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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.
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1 to 25 of 12227 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
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
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
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
Amu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Kistler A, Decker S, Steiger D
AHRQ Author: Decker S
A multimode strategy to contact participants and collect responses in a supplement to a longitudinal household survey.
In seeking to understand connections between Americans’ health care expenditures and use and social determinants of health, The Agency for Healthcare Research and Quality (AHRQ) and Westat conducted a new Medical Expenditure Panel Survey (MEPS) supplemental study in 2021 using a multimode (web and paper) instrument. Participants were encouraged to complete the web survey, but were provided the option of responding by paper. Response was encouraged through a multimode contact strategy, including text messages, emails, and/or mailings. The purpose of this paper was to review the protocol for encouraging web response and the response rates when utilizing various contact modes. The overall unweighted response rate for the survey was 74.2%, with 69.3% of responses submitted via the web. Response rates were 85.5% which was the highest among adults for whom both email and mobile phone information were provided.
AHRQ-authored.
Citation: Kistler A, Decker S, Steiger D .
A multimode strategy to contact participants and collect responses in a supplement to a longitudinal household survey.
Survey Methods: Insights From the Field 2024 May 1. doi: 10.13094/SMIF-2024-00001..
Keywords: Medical Expenditure Panel Survey (MEPS)
Kostick-Quenet KM, Lang B, Dorfman N
Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy.
This study explored stakeholder attitudes toward the utility, acceptability, usefulness, and best practices for integrating personalized risk (PR) estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). This was a 5-year multi-institutional AHRQ project where the authors conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers) and analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards PR integration in decision making. Physicians felt PR can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance.
AHRQ-funded; HS027784.
Citation: Kostick-Quenet KM, Lang B, Dorfman N .
Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy.
Patient Educ Couns 2024 May; 122:108157. doi: 10.1016/j.pec.2024.108157.
Keywords: Education: Patient and Caregiver, Risk, Cardiovascular Conditions
Bouchelle Z, Menko SG, Yazdani M
Parent perspectives on documentation and sharing of health-related social needs data.
This survey aimed to examine parents of pediatric patients’ preferences regarding how health-related social needs (HRSN) screening program data are documented and shared. The authors conducted semi-structured interviews with parents of hospitalized children participating in an HRSN screening program at a quaternary care children's hospital. Interviews were then coded to identify emergent themes. A total of 20 parents were interviewed with all being female, 55% identifying as Black or African American and 20% identifying as Hispanic or Latino. Parents expressed comfort with electronic health record documentation of HRSN data and the use of ICD-10 Revision Z codes as long as this information was used to provide families with meaningful support. Most parents viewed social workers and medical teams as being the most appropriate recipients of the data, with few parents feeling comfortable with HRSN data being shared with payors. Parents wanted transparency around HRSN data sharing, with many expressing concerns that documentation and sharing of HRSN data could lead to unwanted or unsafe disclosures or result in child welfare referrals.
AHRQ-funded; HS028555.
Citation: Bouchelle Z, Menko SG, Yazdani M .
Parent perspectives on documentation and sharing of health-related social needs data.
Hosp Pediatr 2024 Apr; 14(4):308-16. doi: 10.1542/hpeds.2023-007478..
Keywords: Children/Adolescents, Screening, Electronic Health Records (EHRs), Health Information Technology (HIT)
Achola EM, Griffith KN, Wrenn JO
Injuries from legal interventions involving conducted energy devices.
