National Healthcare Quality and Disparities Report
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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 248 Research Studies DisplayedKerlikowske K, Zhu W, Su YR
Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density.
This study compared using supplemental magnetic resonance imaging (MRI) with or without mammography to inform discussions about supplemental MRI in women with dense breasts. The authors evaluated 52, 237 women aged 40-79 years who underwent 2611 screening MRIs alone and 6518 supplemental MRI plus mammography pairs propensity score-matched to 65, 810 screening mammograms. They estimated rates per 1000 examinations of interval, advanced, and screen-detected early-stage invasive cancers and false-positive recall and biopsy recommendation by breast density (nondense = almost entirely fatty or scattered fibroglandular densities; dense = heterogeneously/extremely dense) adjusting for registry, examination year, age, race and ethnicity, family history of breast cancer, and prior breast biopsy. Screen-detected early-stage cancer rates were statistically higher for MRI plus mammography vs mammography for nondense (9.3 vs 2.9) and dense (7.5 vs 3.5) breasts and for MRI vs MRI plus mammography for dense breasts (19.2 vs 7.5). Interval rates were not statistically different for MRI plus mammography vs mammography for nondense (0.8 vs 0.5) or dense breasts (1.5 vs 1.4), nor were advanced cancer rates. MRI plus mammography had statistically higher false-positive recall and biopsy recommendation rates than mammography alone.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Zhu W, Su YR .
Supplemental magnetic resonance imaging plus mammography compared with magnetic resonance imaging or mammography by extent of breast density.
J Natl Cancer Inst 2024 Feb 8; 116(2):249-57. doi: 10.1093/jnci/djad201.
Keywords: Imaging, Cancer
Gyftopoulos S, Simon E, Swartz JL
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
The objective of this study was to evaluate the efficacy of a multimodal intervention to reduce overutilization of computed tomography pulmonary angiography (CTPA) for suspected pulmonary embolism in the emergency department. Results indicated that guideline concordance increased significantly after intervention. The authors concluded that their success in increasing guideline concordance demonstrated the efficacy of a mixed-methods, human-centered approach to behavior change; however, given that neither of the secondary outcomes improved, the results may demonstrate potential limitations to the guidelines directing the ordering of CTPA studies.
AHRQ-funded; HS024376.
Citation: Gyftopoulos S, Simon E, Swartz JL .
Efficacy and impact of a multimodal intervention on CT pulmonary angiography ordering behavior in the emergency department.
J Am Coll Radiol 2024 Feb; 21(2):309-18. doi: 10.1016/j.jacr.2023.02.033.
Keywords: Emergency Department, Respiratory Conditions, Imaging, Diagnostic Safety and Quality, Blood Clots
Morrone K, Andreca M, Silver EJ
Associating a standardized reporting tool for chest radiographs with clinical complications in pediatric acute chest syndrome.
The objective of this retrospective cohort study was to analyze the interobserver agreement among pediatric radiologists' interpretations for pediatric acute chest syndrome (ACS) chest radiographs. The researchers also explored the association of radiographic findings with ACS complications. Data was taken from pediatric ACS admissions from a single institution in 2019. The results showed moderate to near-perfect agreement between radiologists. Left lower opacity, and pleural effusion were associated with increased risk of ACS complications.
AHRQ-funded.
Citation: Morrone K, Andreca M, Silver EJ .
Associating a standardized reporting tool for chest radiographs with clinical complications in pediatric acute chest syndrome.
Pediatr Pulmonol 2023 Nov; 58(11):3139-46. doi: 10.1002/ppul.26634..
Keywords: Children/Adolescents, Imaging, Sickle Cell Disease, Respiratory Conditions
Kerlikowske K, Bissell MCS, Sprague BL
Impact of BMI on prevalence of dense breasts by race and ethnicity.
