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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.
Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?
The researchers sought to validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data. They concluded that EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients.
J Am Med Inform Assoc 2015 Jul;22(4):909-13. doi: 10.1093/jamia/ocv033.
AHRQ-funded; HS021522.
View abstract on the National Library of Medicine site.
Keywords: Electronic Health Records (EHRs), Health Insurance, Medicaid, Low-Income Population, Children
Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
The researchers investigated changes in trend for type 2 diabetes mellitus (DM-II) quality indicators after patient-centered medical home (PCMH) implementation at Southcentral Foundation, a tribal health organization in Alaska. They found that rates of new DM-II diagnoses were stable prior to but increased after implementation. DM-II rates of HbA1c screening increased, though not significantly before and remained stable after implementation.
Prim Care Diabetes 2015 Apr;9(2):120-6. doi: 10.1016/j.pcd.2014.06.005.
AHRQ-funded; HS019154.
View abstract on the National Library of Medicine site.
Keywords: Quality Indicators, Diabetes, Patient-Centered Medical Home, Primary Care, Prevention and Care Management
Management of chronic pain in older adults.
This review summarized recent evidence on the assessment and management of pain in older patients. Evidence is taken from systematic reviews, meta-analyses, individual trials, and clinical guidelines. Based on their review, the authors argue that all older adults with chronic pain should undergo a comprehensive geriatric pain assessment and that a comprehensive assessment can guide selection of treatments most likely to benefit the patient and identify targets for intervention besides pain relief.
BMJ 2015;350:h532. doi: 10.1136/bmj.h532.
AHRQ-funded; HS020648.
View abstract on the National Library of Medicine site.
Keywords: Chronic Pain, Elderly, Comparative Effectiveness, Prevention and Care Management
Implementing quality measures for inflammatory bowel disease.
The author argues that implementation of quality measures may depend on the care setting and whether quality measurement and improvement can be incorporated into workflows and electronic medical records. He also asserts that collaborative networks, utilization of care pathways, and standardized treatment algorithms may represent avenues for wide-scale implementation of quality improvement.
Curr Gastroenterol Rep 2015 Apr;17(4):14. doi: 10.1007/s11894-015-0437-1.
AHRQ-funded; HS021747.
View abstract on the National Library of Medicine site.
Keywords: Quality Measures, Health Care Quality, Quality Improvement, Electronic Medical Records (EMRs), Health Information Technology (HIT)
Primary adherence to controller medications for asthma is poor.
The objective of this study was to compare real-world adherence, including both primary and secondary adherence, to the major controller regimens (inhaled corticosteroids (ICSs), leukotriene antagonists (LTRAs), or ICS/long-acting b-agonists (ICS/LABAs) in diverse, insured populations. It found that adherence to controller medications is poor and many patients do not ever fill prescriptions for controller medications. However, primary adherence to ICSs was better than to LTRAs and ICS/LABAs.
Ann Am Thorac Soc 2015 Feb;12(2):161-6. doi: 10.1513/AnnalsATS.201410-459OC.
AHRQ-funded; HS019669.
View abstract on the National Library of Medicine site.
Keywords: Asthma, Patient Adherence, Medications, Comparative Effectiveness
Variation in hospital mortality rates with inpatient cancer surgery.
The purpose of this national study was to elucidate clinical mechanisms underlying variation in hospital mortality with major cancer surgery. It found that case-fatality rates among patients with complications at high-mortality hospitals were approximately twice as high as at low-mortality hospitals. This study implicates failure to rescue as the major reason for differences in hospital mortality rates with major cancer surgery.
Ann Surg 2015 Apr;261(4):632-6. doi: 10.1097/sla.0000000000000690.
AHRQ-funded; HS020937.
View abstract on the National Library of Medicine site.
Keywords: Mortality, Surgery, Cancer, Patient Safety, Health Care Quality
National trends in patient safety for four common conditions, 2005-2011.
The researchers estimated trends in the rate of occurrence of adverse events for which patients were at risk, the proportion of patients with one or more adverse events, and the number of adverse events per 1000 hospitalizations. From 2005 through 2011, adverse-event rates declined substantially among patients hospitalized for acute myocardial infarction or congestive heart failure but not among those hospitalized for pneumonia or conditions requiring surgery.
AHRQ-authored; AHRQ-funded; 290201200003C.
N Engl J Med 2014 Jan 23;370(4):341-51. doi: 10.1056/NEJMsa1300991.
