National Healthcare Quality and Disparities Report
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- Alcohol Use (1)
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- (-) Patient-Centered Outcomes Research (25)
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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 25 Research Studies DisplayedTimbie JW, Reynolds KA, Evans EL
AHRQ Author: Cohen JW
Advancing data capacity for economic outcomes in patient-centered outcomes research: challenges and opportunities.
The HHS Office of the Assistant Secretary for Planning and Evaluation convened a symposium that brought together patients, researchers, federal agency representatives, and other stakeholders to discuss research on the collection, linkage, and analysis of economic outcomes data for patient-centered outcomes research (PCOR) studies. The purpose of this paper was to synthesize the information gathered in the symposium to guide efforts to build data capacity. The authors then emphasize preliminary opportunities to expand the availability and use of relevant, high-quality economic outcomes data as part of evidence generation in patient-centered outcomes research. Across panel discussions, 4 overarching themes arose to guide efforts to build data capacity for PCOR studies with economic outcomes: 1) Measurement and data collection for economic outcomes should enable a comprehensive, person-centered, and longitudinal understanding of health and other impacts; 2) Research data on economic outcomes should be high quality, accessible, timely, interoperable, and linkable. 3) Collaborative partnerships across stakeholder groups are essential for aligning, advancing, and sustaining efforts to improve the measurement and use of economic outcomes in PCOR; and 5) Economic outcomes in PCOR studies should be defined, collected, and analyzed in ways that advance health equity. With those factors in mind, the researchers explored opportunities to build data capacity for economic outcomes in patient-centered outcomes research in 4 domains: measurement, data collection, data linkage, and data access and use. Within each domain the researchers emphasize opportunities for meaningful, impactful improvements.
AHRQ-authored.
Citation: Timbie JW, Reynolds KA, Evans EL .
Advancing data capacity for economic outcomes in patient-centered outcomes research: challenges and opportunities.
Med Care 2023 Dec; 61(12 Suppl 2):s161-s65. doi: 10.1097/mlr.0000000000001901..
Keywords: Patient-Centered Outcomes Research, Evidence-Based Practice, Patient-Centered Healthcare
Bingham CA, Harris JG, Qui T
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
The objective of this study was to describe the selection, development, and implementation of quality measures for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome quality measures and a committee of rheumatologists and data analysts developed operational definitions. Initial measures were clinical inactive disease, low pain score, and optimal physical functioning; the revised set included additional measures of disease activity, data quality, and a balancing measure. The authors concluded that PR-COIN's set of JIA quality measures is the first comprehensive set used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.
AHRQ-funded; HS021114.
Citation: Bingham CA, Harris JG, Qui T .
Pediatric Rheumatology Care and Outcomes Improvement Network's quality measure set to improve care of children with juvenile idiopathic arthritis.
Arthritis Care Res 2023 Dec; 75(12):2442-52. doi: 10.1002/acr.25168.
Keywords: Children/Adolescents, Arthritis, Quality Measures, Quality Improvement, Quality of Care, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
McPheeters M, O'Connor EA, Riley S
Pharmacotherapy for alcohol use disorder: a systematic review and meta-analysis.
Researchers conducted a literature review and analysis to compare efficacy of therapies for alcohol use disorder. Their findings supported the use of oral naltrexone at 50 mg/d and acamprosate as first-line pharmacotherapies in conjunction with psychosocial interventions for treating alcohol use disorder.
AHRQ-funded; 75Q80120D00007.
Citation: McPheeters M, O'Connor EA, Riley S .
Pharmacotherapy for alcohol use disorder: a systematic review and meta-analysis.
JAMA 2023 Nov 7; 330(17):1653-65. doi: 10.1001/jama.2023.19761..
