National Healthcare Quality and Disparities Report
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Topics
- Access to Care (2)
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- (-) Cancer (21)
- Cancer: Breast Cancer (2)
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- Cancer: Lung Cancer (2)
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- Case Study (1)
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- Diagnostic Safety and Quality (4)
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- Prevention (6)
- (-) Primary Care (21)
- Primary Care: Models of Care (5)
- Provider: Physician (1)
- Quality Improvement (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- Screening (9)
- Shared Decision Making (2)
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- Vulnerable Populations (2)
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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 21 of 21 Research Studies DisplayedKukhareva PV, Li H, Caverly TJ
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
The authors conducted pre- and post-intervention analysis in primary care and pulmonary clinics to explore whether clinician-facing electronic health record (EHR) prompts and an EHR-integrated shared decision-making (SDM) tool designed to support incorporation of SDM into primary care could improve low-dose computer tomography scan imaging ordering and completion. Subjects were patients who met US Preventive Services Task Force criteria for lung cancer screening (LCS). The results indicated that EHR prompts and the EHR-integrated SDM tool were promising approaches to improving LCS in the primary care setting. The authors noted that further research is warranted.
AHRQ-funded; HS026198; HS028791.
Citation: Kukhareva PV, Li H, Caverly TJ .
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
Chest 2023 Nov; 164(5):1325-38. doi: 10.1016/j.chest.2023.04.040..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Shared Decision Making
Rao G, Ufholz K, Saroufim P
Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care.
The objective of this study was to identify the incidence, rate of physician recognition, diagnostic practices, and cancer outcomes for unintentional weight loss. Researchers completed a secondary analysis of structured and unstructured EHR data collected from adult, established primary care patients with a minimum of two weight measurements in 2020 and in 2021. The results indicated that unintentional weight loss is poorly recognized across a diverse range of patients. The researchers concluded that lack of research-informed guidance may explain low rates of recognition and variability in diagnostic practices.
AHRQ-funded; HS029358.
Citation: Rao G, Ufholz K, Saroufim P .
Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care.
Diagnosis 2023 Aug 1; 10(3):267-74. doi: 10.1515/dx-2023-0002..
Keywords: Cancer, Primary Care, Diagnostic Safety and Quality, Provider: Physician
Pagani K, Lukac D, Olbricht SM
Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.
The purpose of this study was to explore primary care and dermatology triaging and processing of urgent dermatology referrals. The researchers conducted chart reviews of all dermatology referrals designated by primary care as urgent for evaluation of a lesion concerning for skin cancer. Dermatology encounters for patients occurred on or before 30 days for 50.6% of referrals and on or after 31 days for 38.4% of referrals, with 10.9% never completed. The rate of non-English languages in the delayed group was 7.1% greater than in the timely group. The rate of all races excluding whites, non-Hispanic in the delayed appointment group (31 days or more) was 15.1% greater than in the timely appointment group (30 days or less). Overall, 15.8% of referrals yielded malignancy diagnoses, while 76.8% and 7.4% resulted in benign and pre-malignant diagnoses, respectively. The primary care team documented completed, incomplete, or pending referral status during their subsequent visits with the patients in only 37.5% of the referrals.
AHRQ-funded; HS027282.
Citation: Pagani K, Lukac D, Olbricht SM .
Urgent referrals from primary care to dermatology for lesions suspicious for skin cancer: patterns, outcomes, and need for systems improvement.
Arch Dermatol Res 2023 Jul; 315(5):1397-400. doi: 10.1007/s00403-022-02456-7..
Keywords: Cancer: Skin Cancer, Cancer, Primary Care, Skin Conditions, Access to Care
Snyder C, Choi Y, Smith KC
Realist review of care models that include primary care for adult childhood cancer survivors.
The authors conducted a realist review to describe how models of care that include primary care and relevant resources could be effective for adult survivors of childhood cancer. The variables from this program theory found most consistently in the literature included oncology vs primary care specialty, survivor and provider knowledge, provider comfort treating childhood cancer survivors, communication and coordination between and among providers and survivors, and delivery/receipt of prevention and surveillance of late effects.
AHRQ-funded; 75Q80120D00003.
Citation: Snyder C, Choi Y, Smith KC .
Realist review of care models that include primary care for adult childhood cancer survivors.
JNCI Cancer Spectr 2022 Mar 2;6(2). doi: 10.1093/jncics/pkac012..
