system executives was crucial in implementing strategies to enhance researchers' internal contributions. Key strategies employed by LHS program leaders included aligning funded research topics with long-term system needs, securing internal funding for implementing and sustaining practice changes, and diversifying funding sources.
AHRQ-authored.
Citation: Harrison MI, Borsky AE .
Funding learning health system research: challenges and strategies.
Acad Med 2024 Jun; 99(6):673-82. doi: 10.1097/acm.0000000000005661..
Keywords: Learning Health Systems, Health Systems
Goedken AM, Ismail WW, Barrett LDG
Kidney transplantation in patients with tuberous sclerosis complex.
This study investigated kidney transplantation patterns among patients with tuberous sclerosis complex (TSC), a disorder affecting the mTOR pathway that can lead to renal angiomyolipoma and chronic kidney disease. The researchers conducted a retrospective cohort analysis using United Network for Organ Sharing (UNOS) data, focusing on individuals waitlisted for their first kidney transplant due to TSC-associated kidney failure between 1987 and 2020. The study identified 200 patients with TSC-associated kidney failure on the waitlist, including 12 pediatric cases. Women comprised two-thirds of the waitlisted individuals. Of the total cohort, 140 patients received a transplant, with a median waitlist duration of two years. The analysis revealed that younger age at the time of waitlisting was associated with a higher likelihood of proceeding to transplantation. Post-transplant outcomes were promising, with 91.8% of recipients surviving with a functioning allograft one year after the procedure. These findings suggest that most TSC patients who are waitlisted for kidney transplantation do receive a transplant and experience favorable short-term outcomes.
AHRQ-funded; HS029292.
Citation: Goedken AM, Ismail WW, Barrett LDG .
Kidney transplantation in patients with tuberous sclerosis complex.
Pediatr Transplant 2024 Jun; 28(4):e14765. doi: 10.1111/petr.14765..
Keywords: Transplantation, Kidney Disease and Health
Ahmed M, Pu A, Jencks K
Predictors of irritable bowel syndrome-like symptoms in quiescent inflammatory bowel disease.
This study’s aim was to identify risk factors development of irritable bowel syndrome (IBS)-like symptoms in quiescent inflammatory bowel disease (IBD) patients. The authors performed a single-center retrospective cohort study of adults with IBD from 2015 to 2021. Quiescent IBD was defined by a fecal calprotectin level <250 μg/g of stool or through endoscopic evidence of quiescent disease. The cohort included 386 IBD patients, including 278 patients with UC and 88 with Crohn's disease. 15.5% of quiescent IBD patients developed IBS symptoms, with an incidence rate of 63.3 per 1000 person-years. Mood disorders (including anxiety and depression) and Crohn's disease were associated with increased risk for developing IBS symptoms, with male sex and higher iron levels conferring lower risk.
AHRQ-funded; HS027431.
Citation: Ahmed M, Pu A, Jencks K .
Predictors of irritable bowel syndrome-like symptoms in quiescent inflammatory bowel disease.
Neurogastroenterol Motil 2024 Jun; 36(6):e14809. doi: 10.1111/nmo.14809..
Keywords: Digestive Disease and Health
Dossabhoy SS, Fisher AT, Chang TI
Preoperative proteinuria is independently associated with mortality after fenestrated endovascular aneurysm repair.
This study’s objective was to determine whether preoperative proteinuria impacts long-term survival after fenestrated endovascular aneurysm repair (FEVAR). This review looked at all elective FEVAR. Preoperative proteinuria was assessed by urinalysis on a scale of 0 to 3+. Proteinuria was defined as ≥30 mg/dL from urinalysis. The primary outcome was all-cause mortality. Among 181 FEVAR patients from 2012 to 2022, any proteinuria was noted in 30 patients (16.6%). Patients with proteinuria were more likely to be Black (10.0% vs 1.3%) with a lower estimated glomerular filtration rate (eGFR), higher Society for Vascular Surgery comorbidity score, and calcium channel blocker therapy (50.0% vs 29.1%), and larger maximal aneurysm diameter. Thirty-day mortality was higher in the proteinuria group. Overall survival at 1 and 5 years was significantly lower for those with proteinuria. Preoperative proteinuria was independently associated with over threefold higher hazard of mortality, whereas preoperative eGFR was not predictive. Additional significant predictors included chronic obstructive pulmonary disease, older age, and larger maximal aneurysm diameter.