Keywords: Medication, Alcohol Use, Evidence-Based Practice, Patient-Centered Outcomes Research
Ross SM, Wang A, Anthony L
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
The purpose of this study was to research the effects of interventions for blood pressure in small- and medium-sized practices. The researchers utilized retrospective analysis on data from Healthy Hearts in the Heartland (H3), a research program conducted in 2016-2018 as part of the Agency for Healthcare Research and Quality's EvidenceNOW initiative, to examine the impact of implementing more interventions for BP control in these settings. The study included 38 H3 practices which met inclusion criteria and researchers assigned each practice to an implementer group (high or low) based on the number of interventions implemented. Practices in the high-implementer group implemented an average of 2.2 additional interventions relative to the low-implementer group. Groups were compared on two measures of BP control: (1) mean percentage of hypertensive patients with a most recent BP below 140/90, and (2) mean systolic and diastolic BP of hypertensive patients. In the first measure, practices in the high-implementer group had better improvement between baseline and the end of the study. Among the 10,150 patients included in the second measure, reductions in mean SBP and DBP were better for the high-implementer group.
AHRQ-funded; HS000078; HS000084; HS023921.
Citation: Ross SM, Wang A, Anthony L .
Is more better? The impact of implementing more interventions for hypertension control in a practice facilitation study for small- and medium-sized practices.
J Hum Hypertens 2023 Nov; 37(11):1007-14. doi: 10.1038/s41371-023-00813-1..
Keywords: Blood Pressure, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Practice Improvement
Krefman AE, Ciolino Jd, Kan AK
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
The objective of the Healthy Hearts for Michigan (HH4M) study is to promote hypertension management and smoking cessation through practice facilitation and quality improvement efforts. This three-year research program evaluates rural and medically underserved primary care practices’ ability to implement the quality improvement model and tests whether the model improves blood pressure control and tobacco use screening and cessation. Primary care practices in rural and underserved areas of Michigan were recruited to join HH4M. HH4M is part of the multi-state EvidenceNOW: Building State Capacity initiative to provide external support to primary care practices to improve care delivery.
AHRQ-funded; HS027954.
Citation: Krefman AE, Ciolino Jd, Kan AK .
Rationale and design for Healthy Hearts for Michigan (HH4M): a pragmatic single-arm hybrid effectiveness-implementation study.
Contemp Clin Trials Commun 2023 Oct; 35:101199. doi: 10.1016/j.conctc.2023.101199..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Outcomes Research, Primary Care
Saldanha IJ, Adam GP, Kanaan G
Delivery strategies for postpartum care: a systematic review and meta-analysis.
This systematic review examined the effects of postpartum health care-delivery strategies on health care utilization and maternal outcomes. The authors searched medical databases from inception to November 16, 2022. They found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). The review found that for general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (moderate strength of evidence). Low strength of evidence was found for location of breastfeeding affecting hospitalization, other unplanned care utilization, or mental health symptoms. Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3-6 months but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months but not exclusive breastfeeding (all moderate strength of evidence). Moderate strength of evidence was found for the association of use and nonuse of information technology for breastfeeding care with comparable rates of breastfeeding. Moderate strength of evidence was found for the association of testing reminders for screening or preventive care and greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A1c testing.
AHRQ-funded; 75Q80120D00001; 75Q80121F32007.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Delivery strategies for postpartum care: a systematic review and meta-analysis.
Obstet Gynecol 2023 Sep 1; 142(3):529-42. doi: 10.1097/aog.0000000000005293..
Keywords: Maternal Care, Women, Healthcare Delivery, Evidence-Based Practice, Patient-Centered Outcomes Research
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
AHRQ-funded; HS027804.
Citation: Krishnan JA, Margellos-Anast H, Kumar R .
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities
Steele DW, Adam GP, Saldanha IJ
Postpartum home blood pressure monitoring: a systematic review.
This systematic review’s objective was to assess the effectiveness of postpartum home blood pressure (BP) monitoring compared with clinic-based follow-up and the comparative effectiveness of alternative home BP-monitoring regimens. The authors included randomized controlled trials (RCTs), nonrandomized comparative studies, and single-arm studies that evaluated the effects of postpartum home BP monitoring (up to 1 year), with or without telemonitoring, on postpartum maternal and infant outcomes, health care utilization, and harm outcomes. After double screening, they extracted demographics and outcomes to SRDR+. Thirteen studies (3 RCTs, 2 nonrandomized comparative studies, and 8 single-arm studies) met eligibility criteria. Home BP monitoring was not associated with the rate of BP treatment initiation but was associated with reduced unplanned hypertension-related hospital admissions. Home BP monitoring, compared with office-based follow-up, was associated with reduced racial disparities in BP ascertainment by approximately 50%. Most patients (ranging from 83.3% to 87.0%) were satisfied with management related to home BP monitoring.
