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
76 to 100 of 142 Research Studies DisplayedWarsame F, Haugen CE, Ying H
Limited health literacy and adverse outcomes among kidney transplant candidates.
More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. In this study the investigators evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. The investigators concluded that limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.
AHRQ-funded; HS024600.
Citation: Warsame F, Haugen CE, Ying H .
Limited health literacy and adverse outcomes among kidney transplant candidates.
Am J Transplant 2019 Feb;19(2):457-65. doi: 10.1111/ajt.14994..
Keywords: Health Literacy, Transplantation, Adverse Events, Patient-Centered Outcomes Research, Outcomes, Surgery, Mortality, Kidney Disease and Health
Dunn T, Saeed MJ, Shpigel A
The association of preoperative cardiac stress testing with 30-day death and myocardial infarction among patients undergoing kidney transplantation.
This study examined whether the use of preoperative cardiac stress testing of patients undergoing kidney transplantation reduced 30-day- death and myocardial infarction post-transplantation. ESRD patients 40 years or older with primary Medicare insurance between 2006 and 2013 were identified using the United States Renal Data System. In a matched cohort of 17,304 patients, there was little difference in 30-day post-transplantation mortality and myocardial infarction between those receiving a stress test and those who did not.
AHRQ-funded; HS019455.
Citation: Dunn T, Saeed MJ, Shpigel A .
The association of preoperative cardiac stress testing with 30-day death and myocardial infarction among patients undergoing kidney transplantation.
PLoS One 2019 Feb;14(2):e0211161. doi: 10.1371/journal.pone.0211161..
Keywords: Transplantation, Kidney Disease and Health, Heart Disease and Health, Cardiovascular Conditions, Chronic Conditions, Risk, Surgery
Wey A, Salkowski N, Kasiske BL
The relationship between the C-statistic and the accuracy of program-specific evaluations.
The C-statistic of the risk-adjustment model is often used to judge the accuracy of program evaluations. However, the C-statistic depends on the variability in risk for individual transplants and may be inappropriate for determining the accuracy of program evaluations. This simulation study investigated the association of the C-statistic with several metrics of program evaluation accuracy, including categorizing programs into the 5-tier system and identifying programs for regulatory review.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kasiske BL .
The relationship between the C-statistic and the accuracy of program-specific evaluations.
Am J Transplant 2019 Feb;19(2):407-13. doi: 10.1111/ajt.15132..
Keywords: Transplantation, Surgery, Registries
Novogrodsky E, Yaghoubian A, Connor SE
The role of media in non-directed (altruistic) living kidney donation.
This study sought to characterize how non-directed living kidney donors use media and informational resources over the course of their kidney donation journey. The investigators conducted semi-structured interviews with non-directed donors (NDDs) who initiated kidney transplant chains. The investigators concluded that media and informational resources play an important role in the process of donation for NDDs, including inspiring interest in donation through personal narratives.
AHRQ-funded; HS000029.
Citation: Novogrodsky E, Yaghoubian A, Connor SE .
The role of media in non-directed (altruistic) living kidney donation.
Health Commun 2019 Feb;34(2):259-67. doi: 10.1080/10410236.2017.1405480..
Keywords: Kidney Disease and Health, Transplantation, Shared Decision Making, Communication, Education: Patient and Caregiver
Holscher CM, Luo X, Massie AB
Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States.
This study used Scientific Registry of Transplant Recipients data 2001-2016 to evaluate death-censored graft failure (DCGF) and mortality for recipients of offspring versus nonoffspring living donor kidneys, using Cox regression models with interaction terms. The investigators found that kidneys from offspring donors provided lower graft failure and comparable mortality.
AHRQ-funded; HS024600.
Citation: Holscher CM, Luo X, Massie AB .
Better graft outcomes from offspring donor kidneys among living donor kidney transplant recipients in the United States.
Am J Transplant 2019 Jan;19(1):269-76. doi: 10.1111/ajt.15126..
Keywords: Transplantation, Surgery, Registries, Outcomes, Mortality, Adverse Events
Ruck JM, Henderson ML, Eno AK
Use of Twitter in communicating living solid organ donation information to the public: an exploratory study of living donors and transplant professionals.