Researchers evaluated differences in body mass index (BMI) in relation to differences in dense breasts prevalence by race/ethnicity. Their results indicated that dense breasts were most prevalent among Asian women followed by non-Hispanic White, Hispanic, and Black women. Clinically important differences in breast density prevalence are present across racial/ethnic groups after accounting for age, menopausal status, and BMI. IMPACT: If breast density is the sole criterion used to notify women of dense breasts and discuss supplemental screening it may result in implementing inequitable screening strategies across racial/ethnic groups.
AHRQ-funded; HS018366.
Citation: Kerlikowske K, Bissell MCS, Sprague BL .
Impact of BMI on prevalence of dense breasts by race and ethnicity.
Cancer Epidemiol Biomarkers Prev 2023 Nov; 32(11):1524-30. doi: 10.1158/1055-9965.Epi-23-0049..
Keywords: Obesity, Women, Racial and Ethnic Minorities, Cancer: Breast Cancer, Cancer, Imaging
Liu C, Liu Z, Holmes J
Artificial general intelligence for radiation oncology.
This paper explores full-spectrum applications of artificial general intelligence (AGI) across radiation oncology including initial consultation, simulation, treatment planning, treatment delivery, treatment verification, and patient follow-up. The fusion of vision data with large language models (LLMs) such as GPT-4 and PaLM-2 also creates powerful multimodal models that elucidate nuanced clinical patterns. This fusion promises to catalyze a shift towards data-driven, personalized radiation therapy. This paper provides an overview of how AGI can transform radiation oncology to elevate the standard of patient care in radiation oncology, with the key insight being AGI's ability to exploit multimodal clinical data at scale.
AHRQ-funded; HS029009.
Citation: Liu C, Liu Z, Holmes J .
Artificial general intelligence for radiation oncology.
Meta Radiol 2023 Nov; 1(3). doi: 10.1016/j.metrad.2023.100045.
Keywords: Health Information Technology (HIT), Imaging, Cancer
Abdulkadir Y, Luximon D, Morris E
Human factors in the clinical implementation of deep learning-based automated contouring of pelvic organs at risk for MRI-guided radiotherapy.
This study evaluated the performance and clinical implementation of a novel deep learning-based auto-contouring workflow for 0.35T magnetic resonance imaging (MRI)-guided pelvic radiotherapy, focusing on automation bias and objective measures of workflow savings. UNet-derived architecture was used to develop an auto-contouring model for the femoral heads, bladder, and rectum in 0.35T MR images. Training data was taken from 75 patients treated with MRI-guided radiotherapy at the authors’ institution. The model was tested against 20 retrospective cases outside the training set. It was subsequently implemented, with usability evaluated on the first 30 clinical cases by computing Dice coefficient (DSC), Hausdorff distance (HD), and the fraction of slices that were used un-modified by planners. The authors observed automation bias, but it had little deleterious effect on treatment planning.
AHRQ-funded; HS026486.
Citation: Abdulkadir Y, Luximon D, Morris E .
Human factors in the clinical implementation of deep learning-based automated contouring of pelvic organs at risk for MRI-guided radiotherapy.
Med Phys 2023 Oct; 50(10):5969-77. doi: 10.1002/mp.16676..
Keywords: Imaging, Health Information Technology (HIT)
Abbasi N, Lacson R, Kapoor N
Development and external validation of an artificial intelligence model for identifying radiology reports containing recommendations for additional imaging.
This study’s purpose was to develop and externally validate an artificial intelligence (AI)-based model for identifying radiology reports containing recommendations for additional imaging (RAIs). This retrospective study was performed at a multisite health center using a total of 6300 randomly selected radiology reports generated at one site from January 2015 to June 30, 2021. A bidirectional encoder representations from transformers (BERT)-based technique for identifying RAIS was developed using the 1260 report training set. Performance of the BERT-based model and a previously developed traditional machine learning (TML) model was assessed and compared in the test set. Among a total of 7419 unique patients, 10% of 7560 reports contained RAI. The test set using the BERT-based model had 94.4% precision, 65.4% recall, and an F1 score of 96.4%. In the test set, the TML model showed 69.0% precision, 65.4% recall, and an F1 score of 67.2%. Also in the test set, accuracy was greater for the BERT-based model than for the TML model (99.2% vs 93.1%). The external validation set showed even higher scores for the BERT-based model (99.2% precision, 91.6% recall, an F1 score of 95.2%, and 99.0% accuracy).
