National Healthcare Quality and Disparities Report
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- Shared Decision Making (6)
- Sickle Cell Disease (1)
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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 64 Research Studies DisplayedSchuttner L, Richardson C, Parikh T
"Low-value" glycemic outcomes among older adults with diabetes cared for by primary care nurse practitioners or physicians: a retrospective cohort study.
The objective of this retrospective cohort study was to compare patients with diabetes reassigned to nurse practitioners to those reassigned to physicians after their previous physician separated from practice in an integrated US health system. Participants were patients aged at least 65 with diabetes who were at increased risk for hypoglycemia, whose primary care physician had left the Veterans Health Administration, and who were reassigned to a new primary care provider in the following year. The results indicated that primary care nurse practitioners delivered equivalent or better rates of low-value diabetes care for older patients, compared to physicians.
AHRQ-funded; HS026369.
Citation: Schuttner L, Richardson C, Parikh T .
"Low-value" glycemic outcomes among older adults with diabetes cared for by primary care nurse practitioners or physicians: a retrospective cohort study.
Int J Nurs Stud 2023 Sep; 145:104532. doi: 10.1016/j.ijnurstu.2023.104532..
Keywords: Elderly, Primary Care, Diabetes, Chronic Conditions
McClintock HF, Edmonds SE, Bogner HR
Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes.
This study’s objective was to examine patterns of adherence to oral hypoglycemic agents among primary care patients with type 2 diabetes mellitus and to assess whether these patterns were associated with baseline intervention allocation, sociodemographic characteristics, and clinical indicators. Adherence patterns for 72 participants were examined by Medication Event Monitoring System (MEMS) caps at baseline and 12 weeks. Participants were randomly allocated to a Patient Prioritized Planning (PPP) intervention or a control group. A card-sort task was used in the PPP intervention to identify health-related priorities that included social determinants of health to address medication nonadherence. Afterward, a problem-solving process was used to address unmet needs involving referral to resources. Patients were found to be either adherent, increasingly adherent, or non-adherent. Participants assigned to the PPP intervention were significantly more likely to have a pattern of improving adherence and adherence than participants assigned to the control group.
AHRQ-funded; HS023445.
Citation: McClintock HF, Edmonds SE, Bogner HR .
Adherence patterns to oral hypoglycemic agents among primary care patients with type 2 diabetes.
Prim Care Diabetes 2023 Apr;17(2):180-84. doi: 10.1016/j.pcd.2023.01.014.
Keywords: Diabetes, Patient Adherence/Compliance, Primary Care, Medication, Chronic Conditions
Gay HC, Yu J, Persell SD
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Researchers sought to describe trends in prescribing for sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1-RAs) to reduce cardiovascular events and mortality in adult patients with type 2 diabetes mellitus (T2DM) in diverse care settings. Their focus was on outpatient clinics in a midwestern integrated health system and small- and medium-sized community-based primary care practices and health centers in three Midwestern states. Results showed that an increase in prescription rates was greater for SGLT2is than for GLP1-RAs in a large integrated medical center and community primary care practices; overall, prescription rates for eligible patients were low, and the researchers observed racial disparities.
AHRQ-funded; HS026385; HS023921.
Citation: Gay HC, Yu J, Persell SD .
Comparison of sodium-glucose cotransporter-2 inhibitor and glucagon-like peptide-1 receptor agonist prescribing in patients with diabetes mellitus with and without cardiovascular disease.
Am J Cardiol 2023 Feb 15; 189:121-30. doi: 10.1016/j.amjcard.2022.10.041..
Keywords: Diabetes, Cardiovascular Conditions, Chronic Conditions, Medication, Primary Care
Hinesley JLG, Brooks EM, O'Loughlin K
Feasibility of patient navigation for care planning in primary care.
The purpose of this study was to help better control chronic conditions by connecting patients with a navigator for support creating a personal care goal. Twenty-four clinicians in 12 practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) participated in a care planning intervention under a structured process that guided 87 patients with uncontrolled chronic conditions, trained navigators, and adapted the navigation process to meet the needs of each practice. Findings indicated that patient navigation to address care plans should be feasible, with a minimal time commitment and non-intensive training. However, given the burden and competing demands in primary care, this help cannot be offered without additional resources.