As transplant centers start leveraging Twitter for information dissemination and public engagement, it is important to understand current living solid organ donation-related Twitter use. This paper investigated use of Twitter in communicating living solid organ donation information to the public. It provides insight into how the social media platform may be used to communicate about and disseminate information about living donation.
AHRQ-funded; HS023876.
Citation: Ruck JM, Henderson ML, Eno AK .
Use of Twitter in communicating living solid organ donation information to the public: an exploratory study of living donors and transplant professionals.
Clin Transplant 2019 Jan;33(1):e13447. doi: 10.1111/ctr.13447..
Keywords: Transplantation, Social Media, Communication, Education: Patient and Caregiver
Mogul DB, Luo X, Garonzik-Wang J
Expansion of the liver donor supply through greater use of split-liver transplantation: identifying optimal recipients.
While the outcomes of split liver transplantation (SLT) and whole liver transplantation (WLT) are similar among pediatric recipients, the authors hypothesize that the relationship between graft type and outcomes may vary by patient, donor, or surgical characteristics. The study evaluated graft survival among transplant recipients using data from the Scientific Registry of Transplant Recipients to identify similar conditions for risk of graft loss between SLT and WLT. Characteristics associated with graft loss include: donor age, recipient weight, acute hepatic necrosis, autoimmune diseases, tumors, insurance type, and cold ischemia time.
AHRQ-funded; HS023876.
Citation: Mogul DB, Luo X, Garonzik-Wang J .
Expansion of the liver donor supply through greater use of split-liver transplantation: identifying optimal recipients.
Liver Transpl 2019 Jan;25(1):119-27. doi: 10.1002/lt.25340..
Keywords: Children/Adolescents, Patient-Centered Outcomes Research, Transplantation
Kelly MS, Spees L, Vinesett R
Utility of autopsy among pediatric allogeneic hematopoietic stem cell transplant recipients: one last chance to learn?
Researchers conducted a retrospective cohort study of children undergoing allogeneic hematopoietic stem cell transplant (HSCT) at Duke University who died of any cause in 1995 and 2016. They found no associations between autopsy performance and patient age, sex, HSCT indication, or HSCT donor. Additionally, the proportion of autopsies with an unexpected diagnosis did not change during the study period. The researchers conclude that the utility of autopsy in this patient population remains high despite a reduction in the identification of unexpected infections.
AHRQ-funded; HS000032.
Citation: Kelly MS, Spees L, Vinesett R .
Utility of autopsy among pediatric allogeneic hematopoietic stem cell transplant recipients: one last chance to learn?
Biol Blood Marrow Transplant 2018 Sep;24(9):1861-65. doi: 10.1016/j.bbmt.2018.05.030..
Keywords: Children/Adolescents, Transplantation
Wey A, Valapour M, Skeans
Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield.
Variation in heart and lung offer acceptance practices may affect numbers of transplanted organs and create variability in waitlist mortality. In this study, the authors examined offered acceptance ratios, or adjusted odds ratios, for heart and lung transplant programs individually and for all programs within donation service areas (DSAs) using offers from donors recovered July 1, 2016, and June 30, 2017.
AHRQ-funded; HS024527.
Citation: Wey A, Valapour M, Skeans .
Heart and lung organ offer acceptance practices of transplant programs are associated with waitlist mortality and organ yield.
Am J Transplant 2018 Aug;18(8):2061-67. doi: 10.1111/ajt.14885..
Keywords: Transplantation, Health Services Research (HSR), Mortality
Kumar K, Tonascia JM, Muzaale AD
Racial differences in completion of the living kidney donor evaluation process.
Racial disparities in living donor kidney transplantation (LDKT) persist, but the most effective target to eliminate these disparities remains unknown. The researchers investigated delays during completion of the live donor evaluation process. They concluded that delays may be a manifestation of the transplant candidate's social network and recommended targeted efforts to optimize networks for identification of donor candidates in order to address LDKT disparities.
AHRQ-funded; HS024600.