This cross-sectional study evaluated emergency department (ED) visits for physical injuries from use of conducted energy devices (CEDs) such as TASERs by police departments. The authors evaluated sociodemographic and clinical characteristics of patients presenting with law enforcement-related CED injuries. They sampled US ED visits from the Nationwide Emergency Department Sample, which provided a 20% stratified sample of all EDs and weights to allow calculation of national representative estimates for all ED visits. They identified 1276 visits with the ICD-10 Y35.83X codes for CED injuries. Patients included 1186 males and 91 females with a mean age of 32.9 years residing in zip codes below the 50th percentile for median household income (67.5%). Most presented to teaching hospitals (70.8%) in metropolitan areas (86.1%) and were Asian or Pacific Islander (1.4%), Black (35.7%), Hispanic (17.6%), Native American (1.8%), White (39.2%), or other (4.3%) race and ethnicity. Among patients with serious injuries (70.8%), most (61.1%) were minor, 25.4% were moderate, 2.9% were severe, and 1.6% were critical injuries. The most common area of injury was extremities (36.9%), followed by chest (27.4%), head and neck (25.6%), abdomen (24.2%), and face (8.7%). Patients with lower income were more likely to receive serious, severe, or critical injuries, but these differences were not statistically significant.
AHRQ-funded; HS026395.
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Citation: Achola EM, Griffith KN, Wrenn JO .
Injuries from legal interventions involving conducted energy devices.
JAMA Intern Med 2024 Apr; 184(4):440-43. doi: 10.1001/jamainternmed.2023.8012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Injuries and Wounds, Emergency Department
Chase AM, Forehand CC, Keats KR
Evaluation of critical care pharmacist evening services at an academic medical center.
This study’s purpose was to investigate the number of interventions, type of interventions, and associated cost savings with the addition of 1 board certified critical care clinical pharmacist to evening shift. Over a 12-week period, a prospective collection and characterization of 1 evening shift critical care pharmacist’s clinical interventions was conducted. Interventions were collected and categorized daily from 1 pm to 11 pm Monday through Friday. The authors collected a total of 510 interventions with an average of 9.8 interventions accepted per day. The highest proportion of interventions occurred in the medical intensive care unit, and the most common interventions included transitions of care, medication dose adjustment, and antibiotic de-escalation. They calculated an estimated cost avoidance of $66,537.80 for an average of $1279.57 saved per day. Additionally, 4.1% of interventions were considered high yield interventions upon independent review by 2 pharmacists.
AHRQ-funded; HS029009; HS028485.
Citation: Chase AM, Forehand CC, Keats KR .
Evaluation of critical care pharmacist evening services at an academic medical center.
Hosp Pharm 2024 Apr; 59(2):228-33. doi: 10.1177/00185787231207996..
Keywords: Provider: Pharmacist, Medication, Critical Care
Aklilu AM, Kumar S, Nugent J
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
This retrospective longitudinal multicenter cohort study’s objective was to assess long-term kidney outcomes of patient who had COVID-19-associated acute kidney injury (AKI). This study was conducted in a large hospital system using electronic health records data on adult hospitalized patients with AKI and COVID-19 or other illnesses. Included patients were those 1) who were hospitalized during the COVID-19 pandemic (March 2020-June 2022), were screened for SARS-CoV-2, had AKI, and survived to discharge, or 2) had been hospitalized during the 5 years before the pandemic (October 2016-January 2020), had a positive influenza A or B test result, had AKI, and survived to discharge. The study cohort included 9624 hospitalized patients (mean age, 69.0 years; 4955 females) with AKI, including 987 patients with COVID-AKI, 276 with influenza-associated AKI, and 8361 with AKI associated with other illnesses (other-AKI). When compared with the other 2 groups, patients with COVID-19-associated AKI were slightly younger in age, had a higher baseline eGFR, worse baseline comorbidity scores, higher markers of illness severity, and longer hospital stay. Compared with the other-AKI group, the COVID-AKI group had lower major adverse kidney events (MAKE) (adjusted hazard ratio [aHR], 0.67) due to lower all-cause mortality (aHR, 0.31) and lower rates of worsened kidney function.
AHRQ-funded; HS027626.
Citation: Aklilu AM, Kumar S, Nugent J .
COVID-19-associated acute kidney injury and longitudinal kidney outcomes.
JAMA Intern Med 2024 Apr; 18(4):414-23. doi: 10.1001/jamainternmed.2023.8225..
Keywords: COVID-19, Kidney Disease and Health, Outcomes
Brokamp C, Jones MN, Duan Q
Causal mediation of neighborhood-level pediatric hospitalization inequities.
