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
101 to 125 of 184 Research Studies DisplayedPantell MS, Shields-Zeeman L
Maintaining social connections in the setting of COVID-19 social distancing: a call to action.
The COVID-19 pandemic is an unprecedented public health crisis, with substantial health, social, and economic implications. The devastating direct medical consequences of COVID-19 have been accompanied by far reaching economic and social consequences, including increased risk of social isolation and loneliness. The authors discuss the need to remember that “social distancing” should refer to physical distancing and isolation, but not social isolation as changes to social routines impact the country.
AHRQ-funded; HS019264.
Citation: Pantell MS, Shields-Zeeman L .
Maintaining social connections in the setting of COVID-19 social distancing: a call to action.
Health Educ Behav 2020 Aug;47(4):569-80. doi: 10.1177/1090198120920529..
Keywords: COVID-19, Public Health
Bettencourt AP, Vance AJ, Jun J
Maximizing the academic nursing model in the era of COVID-19 and beyond.
This opinion paper revisits the 2016 American Association of Colleges of Nursing (AACN) position statement on academic nursing. In the age of COVID-19, the statement is reimagined as a means to maximize nursing’s contributions to this global health crises. The 2016 position statement discussed the potentials for nursing schools to work within healthcare systems beyond clinic training. Most academic nurses do not also provide clinical care which is limited by structural barriers that inhibit academic nursing transformation. Many academic nurses who also have a clinical practice have had to do so on their own time. This new vision would capitalize on nursing’s strength in population health. The authors urge nursing schools to transform their model of academic nursing.
AHRQ-funded; HS024552.
Citation: Bettencourt AP, Vance AJ, Jun J .
Maximizing the academic nursing model in the era of COVID-19 and beyond.
Nurs Outlook 2020 Sep-Oct;68(5):542-44. doi: 10.1016/j.outlook.2020.04.013..
Keywords: COVID-19, Nursing, Provider: Nurse, Public Health, Education: Academic
Patterson ES, Papautsky EL, Krok-Schoen JL
Scheduling delayed treatment and surgeries post-pandemic: a stakeholder analysis.
The purpose of this study was to assess diverse stakeholder perspectives regarding how to trade off risks and benefits to patients, healthcare providers, and the local community. The study found that there exists a high number of different categories of stakeholders affected by the post-pandemic decisions to reschedule delayed treatments and surgeries. The primary stakeholders for a delayed surgery are the surgeon with knowledge of the clinical benefits of undertaking an operation and the patient's willingness to tolerate uncertainty and the increased risk of infection. For decisions about capacity in the operating rooms and inpatient setting after the surgery, the primary factors are reducing staff infections, preventing patients from contracting COVID-19 during operations and during post-surgical recovery at the hospital, conserving critical resources such as Personal Protective Equipment (PPE), and addressing the quality of life needs of hospital staff, such as childcare and preventing infecting members of their household. The timing and selection of elective surgery cases has an effect on the ability of hospitals to manage finances, which impacts decisions about staff employment when resources such as rooms are not being utilized.
AHRQ-funded; HS024379.
Citation: Patterson ES, Papautsky EL, Krok-Schoen JL .
Scheduling delayed treatment and surgeries post-pandemic: a stakeholder analysis.
Proc Int Symp Hum Factors Ergon Healthc 2020 Sep;9(1):10-14. doi: 10.1177/2327857920091066..
Keywords: COVID-19, Surgery, Public Health, Access to Care
Bartsch SM, Mitgang EA, Geller G
What if the influenza vaccine did not offer such variable protection?
This study looked at the impact of reducing the variability in responses to the influenza vaccine across the population. Protection from the vaccine can vary significantly from person to person due to differences in immune systems, body types, and other factors. The authors compared the projected cases, direct medical costs, and productivity losses at the 30%, 50%, and 70% efficacy rates.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Mitgang EA, Geller G .
What if the influenza vaccine did not offer such variable protection?
J Infect Dis 2020 Sep 1;222(7):1138-44. doi: 10.1093/infdis/jiaa240..