AHRQ-authored; AHRQ-funded; 290201200003C.
View abstract on the National Library of Medicine site.
Keywords: Patient Safety, Adverse Medical Events, Hospitalization, Myocardial Infarction, Heart Failure
Rethinking elective colectomy for diverticulitis: a strategic approach to population health.
The authors argue that a rethinking of elective colectomy should come from a patient-centered approach that considers the risks of recurrence, quality of life, patient wishes and experiences about surgical and medical treatment options as well as operative morbidity and risks.
World J Gastroenterol 2014 Nov 28;20(44):16609-14. doi: 10.3748/wjg.v20.i44.16609.
AHRQ-funded; HS020025.
View abstract on the National Library of Medicine site.
Keywords: Patient-Centered Outcomes Research, Comparative Effectiveness, Surgery, Adverse Medical Events, Risk Factors
Impact of an electronic alert notification system embedded in radiologists' workflow on closed-loop communication of critical results: a time series analysis.
The researchers evaluated the impact of a patient safety initiative with an alert notification system on reducing critical results lacking documented communication, and assessed potential overuse of the alerting system for communicating results. They found that a patient safety initiative with an alert notification system reduced the proportion of critical results among reports lacking documented communication between care providers.
BMJ Qual Saf 2016 Jul;25(7):518-24. doi: 10.1136/bmjqs-2015-004276.
AHRQ-funded; HS022586.
View abstract on the National Library of Medicine site.
Keywords: Patient Safety, Health Information Technology (HIT), Communications
Citation searches are more sensitive than keyword searches to identify studies using specific measurement instruments.
This study compared the effectiveness of two search methods in identifying studies that used the Control Preferences Scale (CPS), a health care decision-making instrument commonly used in clinical settings. It found that keyword searches in bibliographic databases yielded high average precision (90%) but low average sensitivity (16%). PubMed was the most precise, followed closely by Scopus and WOS.
J Clin Epidemiol 2015 Apr;68(4):412-7. doi: 10.1016/j.jclinepi.2014.10.008.
AHRQ-funded; HS022134.
View abstract on the National Library of Medicine site.
Keywords: Research Methodologies, Decisionmaking, Evidence-based Research
National trends in heart failure hospitalization after acute myocardial infarction for Medicare beneficiaries: 1998-2010.
This study used a complete national sample of 2 789 943 AMI hospitalizations of Medicare fee-for-service beneficiaries from 1998 through 2010, we evaluated annual changes in the incidence of subsequent heart failure (HF) hospitalization and mortality using Poisson and survival analysis models. It found that HF hospitalization after AMI decreased from 1998 to 2010, which may indicate improvements in the management of AMI.
Circulation 2013 Dec 17;128(24):2577-84. doi: 10.1161/circulationaha.113.003668.
AHRQ-funded; HS018781.
View abstract on the National Library of Medicine site.
Keywords: Hospitalization, Medicare, Myocardial Infarction, Heart Failure, Mortality
Reliable implementation of evidence: a qualitative study of antenatal corticosteroid administration in Ohio hospitals.
The objective of this study was to understand conditions that enable delivery of antenatal corticosteroid administration (ANCS) with high reliability among hospitals participating in an Ohio Perinatal Quality Collaborative (OPQC) ANCS project. Among the major themes supporting reliable implementation of ANCS at these hospitals that emerged were: (1) presence of a high reliability culture, (2) processes that emphasize high reliability, and (3) timely and efficient administration process.
BMJ Qual Saf 2016 Jun 8;25(3):173-81. doi: 10.1136/bmjqs-2015-003984.
AHRQ-funded; HS021114.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Patient-Centered Outcomes Research, Maternal Care, health care delivery
A qualitative study of vulnerable patient views of type 2 diabetes consumer reports.
This study aims to identify whether vulnerable populations with type 2 diabetes perceive consumer reports as helpful in making decisions about diabetes care. It found that participants in 18 focus groups expressed minimal interest in currently available consumer reports. They instead listed personal referrals and interpersonal interactions among the most important factors when choosing a physician.
Patient 2016 Jun;9(3):231-40. doi: 10.1007/s40271-015-0146-8.
AHRQ-funded; HS021902.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Consumer Information and Education, Consumer Health, Decisionmaking, Chronic Care: Management
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005.
AHRQ-funded; HS019815.
View abstract on the National Library of Medicine site.
Keywords: Diabetes, Prevention and Care Management, Health Care Utilization, Primary Care
Screening for chronic obstructive pulmonary disease (COPD) in an urban HIV clinic: a pilot study.
