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
526 to 548 of 548 Research Studies DisplayedFuruno JP, Comer AC, Johnson JK
Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
The researchers describe the design and implementation of a skilled nursing facility (SNF) specific antibiogram to improve empirical antibiotic prescribing. They estimated the frequency of inappropriate antibiotic prescribing in 3 Maryland SNFs and measured the effectiveness of the antibiograms on antibiotic prescribing in 1 of the SNFs.
AHRQ-funded; 290200600020I
Citation: Furuno JP, Comer AC, Johnson JK .
Using antibiograms to improve antibiotic prescribing in skilled nursing facilities.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S56-61. doi: 10.1086/677818..
Keywords: Long-Term Care, Antimicrobial Stewardship, Nursing Homes, Diagnostic Safety and Quality
Fierro JL, Prasad PA, Localio AR
Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians.
The researchers compared practice patterns regarding the diagnosis and management of streptococcal pharyngitis across 25 pediatric primary care practices sharing an electronic health record. They found that only 18 of 222 clinicians wrote 50 percent of all broad-spectrum antibiotic prescriptions for children with group a streptococcus pharyngitis. They suggested targeted interventions to improve adherence to prescribing guidelines.
AHRQ-funded; 290200710013
Citation: Fierro JL, Prasad PA, Localio AR .
Variability in the diagnosis and treatment of group a streptococcal pharyngitis by primary care pediatricians.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S79-85. doi: 10.1086/677820..
Keywords: Antibiotics, Children/Adolescents, Diagnostic Safety and Quality, Primary Care, Practice Patterns
Deppen SA, Blume JD, Kensinger CD
Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis.
The purpose of this study was to estimate the diagnostic accuracy of positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) for pulmonary modules suspicious for lung cancer in regions where infectious lung disease is endemic and compare the accuracy in regions where such disease is rare. It found that the accuracy of FDG-PET was extremely heterogeneous.
AHRQ-funded; HS021554.
Citation: Deppen SA, Blume JD, Kensinger CD .
Accuracy of FDG-PET to diagnose lung cancer in areas with infectious lung disease: a meta-analysis.
JAMA 2014 Sep 24;312(12):1227-36. doi: 10.1001/jama.2014.11488..
Keywords: Cancer, Cancer: Lung Cancer, Diagnostic Safety and Quality, Respiratory Conditions, Imaging
Dood RL, Gracia CR, Sammel MD
Endometrial cancer after endometrial ablation vs medical management of abnormal uterine bleeding.
The authors investigated whether endometrial ablation is associated with increased risk or delayed diagnosis of endometrial cancer compared with medical management of abnormal uterine bleeding. They observed no difference in endometrial cancer rates, nor was there a delay in diagnosis when comparing endometrial ablation vs medical management.
AHRQ-funded; HS021336.
Citation: Dood RL, Gracia CR, Sammel MD .
Endometrial cancer after endometrial ablation vs medical management of abnormal uterine bleeding.
J Minim Invasive Gynecol 2014 Sep-Oct;21(5):744-52. doi: 10.1016/j.jmig.2014.02.012.
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Keywords: Cancer, Comparative Effectiveness, Diagnostic Safety and Quality, Patient-Centered Outcomes Research, Women
Haines CF, Fleishman JA, Yehia BR
AHRQ Author: Fleishman JA
Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era.
The authors sought to determine whether the CD4 count at presentation, a surrogate for time to presentation, increased from 2003 to 2011. They demonstrated a small, but statistically significant, increase in CD4 at presentation after the 2006 CDC HIV-screening guideline revision.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Haines CF, Fleishman JA, Yehia BR .
Increase in CD4 count among new enrollees in HIV care in the modern antiretroviral therapy era.
J Acquir Immune Defic Syndr 2014 Sep 1;67(1):84-90. doi: 10.1097/qai.0000000000000228.
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Keywords: Diagnostic Safety and Quality, Human Immunodeficiency Virus (HIV)
Boehme AK, Rawal PV, Lyerly MJ
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
The researchers compared several scoring systems among patients receiving systemic and endovascular treatments. They concluded that their study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.
AHRQ-funded; HS013852.
Citation: Boehme AK, Rawal PV, Lyerly MJ .
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
J Stroke Cerebrovasc Dis 2014 Sep;23(8):2001-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.003.
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Keywords: Shared Decision Making, Diagnostic Safety and Quality, Risk, Stroke
Patel PA, Schora DM, Peterson KE
Performance of the Cepheid Xpert(R) SA Nasal Complete PCR assay compared to culture for detection of methicillin-sensitive and methicillin-resistant Staphylococcus aureus colonization.