Keywords: Influenza, Vaccination, Respiratory Conditions, Public Health
Steele MK, Wikswo ME, Hall AJ
Characterizing norovirus transmission from outbreak data, United States.
Norovirus is the leading cause of acute gastroenteritis outbreaks in the United States. In this study, the investigators estimated the basic (R(0)) and effective (R(e)) reproduction numbers for 7,094 norovirus outbreaks reported to the National Outbreak Reporting System (NORS) during 2009-2017 and used regression models to assess whether transmission varied by outbreak setting.
AHRQ-funded; HS025987.
Citation: Steele MK, Wikswo ME, Hall AJ .
Characterizing norovirus transmission from outbreak data, United States.
Emerg Infect Dis 2020 Aug;26(8):1818-25. doi: 10.3201/eid2608.191537..
Keywords: Infectious Diseases, Public Health, Digestive Disease and Health
Auerbach A, O'Leary KJ, Greysen SR
Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.
The authors sought to characterize inpatient adaptations to care for non-ICU COVID-19 patients. They found that the COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of respiratory isolation units and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.
AHRQ-funded; HS026383; HS026215; HS027369.
Citation: Auerbach A, O'Leary KJ, Greysen SR .
Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.
J Hosp Med 2020 Aug;15(8):483-88. doi: 10.12788/jhm.3476..
Keywords: COVID-19, Emergency Preparedness, Hospitals, Public Health, Healthcare Delivery, Inpatient Care
Khazanie P, Wynia MK, Dickert NW. P, Wynia MK, Dickert NW
Forced choices: ethical challenges in cardiology during the COVID-19 pandemic.
This article discusses the ethical dilemmas that cardiologists may face with cardiac patients due to the COVID-19 pandemic. The influx of patients threatens to exhaust resources in many hospitals and creates many challenges. These include determining the urgency of subacute and chronic cardiovascular diseases. Another challenge is critical care triage in cardiac patients. Protocols were developed during the 2009 H1N1 pandemic which are now adapted for the COVID-19 pandemic. The largest challenge has been interacting with patients and their families. A cardiac patient may not be able to go to an intensive care unit due to severe scarcity of beds and to minimize risks to them and the medical staff.
AHRQ-funded; R01 HS026081.
Citation: Khazanie P, Wynia MK, Dickert NW. P, Wynia MK, Dickert NW .
Forced choices: ethical challenges in cardiology during the COVID-19 pandemic.
Circulation 2020 Jul 21;142(3):194-96. doi: 10.1161/circulationaha.120.047681..
Keywords: COVID-19, Cardiovascular Conditions, Heart Disease and Health, Public Health, Healthcare Delivery
Vyles D, Antoon JW, Norton A
Children with reported penicillin allergy: public health impact and safety of delabeling.
The objectives of this study were to: 1.) Review the relevant literature related to children with reported penicillin allergy 2.) Highlight the different ways in which children could be delabeled and 3.) Evaluate the public health impact that a penicillin allergy has for children. The investigators concluded that penicillin allergy was overdiagnosed, often incorrectly, and the label was frequently first applied during childhood.
AHRQ-funded; HS026395.
Citation: Vyles D, Antoon JW, Norton A .
Children with reported penicillin allergy: public health impact and safety of delabeling.
Ann Allergy Asthma Immunol 2020 Jun;124(6):558-65. doi: 10.1016/j.anai.2020.03.012..
Keywords: Children/Adolescents, Medication, Medication: Safety, Patient Safety, Adverse Drug Events (ADE), Adverse Events, Public Health
Cho HJ, Feldman LS, Keller S
Choosing Wisely in the COVID-19 era: preventing harm to healthcare workers.
