Searchable Database Provides Access to AHRQ-Funded Articles Published Since 2014
Recently published articles on nurse-patient partnerships, compliance with infection control practices in home health care, and racial/ethnic differences in end-of-life cancer care are among more than 4,600 agency-supported articles now available in the AHRQ Research Studies database. The studies, searchable by keyword, showcase the breadth of the agency’s research endeavors and the diversity of academic journals that have published AHRQ-sponsored research findings. Each database entry includes a title, a brief summary of the research and a link to an abstract on the National Library of Medicine website.
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
Clinical decision support (CDS) hard-stop alerts-those in which the user is either prevented from taking an action altogether or allowed to proceed only with the external override of a third party-are increasingly common but can be problematic. To understand their appropriate application, the investigators explored 3 key questions: (1) To what extent are hard-stop alerts effective in improving patient health and healthcare delivery outcomes? (2) What are the adverse events and unintended consequences of hard-stop alerts? (3) How do hard-stop alerts compare to soft-stop alerts?
J Am Med Inform Assoc 2018 Nov;25(11):1556-66. doi: 10.1093/jamia/ocy112.
AHRQ-funded; HS024332.
View abstract on the National Library of Medicine site.
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare: Delivery, Patient Safety
Nurses and patients: Natural partners to advance patient safety.
In this Agency for Healthcare Research and Quality commentary, the authors discuss the nurse-patient partnership and its potential for enhancing communication and improving patient safety practices.
J Nurs Care Qual 2019 Jan/Mar;34(1):1-3. doi: 10.1097/ncq.0000000000000377.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Nursing, Provider: Nurse, Patient Safety
High burden of palliative care needs of older adults during emergency major abdominal surgery.
The purpose of this retrospective study was to quantify preoperative illness burden in older adults undergoing emergency major abdominal surgery (EMAS), to examine the association between illness burden and postoperative outcomes, and to describe end-of-life care in the year after discharge. The investigators found that most older adults undergoing EMAS have preexisting high illness burden and experience high mortality and healthcare use in the year after surgery, particularly near the end of life.
J Am Geriatr Soc 2018 Nov;66(11):2072-78. doi: 10.1111/jgs.15516.
AHRQ-funded; HS022763.
View abstract on the National Library of Medicine site.
Keywords: Acute Care, Elderly, Palliative Care, Surgery
Hospital utilization and disposition among patients with malignant bowel obstruction: a population-based comparison of surgical to medical management.
In this study, the investigators sought to compare clinically meaningful outcomes in malignant bowel obstruction (MBO) patients treated with surgical versus medical management using population-based data. In this population-based analysis, medical management was associated with less hospital utilization at 30- and 90-days, fewer in-hospital deaths, and more frequent discharges to home. The authors suggest that these data underscore the potential benefits of medical management for MBO patients at the end-of-life.
BMC Cancer 2018 Nov 26;18(1):1166. doi: 10.1186/s12885-018-5108-9.
AHRQ-funded; HS022236.
View abstract on the National Library of Medicine site.
Keywords: Cancer, Comparative Effectiveness, Hospitalization, Palliative Care, Patient-Centered Outcomes Research, Surgery
Quantifying and presenting overall evidence in network meta-analysis.
This article classified treatment networks into three types under different assumptions; they included networks with each treatment comparison's edge width proportional to the corresponding number of studies, sample size, and precision. In addition, three new measures (ie, the effective number of studies, the effective sample size, and the effective precision) were proposed to preliminarily quantify overall evidence gained in Network meta-analysis.
Stat Med 2018 Dec 10;37(28):4114-25. doi: 10.1002/sim.7905.
AHRQ-funded; HS024743.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Research, Research Methodologies
Regional practice patterns and racial/ethnic differences in intensity of end-of-life care.
The purpose of this study was to examine whether regional practice patterns impact racial/ethnic differences in intensity of end-of-life care for cancer decedents. The investigators found that there was greater variation in intensity of end-of-life care among Hispanics, Asians, and whites in high-expenditure hospital referral regions (HRRs) than in low-expenditure HRRs.
Health Serv Res 2018 Dec;53(6):4291-309. doi: 10.1111/1475-6773.12998.