Citation: Kumar K, Tonascia JM, Muzaale AD .
Racial differences in completion of the living kidney donor evaluation process.
Clin Transplant 2018 Jul;32(7):e13291. doi: 10.1111/ctr.13291..
Keywords: Transplantation, Racial and Ethnic Minorities, Disparities, Kidney Disease and Health
Henderson ML, DiBrito SR, Thomas AG
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
This registry-based cohort study examined the patient characteristics and outcomes associated with living multiorgan donation in the United States. The authors assert that careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.
AHRQ-funded; HS024600.
Citation: Henderson ML, DiBrito SR, Thomas AG .
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
Transplantation 2018 Jul;102(7):1148-55. doi: 10.1097/tp.0000000000002082..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Policy, Registries, Transplantation
Wey A, Gustafson SK, Salkowski N
Program-specific transplant rate ratios: association with allocation priority at listing and posttransplant outcomes.
The Scientific Registry of Transplant Recipients (SRTR) is considering more prominent reporting of program-specific adjusted transplant rate ratios (TRRs). To enable more useful reporting of TRRs, SRTR updated the transplant rate models to adjust explicitly for components of allocation priority. In this study, the investigators evaluated potential associations between TRRs and components of allocation priority that could indicate programs' ability to manipulate TRRs by denying or delaying access to low-priority candidates.
AHRQ-funded; HS024527.
Citation: Wey A, Gustafson SK, Salkowski N .
Program-specific transplant rate ratios: association with allocation priority at listing and posttransplant outcomes.
Am J Transplant 2018 Jun;18(6):1360-69. doi: 10.1111/ajt.14684..
Keywords: Transplantation, Registries, Health Services Research (HSR)
Wey A, Salkowski N, Kasiske BL
A five-tier system for improving the categorization of transplant program performance.
The purpose of this study was to better inform health care consumers by identifying the differences in transplant program performance. Researchers compared the differentiation of program performance and a simulated misclassification rate of the five-tier system with the previous three-tier system based on the 95 percent credible interval, using data on adult kidney transplants collected from the Scientific Registry of Transplant Recipients database. The study finds that the five-tier system improved differentiation and maintained a lower misclassification rate than programs differing by two tiers, and concludes that the five-tier system can improve the informing of health care consumers about transplant program performance.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kasiske BL .
A five-tier system for improving the categorization of transplant program performance.
Health Serv Res 2018 Jun;53(3):1979-91. doi: 10.1111/1475-6773.12726..
Keywords: Transplantation, Provider Performance, Quality of Care, Registries
Ashlagi I, Bingaman A, Burq M
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Many U.S. kidney paired donation (KPD) registries have gradually shifted to high-frequency match-runs, raising the question of whether this harms the number of transplants. The authors conducted simulations and found that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting these patients. Further, increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.
AHRQ-funded; HS020610.
Citation: Ashlagi I, Bingaman A, Burq M .
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Am J Transplant 2018 May;18(5):1177-86. doi: 10.1111/ajt.14566..
Keywords: Transplantation, Kidney Disease and Health, Health Services Research (HSR), Policy, Registries
Mogul DB, Luo X, Bowring MG
Fifteen-year trends in pediatric liver transplants: split, whole deceased, and living donor grafts.
This study evaluated changes in patient and graft survival for pediatric liver transplant recipients since 2002, and to determine if these outcomes vary by graft type (whole liver transplant, split liver transplant [SLT], and living donor liver transplant [LDLT]). It concluded that in recent years, outcomes after the use of technical variant grafts are comparable with whole grafts, and may be superior for LDLT.
AHRQ-funded; HS023876.
Citation: Mogul DB, Luo X, Bowring MG .
Fifteen-year trends in pediatric liver transplants: split, whole deceased, and living donor grafts.
J Pediatr 2018 May;196:148-53.e2. doi: 10.1016/j.jpeds.2017.11.015.
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Keywords: Children/Adolescents, Patient-Centered Outcomes Research, Children/Adolescents, Transplantation
Bachmann JM, Shah AS, Duncan MS
Cardiac rehabilitation and readmissions after heart transplantation.
