Research Activities, December 2011, No. 376
Bannunu, R.R., Dvorak, T., Obadan, N., and others (2011, August). "Comparative evaluation of radiation treatments for clinically localized prostate cancer: An updated systematic review." (Contract No. 290-07-10055). Annals of Internal Medicine 155(3), pp. 171-178.
A systematic review of 10 randomized, controlled trials and 65 nonrandomized studies focusing on radiation treatments for localized prostate cancer found a lack of high-quality comparative evidence. It is therefore difficult to make any definitive statements on the effectiveness of radiation treatment compared to no treatment in patients with localized prostate cancer.
Berkman, N.D., Sheridan, S.L., Donahue, K.E., and others (2011, July). "Low health literacy and health outcomes: An updated systematic review." (Contract No. 290-07-10056). Annals of Internal Medicine 155(2), pp. 97-107.
A new review of 96 studies finds that low health literacy is associated with not only a poorer ability to understand and follow medical advice, but also poorer health outcomes. Patients with low health literacy tend to have more hospitalizations and emergency care visits, as well as lower rates of mammograms and flu shots. The review also found that low health literacy can explain racial disparities in some outcomes.
Blustein, J., Weissman, J.S., Ryan, A.M. and others (2011, June). "Analysis raises questions on whether pay-for-performance in Medicaid can efficiently reduce racial and ethnic disparities." (AHRQ grant HS18546). Health Affairs 30(6), pp. 1165-1175.
Massachusetts took pay-for-performance to a new level by using it as a way to target racial and ethnic disparities in hospital care for Medicaid patients. Researchers recently described how this innovative program was implemented, the challenges it encountered, and what outcomes were achieved. Although early in its implementation, the pay-for-performance program has found little evidence of racial or ethnic disparity in hospital care in Massachusetts.
Marawar, S., Girardi, F.P., Sama, A.A., and others (2011). "National trends in anterior cervical fusion procedures." (AHRQ grant HS15114). Spine 35(15), pp. 1454-1459.
An analysis of national trends in anterior cervical discectomy and fusion (ACDF) surgery for degenerative disc disease found the highest increase in utilization among patients 65 years of age and older. Between 1990 and 2004, there was an 8-fold increase in the total number of ACDF surgeries performed. The age of patients undergoing the procedure increased from 47 to 50, according to data from the National Hospital Discharge Survey.
McBee-Strayer, S., Gardner, W., Kelleher, K., and others (2011). Monitoring pediatric antidepressant use. (AHRQ grant HS17258). Behavioral Healthcare 30(10), pp. 19-21.
This article describes the Pharmaceutical and Safety Tracking System (PhaST), an automated voice-response computer system that has been programmed to call new pediatric patients prescribed antidepressant medications and to page a triage staff member to do risk assessment if a concern is detected. The researchers report on the status of a randomized trial that compares monitoring using PhaST with usual care in a large, urban pediatric health care system.
Percac-Lima, S., Aldrich, L.S., Gamba, G.B., and others (2011). Barriers to follow-up of an abnormal Pap smear in Latina women referred for colposcopy. (AHRQ grant HS19161). Journal of General Internal Medicine 25(11), pp. 1198-1204.
Researchers have identified four primary barriers to women having colposcopy: (1) anxiety or fear of the test; (2) difficulty scheduling the test around work and/or child care commitments; (3) poor communication with patients regarding the appointment—including lack of explanation about the reason for the new test; and (4) concern about pain. The study participants were 40 Latina women, of whom 75 percent spoke only Spanish.
Selker, H.P., Ruthazer, R., Terrin, N., and others (2011). "Random treatment assignment using mathematical equipoise for comparative effectiveness trials." (AHRQ grant HS10280). Clinical Translational Science 4(1), pp. 10-16.