AHRQ-funded; HS023900.
View abstract on the National Library of Medicine site.
Keywords: Cancer, End-of-Life Care, Provider Practice Patterns, Racial / Ethnic Minorities
Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: a systematic review.
The objective of this systematic review was to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts. The investigators found that topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety.
Am J Clin Dermatol 2018 Dec;19(6):791-803. doi: 10.1007/s40257-018-0375-4.
AHRQ-funded; HS023011.
View abstract on the National Library of Medicine site.
Keywords: Skin Conditions, Treatment Effectiveness
Do medical homes improve quality of care for persons with multiple chronic conditions?
The purpose of this study was to examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC). The investigators found that patient-centered medical home enrollment was associated with an increased likelihood of receiving eight recommended mental and physical health services, including A1C testing for persons with diabetes, lipid profiles for persons with diabetes and/or hyperlipidemia, and psychotherapy for persons with major depression and persons with schizophrenia.
Health Serv Res 2018 Dec;53(6):4667-81. doi: 10.1111/1475-6773.13024.
AHRQ-funded; HS019659.
View abstract on the National Library of Medicine site.
Keywords: Chronic Care, Chronic Conditions, Health Care Quality, Patient-Centered Healthcare, Quality Improvement
Sustainability of evidence-based acute pain management practices for hospitalized older adults.
This article reported on the sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation.
West J Nurs Res 2018 Dec;40(12):1749-64. doi: 10.1177/0193945917738781.
AHRQ-funded; HS010482.
View abstract on the National Library of Medicine site.
Keywords: Elderly, Evidence-based Practice, Inpatient Care, Pain, Prevention and Care Management
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
This study examined whether inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates widened. Using a large discharge dataset covering the period 2001-2011, the investigators tracked changes at age 65 in multiple dimensions of hospital care.
Int J Health Econ Manag 2018 Dec;18(4):409-23. doi: 10.1007/s10754-018-9240-5.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Health Care Payment, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Inpatient Care, Medicare
Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women.
The aims of this study were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. The authors suggest that adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.
Birth 2018 Dec;45(4):358-67. doi: 10.1111/birt.12358.
AHRQ-funded; HS024733.
View abstract on the National Library of Medicine site.
Keywords: Labor and Delivery, Pregnancy, Women's Health
The study of effect moderation in youth suicide-prevention studies.
A systematic review was conducted focusing on identifying youth suicide-prevention studies within the United States. This paper reports on the methods utilized for understanding possible moderators of suicide-prevention program outcomes. The investigators found that only a small percentage of the reviewed articles assessed moderation effects. They assert that this is a substantial research gap driven by sample size or other limitations which have impeded the identification of intervention effect heterogeneity.
Soc Psychiatry Psychiatr Epidemiol 2018 Dec;53(12):1303-10. doi: 10.1007/s00127-018-1574-2.
AHRQ-funded; 29020150000XI.
View abstract on the National Library of Medicine site.
Keywords: Children/Adolescents, Mental Health, Prevention and Care Management
Severity and timing of onset drive economic costs and clinical outcomes with sepsis.
Sepsis disproportionately affects older adults (mean age, 65 yr); is predominantly community acquired (87%); is expensive (mean hospital costs $21,500); and is associated with high hospital mortality (one in eight patients) and high rates of 30-day readmission for survivors (one in eight patients). In this editorial, the authors discuss an article- by Paoli et al, published in 2018 in Volume 46 of Critical Care Medicine- on sepsis epidemiology.
Crit Care Med 2018 Dec;46(12):2043-44. doi: 10.1097/ccm.0000000000003376.
AHRQ-funded; HS025240.
View abstract on the National Library of Medicine site.
Keywords: Health Care Costs, Mortality, Outcomes, Sepsis
Surgical technical evidence review for gynecologic surgery conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.
The objective of this study was to review the enhanced recovery pathways (ERPs) literature in gynecologic surgery (GS) and provide the framework for Improving Surgical Care and Recovery (ISCR) pathway for GS. The investigators concluded that evidence and existing guidelines supported 29 protocol elements for the AHRQ Safety Program for ISCR in GS.
Am J Obstet Gynecol 2018 Dec;219(6):563.e1-63.e19. doi: 10.1016/j.ajog.2018.07.014.