AHRQ-funded; 75Q80120D00001; 75Q80121F32006.
Citation: Steele DW, Adam GP, Saldanha IJ .
Postpartum home blood pressure monitoring: a systematic review.
Obstet Gynecol 2023 Aug 1; 142(2):285-95. doi: 10.1097/aog.0000000000005270..
Keywords: Maternal Care, Blood Pressure, Women, Evidence-Based Practice, Patient-Centered Outcomes Research
Ayers DC, Yousef M, Yang W
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
The purpose of this prospective, multicenter cohort study was to evaluate the differences in pain, function, and quality of life (QoL) reported 1 year after total knee arthroplasty (TKA) across varying age groups. The researchers preoperatively assessed 11,602 unilateral primary TKA patients, and collected demographic data, comorbid conditions, and patient-reported outcome measures including the knee injury and osteoarthritis outcome score (KOOS), KOOS-12, KOOS Joint Replacement, and Short-Form health survey (12-item) and then collected again at 1-year postoperatively. The study found that prior to surgery, patients less than 55 years reported worse KOOS pain (39), function (50), and QoL (18) scores with poor mental health score (47) than other older patient groups. At 1 year after TKA, patients less than 55 years reported lower KOOS pain, function, and QoL scores when compared to patients 75 years or older. The differences in score changes among the age groups were statistically significant but clinically irrelevant. Further statistical analyses revealed that age was a significant predictor for pain, but not for function at 1 year where KOOS pain score was predicted to be higher in patients 75 years or older when compared to patients less than 55 years of age.
AHRQ-funded; HS018910.
Citation: Ayers DC, Yousef M, Yang W .
Age-related differences in pain, function, and quality of life following primary total knee arthroplasty: results from a FORCE-TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) cohort.
J Arthroplasty 2023 Jul; 38(7 Suppl 2):S169-S76. doi: 10.1016/j.arth.2023.04.005..
Keywords: Orthopedics, Surgery, Quality of Life, Outcomes, Comparative Effectiveness, Evidence-Based Practice, Patient-Centered Outcomes Research, Pain
Bossick AS, Painter I, Williams EC
Development of a composite risk index of reproductive autonomy using state laws: association with maternal and neonatal outcomes.
This study investigated whether greater reproductive autonomy would be associated with lower rates of severe maternal morbidity (SMM), pregnancy-related mortality (PRM), preterm birth (PTB), and low birthweight. It was hypothesized that greater reproductive autonomy would lower the risks of poor maternal and neonatal outcomes. The authors developed a composite index to quantify state legislation, which was used to examine the association with maternal and neonatal outcomes. A Delphi panel was used to inform index development, and restrictive policies were assigned values of -1 and enabling policies +1. Publicly available data was used to conduct a cross-sectional study of all live births in the 50 US states for people ages 15 to 44 from 2016 to 2018 to examine the association between the risk index and PRM, SMM, PTB, and low birthweight. There were 11,530,785 births, 2,846 pregnancy-related deaths, and 154,384 cases of SMM from 2016 to 2018. The Delphi panel found a summed state measure of 106 laws in 8 categories that could affect reproductive anatomy. In adjusted analyses, states in the most enabling reproductive autonomy quartile had a 44.7 per 10,000 higher rate of SMM compared with the most restrictive quartile. However, the most enabling quartile was associated with a 9.87 per 100,000 lower rate of PRM and 0.67 per 100 lower rate of PTB compared with the most restrictive quartile.
AHRQ-funded; HS013853.
Citation: Bossick AS, Painter I, Williams EC .
Development of a composite risk index of reproductive autonomy using state laws: association with maternal and neonatal outcomes.
Womens Health Issues 2023 Jul-Aug; 33(4):359-66. doi: 10.1016/j.whi.2023.03.008..