AHRQ-funded; HS029348.
Citation: Abbasi N, Lacson R, Kapoor N .
Development and external validation of an artificial intelligence model for identifying radiology reports containing recommendations for additional imaging.
AJR Am J Roentgenol 2023 Sep; 221(3):377-85. doi: 10.2214/ajr.23.29120..
Keywords: Imaging, Health Information Technology (HIT)
Offit LR, Chikarmane SA, Lacson RC
Frequency and outcomes of BI-RADS category 3 assessments in patients with a personal history of breast cancer: full-field digital mammography versus digital breast tomosynthesis.
The purpose of this article was to compare the frequency, outcomes, and additional characteristics of BI-RADS category 3 assessments between full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) in patients with a personal history of breast cancer (PHBC). This retrospective study examined electronic health records from 14,845 mammograms in 10,118 patients (mean age, 63 years) with PHBC who had undergone mastectomy and/or lumpectomy. Of these, 8422 examinations were performed by FFDM from October 2014 to October 2016 and the rest examinations by FFDM with DBT from February 2017 to December 2018. The frequency of category 3 assessment was lower for DBT than FFDM (5.6% vs 6.4%). DBT, compared with FFDM, showed a lower malignancy rate for category 3 lesions (1.8% vs 5.0%), higher malignancy rate for category 4 lesions (32.0% vs 23.2%), and no difference in malignancy rate for category 5 lesions (100.0% vs 75.0%). An analysis of index category 3 lesions included 438 lesions for FFDM and 274 lesions for DBT. For category 3 lesions, DBT, compared with FFDM, showed lower PPV3 (13.9% vs 36.1%) and a more frequent mammographic finding of mass (33.2% vs 23.1%).
AHRQ-funded; HS028616.
Citation: Offit LR, Chikarmane SA, Lacson RC .
Frequency and outcomes of BI-RADS category 3 assessments in patients with a personal history of breast cancer: full-field digital mammography versus digital breast tomosynthesis.
AJR Am J Roentgenol 2023 Sep; 221(3):313-22. doi: 10.2214/ajr.23.29067..
Keywords: Cancer: Breast Cancer, Cancer, Imaging, Women
Neylon J, Luximon DC, Ritter T
Proof-of-concept study of artificial intelligence-assisted review of CBCT image guidance.
The authors presented the initial findings of a proof-of-concept clinical implementation of their AI-assisted review of cone beam computed tomography (CBCT) registrations used for patient setup. They developed an automated pipeline which utilized python scripts to interact with the clinical database through DICOM networking protocol and automated data retrieval and analysis. The AI model was validated against independent expert observers; observer scores for the stratified validation dataset showed statistically significant correlation between scores and model predictions. Case studies demonstrated potential benefits of using such a pipeline to bolster quality and safety programs in radiotherapy.
AHRQ-funded; HS026486.
Citation: Neylon J, Luximon DC, Ritter T .
Proof-of-concept study of artificial intelligence-assisted review of CBCT image guidance.
J Appl Clin Med Phys 2023 Sep; 24(9):e14016. doi: 10.1002/acm2.14016..
Keywords: Imaging, Health Information Technology (HIT)
Sprague BL, Ichikawa L, Eavey J
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
This study evaluated mammography screening failure risk among women undergoing supplemental ultrasound screening in clinical practice in comparison with women undergoing mammography alone. Screening ultrasounds and screening mammograms without supplemental screening were identified within three Breast Cancer Surveillance Consortium registries. A clinically significant proportion of women who had undergone mammography screening alone were at high mammography screening failure risk. Ultrasound screening was highly targeted to women with dense breasts, but only a small proportion were high mammography screening failure risk.