This paper highlights the 5 top recommendations developed for hospitals in the COVID-19 era as part of the Choosing Wisely® campaign. This top 5 list of overuse practices in hospital medicine can lead to harm of both patients and healthcare workers. The recommendations include: 1) Do not obtain nonurgent labs in separate blood draws if they can be batched together; 2) Do not use bronchodilators unless there is active obstructive airway disease; 3) Do not use posteroanterior and lateral chest X-ray (CXR) as initial imaging, use a portable CXR instead; 4) Avoid in-person evaluations in favor of virtual communication unless necessary; and 5) Do not delay goals of care conversations for hospitalized patients who are unlikely to benefit from life-sustaining treatments.
AHRQ-funded; HS025782.
Citation: Cho HJ, Feldman LS, Keller S .
Choosing Wisely in the COVID-19 era: preventing harm to healthcare workers.
J Hosp Med 2020 Jun;15(6):360-62. doi: 10.12788/jhm.3457..
Keywords: COVID-19, Infectious Diseases, Hospitals, Prevention, Public Health, Provider: Health Personnel
Abrams EM, Greenhawt M
Risk communication during COVID-19.
This article focuses on ways the healthcare community can best communicate risk of COVID-19 to the public. Poor risk communication results in hoarding behavior which can lead to lack of medications and personal protective equipment. Utilizing social media channels to ensure an ongoing consistent media presence is one potential way to ensure appropriate risk communication. Including all stakeholders in broader public health messaging is also important.
AHRQ-funded; HS024599.
Citation: Abrams EM, Greenhawt M .
Risk communication during COVID-19.
J Allergy Clin Immunol Pract 2020 Jun;8(6):1791-94. doi: 10.1016/j.jaip.2020.04.012..
Keywords: COVID-19, Communication, Risk, Public Health, Emergency Preparedness
Baker AW, Nehls N, Ilies I
Use of optimised dual statistical process control charts for early detection of surgical site infection outbreaks.
This study analyzed the use of optimized dual statistical process control (SPC) charts to predict surgical site infection (SSI) outbreaks. The researchers retrospectively applied an optimized pair of moving average (MA) SPC charts to all 30 SSI outbreaks previously identified and investigated from 2007 to 2015 in the Duke Infection Control Outreach Network (DICON), which is a network of more than 50 community hospitals. The dual MA SPC chart approach detected all 30 outbreaks at a median of 16 months prior to traditional surveillance detection.
AHRQ-funded; HS23821.
Citation: Baker AW, Nehls N, Ilies I .
Use of optimised dual statistical process control charts for early detection of surgical site infection outbreaks.
BMJ Qual Saf 2020 Jun;29(6):517-20. doi: 10.1136/bmjqs-2019-010586..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Patient Safety, Hospitals, Public Health, Infectious Diseases
Jones KM, Mantey J, Mills JP
COVID-19 preparedness in Michigan nursing homes.
The objectives of this study were to understand preparedness among Michigan nursing homes (NHs) in the midst of an ongoing pandemic and to compare with a 2007 survey on pandemic influenza preparedness in Michigan NHs. Findings showed that, in 2020, NHs were able to make policy and procedure changes within 1 week in response to urgent guidance from CMS and the CDC, which likely helped the facilities prepare for the COVID-19 pandemic. Most NHs had a dedicated staff member responsible for preparedness and were willing to accept patients from hospitals to assist in their surge capacity planning, particularly for non-COVID patients. NHs did express concerns about staffing shortages and PPE supply constraints as cases rose.
AHRQ-funded; HS025451.
Citation: Jones KM, Mantey J, Mills JP .
COVID-19 preparedness in Michigan nursing homes.
J Am Geriatr Soc 2020 May;68(5):937-39. doi: 10.1111/jgs.16490..
Keywords: COVID-19, Elderly, Nursing Homes, Long-Term Care, Emergency Preparedness, Public Health
Shaker MS, Oppenheimer J, Grayson M
COVID-19: pandemic contingency planning for the allergy and immunology clinic.
In the event of a global infectious pandemic, drastic measures may be needed that limit or require adjustment of ambulatory allergy services. However, no rationale for how to prioritize service shut down and patient care exists. A consensus-based ad-hoc expert panel of allergy/immunology specialists from the United States and Canada developed a service and patient prioritization schematic to temporarily triage allergy/immunology services. This paper describes the process, recommendations and feedback.