AHRQ-funded; HS026128.
Citation: Dossabhoy SS, Fisher AT, Chang TI .
Preoperative proteinuria is independently associated with mortality after fenestrated endovascular aneurysm repair.
J Vasc Surg 2024 Jun; 79(6):1360-68.e3. doi: 10.1016/j.jvs.2024.01.013..
Keywords: Mortality, Cardiovascular Conditions
Ilkhani S, Naus AE, Pinkes N
The invisible scars: unseen financial complications worsen every aspect of long-term health in trauma survivors.
This study investigated financial toxicity (FT) among trauma survivors, aiming to understand its prevalence, risk factors, and impact on long-term outcomes. The researchers interviewed adult trauma patients with an Injury Severity Score of 9 or higher from Level I trauma centers, 6 to 14 months after discharge. FT was defined as experiencing income loss, lack of care, newly applied or qualified governmental assistance, new financial problems, or work loss due to injury. The study found that 44% of the 577 participants experienced some form of FT. Protective factors against FT included older age and stronger social support networks. Conversely, having two or more comorbidities, lower education levels, and injuries from road accidents or intentional causes were associated with higher FT risk. Notably, injury severity, sex, and single-family household status did not show significant relationships with FT. Patients experiencing FT demonstrated worse outcomes across all health domains measured by the Patient Reported Outcome Measure Index System (PROMIS). A negative linear relationship was observed between FT severity and both mental and physical health scores.
AHRQ-funded; HS028672.
Citation: Ilkhani S, Naus AE, Pinkes N .
The invisible scars: unseen financial complications worsen every aspect of long-term health in trauma survivors.
J Trauma Acute Care Surg 2024 Jun; 96(6):893-900. doi: 10.1097/ta.0000000000004247..
Keywords: Trauma, Healthcare Costs, Health Status, Injuries and Wounds
Beiter ER, Shanbhag A, Junge-Maughan L
Interdisciplinary videoconference model for identifying potential adverse transition of care events following hospital discharge to postacute care.
This paper discusses the development of an interdisciplinary videoconference model for identifying potential adverse transition of care events for older adults following hospital discharge to postacute care. The authors developed the Extension for Community Healthcare Outcomes-Care Transitions (ECHO-CT) program in an effort to mitigate these risks through a mulitdisciplinary, educational, case-based teleconference between hospital and skilled nursing facility providers. The program was implemented in academic and community hospitals. Weekly sessions were held for clinicians to discuss patients discharged from the hospital, to address clinical concerns, identify errors in care and create plans for remediation, with a total of 1432 discussions occurring for 1326 patients. In 435 discussions, an issue was identified that required further discussion, and the majority of these were related to medications. A medical error defined as 'any preventable event that may cause or lead to inappropriate medical care or patient harm', was identified in 14.7% of all discussions. They found that errors were more likely to occur for patients discharged from surgical services or the emergency department (as compared with medical services) and were less likely to occur for patients who were discharged in the morning.
AHRQ-funded; HS025702.
Citation: Beiter ER, Shanbhag A, Junge-Maughan L .
Interdisciplinary videoconference model for identifying potential adverse transition of care events following hospital discharge to postacute care.
BMJ Open Qual 2024 May 24; 13(2). doi: 10.1136/bmjoq-2023-002508..
Keywords: Transitions of Care, Hospital Discharge, Communication, Elderly, Patient Safety
Bunni D, Walters G, Hwang M
Oncology patients' willingness to report their medication safety concerns from home: a qualitative study.