AHRQ-funded; HS018366.
Citation: Sprague BL, Ichikawa L, Eavey J .
Breast cancer risk characteristics of women undergoing whole-breast ultrasound screening versus mammography alone.
Cancer 2023 Aug 15; 129(16):2456-68. doi: 10.1002/cncr.34768..
Keywords: Cancer: Breast Cancer, Cancer, Women, Imaging, Screening, Risk
DeSimone AK, Kapoor N, Lacson R
Impact of an automated closed-loop communication and tracking tool on the rate of recommendations for additional imaging in thoracic radiology reports.
The objectives of this retrospective, institutional review board-approved study set in academic quaternary care hospital were to assess the effects of feedback reports and the implementation of a closed-loop communication system based on rates of recommendations for additional imaging (RAIs) in thoracic radiology reports. A previously validated natural language processing tool was used to classify reports with an RAI. The results showed that feedback reports alone increased RAI rates; an IT intervention that promoted documentation of complete RAI in addition to feedback reports led to significant reductions in RAI rate, incomplete RAI, and improved overall completeness of radiology recommendations.
AHRQ-funded; HS029348.
Citation: DeSimone AK, Kapoor N, Lacson R .
Impact of an automated closed-loop communication and tracking tool on the rate of recommendations for additional imaging in thoracic radiology reports.
J Am Coll Radiol 2023 Aug; 20(8):781-88. doi: 10.1016/j.jacr.2023.05.004..
Keywords: Imaging, Health Information Technology (HIT), Communication
Geanacopoulos AT, Neuman MI, Lipsett SC
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
This study’s objective was to evaluate the association of performing a chest radiograph (CXR) with 7-day hospitalization after emergency department (ED) discharge among pediatric patients with community-acquired pneumonia (CAP). This retrospective cohort study included 206,694 children aged 3 months to 17 years discharged from any ED within 8 states from 2014 to 2019. Secondary outcomes included 7-day ED revisits and a 7-day hospitalization with severe CAP. Among these children diagnosed with CAP, rates of 7-day ED revisit, hospitalization, and severe CAP were 8.9%, 1.6%, and 0.4%, respectively. After adjusting for illness severity, CXR was associated with fewer 7-day hospitalizations (1.6% vs 1.7%). CXR performance varied somewhat between EDs (median 91.5%). EDs in the highest quartile had fewer 7-day hospitalizations (1.4% vs 1.9%), ED revisits (8.5% vs 9.4%), and hospitalizations for severe CAP (0.3% vs 0.5%) as compared to EDs with the lowest quartile of CXR utilization.
AHRQ-funded; HS026503.
Citation: Geanacopoulos AT, Neuman MI, Lipsett SC .
Association of chest radiography with outcomes in pediatric pneumonia: a population-based study.
Hosp Pediatr 2023 Jul; 13(7):614-23. doi: 10.1542/hpeds.2023-007142..
Keywords: Children/Adolescents, Imaging, Pneumonia, Respiratory Conditions, Community-Acquired Infections
Couch E, Ashford MT, Zhang W
Psychosocial and behavioral outcomes for persons with cognitive impairment and caregivers following amyloid-β PET scan disclosure: a systematic review.
This systematic review investigated the psychosocial and behavioral outcomes for persons with cognitive impairment and caregivers following amyloid-β pet scan disclosure. The authors identified 10 papers from 7 studies. While there was little evidence of an association between disclosure and depression, persons with mild cognitive impairment and their caregivers with elevated levels of amyloid had an increased risk of distress or anxiety compared with those without elevated amyloid. They did not identify any studies measuring behavioral outcomes.
AHRQ-funded; HS000011.
Citation: Couch E, Ashford MT, Zhang W .
Psychosocial and behavioral outcomes for persons with cognitive impairment and caregivers following amyloid-β PET scan disclosure: a systematic review.
Alzheimer Dis Assoc Disord 2023 Jul-Sep; 37(3):246-58. doi: 10.1097/wad.0000000000000569..