AHRQ-funded; HS024599.
Citation: Shaker MS, Oppenheimer J, Grayson M .
COVID-19: pandemic contingency planning for the allergy and immunology clinic.
J Allergy Clin Immunol Pract 2020 May;8(5):1477-88.e5. doi: 10.1016/j.jaip.2020.03.012..
Keywords: COVID-19, Respiratory Conditions, Emergency Preparedness, Public Health, Healthcare Delivery, Ambulatory Care and Surgery, Infectious Diseases
Steuart R, Huang FS, Schaffzin JK
Finding the value in personal protective equipment for hospitalized patients during a pandemic and beyond.
Innovative protocols have been conceptualized and used to conserve PPE in hospitals. Conservation protocols often fail to identify missed opportunities to improve the value of personal protective equipment (PPE) that already exist in hospital care. By defining the value of inpatient PPE, hospitals can identify opportunities for value improvement. Changes implemented now will maximize PPE value and preserve supply during this pandemic and beyond. In this article, the authors discuss the value in PPE for hospitalized patients during a pandemic and beyond.
AHRQ-funded; HS025138.
Citation: Steuart R, Huang FS, Schaffzin JK .
Finding the value in personal protective equipment for hospitalized patients during a pandemic and beyond.
J Hosp Med 2020 May;15(5):295-98. doi: 10.12788/jhm.3429..
Keywords: COVID-19, Emergency Preparedness, Public Health, Hospitals, Patient Safety
Dixon BE, Zhang Z, Amo JN
Improving notifiable disease case reporting through electronic information exchange-facilitated decision support: a controlled before-and-after trial.
This study examined the results of implementing an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities. They conducted a 2-year controlled before-and-after trial of a health information exchange (HIE) in Indiana. Data was analyzed from electronic prepopulated reports and paper and fax reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Provider reporting rates for chlamydia and gonorrhea increased significantly during the baseline period. During the intervention period they decreased significantly in control clinics. Completion and timeliness improved for both intervention and control clinics.
AHRQ-funded; HS020909.
Citation: Dixon BE, Zhang Z, Amo JN .
Improving notifiable disease case reporting through electronic information exchange-facilitated decision support: a controlled before-and-after trial.
Public Health Rep 2020 May/Jun;135(3):401-10. doi: 10.1177/0033354920914318..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Electronic Health Records (EHRs), Public Health, Public Reporting, Ambulatory Care and Surgery
Kang JX, Levanon Seligson A, Dragan KL
Identifying New York City neighborhoods at risk of being overlooked for interventions.
Public health agencies are often faced with difficult decisions about where and how to allocate funding and resources. In this study, the investigators walked readers through a process of identifying needs across different neighborhoods in New York City (NYC) by examining community district-level health outcomes using data from published Community Health Profile reports released by the NYC Department of Health and Mental Hygiene (DOHMH) in 2015.
AHRQ-funded; HS000055.
Citation: Kang JX, Levanon Seligson A, Dragan KL .
Identifying New York City neighborhoods at risk of being overlooked for interventions.
Prev Chronic Dis 2020 Apr 23;17:E32. doi: 10.5888/pcd17.190325..
Keywords: Public Health, Disparities, Urban Health, Vulnerable Populations
Dixon BE, Wen C, French T
Extending an open-source tool to measure data quality: case report on Observational Health Data Science and Informatics (OHDSI).
The authors extended the open-source software Observational Health Data Sciences and Informatics (OHDSI) to incorporate new functions useful for population health. They developed and tested methods to measure the completeness, timeliness and entropy of information; timeliness was not adopted as its context did not fit with the existing OHDSI domains. The case report examined the process and reasons for acceptance and rejection of ideas proposed to an open-source community like OHDSI.
AHRQ-funded; HS025502.
Citation: Dixon BE, Wen C, French T .