AHRQ-funded; HS026223.
Citation: Hinesley JLG, Brooks EM, O'Loughlin K .
Feasibility of patient navigation for care planning in primary care.
J Prim Care Community Health 2022 Jan-Dec;13:21501319221134754. doi: 10.1177/21501319221134754..
Keywords: Primary Care, Chronic Conditions, Patient and Family Engagement
Schuttner L, Lee JR, Hockett Sherlock S
Primary care physician perspectives on the influence of patient values, health priorities, and preferences on clinical decision-making for complex patients with multimorbidity: a qualitative study.
The purpose of this study was to explore primary care physician (PCP) perspectives on the influence of patients' values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and higher psychosocial complexity. Between May and July 2020 the researchers utilized semi-structured telephone interviews with 23 PCPs in patient-centered medical home teams in a nationally integrated health system in the United States. The study found three major themes: (1) The personal values of patients were rarely directly discussed in routine clinical encounters but informed more typically discussed constructs of patient preferences, goals, and priorities; (2) Patient preferences, goals, and priorities were sources of conflicting perspectives about care plans between healthcare teams, patients, and families; (3) Physicians used direct strategies to communicate and negotiate about patient preferences, goals, and priorities when developing care plans. The researchers concluded that during clinical decision-making for complex patients with multimorbidity, primary care physicians perceive patient values, preferences, health priorities and goals as influential.
AHRQ-funded; HS026369.
Citation: Schuttner L, Lee JR, Hockett Sherlock S .
Primary care physician perspectives on the influence of patient values, health priorities, and preferences on clinical decision-making for complex patients with multimorbidity: a qualitative study.
Risk Manag Healthc Policy 2022 Nov 16; 15:2135-46. doi: 10.2147/rmhp.S380021..
Keywords: Primary Care, Provider: Physician, Shared Decision Making, Chronic Conditions
Grauer A, Duran AT, Liyanage-Don NA
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
The purpose of this retrospective cohort study was to explore whether there is a relationship between telemedicine use in primary care and risk factor assessment and control for patients with diabetes mellitus. The study included patients with diabetes mellitus ages 18-75 with a telemedicine visit in a primary care network between February 2020 and December 2020. Researchers evaluated whether low-density lipoprotein cholesterol (LDL-C), blood pressure (BP), and hemoglobin A1c (HbA1c) and were assessed for each patient. The study identified 1,824 patients with diabetes during the study period and found that telemedicine use was associated with a lower proportion of patients with all three risk factors assessed. The researchers concluded that telemedicine use was related with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic.
AHRQ-funded; HS026121; HS024262.
Citation: Grauer A, Duran AT, Liyanage-Don NA .
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
J Endocrinol Invest 2022 Sep;45(9):1749-56. doi: 10.1007/s40618-022-01814-6..
Keywords: Diabetes, Chronic Conditions, Telehealth, Health Information Technology (HIT), Primary Care, Risk
Salloum RG, Bilello L, Bian J
Study protocol for a type III hybrid effectiveness-implementation trial to evaluate scaling interoperable clinical decision support for patient-centered chronic pain management in primary care.
The objective of this 3-year project is to study the adaptation and implementation of an existing interoperable clinical decision support (CDS) tool for pain treatment shared decision making, with tailored implementation support, in new clinical settings in the OneFlorida Clinical Research Consortium. The evaluation will be organized by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, with an adaptation and tailoring of PainManager, an open source interoperable CDS tool. It is anticipated that this evaluation will establish the feasibility and obtain preliminary data in preparation for a multi-site pragmatic trial targeting the effectiveness of PainManager and tailored implementation support on shared decision making and patient-reported pain and physical function.
AHRQ-funded; R18 HS028584.
Citation: Salloum RG, Bilello L, Bian J .
Study protocol for a type III hybrid effectiveness-implementation trial to evaluate scaling interoperable clinical decision support for patient-centered chronic pain management in primary care.
Implement Sci 2022 Jul 15;17(1):44. doi: 10.1186/s13012-022-01217-4..