Keywords: Maternal Care, Sexual Health, Women, Newborns/Infants, Outcomes, Patient-Centered Outcomes Research
Balk EM, Danilack VA, Bhuma MR
Reduced compared with traditional schedules for routine antenatal visits: a systematic review.
This systematic review’s objective was to assess differences in maternal and child outcomes in studies comparing reduced routine antenatal visit schedules with traditional schedules. The search was conducted in multiple databases searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms. Abstrackr was used for double independent screening for studies comparing televisits and in person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. The authors found five randomized controlled trials and five nonrandomized comparative studies that compared reduced routine antenatal visit schedules with traditional schedules. The studies did not find differences between schedules in gestational age at birth, likelihood of being small for gestational age, likelihood of a low Apgar score, likelihood of neonatal intensive care unit admission, maternal anxiety, likelihood of preterm birth, and likelihood of low birth weight. There was also insufficient evidence for numerous prioritized outcomes of interest, including completion of the American College of Obstetricians and Gynecologists-recommended services and patient experience measures.
AHRQ-funded; 75Q80120D00001.
Citation: Balk EM, Danilack VA, Bhuma MR .
Reduced compared with traditional schedules for routine antenatal visits: a systematic review.
Obstet Gynecol 2023 Jul 1; 142(1):8-18. doi: 10.1097/aog.0000000000005193..
Keywords: Maternal Care, Newborns/Infants, Women, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Evidence-Based Practice
Saldanha IJ, Adam GP, Kanaan G
Health insurance coverage and postpartum outcomes in the US: a systematic review.
The objective of this evidence review was to assess whether extension of health insurance coverage or improvements in health care access are associated with postpartum health care utilization and maternal outcomes. Findings with moderate strength of evidence suggested that more comprehensive association was likely to be related to greater postpartum visit attendance; findings with low strength of evidence indicated a possible association between more comprehensive insurance, fewer preventable readmissions, and emergency department visits. The authors concluded that these findings suggested that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate strength of evidence. They recommended that future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.
AHRQ-funded; 75Q80120D00001.
Citation: Saldanha IJ, Adam GP, Kanaan G .
Health insurance coverage and postpartum outcomes in the US: a systematic review.
JAMA Netw Open 2023 Jun; 6(6):e2316536. doi: 10.1001/jamanetworkopen.2023.16536..
Keywords: Health Insurance, Maternal Care, Women, Outcomes, Medicaid, Patient-Centered Outcomes Research, Evidence-Based Practice
Lindner SR, Balasubramanian B, Marino M
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
The purpose of this study was to estimate decreases in 10-year atherosclerotic cardiovascular disease (ASCVD) risk associated with EvidenceNOW, an initiative spanning multiple states that sought to improve cardiovascular preventive care by providing supportive interventions such as practice facilitation to address the “ABCS”: (A)spirin for high-risk patients, (B)lood pressure control for hypertensive people, (C)holesterol management, and (S)moking screening and cessation counseling. The researchers conducted an analytic modeling study that combined 1) data from 1,278 EvidenceNOW practices collected from 2015 to 2017; (2) patient-level information of 1,295 individuals who participated in the 2015 to 2016 National Health and Nutrition Examination Survey; and (3) 10-year ASCVD risk prediction equations. The study found the average 10-year ASCVD risk of these patients before intervention was 10.11%. Improvements in ABCS due to EvidenceNOW reduced their 10-year ASCVD risk to 10.03% which would prevent 3,169 ASCVD events over 10 years and $150 million in 90-day direct medical costs.
AHRQ-funded; HS023940.
Citation: Lindner SR, Balasubramanian B, Marino M .
Estimating the cardiovascular disease risk reduction of a quality improvement initiative in primary care: findings from EvidenceNOW.
J Am Board Fam Med 2023 May 8; 36(3):462-76. doi: 10.3122/jabfm.2022.220331R1..
Keywords: Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Patient-Centered Outcomes Research, Quality Improvement, Quality of Care, Blood Pressure
Brown-Johnson C, Calma J, Amano A
Evaluating the implementation of patient-reported outcomes in heart failure clinic: a qualitative assessment.