Keywords: Neurological Disorders, Imaging
Lee SJC, Lee J, Zhu H
Assessing barriers and facilitators to lung cancer screening: initial findings from a patient navigation intervention.
This study’s objective was to examine the challenges to providing lung cancer screening using low-dose computed tomography for patients, particularly minority, under-, and uninsured populations. The authors conducted a pragmatic randomized controlled trial of telephone-based navigation for lung cancer screening in an integrated, urban safety-net health care system. They used bilingual navigators (Spanish and English) to make systematic contact with patients, recording standardized call characteristics in a study-specific database. A total of 225 patients (mean age 63 years, 46% female, 70% racial/ethnic minority) were assigned navigators, with a total of 559 barriers to screening identified during 806 telephone calls. The most common barrier types were personal (46%), provider (30%), and practical (17%). System (6%) and psychosocial (1%) barriers were described by English-speaking patients, but not by Spanish-speaking patients. Provider-related barriers decreased by 80% over the course of the lung cancer screening process.
AHRQ-funded; HS022418.
Citation: Lee SJC, Lee J, Zhu H .
Assessing barriers and facilitators to lung cancer screening: initial findings from a patient navigation intervention.
Popul Health Manag 2023 Jun; 26(3):177-84. doi: 10.1089/pop.2023.0053..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Prevention, Imaging
Petragallo R, Bertram P, Halvorsen P
Development and multi-institutional validation of a convolutional neural network to detect vertebral body mis-alignments in 2D x-ray setup images.
In image-guided radiotherapy (IGRT), lack of correct alignment to the vertebral body continues to be a rare but serious risk to patient safety. The researchers propose that an automated image-review algorithm be included in the IGRT process as an interlock to detect off-by-one vertebral body errors. The purpose of this study was to describe the development and validation of a convolutional neural network (CNN)-based approach for an automated image-review algorithm using patient image data from a planar stereoscopic x-ray IGRT system. The researchers collected X-rays and digitally reconstructed radiographs (DRRs) from 429 spine radiotherapy patients treated using a stereoscopic x-ray image guidance system. True-negative, "no-error" cases were established using clinically-applied, physician approved alignments. "Off-by-one vertebral body" errors were simulated by translating DRRs along the spinal column using a semi-automated method. A leave-one-institution-out method was utilized to estimate the accuracy of the model on data from unseen institutions as follows: every image from five of the institutions was used to train a CNN model from scratch. The size of the resulting training set ranged from 5700 to 9372 images, and was dependent on which five institutions had contributed data. The training set was randomized and split using a 75/25 split into the final training/ validation sets. X-ray/ DRR image pairs and the related labels of "no-error" or "shift" were used as the model input. Accuracy of the model was assessed utilizing images from the sixth institution, which was omitted from the training phase. This test set ranged from 180 to 3852 images, again depending on which institution had been left out of the training phase. The trained model was utilized to categorize the images from the test set as either "no-error" or "shifted", and the model predictions were compared to the ground truth labels to evaluate model accuracy. This process was repeated until the images of each institution had been utilized as the testing dataset. The study found that when the six models were utilized to categorize unseen image pairs from the institution omitted during training, the resulting receiver operating characteristic area under the curve values ranged from 0.976 to 0.998.
AHRQ-funded; HS026486.
Citation: Petragallo R, Bertram P, Halvorsen P .
Development and multi-institutional validation of a convolutional neural network to detect vertebral body mis-alignments in 2D x-ray setup images.
Med Phys 2023 May; 50(5):2662-71. doi: 10.1002/mp.16359..
Keywords: Imaging, Patient Safety, Diagnostic Safety and Quality
Le P, Payne JY, Zhang L
Disease state transition probabilities across the spectrum of NAFLD: a systematic review and meta-analysis of paired biopsy or imaging studies.