Keywords: Clinical Decision Support (CDS), Pain, Chronic Conditions, Primary Care, Health Information Technology (HIT), Patient-Centered Outcomes Research, Patient-Centered Healthcare
Allen KS, Danielson EC, Downs SM
Evaluating a prototype clinical decision support tool for chronic pain treatment in primary care.
This study evaluates a prototype decision support tool to aid primary care clinicians when caring for patients with chronic noncancer pain called The Chronic Pain Treatment Tracker (Tx Tracker). The authors conducted 12 semi-structured interviews with primary care clinicians from four Indiana health systems. The interviews were conducted in two waves, with the last 6 interviews prototype and interview guide revisions. The interviews explored the Tx Tracker using a think-aloud approach and a clinical scenario. Evaluation questions were also asked. The researchers identified several themes: the need for clinicians to be presented with a comprehensive patient history, the usefulness of Tx Tracker in patient discussions about treatment planning, potential usefulness of Tx Tracker for patients with high uncertainty or risk, potential usefulness of Tx Tracker in aggregating scattered information, variability in expectations about workflows, skepticism about underlying electronic health record data quality, interest in using Tx Tracker to annotate or update information, interest in using Tx Tracker to translate information to clinical action, desire for interface with visual cues for risks, warnings, or treatment options, and desire for interactive functionality.
AHRQ-funded; HS023306.
Citation: Allen KS, Danielson EC, Downs SM .
Evaluating a prototype clinical decision support tool for chronic pain treatment in primary care.
Appl Clin Inform 2022 May;13(3):602-11. doi: 10.1055/s-0042-1749332..
Keywords: Clinical Decision Support (CDS), Primary Care, Chronic Conditions, Health Information Technology (HIT)
Schuttner L, Hockett Sherlock S, Simons C
Factors affecting primary care physician decision-making for patients with complex multimorbidity: a qualitative interview study.
Researchers sought to describe factors affecting physician decision-making when care planning for complex patients with multimorbidity within the team-based, patient-centered medical home setting in the integrated healthcare system of the U.S. Department of Veterans Affairs, the Veterans Health Administration (VHA). They found that primary care physicians described internal, external, and relationship-based factors that affected their care planning for high-risk and complex patients with multimorbidity in the VHA.
AHRQ-funded; HS026369.
Citation: Schuttner L, Hockett Sherlock S, Simons C .
Factors affecting primary care physician decision-making for patients with complex multimorbidity: a qualitative interview study.
BMC Prim Care 2022 Feb 5;23(1):25. doi: 10.1186/s12875-022-01633-x..
Keywords: Primary Care, Shared Decision Making, Chronic Conditions, Patient-Centered Healthcare
White AEC, Hood-Medland EA, Kravitz RL
Visit linearity in primary care visits for patients with chronic pain on long-term opioid therapy.
Physicians and patients report frustration after primary care visits for chronic pain. The need to shift between multiple clinical topics to address competing demands during visits may contribute to this frustration. This study created a novel measure, "visit linearity," to assess visit organization and examined whether visits that required less shifting back and forth between topics were associated with better patient and physician visit experiences.
AHRQ-funded; HS022236.
Citation: White AEC, Hood-Medland EA, Kravitz RL .
Visit linearity in primary care visits for patients with chronic pain on long-term opioid therapy.
J Gen Intern Med 2022 Jan;37(1):78-86. doi: 10.1007/s11606-021-06917-z..
Keywords: Opioids, Pain, Chronic Conditions, Primary Care, Medication
Ibemere SO, Tanabe P, Bonnabeau E
Awareness and use of the sickle cell disease toolbox by primary care providers in North Carolina.
The authors developed a decision support tool for sickle cell disease (SCD) for SCD management (SCD Toolbox) based on the National Heart, Lung, and Blood Institute's SCD guidelines. Using data from primary care providers (PCPs) in North Carolina, they found that PCPs rarely co-managed with a specialist, had low awareness and use of the SCD Toolbox, and requested multiple formats for the toolbox.
AHRQ-funded; HS024501.
Citation: Ibemere SO, Tanabe P, Bonnabeau E .
Awareness and use of the sickle cell disease toolbox by primary care providers in North Carolina.