Conventional culture-based methods, including several chromogenic agars, are available for SA and MRSA surveillance but they can take several days and have reduced sensitivity compared to amplification assays. Overall, the Cepheid assay proved a rapid, sensitive, and clinically useful test for the early detection and differentiation of MRSA and MSSA colonization on patients.
AHRQ-funded; HS019968.
Citation: Patel PA, Schora DM, Peterson KE .
Performance of the Cepheid Xpert(R) SA Nasal Complete PCR assay compared to culture for detection of methicillin-sensitive and methicillin-resistant Staphylococcus aureus colonization.
Diagn Microbiol Infect Dis 2014 Sep;80(1):32-4. doi: 10.1016/j.diagmicrobio.2014.05.019..
Keywords: Diagnostic Safety and Quality, Genetics, Methicillin-Resistant Staphylococcus aureus (MRSA)
Cadnum JL, Hurless KN, Deshpande A
Sensitive and selective culture medium for detection of environmental Clostridium difficile isolates without requirement for anaerobic culture conditions.
The researchers developed a low-cost selective broth medium containing thioglycolic acid and L-cystine, termed C. difficile Brucella broth with thioglycolic acid and L-cystine (CDBB-TC), for the detection of C. difficile from environmental specimens under aerobic culture conditions. Their findings demonstrate that a broth medium containing thioglycolic acid and L-cystine provides a sensitive and selective method for the culture of C. difficile from environmental specimens without the need for anaerobic culture conditions.
AHRQ-funded; HS020004.
Citation: Cadnum JL, Hurless KN, Deshpande A .
Sensitive and selective culture medium for detection of environmental Clostridium difficile isolates without requirement for anaerobic culture conditions.
J Clin Microbiol 2014 Sep;52(9):3259-63. doi: 10.1128/jcm.00793-14..
Keywords: Clostridium difficile Infections, Diagnostic Safety and Quality
Kelly JD, Hartman C, Graham J
Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study.
The researchers studied 168 persons newly diagnosed with AIDS to determine if social support contributes to various aspects of HIV care. They found that higher social support scores were associated with earlier HIV diagnosis, linkage to care, and adherence to antiretroviral therapy (ART). However, social support did not contribute to use of ART or retention in HIV care.
AHRQ-funded; HS016093
Citation: Kelly JD, Hartman C, Graham J .
Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study.
J Assoc Nurses AIDS Care. 2014 Sep-Oct;25(5):405-13. doi: 10.1016/j.jana.2013.12.002..
Keywords: Human Immunodeficiency Virus (HIV), Patient Adherence/Compliance, Diagnostic Safety and Quality
Leung LA, Swaminathan S, Trivedi AN
Diabetes diagnosis and exercise initiation among older Americans.
The investigators sought to determine whether exercise participation increased following a new diagnosis of diabetes using a sample of U.S. individuals aged 50 and over who did not report exercise prior to diagnosis. They found that over 35% of persons with a new diagnosis of diabetes initiated moderate or vigorous exercise in the year following their diagnosis.
AHRQ-funded; HS000011.
Citation: Leung LA, Swaminathan S, Trivedi AN .
Diabetes diagnosis and exercise initiation among older Americans.
Prev Med 2014 Aug;65:128-32. doi: 10.1016/j.ypmed.2014.05.001.
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Keywords: Diabetes, Diagnostic Safety and Quality, Elderly, Lifestyle Changes, Patient Self-Management
Cole B, Dickerson JA, Graber ML
AHRQ Author: Henriksen K
A prospective tool for risk assessment of sendout testing.
The authors developed a tool to assess risk of diagnostic errors involving laboratory sendout testing. The tool was determined, through testing at nine pilot sites, to be both useful and easy to use. It could be used by other laboratories to identify the areas of highest risk to patients, which in turn may guide them in focusing their quality improvement efforts and resources.
AHRQ-authored; AHRQ-funded; 29032001T.
Citation: Cole B, Dickerson JA, Graber ML .
A prospective tool for risk assessment of sendout testing.
Clin Chim Acta 2014 Jul 1;434:1-5. doi: 10.1016/j.cca.2014.03.028.
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Keywords: Diagnostic Safety and Quality, Quality of Care, Medical Errors, Patient Safety
Cleveland N, Colwell C, Douglass E
Motor vehicle crash severity estimations by physicians and prehospital personnel.
The purpose of this study was to determine whether emergency physicians (EPs) and EMS personnel differ in their assessment of motor vehicle collision severity and the potential for serious injury when viewing crash scene photographs. They found excellent crash and injury agreement at both ends of the severity spectrum but only modest agreement, and therefore greater variability, in the middle of the severity spectrum.