This study’s objective was to estimate the total inequities in population-level hospitalization rates of children and determine how much is mediated by place-based exposures and community characteristics. The authors employed a population-wide, neighborhood-level study that included youth <18 years hospitalized between July 1, 2016 and June 30, 2022. They defined a causal directed acyclic graph a priori to estimate the mediating pathways by which marginalized population composition causes census tract-level hospitalization rates. They analyzed 50,719 hospitalizations experienced by 28,390 patients and calculated census tract-level hospitalization rates per 1000 children, which ranged from 10.9 to 143.0 across included tracts. For every 10% increase in the marginalized population, the tract-level hospitalization rate increased by 6.2%. After adjustment for tract-level community material deprivation, crime risk, English usage, housing tenure, family composition, hospital access, greenspace, traffic-related air pollution, and housing conditions, no inequity remained (0.2%). There were different results when considering subsets of asthma, type 1 diabetes, sickle cell anemia, and psychiatric disorders.
AHRQ-funded; HS027996.
Citation: Brokamp C, Jones MN, Duan Q .
Causal mediation of neighborhood-level pediatric hospitalization inequities.
Pediatrics 2024 Apr; 153(4):e2023064432. doi: 10.1542/peds.2023-064432..
Keywords: Children/Adolescents, Medication, Disparities, Hospitalization
Decker SL, Zuvekas SH
AHRQ Author: Decker SL, Zuvekas SH
A nationally representative summary of 2020 changes in the use of health care in the United States.
The authors used Medical Expenditure Panel Survey data to summarize changes in all types of health care from 2018 to 2020. The results showed that outpatient and emergency department visits, as well as inpatient admissions each fell ~35% in April 2020; dental visits fell by over 80%, and mammograms 82%. By the end of 2020, specialist physician visits recovered, though primary care and dental visits remained 12% lower than in 2019. Psychiatric visits, however, rose slightly.
AHRQ-authored.
Citation: Decker SL, Zuvekas SH .
A nationally representative summary of 2020 changes in the use of health care in the United States.
J Ambul Care Manage 2024 Apr-Jun; 47(2):64-83. doi: 10.1097/jac.0000000000000488.
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Healthcare Delivery, Public Health
Hahn AL, Michaels CL, Khawly G
Comparison of evaluation methods for improving the usability of a Spanish mHealth tool.
The purpose of this study was to compare two usability evaluation methods for adapting an evidence-based mHealth tool from English into Spanish. The authors conducted cognitive interviews and usability assessments using a think-aloud protocol to evaluate the usability of an HIV mHealth application among 40 Spanish-speaking adults with HIV in New York City and in La Romana in the Dominican Republic. Findings highlighted contributions and limitations of including these methods in mHealth usability testing. The authors concluded that future research should employ a multi-method approach that incorporated complementary usability evaluation methods and engaged participants in multiple assessments.
AHRQ-funded; HS028523.
Citation: Hahn AL, Michaels CL, Khawly G .
Comparison of evaluation methods for improving the usability of a Spanish mHealth tool.
Int J Med Inform 2024 Apr; 184:105355. doi: 10.1016/j.ijmedinf.2024.105355.
Keywords: Telehealth, Health Information Technology (HIT)
Simpson RL, Lee JA, Li Y
Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.
This case report outlines the development and implementation of Amazon Web Services (AWS) at Emory University to securely store and analyze research data from the Centers for Medicare and Medicaid Services (CMS). Several interdisciplinary teams collaborated and ensured compliance with CMS policy. Results showed successful transition to a cloud-based environment with enhanced security measures and regular review processes. User training addressed cloud computing challenges. Lessons learned from challenges benefited CMS and interdisciplinary teams university-wide.
AHRQ-funded; HS026232.
Citation: Simpson RL, Lee JA, Li Y .
Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.
JAMIA Open 2024 Apr; 7(1):ooae007. doi: 10.1093/jamiaopen/ooae007.