J Prim Care Community Health 2021 Jan-Dec;12:21501327211049050. doi: 10.1177/21501327211049050..
Keywords: Sickle Cell Disease, Primary Care, Chronic Conditions, Shared Decision Making, Evidence-Based Practice
Heller CG, Rehm CD, Parsons AH
The association between social needs and chronic conditions in a large, urban primary care population.
This study sought to understand the association between social needs and chronic health conditions using a screening tool and clinical data from Electronic Health Records. From April 2018 to December 2019, 33,550 adult patients completed a 10-item social needs screening tool during primary visits in Bronx and Westchester Counties, NY. A positive, cumulative association between social needs and each of the eight outcomes asked about was found. The relationship was strongest for elevated PHQ-2 (depression screening), alcohol/drug use disorder, and smoking. Those with 3 or greater social needs were 3.9 times more likely to have an elevated PHQ-2 than those without needs. Healthcare transportation challenges was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. Examples included those with an alcohol/drug use disorder (84% more likely), and smokers (41% more likely).
AHRQ-funded; HS026396.
Citation: Heller CG, Rehm CD, Parsons AH .
The association between social needs and chronic conditions in a large, urban primary care population.
Prev Med 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752..
Keywords: Chronic Conditions, Urban Health, Primary Care, Low-Income, Social Determinants of Health, Screening
Savitz LA, Bayliss EA
Emerging models of care for individuals with multiple chronic conditions.
The objective of this study was to characterize emerging and current practice models to more effectively treat and support patients with multiple chronic conditions (MCC). The investigators concluded that integrating care for MCC patient populations requires processes for determining different subpopulation needs in various settings and lived experiences. Innovation should be anchored at the nexus of payment systems, social risks, medical needs, and community-based resources.
AHRQ-funded; 290201600001B.
Citation: Savitz LA, Bayliss EA .
Emerging models of care for individuals with multiple chronic conditions.
Health Serv Res 2021 Oct;56(Suppl 1):980-89. doi: 10.1111/1475-6773.13774..
Keywords: Chronic Conditions, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care
Bierman AS, Wang J, O'Malley PG
AHRQ Author: Bierman AS, Wang J, O'Malley PG, Moss DK
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
AHRQ-authored.
Citation: Bierman AS, Wang J, O'Malley PG .
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords: Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
Misra-Hebert AD, Hu B, Pantalone KM
Primary care health care use for patients with type 2 diabetes during the COVID-19 pandemic.
This study sought to examine factors associated with total and virtual primary care use for patients with type 2 diabetes (T2D) during the COVID-19 pandemic. This study used electronic medical records in the Cleveland Clinic Health System comparing prepandemic use from August 2019 to March 2020 (baseline period 0) to two pandemic periods: March to June 2020 (period 1) when in-person visits were converted to virtual; and July to November 2020 when in-person visits resumed (period 2). Demographic characteristics were obtained including age, sex, race, insurance type, median income estimated by zip code and baseline HbA1C. The study included 76,015 patients with T2D who completed a primary care visit in baseline period 0. Cohort median age was 66.2 years, 50.7% women, 21.7% Black, 71.0% White and 7.4 Other. Insurance distribution was 43.2% private, 46.5% Medicare, and 9.5% Medicaid. Median income was estimated at $59,000 and baseline HbA1C was ≤ 7% for 59.6% of patients. There were higher odds of Black patients, those with uncontrolled T2D, and those with Medicare and Medicare using virtual visits during the 2 postpandemic periods suggesting that virtual visits may be a preference for those groups. Older and male patients had lower odds of visit completion.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Pantalone KM .
Primary care health care use for patients with type 2 diabetes during the COVID-19 pandemic.
Diabetes Care 2021 Sep;44(9):e173-e74. doi: 10.2337/dc21-0853..
Keywords: COVID-19, Diabetes, Primary Care, Telehealth, Health Information Technology (HIT), Healthcare Delivery, Access to Care, Chronic Conditions
Bifulco L, Anderson DR, Blankson ML
Evaluation of a chronic pain screening program implemented in primary care.