AHRQ-funded; HS017526
Citation: Cleveland N, Colwell C, Douglass E .
Motor vehicle crash severity estimations by physicians and prehospital personnel.
Prehosp Emerg Care. 2014 Jul-Sep;18(3):402-7. doi: 10.3109/10903127.2014.891065..
Keywords: Emergency Medical Services (EMS), Trauma, Injuries and Wounds, Provider: Health Personnel, Diagnostic Safety and Quality
Wernli KJ, Hubbard RA, Johnson E
Patterns of colorectal cancer screening uptake in newly eligible men and women.
The researchers describe patterns of colorectal cancer screening uptake in a U.S. insured population as individuals become newly eligible for screening at age 50 and assess temporal trends and patient characteristics with screening uptake. Their results suggest that characteristics of newly eligible individuals who initiate colorectal cancer screening are similar to the characteristics of all U.S. adults who receive colorectal cancer screening tests.
AHRQ-funded; HS019482.
Citation: Wernli KJ, Hubbard RA, Johnson E .
Patterns of colorectal cancer screening uptake in newly eligible men and women.
Cancer Epidemiol Biomarkers Prev 2014 Jul;23(7):1230-7. doi: 10.1158/1055-9965.epi-13-1360..
Keywords: Screening, Colonoscopy, Diagnostic Safety and Quality, Healthcare Utilization
Pruitt SL, Leonard T, Zhang S
Physicians, clinics, and neighborhoods: multiple levels of influence on colorectal cancer screening.
The researchers described variability in colorectal cancer (CRC) test use across multiple levels, including physician, clinic, and neighborhood; and (ii) compared the performance of novel cross-classified models versus traditional hierarchical models. Significant variability was observed across all levels in both hierarchical and cross-classified models that was unexplained by measured covariates. For colonoscopy, variance was similar across all levels.
AHRQ-funded; HS022418.
Citation: Pruitt SL, Leonard T, Zhang S .
Physicians, clinics, and neighborhoods: multiple levels of influence on colorectal cancer screening.
Cancer Epidemiol Biomarkers Prev 2014 Jul;23(7):1346-55. doi: 10.1158/1055-9965.epi-13-1130..
Keywords: Cancer: Colorectal Cancer, Diagnostic Safety and Quality, Screening
Newman-Toker DE, Moy E, Valente E
AHRQ Author: Moy E
Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample.
The authors sought to estimate the frequency of missed stroke and examine associations with patient, emergency department (ED), and hospital characteristics. They estimated 15,000-165,000 misdiagnosed cerebrovascular events annually in US EDs, disproportionately presenting with headache or dizziness. They recommended that physicians evaluating these symptoms be particularly attuned to the possibility of stroke in younger, female, and non-White patients.
AHRQ-authored; AHRQ-funded; HS019252.
Citation: Newman-Toker DE, Moy E, Valente E .
Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample.
Diagnosis 2014 Jun;1(2):155-66. doi: 10.1515/dx-2013-0038.
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Keywords: Diagnostic Safety and Quality, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Patient Safety, Stroke
Suri P, Boyko EJ, Goldberg J
Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK).
The researchers examined the association of incident lumbar MRI findings with two specific spine-related symptom outcomes: 1) incident chronic bothersome lower back pain, and 2) incident radicular symptoms such as pain, weakness, or sensation alterations in the lower extremity. They found that even when applying more specific definitions for spine-related symptom outcomes, few MRI findings show strong associations with symptom outcomes.
AHRQ-funded; HS019222
Citation: Suri P, Boyko EJ, Goldberg J .
Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK).
BMC Musculoskelet Disord. 2014 May 13;15:152. doi: 10.1186/1471-2474-15-152..
Keywords: Back Health and Pain, Chronic Conditions, Diagnostic Safety and Quality, Imaging, Pain
Bohannon RW, Bubela DN, Magasi S
Comparison of walking performance over the first 2 minutes and the full 6 minutes of the Six-Minute Walk Test.
The purpose of this study was to describe completion rates and distance walked and ascertain the relationship between distance walked in the first 2 minutes and the full 6 minutes of the Six Minute Walk Test. Based on completion rates, distances walked, reliability and the high correlation between the distance walked in 2 and 6 minutes, the distance walked over 2 minutes can be considered a legitimate alternative to the 6 minute distance for indicating functional endurance.
AHRQ-funded; 260200600007C
Citation: Bohannon RW, Bubela DN, Magasi S .
Comparison of walking performance over the first 2 minutes and the full 6 minutes of the Six-Minute Walk Test.
BMC Res Notes. 2014 Apr 25;7:269. doi: 10.1186/1756-0500-7-269..