This study evaluated clinician perceptions of the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12), a patient reported outcome (PRO) survey that captures symptom frequency, symptom burden, physical limitations, social limitations, and quality of life. The authors conducted interviews with cardiologists from 4 institutions across the United States and Canada (n=16) and observed clinic visits at 1 institution in Northern California (n=5). They conducted 2 rounds of interviews and did a qualitative analysis on (1) rapid analysis constructed around major themes related to the aims of the study and (2) content analysis with codes derived from the rapid analysis and implementation science. Most cardiologists reported the KCCQ-12 was acceptable, appropriate, and useful in clinical care. The survey was found to improve the consistency of patient history taking, focus patient-clinician conversations, collect a more accurate account of patient quality of life, track trends in patient well-being over time, and refine clinical decision-making.
AHRQ-funded; HS026128.
Citation: Brown-Johnson C, Calma J, Amano A .
Evaluating the implementation of patient-reported outcomes in heart failure clinic: a qualitative assessment.
Circ Cardiovasc Qual Outcomes 2023 May; 16(5):e009677. doi: 10.1161/circoutcomes.122.009677..
Keywords: Patient-Centered Outcomes Research, Outcomes, Heart Disease and Health, Cardiovascular Conditions
Dhopeshwarkar RV, Freij M, Callaham M
AHRQ Author: Harrison MI, Swiger J, Lomotan EA, Dymek C
Lessons learned from a national initiative promoting publicly available standards-based clinical decision support.
The purpose of this study was to discuss lessons learned from a national program promoting publicly available, standards-based Clinical decision support (CDS) resources, describe the challenges encountered with their use, and make suggestions for areas of improvement. The source of the findings was an evaluation of the Agency for Healthcare Research and Quality (AHRQ) Patient-Centered Outcomes Research CDS Initiative, the purpose of which was to advance evidence into practice through standards-based and publicly available CDS. The researchers utilized a review of literature and program materials, conducted key informant interviews, and administered a web-based survey about a public repository of CDS archives and tools for writing standards-based CDS. The review identified key lessons for developing and implementing standards-based CDS through publicly available repositories such as CDS Connect. The researchers identified trust as a key factor in uptake, which can be strengthened by transparent information on underlying evidence, collaboration with experts, and feedback loops between users and developers to support continuous quality improvement. In addition, lower-resourced health systems will need more support to ensure effective implementation and utilization. Finally, the study found that health systems want more information about patient-centered, clinical, and cost-related outcomes to facilitate justifying the investment required to implement publicly available, standards-based CDS.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dhopeshwarkar RV, Freij M, Callaham M .
Lessons learned from a national initiative promoting publicly available standards-based clinical decision support.
Appl Clin Inform 2023 May; 14(3):566-74. doi: 10.1055/s-0043-1769911..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Patient-Centered Outcomes Research
Cantor AG, Nelson HD, Pappas M
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
This comparative effectiveness review was conducted on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services. A literature search was conducted for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care for the period July 2016 to May 2022. Eight RCTs, 1 nonrandomized trial, and 7 observational studies were included (7 studies of contraceptive care and 9 of IPV services). Telehealth services demonstrated similar care as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]). Evidence on abortion was insufficient. Outcomes were also similar between telehealth and usual care interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). Telehealth barriers identified included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Safety strategies increased telehealth use for IPV services. Evidence lacked on access, health equity, or harms.
AHRQ-funded; 75Q80120D00006.
Citation: Cantor AG, Nelson HD, Pappas M .
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
J Gen Intern Med 2023 May; 38(7):1735-43. doi: 10.1007/s11606-023-08033-6..
Keywords: Telehealth, Health Information Technology (HIT), Women, Prevention, Domestic Violence, Evidence-Based Practice, Maternal Care, Sexual Health, Patient-Centered Outcomes Research, Comparative Effectiveness
McHugh M, Philbin S, Carroll AJ
An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care.