Extending an open-source tool to measure data quality: case report on Observational Health Data Science and Informatics (OHDSI).
BMJ Health Care Inform 2020 Mar;27(1). doi: 10.1136/bmjhci-2019-100054..
Keywords: Public Health, Data
McHaney-Lindstrom M, Hebert C, Miller H
Network analysis of intra-hospital transfers and hospital onset Clostridium difficile infection.
This paper explores how social network analysis (SNA) software can be used to analyze intra-hospital networks of individuals with a healthcare associated infection (HAI) for further analysis in a GIS environment. The SNA analysis compared cases to controls which highlighted significant differences in the overall structure of the networks.
AHRQ-funded; HS024379.
Citation: McHaney-Lindstrom M, Hebert C, Miller H .
Network analysis of intra-hospital transfers and hospital onset Clostridium difficile infection.
Health Info Libr J 2020 Mar;37(1):26-34. doi: 10.1111/hir.12274..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Public Health
Adams C, Young D, Gastanaduy PA
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.
Norovirus transmissibility is poorly understood and the goal of this study was to examine transmission via vomiting, diarrhea, and patient exposures. Six nursing home outbreaks in South Carolina were examined from 2014 to 2016. Vomiting infected 2.12 times the number of individuals as non-vomiters, diarrhea 1.39 times, and resident cases infected 1.53 times the number of individuals as staff cases. This finding is important for not just nursing homes, but other sites of norovirus outbreaks such as cruise ships.
AHRQ-funded; HS025987.
Citation: Adams C, Young D, Gastanaduy PA .
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.
PLoS Comput Biol 2020 Mar;16(3):e1007271. doi: 10.1371/journal.pcbi.1007271..
Keywords: Elderly, Nursing Homes, Long-Term Care, Infectious Diseases, Healthcare-Associated Infections (HAIs), Prevention, Public Health
Bartsch SM, Asti L, Stokes-Cawley OJ
The potential economic value of a Zika vaccine for a woman of childbearing age.
The authors mapped the Zika vaccine and vaccination characteristic thresholds at which vaccination becomes cost effective, highly cost effective, and cost saving. They developed a Markov model to simulate a woman of childbearing age to follow the potential risk and clinical course of a Zika infection. They found that, in some cases, the vaccine was cost effective when the risk was as low as 0.015%, the cost was as high as $7,500, the efficacy was as low as 25%, and the duration of protection was 1 year. They concluded that the thresholds at which vaccination becomes cost effective and cost saving can provide targets for Zika vaccine development and implementation.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Asti L, Stokes-Cawley OJ .
The potential economic value of a Zika vaccine for a woman of childbearing age.
Am J Prev Med 2020 Mar;58(3):370-77. doi: 10.1016/j.amepre.2019.10.023..
Keywords: Vaccination, Women, Infectious Diseases, Public Health, Healthcare Costs, Prevention
Feldman AG, Hsu EK, Mack CL
The importance of prioritizing pre and posttransplant immunizations in an era of vaccine refusal and epidemic outbreaks.
This paper discusses the prevalence of vaccine-preventable outbreaks occurring both nationally and internationally. Rates of vaccine hesitancy and refusal have been increasing which leads to decreased herd immunity. This poses greater risk to immunosuppressed transplant recipients, and currently 1 in 6 pediatric solid organ transplant recipients are hospitalized with a vaccine-preventable infection in the first 5 years posttransplant. This often results in significant morbidity, mortality, and increased hospitalization costs. Surprisingly, many transplant recipients are not up-to-date on age appropriate immunizations at the time of transplant and thereafter. The authors feel that immunizations must be prioritized in both pre and posttransplant care. They call for more research to understand how to monitor immune response to vaccines in immunosuppressed patients and when to optimally immunize patients posttransplant. They also recommend reexamination of the administration of live vaccines posttransplant.
AHRQ-funded; HS026510.
Citation: Feldman AG, Hsu EK, Mack CL .