This paper is a meta-analysis that summarized the rates of progression to and regression of nonalcoholic fatty liver (NAFL), nonalcoholic steatohepatitis (NASH), and fibrosis in adults with nonalcoholic fatty liver disease (NAFLD). PubMed/MEDLINE and 4 other databases were searched from 1985 to 2020. The authors included observational studies and randomized controlled trials in any language that used liver biopsy or imaging to diagnose NAFLD in adults with a follow-up period of ≥48 weeks. They screened 9744 articles and included 54 studies involving 26,738 patients. Among observational studies, 20% of healthy adults developed NAFL while 21% of people with fatty liver had resolution of NAFL after a median of approximately 4.5 years. In addition, 31% of patients developed NASH after 4.7 years, whereas in 29% of those with NASH, resolution occurred after a median of 3.5 years. Fibrosis stages range from F0 to F3, and time to progression by 1 fibrosis stage was 9.9, 10.3, 13.3, and 22.2 years for F0, F1, F2, and F3, respectively. In reverse, time to regress by 1 stage was 21.3, 12.5, 20.4, and 40.0 years for F4, F3, F2, and F1, respectively.
AHRQ-funded; HS026937.
Citation: Le P, Payne JY, Zhang L .
Disease state transition probabilities across the spectrum of NAFLD: a systematic review and meta-analysis of paired biopsy or imaging studies.
Clin Gastroenterol Hepatol 2023 May; 21(5):1154-68. doi: 10.1016/j.cgh.2022.07.033..
Keywords: Imaging, Diagnostic Safety and Quality
Lee CI, Abraham L, Miglioretti DL
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
The purpose of this study was to develop performance benchmarks for digital breast tomosynthesis (DBT) screening and assess longitudinal performance patterns in United States community practice. Between 2011 and 2018 the researchers collected DBT screening examinations from five Breast Cancer Surveillance Consortium (BCSC) registries. Measures of performance were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition and included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR). These rates were compared with previously published BCSC and National Mammography Database benchmarks, concurrent BCSC DM screening examinations, and expert opinion acceptable performance ranges. The study included a total of 896,101 women undergoing 2,301,766 screening examinations and 1,843,591 DM examinations were included in this study. All performance measures were higher for DBT except sensitivity and FNR, when compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks. The following rates of radiologists received acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity.
AHRQ-funded; HS018366.
Citation: Lee CI, Abraham L, Miglioretti DL .
National performance benchmarks for screening digital breast tomosynthesis: update from the Breast Cancer Surveillance Consortium.
Radiology 2023 May; 307(4):e222499. doi: 10.1148/radiol.222499..
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Prevention, Women
Su YR, Buist DSM, Lee JM
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
The authors compared the relative predictive performance of statistical and machine learning (ML) models to guide modeling strategy selection for surveillance mammography outcomes in women with a personal history of breast cancer. They cross-validated seven risk prediction models for two surveillance outcomes, using 9,447 mammograms. The results suggested that regularized regression outperformed other modeling approaches for predicting breast cancer surveillance mammography outcomes and balanced the trade-off between model flexibility and interpretability.
AHRQ-funded; HS018366.
Citation: Su YR, Buist DSM, Lee JM .
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
Cancer Epidemiol Biomarkers Prev 2023 Apr 3; 32(4):561-71. doi: 10.1158/1055-9965.Epi-22-0677..
Keywords: Cancer: Breast Cancer, Cancer, Health Information Technology (HIT), Imaging
Wahid KA, Lin D, Sahin O
Large scale crowdsourced radiotherapy segmentations across a variety of cancer anatomic sites.
This article describes a data process in which over 200 expert and non-expert clinician annotators manually generated segmentations for regions of interest (ROIs) on computed tomography images across a variety of cancer sites for the Contouring Collaborative for Consensus in Radiation Oncology challenge. The author converted the data into Neuroimaging Informatics Technology Initiative format with standardized nomenclature for ease of use, and generated consensus segmentations using the Simultaneous Truth and Performance Level Estimation method. They conclude that these standardized, structured, and easily accessible data are a valuable resource for the systematic study of variability in segmentation applications, which is crucial for radiotherapy.