Cardiac transplant recipients always are referred to cardiac rehabilitation (CR) after transplantation, and is associated with a lower 1-year readmission risk. This study’s objective was to determine rates of CR for heart transplant recipients in the US and also 1-year readmission rates using 2013-2014 Medicare data. Out of the 2,531 heart transplant patients in the US in 2013, about 24% received Medicare coverage and were included in the study. Rates of CR utilization was only, with only 55% participating in the program. Younger transplant patients ages 35 to 49 years were less likely to initiate CR than patients 65 and older. In all groups patients did not attend all 36 prescribed sessions, with a mean of 26.7 sessions attended. The 1-year readmission risk was 29% lower for CR participation patients.
AHRQ-funded; HS022990.
Citation: Bachmann JM, Shah AS, Duncan MS .
Cardiac rehabilitation and readmissions after heart transplantation.
J Heart Lung Transplant 2018 Apr;37(4):467-76. doi: 10.1016/j.healun.2017.0.017.
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Keywords: Transplantation, Surgery, Rehabilitation, Cardiovascular Conditions, Heart Disease and Health, Hospital Readmissions, Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
Wey A, Salkowski N, Kremers WK
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
The researchers developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and they characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kremers WK .
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
Am J Transplant 2018 Apr;18(4):897-906. doi: 10.1111/ajt.14506.
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Keywords: Clinical Decision Support (CDS), Shared Decision Making, Kidney Disease and Health, Medical Expenditure Panel Survey (MEPS), Transplantation
Wey A, Pyke J, Schladt DP
Offer acceptance practices and geographic variability in allocation model for end-stage liver disease at transplant.
Offer acceptance practices may cause geographic variability in allocation Model for End-Stage Liver Disease (aMELD) score at transplant and could magnify the effect of donor supply and demand on aMELD variability. To evaluate these issues, offer acceptance practices of liver transplant programs and donation service areas (DSAs) were estimated using offers of livers from donors recovered between January 1, 2016, and December 31, 2016.
AHRQ-funded; HS024527.
Citation: Wey A, Pyke J, Schladt DP .
Offer acceptance practices and geographic variability in allocation model for end-stage liver disease at transplant.
Liver Transpl 2018 Apr;24(4):478-87. doi: 10.1002/lt.25010..
Keywords: Health Services Research (HSR), Policy, Transplantation
Ruck JM, Holscher CM, Purnell TS
https://www.ncbi.nlm.nih.gov/pubmed/29068176
Factors associated with perceived donation-related financial burden among living kidney donors.
The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. In this study, the investigators sought to identify characteristics that predicted higher risk of perceived financial burden.
AHRQ-funded; HS024600.
Citation: Ruck JM, Holscher CM, Purnell TS .
Factors associated with perceived donation-related financial burden among living kidney donors.
Am J Transplant 2018 Mar;18(3):715-19. doi: 10.1111/ajt.14548..
Keywords: Transplantation, Healthcare Costs, Kidney Disease and Health
Bozek DN, Dunn TB, Kuhr CS
Complete chain of the first global kidney exchange transplant and 3-yr follow-up.
While the promise of Global Kidney Exchange (GKE) is significant, it has been met with ethical criticism since its inception in 2015. This paper aims to demonstrate the selection process and provide >3 yr of follow-up on the first GKE donor and recipient from the Philippines. The authors concluded that, although criticisms of GKE highlight concerns for possible exploitation of financially disadvantaged groups, their results demonstrated that these concerns did not come to fruition.
AHRQ-funded; HS020610.
Citation: Bozek DN, Dunn TB, Kuhr CS .
Complete chain of the first global kidney exchange transplant and 3-yr follow-up.
Eur Urol Focus 2018 Mar;4(2):190-97. doi: 10.1016/j.euf.2018.07.021..
Keywords: Kidney Disease and Health, Transplantation
Mogul DB, Luo X, Chow EK
Impact of race and ethnicity on outcomes for children waitlisted for pediatric liver transplantation.