This study’s goal was to describe an approach for evaluating the development and effectiveness of a multisector partnership using data from the first year of the Healthy Hearts for Michigan (HH4M) Cooperative, a multisector partnership of nine organizations tasked with designing and implementing evidence-based QI strategies for hypertension management and tobacco cessation in 50 rural primary care practices. A 49-item survey focused on factors that facilitate or hinder multisector partnerships, drawing on implementation science and partnership, engagement, and collaboration research was developed. All 44 members of the HH4M Cooperative (79.5% response rate) were surveyed, interviews conducted with 14 members. Having a clear purpose and trust and respect among members were the strengths reported. A need for common terminology, clarification of roles and functions, and improvement in communication across workgroups were areas for improvement. The Cooperative’s biggest challenge was the lack of engagement from physician practices due to capacity constraints, exacerbated by the COVID-19 pandemic.
AHRQ-funded; HS027954.
Citation: McHugh M, Philbin S, Carroll AJ .
An approach to evaluating multisector partnerships to support evidence-based quality improvement in primary care.
Jt Comm J Qual Patient Saf 2023 Apr;49(4):199-206. doi: 10.1016/j.jcjq.2023.01.002.
Keywords: Quality Improvement, Evidence-Based Practice, Primary Care, Quality of Care, Patient-Centered Outcomes Research
JE Wallis, CJD Huang, LC
AHRQ Author: Tallman
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Researchers evaluated the impact of compliance with nationally recognized radiation therapy quality measures on patient-reported health-related quality of life outcomes in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) population-based, prospective cohort study of men with localized prostate cancer. Eight quality measures were identified based on national guidelines. In multivariable analyses, no clinically significant associations were discovered between compliance with evaluated radiation therapy quality measures and patient-reported outcomes such as urinary irritation, urinary incontinence, bowel, sexual or hormonal function. The researchers concluded that further work would be needed to identify patient-centered quality measures of prostate cancer care.
AHRQ-funded; HS019356.
Citation: JE Wallis, CJD Huang, LC .
Association between adherence to radiation therapy quality metrics and patient reported outcomes in prostate cancer.
Prostate Cancer Prostatic Dis 2023 Mar;26(1):80-87. doi: 10.1038/s41391-022-00518-5.
Keywords: Cancer: Prostate Cancer, Cancer, Patient-Centered Outcomes Research, Evidence-Based Practice, Quality Measures
Humbert-Droz M, Izadi Z, Schmajuk G
Development of a natural language processing system for extracting rheumatoid arthritis outcomes from clinical notes using the national rheumatology informatics system for effectiveness registry.
Researchers developed and evaluated a natural language processing pipeline for extracting outcome measures in rheumatology from free-text outpatient rheumatology notes within the ACR's Rheumatology Informatics System for Effectiveness (RISE) registry. All patients in RISE from 2015 to 2018 were included. The researchers found the pipeline to have good internal and external validity and they concluded that it could facilitate measurement of clinical and patient reported outcomes for use in both research and quality measurement.
AHRQ-funded; HS025638.
Citation: Humbert-Droz M, Izadi Z, Schmajuk G .
Development of a natural language processing system for extracting rheumatoid arthritis outcomes from clinical notes using the national rheumatology informatics system for effectiveness registry.
Arthritis Care Res 2023 Mar; 75(3):608-15. doi: 10.1002/acr.24869..
Keywords: Arthritis, Electronic Health Records (EHRs), Health Information Technology (HIT), Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Bierman AS, Burke BT, Comfort LN
AHRQ Author: Bierman AS, Burke BT, Comfort LN, Gerstein M, Mueller NM, Umscheid CA
From precision medicine to precision care: choosing and using precision medicine in the context of multimorbidity.