AHRQ-funded; HS026881.
Citation: Wahid KA, Lin D, Sahin O .
Large scale crowdsourced radiotherapy segmentations across a variety of cancer anatomic sites.
Sci Data 2023 Mar 22;10(1):161. doi: 10.1038/s41597-023-02062-w.
Keywords: Cancer, Imaging
Ganguli I, Ying W, Shakley T
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
The purpose of this study was to examine the impact of low-value imaging on cascade services and spending in commercially-insured adults with uncomplicated acute low back pain. The researchers analyzed medical claims from Blue Cross Blue Shield of Massachusetts members aged 18-50 years who received a 2018 diagnosis of uncomplicated low back pain, for which imaging was considered inappropriate according to the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) criteria. In 2018, 30,892 members were eligible for low-value imaging. Of these, 6009 (19.5%) received low-value imaging: 5091 (16.5%) X-ray and 787 (2.5%) MRI. The study found that when compared to patients without low-value imaging, those with low-value X-ray or MRI had higher adjusted probabilities of receiving cascade services and greater adjusted total spending at 3, 6, and 12 months. These results were robust to falsification testing. Members with high deductible health plans (HDHP) had higher narrowly defined cascade-associated out-of-pocket spending than those in other plans. The most common sources of narrowly defined cascade-associated spending were physical therapy, office visits, radiology studies, laboratory studies, and surgery.
J Gen Intern Med 2023 Mar;38(4):1102-05. doi: 10.1007/s11606-022-07829-2
Citation: Ganguli I, Ying W, Shakley T .
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
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Keywords: Imaging, Back Health and Pain, Pain, Healthcare Costs
Ho TH, Bissell MCS, Lee CI
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
The purpose of this study was to establish a prioritization method for immediate interpretation of screening mammograms and potential diagnostic assessment. A cohort based on the population, comprising screening mammograms conducted from 2012 to 2020 at 126 radiology centers from 7 Breast Cancer Surveillance Consortium registries, was examined. Classification trees were used to identify combinations of clinical history (age, BI-RADS density, time elapsed since the previous mammogram, history of false-positive recall or biopsy outcome), screening technique (digital mammography, digital breast tomosynthesis), and facility features (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 classified as high and ≥16/100 as very high. The efficiency ratio was calculated as the percentage of recalls divided by the percentage of mammograms. The research cohort consisted of 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The study found that the primary predictor of recall was the time interval since the last mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening method. Recall rates were extremely high for baseline mammograms and high for women with ≥5 years since their previous mammogram. The 9.2% of mammograms in subgroups with very high and high recall rates represented 19.2% of recalls, yielding an efficiency ratio of 2.1 compared to a random strategy. Including women under 50 with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Findings incorporating facility-level characteristics were analogous.
AHRQ-funded; HS018366
Citation: Ho TH, Bissell MCS, Lee CI .
Prioritizing screening mammograms for immediate interpretation and diagnostic evaluation on the basis of risk for recall.
J Am Coll Radiol 2023 Mar;20(3):299-310. doi: 10.1016/j.jacr.2022.09.030.
Keywords: Cancer: Breast Cancer, Cancer, Screening, Imaging, Women, Prevention, Diagnostic Safety and Quality
Montgomery KB, Gillis A, Ramonell KM
Comparative utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism.
This retrospective review examined the utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism (PHPT) patients. The review was conducted on all PHPT patients who underwent parathyroidectomy from 2001 to 2019. The cohort included 2218 patients, with 433 normocalcemic PHPT (19.5%) and 1785 hypercalcemic PHPT (80.5%). Among normocalcemic patients, there were no differences in cure rates in patients with preoperative imaging versus those without (100% vs 99%). There were no differences in postoperative complications except for a slight increase in transient hypocalcemia in patients without imaging. There were equivalent cure and complication rates for normocalcemic PHPT patients with or without preoperative imaging compared to hypercalcemic patients.