Keywords: Diagnostic Safety and Quality
Crane HM, Heckbert SR, Drozd DR
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
In this study, a team of researchers developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. They found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half the events ultimately determined to be MIs were not identified by clinical diagnoses.
AHRQ-funded; HS019515
Citation: Crane HM, Heckbert SR, Drozd DR .
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
Am J Epidemiol. 2014 Apr 15;179(8):996-1005. doi: 10.1093/aje/kwu010..
Keywords: Human Immunodeficiency Virus (HIV), Heart Disease and Health, Clinical Decision Support (CDS), Diagnostic Safety and Quality
Newman-Toker DE
A unified conceptual model for diagnostic errors: underdiagnosis, overdiagnosis, and misdiagnosis.
Newman-Toker proposed a novel framework for considering diagnostic errors, offering a unified conceptual model for underdiagnosis, overdiagnosis, and misdiagnosis, concluding that the model should serve as a foundation for developing consensus terminology and operationalized definitions for relevant diagnostic-error categories.
AHRQ-funded; HS019252.
Citation: Newman-Toker DE .
A unified conceptual model for diagnostic errors: underdiagnosis, overdiagnosis, and misdiagnosis.
Diagnosis 2014 Jan;1(1):43-48. doi: 10.1515/dx-2013-0027.
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Keywords: Diagnostic Safety and Quality, Medical Errors, Patient Safety
Sloane PD, Kistler C, Mitchell CM
Role of body temperature in diagnosing bacterial infection in nursing home residents.
The goals of this study were to provide empirically based guidance on the role of body temperature and fever in the clinical diagnosis of infections. When the researchers compared their empirically derived definitions of fever with those commonly used to justify the prescription of antibiotics for systemic infections, they concluded that the empirical, less-stringent definitions appeared to better fit the clinical realities of nursing home work.
AHRQ-funded; 290200600011I.
Citation: Sloane PD, Kistler C, Mitchell CM .
Role of body temperature in diagnosing bacterial infection in nursing home residents.
J Am Geriatr Soc 2014 Jan;62(1):135-40..
Keywords: Nursing Homes, Diagnostic Safety and Quality, Shared Decision Making
Lawrence JM, Black MH, Zhang JL
Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.
The researchers explored the utility of different algorithms for diabetes case identification by using electronic health records. They found that case identification accuracy was highest in 75% of bootstrapped samples for those who had 1 or more outpatient diabetes diagnoses or 1 or more insulin prescriptions and in 25% of samples for those who had 2 or more outpatient diabetes diagnoses and 1 or more antidiabetic medications.
AHRQ-funded; HS019859.
Citation: Lawrence JM, Black MH, Zhang JL .
Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.
Am J Epidemiol 2014 Jan;179(1):27-38. doi: 10.1093/aje/kwt230..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality
Henriksen K, Brady J
AHRQ Author: Henriksen K, Brady J
The pursuit of better diagnostic performance: a human factors perspective.
Improving diagnostic performance is increasingly recognised as a multifaceted challenge. This paper addresses a few of these challenges, including questions that focus on who owns the problem, treating cognitive and system shortcomings as separate issues, why knowledge in the head is not enough, and what we are learning from health information technology and the use of checklists. The authors propose a systems engineering approach making use of rapid-cycle prototyping and simulation, and they call for the formation of substantive partnerships with those in disciplines beyond the clinical domain.
AHRQ-authored.
Citation: Henriksen K, Brady J .
The pursuit of better diagnostic performance: a human factors perspective.
BMJ Qual Saf 2013 Oct;22 Suppl 2:ii1-ii5. doi: 10.1136/bmjqs-2013-001827.
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Keywords: Diagnostic Safety and Quality, Health Information Technology (HIT), Medical Errors, Health Information Technology (HIT), Quality Improvement
Dahabreh IJ, Chung M, Kitsios GD
Survey of the methods and reporting practices in published meta-analyses of test performance: 1987 to 2009.
The researchers performed a survey of meta-analyses of test performance to describe the evolution in their methods and reporting. They found that the most common clinical areas were cardiovascular disease and oncology, while the most common test categories were imaging and biomarker tests. They concluded that the methods employed in meta-analyses of test performance have improved with the introduction of quality assessment checklists and the development of more sophisticated statistical methods.
AHRQ-funded; 290200710055I; HS013328.
Citation: Dahabreh IJ, Chung M, Kitsios GD .
Survey of the methods and reporting practices in published meta-analyses of test performance: 1987 to 2009.
Res Synth Methods 2013 Sep;4(3):242-55. doi: 10.1002/jrsm.1083.
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Keywords: Comparative Effectiveness, Diagnostic Safety and Quality, Research Methodologies