Keywords: Medicare, Health Information Technology (HIT)
Carey K, Cole MB
Mental health care provision in community health centers and hospital emergency department utilization.
This study examined whether community health centers (CHCs) are effective in offsetting mental health emergency department (ED) visits. The study used the HRSA Uniform Data System and the HCUP State ED Databases for Florida patients during 2012-2019. The authors identified CHC-year-specific service areas using patient origin zip codes, and then estimated panel data models for number of ED mental health visits per capita in a CHC's service area. During 2012-2019, CHC mental health utilization increased 100%. There were small reductions in ED mental health utilization associated with increased CHC mental health provision. An annual increase of 1000 CHC mental health care visits (5%) was associated with 0.44% fewer ED mental health care visits, and an increase of 1000 CHC mental health care patients (15%) with 1.9% fewer ED mental health care visits. An increase of 1 annual mental health visit per patient was associated with 16% fewer ED mental health care visits.
AHRQ-funded; HS028054.
Citation: Carey K, Cole MB .
Mental health care provision in community health centers and hospital emergency department utilization.
Health Serv Res 2024 Apr; 59(2):e14283. doi: 10.1111/1475-6773.14283..
Keywords: Healthcare Cost and Utilization Project (HCUP), Community-Based Practice, Behavioral Health, Emergency Department, Healthcare Utilization
Bradford W, Akselrod H, Bassler J
Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment.
This multisite, retrospective cohort study of hospitalized patients with opioid use disorder with infectious complications of injection drug use looked at rates of HIV screening, pre-exposure prophylaxis, and treatment among these patients. The authors included 322 patients, with most (300) now known to have HIV. Of those, only 2 had a documented discussion of PrEP, while only 1 was prescribed PrEP on discharge. Among the 22 people with HIV (PWH), only 13 had a viral load collected during admission of whom all were viremic and 10 were successfully linked to care post-discharge. Both groups had high rates of readmission, Medicaid or uninsured status, and unstable housing.
AHRQ-funded; HS013852.
Citation: Bradford W, Akselrod H, Bassler J .
Hospitalization is a missed opportunity for HIV screening, pre-exposure prophylaxis, and treatment.
Addict Sci Clin Pract 2024 Mar 26; 19(1):22. doi: 10.1186/s13722-024-00451-z..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Prevention, Inpatient Care
Carrel M, Shi Q, Clore GS
Assessing the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial antibiograms.
This study looked at the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial anagrams. A total of 338,681 S. aureus isolates were obtained in Veterans Health Administration (VHA) outpatient settings from 2010 to 2019, and 6,817 isolates were obtained in University of Iowa Hospitals and Clinics outpatient settings from 2014 to 2019. Standard, seasonal, and spatial antibiograms were created for five commonly used antibiotic classes: cephalosporins, clindamycin, macrolides, tetracycline, trimethoprim/sulfamethoxazole. All models were found to have low predictive capacity, with areas under the curve of <0.7.
AHRQ-funded; HS027472.
Citation: Carrel M, Shi Q, Clore GS .
Assessing the potential for improved predictive capacity of antimicrobial resistance in outpatient Staphylococcus aureus isolates using seasonal and spatial antibiograms.
Antimicrob Resist Infect Control 2024 Mar 22; 13(1):34. doi: 10.1186/s13756-024-01388-3..
Keywords: Antibiotics, Medication
Aghaei P, Bayramzadeh S
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
This study’s objective was to investigate how trauma team members perceive technological equipment and tools in the trauma room (TR) environment and to identify how the technological equipment could be optimized in relation to the TR’s space. The authors conducted a total of 21 focus group sessions with 69 trauma team members, all of whom worked in Level I TRs from six teaching hospitals in the USA. Findings were analyzed and categorized into three parent themes: imaging equipment, assistive devices, and room features. The results suggest that trauma team members place high importance on the availability and versatility of the technological equipment in the TR environment. CT-scanners were not usually optimized for easy access to the TR. Other suggestions included the implementation of cameras and screens to accommodate situation awareness, and the rapid sharing of data such as imaging results. This study will inform health-care designers with the knowledge they need to make informed decisions when designing TRs. It covers key considerations such as room layout, equipment selection, lighting and controls.