AHRQ-funded; HS013852.
Citation: Montgomery KB, Gillis A, Ramonell KM .
Comparative utility of preoperative imaging in normocalcemic versus hypercalcemic primary hyperparathyroidism.
Am J Surg 2023 Feb;225(2):293-97. doi: 10.1016/j.amjsurg.2022.09.042.
Keywords: Imaging, Surgery
Holcomb J, Rajan SS, Ferguson GM
Implementation of an evidence-based intervention with safety net clinics to improve mammography appointment adherence among underserved women.
This study evaluated the implementation of an evidence-based intervention in safety-net clinics to improve mammography appointment adherence in underserved women called the Peace of Mind Program. The intervention was implemented in 19 Federally Qualified Health centers and charity care clinics within the Greater Houston area. Surveys were given prior to adoption and at eight weeks post implementation to assess Consolidated Framework for Implementation Research constructs. A total of 4402 women were surveyed (baseline period 2078, intervention period 2324). Women in the intervention period or who completed the intervention were more likely to attend or reschedule their mammography appointment than those who did not complete the intervention. A total of 15 clinics prior to adoption and eight clinics completed the survey post implementation.
AHRQ-funded; HS023255.
Citation: Holcomb J, Rajan SS, Ferguson GM .
Implementation of an evidence-based intervention with safety net clinics to improve mammography appointment adherence among underserved women.
J Cancer Educ 2023 Feb; 38(1):309-18. doi: 10.1007/s13187-021-02116-w..
Keywords: Evidence-Based Practice, Screening, Patient Adherence/Compliance, Imaging, Vulnerable Populations, Ambulatory Care and Surgery
Peng L, Luo G, Walker A
Evaluation of federated learning variations for COVID-19 diagnosis using chest radiographs from 42 US and European hospitals.
The goals of this study were to compare a single-site, COVID-19 computer diagnosis system that used the Federated Averaging (FedAvg) algorithm with 3-client Federated learning (FL) models, and to evaluate the performance of the four FL variations. Researchers leveraged a FL healthcare collaborative that included data from five US and European healthcare systems encompassing 42 hospitals. They concluded that FedAvg could significantly improve generalization of the model in comparison with other personalization FL algorithms--FedProx, FedBN, and FedAMP--but at the cost of poor internal validity.
AHRQ-funded; HS026379.
Citation: Peng L, Luo G, Walker A .
Evaluation of federated learning variations for COVID-19 diagnosis using chest radiographs from 42 US and European hospitals.
J Am Med Inform Assoc 2022 Dec 13;30(1):54-63. doi: 10.1093/jamia/ocac188..
Keywords: COVID-19, Diagnostic Safety and Quality, Imaging, Hospitals
Kim HS, Hernaez R, Sansgiry S
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
The purpose of this study was to determine the comparative effectiveness of varying colonoscopy intervals on colorectal cancer (CRC) outcomes among patients with inflammatory bowel disease (IBD). Data was from the National Veterans Health Administration. Findings showed that, in a national cohort of patients with CRC-IBD, colonoscopy within 3 years prior to CRC diagnosis was associated with early tumor stage at diagnosis, and colonoscopy within 1 year was associated with a reduced all-cause mortality compared with no colonoscopy, supporting colonoscopy intervals of 1 to 3 years in patients with IBD in order to reduce late-stage CRC and all-cause mortality.
AHRQ-funded; HS024122.
Citation: Kim HS, Hernaez R, Sansgiry S .
Comparative effectiveness of surveillance colonoscopy intervals on colorectal cancer outcomes in a national cohort of patients with inflammatory bowel disease.
Clin Gastroenterol Hepatol 2022 Dec;20(12):2848-57.e2. doi: 10.1016/j.cgh.2022.02.048..
Keywords: Cancer: Colorectal Cancer, Cancer, Digestive Disease and Health, Imaging, Screening, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research