The importance of prioritizing pre and posttransplant immunizations in an era of vaccine refusal and epidemic outbreaks.
Transplantation 2020 Jan;104(1):33-38. doi: 10.1097/tp.0000000000002936..
Keywords: Vaccination, Medication, Emergency Preparedness, Public Health, Transplantation
Mejia-Chew c, O'Halloran JA, Olsen MA
Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective, cohort study.
Candida bloodstream infection is associated with high mortality. Infectious disease consultation improves outcomes in several infections, including Staphylococcus aureus and cryptococcosis, as well as multidrug-resistant organisms. In this study, the investigators aimed to examine the association between infectious disease consultation and differences in management with mortality in candida bloodstream infections.
AHRQ-funded; HS019455.
Citation: Mejia-Chew c, O'Halloran JA, Olsen MA .
Effect of infectious disease consultation on mortality and treatment of patients with candida bloodstream infections: a retrospective, cohort study.
Lancet Infect Dis 2019 Dec;19(12):1336-44. doi: 10.1016/s1473-3099(19)30405-0..
Keywords: Infectious Diseases, Public Health, Mortality
Brault MA, Spiegelman D, Hargreaves J
Treatment as prevention: concepts and challenges for reducing HIV incidence.
This paper reviews the results and lessons learned from four large-scale HIV antiretroviral therapy (ART) clinical trials that were held in sub-Saharan Africa to reduce HIV transmission. These trials used treatment as prevention (TasP) to improve overall health and protect HIV-uninfected sexual partners from infection. There were seemingly inconsistent findings in the major TasP trials held in South African, Kenya, Uganda, Botswana, and Zambia. The review highlighted implementation challenges and identified approaches to optimize programs and incentivize uptake and engagement in HIV testing and ART-based care.
AHRQ-funded; HS023000.
Citation: Brault MA, Spiegelman D, Hargreaves J .
Treatment as prevention: concepts and challenges for reducing HIV incidence.
J Acquir Immune Defic Syndr 2019 Dec 1;82 Suppl 2:S104-s12. doi: 10.1097/qai.0000000000002168..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Infectious Diseases, Public Health, Screening
Springs S, Rofeberg V, Brown S
Community-engaged evidence synthesis to inform public health policy and clinical practice: a case study.
This case study documents the work of the Rhode Island Arts and Health Advisory Group, which convened in 2016 to develop a set of policy, clinical practice, and research recommendations for implementation by the Rhode Island Department of Health, The Rhode Island State Council on the Arts, and partners. Comprised of artists, clinicians, community members, and patients, the group partnered with researchers to complete an evidence synthesis project of arts-based health care interventions.
AHRQ-funded; HS023299; HS022998.
Citation: Springs S, Rofeberg V, Brown S .
Community-engaged evidence synthesis to inform public health policy and clinical practice: a case study.
Med Care 2019 Oct;57 Suppl 10 Suppl 3:S253-s58. doi: 10.1097/mlr.0000000000001180..
Keywords: Public Health, Policy, Case Study, Evidence-Based Practice, Implementation, Patient-Centered Outcomes Research
Ji W, McKenna C, Ochoa A
Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia.
The authors sought to propose and assess potentially objective, efficient, and reproducible surveillance definitions for non-ventilator hospital-acquired pneumonia (NV-HAP) using routine clinical data stored in electronic health record systems. They found that objective surveillance for NV-HAP using electronically computable definitions that incorporate common clinical criteria is feasible and generates incidence, mortality, and adjusted odds ratios for hospital mortality similar to estimates from manual surveillance. They concluded that these definitions have the potential to facilitate widespread, automated surveillance for NV-HAP and thus inform the development and evaluation of prevention programs.
AHRQ-funded; HS025008.
Citation: Ji W, McKenna C, Ochoa A .
Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia.
JAMA Netw Open 2019 Oct 2;2(10):e1913674. doi: 10.1001/jamanetworkopen.2019.13674..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Respiratory Conditions, Public Health, Electronic Health Records (EHRs), Health Information Technology (HIT)