This study aimed to determine the predictive value of a COPD screening strategy validated in the general population and to identify HIV-related factors associated with decreased lung function. It found that questionnaire and peak flow together had low sensitivity, but abnormal peak flow shows potential as a screening tool for COPD in HIV/AIDS. These data suggest that lung function may be influenced by HIV-related factors.
AIDS Patient Care STDS 2015 May;29(5):232-9. doi: 10.1089/apc.2014.0265.
AHRQ-funded; HS000066.
View abstract on the National Library of Medicine site.
Keywords: Human Immunodeficiency Virus (HIV), Screening, Chronic Obstructive Pulmonary Disease (COPD)
Hospital revisits within 30 days after conventional and robotically assisted hysterectomy.
This study compared the rates of hospital readmissions, emergency department, and outpatient clinic visits after discharge for robotically assisted (RA) versus nonrobotic hysterectomy in women age 30 or more with nonmalignant conditions. It found that using 2 different methods to control for selection, there were higher rates of revisits among women undergoing RA versus non-RA hysterectomy for benign conditions.
Med Care 2016 Mar;54(3):311-8. doi: 10.1097/mlr.0000000000000482.
AHRQ-authored
View abstract on the National Library of Medicine site.
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Gynecologic Care, Emergency Medical Services (EMS), Hospital Outpatient Care
How hospitals reengineer their discharge processes to reduce readmissions.
The Re-Engineered Discharge (RED) program is a hospital-based initiative shown to decrease hospital reutilization. Researchers implemented the RED in 10 hospitals to study the implementation process. They found wide variability in the fidelity of the RED intervention. Engaged leadership and multidisciplinary implementation teams were keys to success of the program. Eight out of 10 hospitals reported improvement in 30-day readmission rates after RED implementation.
J Healthc Qual 2016 Mar-Apr;38(2):116-26. doi: 10.1097/jhq.0000000000000005.
AHRQ-authored; AHRQ-funded; 290200600012I.
View abstract on the National Library of Medicine site.
Keywords: ReEngineered Discharge, Readmissions, Hospital Discharge
Process and outcome measures among COPD patients with a hospitalization cared for by an advance practice provider or primary care physician.
This study examined the process and outcomes of care of chronic obstructive pulmonary disease (COPD) patients by Advanced Practice Providers (APPs) and primary care physicians. It found that, compared to patients cared for by physicians, patients cared for by APPs were more likely to receive short acting bronchodilator, oxygen therapy and have been referred to a pulmonologist; however they had lower rates of vaccination probably due to lower age group.
PLoS One 2016 Feb 24;11(2):e0148522. doi: 10.1371/journal.pone.0148522.
AHRQ-funded; HS020642; HS022134.
View abstract on the National Library of Medicine site.
Keywords: Chronic Obstructive Pulmonary Disease (COPD), Primary Care, Patient-Centered Outcomes Research, Outcomes
Outpatient parenteral antimicrobial therapy in pediatrics: an opportunity to expand antimicrobial stewardship.
The researchers reviewed patient discharges with outpatient parenteral antimicrobial therapy (OPAT) to determine whether OPAT was modifiable or unnecessary at a large tertiary care children’s hospital. At least one modification definitely or possibly would have been recommended for 78 percent of episodes. For more than 40 percent of episodes, OPAT was potentially not indicated.
Infect Control Hosp Epidemiol 2015 Feb;36(2):222-4. doi: 10.1017/ice.2014.27.
AHRQ-funded; HS023320.
View abstract on the National Library of Medicine site.
Keywords: Bacterial Infections, Antimicrobials, Children, Hospital Outpatient Care
Quality of health insurance coverage and access to care for children in low-income families.
This study compared health care access, quality, and cost outcomes by insurance type (Medicaid, CHIP, private, and uninsured) for children in households with low to moderate incomes. It found that children with all insurance types experienced challenges in access to specialty care, with caregivers of children insured by the Children’s Health Insurance Program reporting the highest rates of difficulty accessing specialty care, problems obtaining a referral, and frustration obtaining health care services.
JAMA Pediatr 2016 Jan;170(1):43-51. doi: 10.1001/jamapediatrics.2015.3028.
AHRQ-funded; HS021706.
View abstract on the National Library of Medicine site.
Keywords: Children's Health Insurance Program (CHIP), Affordable Care Act, Children, Access to Care, Low-Income Population