AHRQ-funded; HS027261.
Citation: Aghaei P, Bayramzadeh S .
Clinicians’ experience with technology within the physical environment of trauma rooms: a focus group study.
Facilities 2024 Mar 12. 2024/02/14..
Keywords: Workflow, Teams, Emergency Department, Trauma
Chen MA, Rubinson C, O'Donnell EM
High-performing teamlets in primary care: a qualitative comparative analysis.
This study’s purpose was to identify the characteristics of high-performing primary care teamlets, defined as teamlets with low rates of ambulatory care sensitive emergency department (ACSED) visits and ambulatory care sensitive hospital admissions (ACSAs). Teamlets consist of a primary care clinician who works consistently with the same clinical staff member. The authors conducted 26 individual qualitative interviews with physicians and their teamlet staff members across 13 teamlets. They identified, calibrated, and analyzed potentially important characteristics related to high-performing primary care teamlets using qualitative comparative analysis (QCA). Key characteristics identified in teamlets with low rates of ACSED visits and to a lesser extent ACSAs were staff proactiveness in anticipating physician needs and physician-reported trust in their staff member.
AHRQ-funded; HS025716.
Citation: Chen MA, Rubinson C, O'Donnell EM .
High-performing teamlets in primary care: a qualitative comparative analysis.
J Am Board Fam Med 2024 Mar 11; 37(1):105-11. doi: 10.3122/jabfm.2023.230105R1..
Keywords: Primary Care, Teams
Bernstein EY, Bernstein TP, Trivedi S
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
This study looked at outcomes after initiation of medications for alcohol use disorder (MAUD), which are very underutilized. The primary outcome was a composite of all-cause mortality or return to hospital within 30 days of discharge. Secondary outcomes included the previous components separately, return to hospital for alcohol-related diagnoses, and primary care or mental health follow-up within 30 days of discharge. There were 6794 unique individuals representing 9834 alcohol-related hospitalizations (median [IQR] age, 54 years; 3205 hospitalizations among females [32.6%]; 1754 hospitalizations among Black [17.8%], 712 hospitalizations among Hispanic [7.2%], and 7060 hospitalizations among White [71.8%] patients). Of these, 2% of hospitalizations involved discharged MAUD initiation. Discharge MAUD initiation was associated with a 42% decreased incidence of the primary outcome (incident rate ratio, 0.58). These findings were consistent among secondary outcomes (eg, incident rate ratio for all-cause return to hospital, 0.56) except for mortality, which was rare in both groups. Discharge MAUD initiation was associated with a 51% decreased incidence of alcohol-related return to hospital.
AHRQ-funded; HS026215.
Citation: Bernstein EY, Bernstein TP, Trivedi S .
Outcomes after initiation of medications for alcohol use disorder at hospital discharge.
JAMA Netw Open 2024 Mar 4; 7(3):e243387. doi: 10.1001/jamanetworkopen.2024.3387..
Keywords: Medication, Alcohol Use, Substance Abuse, Behavioral Health, Outcomes, Hospital Discharge
Bratches RWR, Onsando W, Puga F
Family caregiver comfort with telehealth technologies: differences by race and ethnicity in a cross-sectional survey.
This study’s objective was to analyze a demographically representative survey of U.S. family caregivers to understand the level of comfort using telehealth technologies among family caregivers. The authors conducted a secondary analysis of survey data collected during the COVID-19 pandemic in 2020. Likert-style questions were used to determine the level of caregiver comfort using computers, smartphones, and tablets. There was a total of 340 caregivers included in the analysis. Compared with non-Hispanic white caregivers, Asian caregivers had higher odds (odds ratio [OR] 3.1) of expressing comfort using computers; black caregivers (OR 0.46) and Hispanic caregivers (OR 0.36) expressed lower odds of comfort using smartphones; and Asian caregivers had higher odds (OR 4.64) of expressing comfort using tablets.