Swift progress in personalized medicine offers significant potential to decrease disease and death rates for numerous health issues. To maximize the advantages of personalized medicine and minimize negative outcomes, addressing real-world obstacles in applying this research to clinical practice is crucial. A primary challenge involves selecting and employing personalized medicine approaches in everyday practice, considering the care of a substantial portion of individuals with multiple coexisting conditions. Personalized medicine should be incorporated into a broader framework of individualized care, which takes into account factors that impact the efficacy of specific treatments. Individualized care combines a patient-focused approach with personalized medicine to guide decision-making and care plans, considering multiple health conditions, functional ability, personal values, goals, preferences, and social and societal contexts. Creating dissemination and implementation strategies for personalized medicine centered around individualized care can enhance patient-centric quality and health outcomes, direct interventions toward those who will benefit most, improve access to novel treatments, reduce the likelihood of treatment withdrawal due to unforeseen side effects, and promote health equity by customizing interventions and care for diverse individuals and communities. Delivering personalized medicine within the scope of individualized care supports respectful treatment that aligns with patient preferences, values, and objectives, fostering trust and offering necessary information for informed decision-making. Accelerating its adoption demands focus on the entire translational research continuum: devising innovative methods, proving their value, disseminating and implementing findings, and involving patients throughout the process. This includes basic science, preclinical and clinical research, and integration into practice, all aimed at enhancing health. This paper scrutinizes the challenges in adopting personalized medicine in the presence of multiple health conditions. The authors conclude that while the promise of personalized medicine is immense, proactive measures are essential to prevent unintended repercussions and ensure its equitable and efficient implementation.
AHRQ-authored: All.
Citation: Bierman AS, Burke BT, Comfort LN .
From precision medicine to precision care: choosing and using precision medicine in the context of multimorbidity.
Cambridge Prisms: Precision Medicine 2023 Feb 21;1:e19. doi:10.1017/pcm.2023.8.
Keywords: Learning Health Systems, Patient-Centered Healthcare, Evidence-Based Practice, Patient-Centered Outcomes Research
Bartels K, Howard-Quijano K, Prin M
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
This article summarized the background and objectives of the first Cardiovascular Outcomes Research in Perioperative Medicine (COR-PM) conference. It also described the conduct of the conference and outlined future directions for scientific meetings which are focused on the fostering of high-quality clinical research in the broader perioperative medicine community.
AHRQ-funded; HS027795.
Citation: Bartels K, Howard-Quijano K, Prin M .
Meeting report: first Cardiovascular Outcomes Research in Perioperative Medicine conference.
Anesth Analg 2023 Feb; 136(2):418-20. doi: 10.1213/ane.0000000000006248..
Keywords: Cardiovascular Conditions, Surgery, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Fishbein AB, Lor J, Penedo FJ
Patient-reported outcomes for measuring sleep disturbance in pediatric atopic dermatitis: cross-sectional study of the patient reported outcomes measurement information system pediatric sleep measures and actigraphy.
The purposes of this cross-sectional study were to test the Patient-Reported Outcomes Measurement Information System (PROMIS) sleep measures in pediatric atopic dermatitis (AD) and to develop an algorithm to screen, evaluate, and intervene to reduce sleep disturbances. Participants were children with AD aged 5 to 17 and one parent who completed sleep, itch, and AD-specific questionnaires. Clinicians assessed disease severity. PROMIS sleep disturbance parent proxy reliability was high and was differentiated among Patient-Oriented Eczema Measure (POEM)-determined disease severity groups. The authors concluded that sleep disturbance in pediatric AD should be screened using the POEM sleep question, and further assessment using the PROMIS sleep disturbance measure or objective sleep monitoring if it is needed.
AHRQ-funded; HS023011.
Citation: Fishbein AB, Lor J, Penedo FJ .
Patient-reported outcomes for measuring sleep disturbance in pediatric atopic dermatitis: cross-sectional study of the patient reported outcomes measurement information system pediatric sleep measures and actigraphy.
J Am Acad Dermatol 2023 Feb; 88(2):348-56. doi: 10.1016/j.jaad.2020.05.138..