Keywords: Cancer, Primary Care, Primary Care: Models of Care
Reese TJ, Schlechter CR, Kramer H
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
This study explored the implementation of lung cancer screening with low-dose computed tomography (CT) in primary care. The study’s two goals included exploring the implementation of lung cancer screening primary care in the context of integrating a decision aid into the electronic health record and a designing of implementation strategies that target hypothesized mechanics of change and context-specific barriers. The two phases included a Qualitative Analysis phase including semi-structured interviews with primary care physicians to elicit key task behaviors, and an Implementation Strategy Design phase consisting of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Fourteen interviews were conducted and out of that 3 key task behaviors and four behavioral determinants emerged. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy, increasing social influence, and addressing key facilitators to using the decision aid.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Kramer H .
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
Transl Behav Med 2022 Feb 16;12(2):187-97. doi: 10.1093/tbm/ibab115..
Keywords: Cancer: Lung Cancer, Cancer, Primary Care, Screening, Implementation, Shared Decision Making
Mojica CM, Gunn R, Pham R
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
This study was conducted to describe clinical workflows for fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in Oregon primary care practices and to identify specific workflow processes that might be associated with higher colorectal cancer (CRC) screening rates. Findings showed that primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Higher CRC screening was associated with having medical assistants discuss and review FIT/FOBT screening and instructions with patients.
AHRQ-funded; HS022981.
Citation: Mojica CM, Gunn R, Pham R .
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
BMC Cancer 2022 Jan 25;22(1):106. doi: 10.1186/s12885-021-09106-7..
Keywords: Workflow, Screening, Cancer: Colorectal Cancer, Cancer, Primary Care, Vulnerable Populations
Tobin JN, Cassells A, Weiss E
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
AHRQ-funded; HS021667.
Citation: Tobin JN, Cassells A, Weiss E .
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
J Health Care Poor Underserved 2021;32(4):1907-34. doi: 10.1353/hpu.2021.0173..
Keywords: Patient-Centered Healthcare, Cancer, Behavioral Health, Primary Care, Depression, Women, Screening
Jones OT, Calanzani N, Saji S
Artificial intelligence techniques that may be applied to primary care data to facilitate earlier diagnosis of cancer: systematic review.
This study’s objective was a systematic review of artificial intelligence (AI) techniques that might facilitate earlier diagnosis of cancer and could be applied to primary care electronic health record (EHR) data. Findings showed that AI techniques have been applied to EHR-type data to facilitate early diagnosis of cancer, but their use in primary care settings is still at an early stage of maturity. Further evidence is needed on their performance using primary care data, implementation barriers, and cost-effectiveness before widespread adoption into routine primary care clinical practice can be recommended.
AHRQ-funded; HS027363.
Citation: Jones OT, Calanzani N, Saji S .
Artificial intelligence techniques that may be applied to primary care data to facilitate earlier diagnosis of cancer: systematic review.
J Med Internet Res 2021 Mar 3;23(3):e23483. doi: 10.2196/23483..
Keywords: Cancer, Diagnostic Safety and Quality, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Radhakrishnan A, Reyes-Gastelum D, Gay B
Primary care provider involvement in thyroid cancer survivorship care.
While prior research has examined how primary care providers (PCPs) can care for breast and colon cancer survivors, little is known about their role in thyroid cancer survivorship. The purpose of this study was to understand PCP involvement and confidence in thyroid cancer survivorship care. The investigators found that while PCPs reported being involved in long-term surveillance, gaps remained in their confidence in handling survivorship care. They indicated that thyroid cancer survivorship guidelines that delineate PCP roles present one opportunity to increase confidence about their participation.
AHRQ-funded; HS024512.
Citation: Radhakrishnan A, Reyes-Gastelum D, Gay B .
Primary care provider involvement in thyroid cancer survivorship care.
J Clin Endocrinol Metab 2020 Sep;105(9):e3300-6. doi: 10.1210/clinem/dgaa437..
Keywords: Cancer: Breast Cancer, Cancer: Colorectal Cancer, Cancer, Primary Care
Zhou Y, Abel GA, Hamilton W
Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: a longitudinal data-linkage study using primary care electronic health records.