AHRQ-funded; HS013852.
Citation: Bratches RWR, Onsando W, Puga F .
Family caregiver comfort with telehealth technologies: differences by race and ethnicity in a cross-sectional survey.
Telemed J E Health 2024 Mar; 30(3):685-91. doi: 10.1089/tmj.2023.0314..
Keywords: Telehealth, Health Information Technology (HIT), Caregiving, Racial and Ethnic Minorities
Chen VW, Rosen T, Dong Y
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
This study examined whether US surgical quality improvement (QI) programs using case sampling is robust enough for identifying hospitals with higher than expected complications. Eligible patients were 18 years and older who underwent a noncardiac operation at US Department of Veterans Affairs (VA) hospitals with a record in the VA Surgical Quality Improvement Program (systematic sample) and the VA Corporate Data Warehouse surgical domain (100% of surgical cases). Most patients in both samples were men (90.2% vs 91.2%) and White (74.7% vs 74.5%). Overall, 30-day complication rates were 7.6% and 5.3% for the sample and universal review cohorts, respectively. Using over 2145 hospital quarters of data, hospitals were identified as an outlier in 15.0% of quarters using the sample and 18.2% with universal review. Average hospital quarterly complication rates were 4.7% for outliers identified using the sample only, 7.2% for universal only, and 7.4% for concurrent identification in both sources. For nonsampled cases, average hospital quarterly complication rates were 7.0% at outliers and 4.4% at nonoutliers. Among outlier hospital quarters in the sample, 54.2% were concurrently identified with universal review, and for those identified with universal review, 44.6% were concurrently identified using the sample.
AHRQ-funded; HS028560.
Citation: Chen VW, Rosen T, Dong Y .
Case sampling for evaluating hospital postoperative morbidity in US surgical quality improvement programs.
JAMA Surg 2024 Mar; 159(3):315-22. doi: 10.1001/jamasurg.2023.6524..
Keywords: Surgery, Quality Improvement, Quality of Care, Hospitals
Rosenberg SM, McCue S, He J
Alliance A151945: accrual and characteristics of adolescent and young adult patients in Alliance trials from 2000 to 2017.
Alliance trials analyzed factors influencing clinical trial enrollment among adolescents and young adults (AYAs) with cancer. Among 188 Alliance trials, AYAs comprised 11% of accrual, varying by cancer type. Hispanic and non-White AYAs were more represented in breast and colorectal cancer trials compared to non-AYAs. Disease characteristics differed by age in selected trials. AYA-specific survival showed no significant age-based differences. The results emphasize the challenge of ensuring equitable access to trials for AYAs.
AHRQ-funded; HS023680.
Citation: Rosenberg SM, McCue S, He J .
Alliance A151945: accrual and characteristics of adolescent and young adult patients in Alliance trials from 2000 to 2017.
Cancer 2024 Mar 1; 130(5):750-69. doi: 10.1002/cncr.35078.
Keywords: Children/Adolescents, Cancer
Neerland C, Slaughter-Acey J, Behrens K
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
The study aimed to identify social and structural determinants of maternal morbidity and mortality during prenatal and postpartum periods in the U.S. Out of 8,378 references screened, 118 studies were included, covering domains like identity, socioeconomic factors, violence, and trauma. Findings revealed mixed patterns between risk factors and outcomes, with notable attention to depression and mental health. Advancing the field long-term should involve developing comprehensive datasets to thoroughly investigate intersections with biological and medical risk factors.
AHRQ-funded; 75Q80120D00008.
Citation: Neerland C, Slaughter-Acey J, Behrens K .
An evidence map for social and structural determinants for maternal morbidity and mortality: a systematic review.
Obstet Gynecol 2024 Mar; 143(3):383-92. doi: 10.1097/aog.0000000000005489.
Keywords: Social Determinants of Health, Maternal Care, Mortality, Evidence-Based Practice, Risk, Women, Outcomes