This study’s purpose was to explore the factors influencing oncology patients' willingness to report adverse events or concerns related to their medication after their transitions back home. This qualitative interview study was conducted with adult patients with breast, prostate, lung, or colorectal cancer. The authors developed a semi-structured interview guide to understand patients' perceptions of reporting mediation-related safety events or concerns from home. Three main themes and six subthemes emerged, including patients’ perceived relationship with clinicians, perceived severity of adverse medication events, and patient activation in self-management. The patient-clinician relationship was a significant factor in patients’ reporting behaviors, which can potentially interact with other factors, including the severity of adverse events. The authors emphasized the importance of engaging oncology patients in medication safety self-reporting from home by enhancing health communication, understanding patients' perceptions of severe events, and promoting patient activation.
AHRQ-funded; HS027846.
Citation: Bunni D, Walters G, Hwang M .
Oncology patients' willingness to report their medication safety concerns from home: a qualitative study.
Support Care Cancer 2024 May 15; 32(6):352. doi: 10.1007/s00520-024-08565-5..
Keywords: Medication: Safety, Medication
Cordwin DJ, Guidi J, Alhashimi L
Differences in provider approach to initiating and titrating guideline directed medical therapy in heart failure with reduced ejection fraction.
This survey examined differences in provider approach to initiating and titrating guideline-directed medical therapy (GMDT) in patients with heart failure with reduced ejection fraction (HFrEF). The authors designed a survey with 20 clinical vignettes of patients with HFrEF which was answered by a national sample of 127 cardiologists and 68 internal/family medicine physicians. Each vignette had four or five options for adjusting GDMT and the option to make no medication changes, with respondents only able to select one option. Cardiologists were more likely to make GDMT changes than general medicine physicians (91.8% vs. 82.0%). Cardiologists were also more likely to initiate beta-blockers (46.3% vs. 32.0%), angiotensin receptor blocker/neprilysin inhibitor (ARNI) (63.8% vs. 48.1%), and hydralazine and isosorbide dinitrate (HYD/ISDN) (38.2% vs. 23.7%) compared to general medicine physicians. There were no differences found in initiating angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARBs), or mineralocorticoid receptor antagonist (MRA), sodium-glucose transporter protein 2 (SGLT2) inhibitors, digoxin, or ivabradine.
AHRQ-funded; HS026874.
Citation: Cordwin DJ, Guidi J, Alhashimi L .
Differences in provider approach to initiating and titrating guideline directed medical therapy in heart failure with reduced ejection fraction.
BMC Cardiovasc Disord 2024 May 11; 24(1):247. doi: 10.1186/s12872-024-03911-1..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Guidelines, Evidence-Based Practice
Cohen DJ, Totten AM, Phillips RL
Measuring primary care spending in the US by state.
This study analyzed methods of states’ estimates of primary care spending that was discussed in AHRQ Technical Brief No. 44. Ten states were analyzed, with Maine, Utah, Virginia, and Washington using different narrow definitions of primary care. Maryland, Maine, Virginia, Utah, and Washington used broad definitions of primary care while Connecticut, Massachusetts, Vermont, and Colorado not defining primary care as narrow or broad. All ten states estimated primary care spending by payer type and for commercial payers. Some provided estimates for Medicaid, Medicare Advantage, and Medicare Fee-for-Service. The authors identified sizable differences in state primary care spending estimates. They could not determine if spending differs across states, time, or in response to policies because there is no standard measure of measurement. They recommend steps policymakers can take towards standardizing those estimates.
AHRQ-funded; 75Q80120D00006.
Citation: Cohen DJ, Totten AM, Phillips RL .
Measuring primary care spending in the US by state.
JAMA Health Forum 2024 May 3; 5(5):e240913. doi: 10.1001/jamahealthforum.2024.0913..
Keywords: Primary Care, Healthcare Costs