Keywords: Children/Adolescents, Sleep Problems, Skin Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice
Moise N, Paniagua-Avila A, Barbecho JM
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
This study used a collaborative care (CC) use case to describe a novel, theory-informed, stakeholder engaged process for operationalizing strategies for sustainability using a behavioral lens. The goal is to optimize depression treatment in primary care clinics using the Transform DepCare shared decision-making and psychoeducation patient tool. The authors applied the Behaviour Change Wheel to their prior mixed methods to identify key sustainability behaviors and determinants of sustainability. The authors enlisted 22 national and local stakeholders to operationalize and adapt a multi-level, multi-component implementation strategy to maximally target behavioral and contextual determinants of sustainability. They identified ongoing care manager CC delivery, provider treatment optimization, and patient enrollment as key sustainability behaviors. They determined that a waiting room that delivered DepCare, the results of which are delivered to providers, as well as ongoing problem-solving meetings/local technical assistance with care managers would be the most acceptable and equitable multi-level strategy in diverse settings seeking to sustain CC programs. Key improvements would include expanding the DepCare tool to incorporate anxiety/suicide screening, triage support, multi-modal delivery, and patient activation (vs. shared decision making) (patient); pairing summary reports with decisional support and yearly onboarding/motivational educational videos (provider); incorporating behavioral health providers into problem-solving meetings and shifting from billing support to quality improvement and triage (system).
AHRQ-funded; HS025198.
Citation: Moise N, Paniagua-Avila A, Barbecho JM .
A theory-informed, rapid cycle approach to identifying and adapting strategies to promote sustainability: optimizing depression treatment in primary care clinics seeking to sustain collaborative care (the transform depcare study).
Implement Sci Commun 2023 Jan 25; 4(1):10. doi: 10.1186/s43058-022-00383-2..
Keywords: Depression, Primary Care, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Rizk S, Kaelin VC, Sim JGC
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
The study’s aim was to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. A mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were conducted and used to share quantitative trial results. All three stakeholder groups identified thematic supports and barriers across multiple constructs within each of four Consolidated Framework for Implementation Research (CFIR) domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) Three themes for "inner setting," and (4) Four themes for "outer setting." Priorities from stakeholders included prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Improving EI access (“outer setting”) using YC-PEM e-PRO results was also articulated by service coordinators and program leadership.
AHRQ-funded; HS027583.
Citation: Rizk S, Kaelin VC, Sim JGC .
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
Appl Clin Inform 2023 Jan; 14(1):91-107. doi: 10.1055/s-0042-1760631..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Children/Adolescents, Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
Rastogi V, Marcaccio CL, Kim NH
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
The purpose of this study was to assess perioperative outcomes in patients in the Vascular Quality Initiative who underwent juxta-/pararenal FEVAR with supraceliac vs infraceliac sealing. 1,486 Patients who received an elective FEVAR for juxta-/pararenal aortic aneurysms in the Vascular Quality Initiative between 2014 and 2021were identified and included.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
The researchers defined supraceliac sealing as proximal sealing in aortic zone 5, or zone 6 with a celiac scallop/fenestration/branch or celiac occlusion. The study’s primary outcomes were perioperative and 3-year mortality, and secondary outcomes were completion endoleaks, in-hospital complications, and variables related with 3-year mortality. The study found that of the included patients, 84% underwent infraceliac sealing, and 16% underwent supraceliac sealing. Of the supraceliac patients, 60% had a celiac fenestration/branch, 31% had a celiac scallop, and 9.2% had a celiac occlusion (intentional or unintentional). Compared with infraceliac sealing, there were no differences after risk-adjusted analysis in perioperative mortality following supraceliac sealing. Supraceliac sealing was associated with lower odds of type-IA completion endoleaks, but higher odds of any complication including cardiac complications, lower extremity ischemia and acute kidney injury when compared with infraceliac sealing. The researchers concluded that supraceliac sealing was associated with lower risk of type IA endoleaks and similar mortality compared with sealing at an infraceliac level. The researchers advise that providers should be aware that supraceliac sealing was related with higher perioperative morbidity.
AHRQ-funded; HS027285.
Citation: Rastogi V, Marcaccio CL, Kim NH .
The effect of supraceliac versus infraceliac landing zone on outcomes following fenestrated endovascular repair of juxta-/pararenal aortic aneurysms.
J Vasc Surg 2023 Jan;77(1):9-19.e2. doi: 10.1016/j.jvs.2022.08.007..
Keywords: Cardiovascular Conditions, Surgery, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes, Comparative Effectiveness, Treatments