Sub-optimal use or interpretation of imaging investigations prior to diagnosis of certain cancers may be associated with less timely diagnosis, but pre-diagnostic imaging activity for urological cancer is unknown. In this study, the investigators analysed linked data derived from primary and secondary care records and cancer registration to evaluate the use of clinically relevant imaging tests pre-diagnosis, in patients with bladder and kidney cancer diagnosed in 2012-15 in England.
AHRQ-funded; HS022087.
Citation: Zhou Y, Abel GA, Hamilton W .
Imaging activity possibly signalling missed diagnostic opportunities in bladder and kidney cancer: a longitudinal data-linkage study using primary care electronic health records.
Cancer Epidemiol 2020 Jun;66:101703. doi: 10.1016/j.canep.2020.101703..
Keywords: Cancer, Diagnostic Safety and Quality, Imaging, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Tracer H, Sanou A
AHRQ Author: Tracer H
Screening for pancreatic cancer.
This “Putting Prevention into Practice: An Evidence Based Approach” case study, is based on the U.S. Preventive Services Task Force (USPSTF) recommendation for pancreatic cancer screening. It describes a patient scenario and poses questions.
AHRQ-authored.
Citation: Tracer H, Sanou A .
Screening for pancreatic cancer.
Am Fam Physician 2019 Dec 15;100(12):771-72..
Keywords: U.S. Preventive Services Task Force (USPSTF), Screening, Prevention, Cancer, Case Study, Primary Care
Nelson HD, Fu R, Zakher B
Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force.
The purpose of this paper was to update the 2013 US Preventive Services Task Force systematic review on medications to reduce risk of primary (first diagnosis) invasive breast cancer in women. Investigators abstracted data on methods, participant characteristics, eligibility criteria, outcome ascertainment, and follow-up; individual trial results were combined using a profile likelihood random-effects model. Results showed that tamoxifen, raloxifene, and aromatase inhibitors were associated with lower risk of primary invasive breast cancer in women but also were associated with adverse effects that differed between medications. Risk stratification methods to identify patients with increased breast cancer risk demonstrated low accuracy.
AHRQ-funded; 290201500009I.
Citation: Nelson HD, Fu R, Zakher B .
Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2019 Sep 3;322(9):868-86. doi: 10.1001/jama.2019.5780..
Keywords: Cancer: Breast Cancer, Cancer, Medication, U.S. Preventive Services Task Force (USPSTF), Evidence-Based Practice, Guidelines, Prevention, Primary Care
Davis MM, Gunn R, Pham R
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
This study focused on ways that Medicaid Accountable Care Organizations (ACOs) are implementing interventions with primary care clinics to improve colorectal cancer screening. The researchers conducted a comparative case study of 14 Medicaid ACOs in Oregon and their contracted primary care clinics. They focused on interventions that reduced structural barriers (12 ACOs), delivered provider assessment and feedback (11 ACOs), and provided patient reminders (7 ACOs). There was an unintended consequence of potential exclusion of smaller clinics and metric focus and fatigue.
AHRQ-funded; HS022981.
Citation: Davis MM, Gunn R, Pham R .
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
Prev Chronic Dis 2019 Aug 15;16:E107. doi: 10.5888/pcd16.180395..
Keywords: Primary Care: Models of Care, Primary Care, Screening, Colonoscopy, Cancer: Colorectal Cancer, Cancer, Quality Improvement, Quality of Care, Care Coordination, Patient-Centered Healthcare
Bravo RI, Kietzman KG, Toy P
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
This paper describes the Healthy Aging Partnerships in Prevention Initiative (HAPPI) which aims to increase colorectal cancer screening and other preventive services among underserved Latinos and African-Americans in South Los Angeles who are 50 years and older. It uses an evidence-based model (SPARC) to leverage existing resources and has multi-sectoral partnerships among different agencies, community health centers (CHCs), and a university. The authors engaged five CHCs in quality improvement activities and eight non-governmental organizations in networking and programming to increase awareness of these preventive services.
AHRQ-funded; HS010858.
Citation: Bravo RI, Kietzman KG, Toy P .
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
Salud Publica Mex 2019 Jul-Aug;61(4):427-35. doi: 10.21149/9450..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Primary Care: Models of Care, Primary Care, Elderly, Racial and Ethnic Minorities, Vulnerable Populations, Patient-Centered Healthcare
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
O'Malley D, Hudson SV, Nekhlyudov L
Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care.
This study describes the experiences of early implementers of primary care-focused cancer survivorship delivery models. Implementation challenges included (1) lack of key stakeholder buy-in; (2) practice resources allocated to competing (non-survivorship) change efforts; and (3) competition with higher priority initiatives incentivized by payers.