The purpose of this study was to evaluate a 2-step process for chronic pain screening and follow-up in primary care. Participants included primary care practitioners and medical assistants from 13 sites who implemented the screening process in primary care, and over 38,000 patients aged 18 or older with a primary care visit during the study’s July 2018-June 2019 time period. Findings showed that a systematic, 2-step process for chronic pain screening and functional assessment in primary care appeared to identify patients with previously undocumented chronic pain and that this process was feasible to implement.
AHRQ-funded; HS025354.
Citation: Bifulco L, Anderson DR, Blankson ML .
Evaluation of a chronic pain screening program implemented in primary care.
JAMA Netw Open 2021 Jul;4(7):e2118495. doi: 10.1001/jamanetworkopen.2021.18495..
Keywords: Pain, Chronic Conditions, Primary Care, Screening
Hood-Medland EA, White AEC, Kravitz RL
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
This study looked at primary care visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience with patients taking opioids for chronic pain. The study analyzed 83 video-recorded US primary care visits at a single academic medical center in California. A total of 49 family medicine and internal resident physicians and 83 patients were filmed. The authors developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discusses. They identified 2 visit opening styles with agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda opening styles (open-ended question, patient launch, physician launch). Only 11% of visits included agenda setting and was associated with fewer surprise patient topics than visits without agenda setting.
AHRQ-funded; HS022236.
Citation: Hood-Medland EA, White AEC, Kravitz RL .
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
BMC Fam Pract 2021 Jan 4;22(1):4. doi: 10.1186/s12875-020-01317-4..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Clinician-Patient Communication, Communication, Ambulatory Care and Surgery
Stephens KA, Ike B, Baldwin LM
Challenges and approaches to population management of long-term opioid therapy patients.
Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. In this study, the investigators identified sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines.
AHRQ-funded; HS023750.
Citation: Stephens KA, Ike B, Baldwin LM .
Challenges and approaches to population management of long-term opioid therapy patients.
J Am Board Fam Med 2021 Jan-Feb;34(1):89-98. doi: 10.3122/jabfm.2021.01.190100..
Keywords: Opioids, Pain, Chronic Conditions, Care Management, Medication, Primary Care, Ambulatory Care and Surgery
Chambers EC, McAuliff KE, Heller CG
Toward understanding social needs among primary care patients with uncontrolled diabetes.
This study examined the relationship between unmet social needs and diabetes among a predominantly Black and Hispanic patient population in a large urban hospital system in Bronx, New York. A total of 5846 patients with diabetes seen at a primary care visit between April 2018 and December 2019 were included and completed a social needs screener. Twenty-two percent of the patient sample had at least 1 unmet social need, with the most prevalent unmet needs being housing issues, food insecurity, and lack of healthcare transportation. Patients with more unmet needs had a greater likelihood of uncontrolled diabetes, with lack of healthcare transportation and food insecurity having the greatest likelihood.
AHRQ-funded; HS026396.
Citation: Chambers EC, McAuliff KE, Heller CG .
Toward understanding social needs among primary care patients with uncontrolled diabetes.
J Prim Care Community Health 2021 Jan-Dec;12:2150132720985044. doi: 10.1177/2150132720985044..
Keywords: Diabetes, Chronic Conditions, Primary Care, Vulnerable Populations, Social Determinants of Health
Militello LG, Hurley RW, Cook RL
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
Investigators sought a better understanding of primary care clinicians’ approaches to managing patients with chronic pain and explored implications for technological and administrative interventions. They found that primary care clinicians’ beliefs about opioid therapy generally align with the clinical evidence but may have some important gaps, suggesting the potential value of interventions that include improved access to research findings, organizational changes to support spending time with patients to develop rapport, and the need for innovative clinical cognitive support.
AHRQ-funded; HS023306.
Citation: Militello LG, Hurley RW, Cook RL .
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
J Gen Intern Med 2020 Dec;35(12):3542-48. doi: 10.1007/s11606-020-06178-2..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Provider: Physician, Provider: Clinician, Provider, Care Management
Fraze TK, Briggs ADM, Whitcomb EK
Role of nurse practitioners in caring for patients with complex health needs.
The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics. Findings showed that nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.
AHRQ-funded; HS024075.
Citation: Fraze TK, Briggs ADM, Whitcomb EK .