AHRQ-funded; 23337004T.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Evidence-based Practice, Health Care Quality, Patient Safety, Quality Improvement, Surgery, Women's Health
Getting what we pay for: how do risk-based payments to Medicare Advantage plans compare with alternative measures of beneficiary health risk?
The purpose of this study was to estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM). The investigators indicate that their findings add to a growing body of evidence suggesting MA receives favorable, or, at worst, neutral selection. They assert that if MA beneficiaries are no healthier and no sicker than similar beneficiaries in TM, then payments to MA plans exceed what is warranted based on their health status.
Health Serv Res 2018 Dec;53(6):4997-5015. doi: 10.1111/1475-6773.12977.
AHRQ-authored.
View abstract on the National Library of Medicine site.
Keywords: Health Care Payment, Medicare
Mind the gap: putting evidence into practice in the era of learning health systems.
This paper discusses two main mechanisms to close the evidence-to-practice gap: (1) integrating Learning Health System (LHS) results with existing systematic review evidence and (2) providing this combined evidence in a standardized, computable data format.
J Gen Intern Med 2018 Dec;33(12):2237-39. doi: 10.1007/s11606-018-4633-1.
AHRQ-funded; 29020120004C.
View abstract on the National Library of Medicine site.
Keywords: Evidence-based Medicine, Evidence-based Practice, Healthcare: Delivery, Learning Health Systems, Translating Research Into Practice (TRIP)
Challenges optimizing the after visit summary.
The purpose of this study was to describe experiences of health systems implementing a redesigned outpatient after visit summary (AVS) in commercially available electronic health record (EHR) systems to inform future optimization. The authors noted limitations to AVS modifications in EHR systems present challenges to optimizing the tool. They recommended that EHR vendors should incorporate learning from healthcare systems innovation efforts and consider building more flexibility into their product development.
Int J Med Inform 2018 Dec;120:14-19. doi: 10.1016/j.ijmedinf.2018.09.009.
AHRQ-authored; AHRQ-funded; HS023844.
View abstract on the National Library of Medicine site.
Keywords: Ambulatory Care and Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), System Design
Safety of obese persons in nursing homes.
This paper discusses the emergence of obese persons as a vulnerable group in the nursing home community. The authors discuss the special needs of this population including that obese residents require special protocols, trained staff, and appropriately sized equipment to prevent and treat skin breakdown.
Med Care 2018 Dec;56(12):1032-34. doi: 10.1097/mlr.0000000000000997.
AHRQ-funded; HS025703.
View abstract on the National Library of Medicine site.
Keywords: Long-Term Care, Obesity, Nursing Homes, Patient Safety, Skin Conditions
Moment-to-moment changes in perceived social support and pain for men living with HIV: an experience sampling study.
In this study, the investigators used an experience sampling method (also called Ecological Momentary Assessment) to assess moment-to-moment experiences of pain and social support 3 times a day for 7 days in a sample of 109 men living with HIV. They found that within-persons, experiences of daily social support reduced experiences of pain. Between-persons, attachment style may have influenced how individuals make use of social support in coping with experiences of pain.
Pain 2018 Dec;159(12):2503-11. doi: 10.1097/j.pain.0000000000001354.
AHRQ-funded; HS013852.
View abstract on the National Library of Medicine site.
Keywords: Human Immunodeficiency Virus (HIV), Pain, Quality of Life
Impact of patient safety indicators on readmission after abdominal aortic surgery.
This analysis evaluated whether Patient Safety Indicator (PSI) events after open surgical repair or endovascular aneurysm repair of abdominal aortic aneurysm (AAA) were associated with increased risk of readmission. The investigators concluded that Agency for Healthcare Quality and Research PSI events may be used to identify patients at the greatest risk for readmission after AAA repair. The risk for 30-day readmission was 71% higher when a PSI event occurred and was not associated with the type of repair.
J Vasc Nurs 2018 Dec;36(4):189-95. doi: 10.1016/j.jvn.2018.08.002.
AHRQ-funded; HS022140.
View abstract on the National Library of Medicine site.
Keywords: Patient Safety, Patient Safety Indicators, Surgery
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