AHRQ-funded; HS021287.
Citation: O'Malley D, Hudson SV, Nekhlyudov L .
Learning the landscape: implementation challenges of primary care innovators around cancer survivorship care.
J Cancer Surviv 2017 Feb;11(1):13-23. doi: 10.1007/s11764-016-0555-2.
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Keywords: Primary Care, Cancer, Healthcare Delivery, Primary Care: Models of Care, Mortality
Meyer AN, Murphy DR, Singh H
Communicating findings of delayed diagnostic evaluation to primary care providers.
In this study, researchers examined the effectiveness of various communication strategies to inform primary care practitioners (PCPs) about the delayed follow-up of cancer-related abnormal or "red-flag" findings. They found that strategies (emails, phone calls, contacting clinic directors) to communicate to PCPs information on delayed follow-up of findings suspicious for cancer were useful, but not fail-safe.
AHRQ-funded; HS022901.
Citation: Meyer AN, Murphy DR, Singh H .
Communicating findings of delayed diagnostic evaluation to primary care providers.
J Am Board Fam Med 2016 Jul-Aug;29(4):469-73. doi: 10.3122/jabfm.2016.04.150363.
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Keywords: Cancer, Communication, Diagnostic Safety and Quality, Primary Care
El-Shami K, Oeffinger KC, Erb NL
American Cancer Society colorectal cancer survivorship care guidelines.
Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of colorectal cancer (CRC) survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.
AHRQ-funded; HS020937.
Citation: El-Shami K, Oeffinger KC, Erb NL .
American Cancer Society colorectal cancer survivorship care guidelines.
CA Cancer J Clin 2015 Nov-Dec;65(6):428-55. doi: 10.3322/caac.21286.
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Keywords: Cancer, Cancer: Colorectal Cancer, Care Coordination, Guidelines, Primary Care
Phillips L, Hendren S, Humiston S
Improving breast and colon cancer screening rates: a comparison of letters, automated phone calls, or both.
The goal of this study was to understand the differential effects of low-cost automated telephone and mailed interventions on cancer screening rates in a primary care practice. It found that letters plus automated telephone calls are better than either alone in increasing cancer screening rates among patients who are overdue for screening.
AHRQ-funded; HS022440
Citation: Phillips L, Hendren S, Humiston S .
Improving breast and colon cancer screening rates: a comparison of letters, automated phone calls, or both.
J Am Board Fam Med. 2015 Jan-Feb;28(1):46-54. doi: 10.3122/jabfm.2015.01.140174..
Keywords: Primary Care, Screening, Cancer, Prevention, Patient Adherence/Compliance
Atlas SJ, Zai AH, Ashburner JM
Non-visit-based cancer screening using a novel population management system.
The authors evaluated whether involving primary care providers (PCPs) in a visit-independent population management IT application led to more effective cancer screening. They found that involving PCPs in a visit-independent population management IT application resulted in similar cancer screening rates compared with an automated reminder system, but fewer patients were sent reminder letters, suggesting that PCPs were able to identify and exclude from contact patients who would have received automated reminder letters but not undergone screening.
AHRQ-funded; HS018161.
Citation: Atlas SJ, Zai AH, Ashburner JM .
Non-visit-based cancer screening using a novel population management system.
J Am Board Fam Med 2014 Jul-Aug;27(4):474-85. doi: 10.3122/jabfm.2014.04.130319.
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Keywords: Cancer, Health Information Technology (HIT), Prevention, Primary Care, Screening
Robin Yabroff K, Short PF, Machlin S
AHRQ Author: Machlin S
Access to preventive health care for cancer survivors.
The researchers evaluated the association between cancer survivorship and access to primary and preventive health care. They concluded that, although access and preventive care use in cancer survivors is generally equivalent or greater compared to that of other individuals, disparities for uninsured and publicly insured cancer survivors aged 18-64 years suggest that improvements in survivor care are needed.
AHRQ-authored.
Citation: Robin Yabroff K, Short PF, Machlin S .
Access to preventive health care for cancer survivors.
Am J Prev Med 2013 Sep;45(3):304-12. doi: 10.1016/j.amepre.2013.04.021.
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Keywords: Access to Care, Cancer, Medical Expenditure Panel Survey (MEPS), Prevention, Primary Care