Role of nurse practitioners in caring for patients with complex health needs.
Med Care 2020 Oct;58(10):853-60. doi: 10.1097/mlr.0000000000001364..
Keywords: Provider: Clinician, Provider: Nurse, Provider, Chronic Conditions, Primary Care, Medicare
Krist AH, O'Loughlin K, Woolf SH
Enhanced care planning and clinical-community linkages versus usual care to address basic needs of patients with multiple chronic conditions: a clinician-level randomized controlled trial.
This paper describes the beginning of a clinician-level cluster-randomized controlled trial to evaluate how primary care clinicians can participate in community and hospital solutions to connecting patients with needed services and whether doing so is effective in controlling multiple chronic conditions. Electronic health records will be used to identify patients with these conditions, including cardiovascular disease or risks, diabetes, obesity, or depression.
AHRQ-funded; HS026223.
Citation: Krist AH, O'Loughlin K, Woolf SH .
Enhanced care planning and clinical-community linkages versus usual care to address basic needs of patients with multiple chronic conditions: a clinician-level randomized controlled trial.
Trials 2020 Jun 11;21(1):517. doi: 10.1186/s13063-020-04463-3..
Keywords: Chronic Conditions, Primary Care, Health Promotion, Access to Care
Huguet N, Kaufmann J, O'Malley J
Using electronic health records in longitudinal studies: estimating patient attrition.
This study’s objective was to estimate overall and among adults with diabetes or hypertension: 1) patient attrition over a 3-year period at community health centers; and 2) the likelihood that patients with Medicaid switched their primary care source. Data was collected from the retrospective cohort study of 2012-2017 claims data Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Data Research Network of community health centers. This study focused on Oregon Medicaid enrollees with a total of 232,891 patients aged 19-64 with a gap of 6 months or more following a claim for a visit billed to a primary care source. The authors theorized the reason was due to patients with Medicaid permanently changing their primary care source. They found that attrition over 3 years averaged 33.5% but patients with diabetes or hypertension was lower (25% or less). Among Medicaid patients the attrition rate 12% for community health center patients compared with 39% for single-provider practice patients.
AHRQ-funded; HS025962.
Citation: Huguet N, Kaufmann J, O'Malley J .
Using electronic health records in longitudinal studies: estimating patient attrition.
Med Care 2020 Jun;58(Suppl 1):S46-S52. doi: 10.1097/mlr.0000000000001298...
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Blood Pressure, Chronic Conditions, Primary Care, Medicaid
Obinwa U, Pérez A, Lingvay I
Multilevel variation in diabetes screening within an integrated health system.
Variation in diabetes screening in clinical practice is poorly described. In this study, the investigators examined the interplay of patient, provider, and clinic factors explaining variation in diabetes screening within an integrated health care system in the U.S. They concluded that screening practices varied widely and were only partially explained by patient, provider, and clinic factors available in the EHR.
AHRQ-funded; HS022418.
Citation: Obinwa U, Pérez A, Lingvay I .
Multilevel variation in diabetes screening within an integrated health system.
Diabetes Care 2020 May;43(5):1016-24. doi: 10.2337/dc19-1622..
Keywords: U.S. Preventive Services Task Force (USPSTF), Diabetes, Screening, Primary Care, Prevention, Evidence-Based Practice, Chronic Conditions
Munson SA, Schroeder J, Karkar R SA, Schroeder J, Karkar R
The importance of starting with goals in N-of-1 studies.
N-of-1 tools offer the potential to support people in monitoring health and identifying individualized health management strategies. The authors argue that elicitation of individualized goals and customization of tracking to support those goals are a critical yet under-studied and under-supported aspect of self-tracking. In this paper, they reviewed examples of self-tracking from across a range of chronic conditions and self-tracking designs (e.g., self-monitoring, correlation analyses, self-experimentation).
AHRQ-funded; HS023654.
Citation: Munson SA, Schroeder J, Karkar R SA, Schroeder J, Karkar R .
The importance of starting with goals in N-of-1 studies.
Front Digit Health 2020 May;2:3. doi: 10.3389/fdgth.2020.00003..
Keywords: Chronic Conditions, Patient Self-Management, Care Management, Primary Care