This study sought to determine whether outcomes on the waitlist (ie, mortality, deceased donor liver transplantation [DDLT], and living-donor liver transplantation [LDLT]) varied by race/ethnicity. It concluded that, compared to Caucasian children, African-American children are less likely to use LDLT but have higher rates of DDLT and similar survival on the waitlist.
AHRQ-funded; HS024600; HS023876.
Citation: Mogul DB, Luo X, Chow EK .
Impact of race and ethnicity on outcomes for children waitlisted for pediatric liver transplantation.
J Pediatr Gastroenterol Nutr 2018 Mar;66(3):436-41. doi: 10.1097/mpg.0000000000001793.
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Keywords: Children/Adolescents, Healthcare Utilization, Racial and Ethnic Minorities, Outcomes, Transplantation
Mehrotra S, Kilambi V, Bui K
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Policymakers are deliberating policy reforms to reduce geographic disparity in liver allocation. This study conducted simulations comparing current allocation with the neighborhoods and sharing policies. The study concluded that the current 11 districts can be adapted systematically by adding neighboring donor service areas (DSAs) to improve geographic disparity, mortality, and airplane travel distance. Modifications to Share 35 and Share 15 policies result in further improvements.
AHRQ-funded; HS024840.
Citation: Mehrotra S, Kilambi V, Bui K .
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Transplantation 2018 Feb;102(2):255-78. doi: 10.1097/tp.0000000000001934..
Keywords: Access to Care, Disparities, Policy, Transplantation
Vranian SC, Covert KL, Mardis CR
Assessment of risk factors for increased resource utilization in kidney transplantation.
The purpose of this study was to identify risk factors for increased health care resource utilization in kidney transplant recipients, based on drug-related problems and self-administered surveys. Adult kidney transplant recipients seen in the transplant clinic were surveyed for self-reported demographics, then assessed for associations between survey results, pharmacist-derived drug-related problems, and health resource utilization over a minimum 6-month follow-up period. The authors conclude that Medicaid insurance, self-rated poor health status, and errors in the medication regimen were significant risk factors for increased health care utilization in kidney transplant recipients. Further research is warranted to validate these potential risk factors.
AHRQ-funded; HS023754.
Citation: Vranian SC, Covert KL, Mardis CR .
Assessment of risk factors for increased resource utilization in kidney transplantation.
J Surg Res 2018 Feb;222:195-202.e2. doi: 10.1016/j.jss.2017.09.037..
Keywords: Healthcare Utilization, Kidney Disease and Health, Transplantation
Arms MA, Fleming J, Sangani DB
Incidence and impact of adverse drug events contributing to hospital readmissions in kidney transplant recipients.
This longitudinal cohort study examined 3 cohorts (no readmissions, readmissions not due to an adverse drug event, and adverse drug events contributing to readmissions) of adult kidney recipients transplanted between 2005 and 2010 and followed through 2013. The study results demonstrated that adverse drug events may be associated with a significant increase in the risk of hospital readmission after kidney transplant and subsequent graft loss.
AHRQ-funded; HS023754
Citation: Arms MA, Fleming J, Sangani DB .
Incidence and impact of adverse drug events contributing to hospital readmissions in kidney transplant recipients.
Surgery 2018 Feb;163(2):430-35. doi: 10.1016/j.surg.2017.09.027..
Keywords: Adverse Drug Events (ADE), Patient Safety, Hospital Readmissions, Transplantation
Kilambi V, Bui K, Mehrotra S
LivSim: An open-source simulation software platform for community research and development for liver allocation policies.
This brief discusses LivSim, an open-source software alternative to the Liver Simulated Allocation Model (LSAM) created by the Scientific Registry of Transplant Recipients. LivSim is an open-source simulation software platform for community research and development for liver allocation policies.
AHRQ-funded; HS024840.
Citation: Kilambi V, Bui K, Mehrotra S .
LivSim: An open-source simulation software platform for community research and development for liver allocation policies.
Transplantation 2018 Feb;102(2):e47-e48. doi: 10.1097/tp.0000000000002000..
Keywords: Health Services Research (HSR), Policy, Transplantation