This study explored whether patients for whom there is no clear preference among treatment options (equipoise) could be included in a trial when the average superiority or inferiority of a therapy has been established. To illustrate this approach, the researchers used logistic regression models of treatment outcomes for acute ST elevation myocardial infarction for which either thrombolytic therapy of percutaneous coronary intervention is potentially life-saving.
Sexton, J.B., Berenholtz, S.M., Goeschel, C.A., and others (2011). "Assessing and improving safety climate in a large cohort of intensive care units." (AHRQ grant HS14246). Critical Care Medicine 39(5), pp. 934-939.
This study evaluated the impact of a comprehensive unit-based safety program (CUSP) on safety climate in a large cohort of intensive care units across the State of Michigan. Over a 2-year period (2004-2006), mean safety climate scores significantly improved from 42.5 percent to 52.2 percent. Five of seven safety climate items significantly improved in this period.
Sorenson, A.V., Harrison, M.I., Kane, H.L., and others (2011). "From research to practice: Factors affecting implementation of prospective targeted injury-detection systems." British Medical Journal of Quality and Safety 20, pp. 527-533. Reprints (AHRQ Publication No. 11-R069) are available from the AHRQ Publications Clearinghouse.
This paper describes factors shaping the implementation of prospective targeted injury-detection systems (TIDS) for adverse drug events (ADEs) and nosocomial pressure ulcers (PrU). The five participating hospitals were more successful in implementing the low-complexity PrU-TIDs than the high-complexity ADE-TIDs. In the latter case, the complexity of TIDS and alignment with existing workflows affected implementation and prospects for sustainability.
Street, R. L., and Haidet, P. (2011). "How well do doctors know their patients? Factors affecting physician understanding of patients' health beliefs." (AHRQ grant HS10876). Journal of General Internal Medicine 26(1), pp. 21-27.
Using the recently developed CONNECT survey instrument, the researchers examined the degree of concordance between physicians' perceptions of their patients' health beliefs and patients' own reports of those beliefs. They found that physicians had a relatively poor understanding of their patients' beliefs. On four of six measured domains, physicians assumed a shared understanding when this was not the case.
Stukenborg, G.J. (2011). "Hospital mortality risk adjustment for heart failure patients using present on admission diagnoses." (AHRQ grant HS17693). Medical Care 49(8), pp. 744�751.
The author uses California hospital discharge records for heart failure from 2007 to test whether more comprehensive use of diagnoses noted as "present on admission" (POA) can improve mortality rate comparisons among hospitals. The author's study of 91,511 discharges from 365 California hospitals confirms that the use of POA secondary diagnoses in mortality risk adjustment reduced the number of hospitals originally identified as having higher-than-expected mortality for heart failure by 50 percent.
Teruya, C., Longshore, D., Andersen, R.M., and others (2011). "Health and health care disparities among homeless women." (AHRQ grant HS08323). Women & Health 50(8), pp. 719-736.
The objective of this study was to provide data to boost understanding of racial/ethnic disparities among homeless women by comparing blacks, Latinas, and whites according to a broad range of population, health, and health care measures. The researchers also sought to identify factors associated with unmet needs for health care. The study found that white, non-Latina women were more likely to report unmet needs than blacks and Latinas. Women suffering from drug abuse, violence, or depression were most in need of care.
Trivedi, R.B., Nieuwsma, J.A., and Williams, J.W. (2011). "Examination of the utility of psychotherapy for patients with treatment resistant depression: A systematic review." (AHRQ grant T32 HS00079). Journal of General Internal Medicine 26(6), pp. 643-650.
This systematic review aimed to determine whether substituting or augmenting current antidepressant treatment with psychotherapy is effective for treating adults with treatment-resistant depression. The researchers found that current evidence is sparse and reveals mixed results. Three good quality studies, one fair quality study, and two poor quality studies demonstrated that psychotherapy may be beneficial either as a substitution or an augmentation strategy. Psychotherapy, the authors concluded, appears to be effective and is a reasonable treatment option for treatment-resistant depression.
Warholak, T.L., Menke, J.M., Hines, L.E., and others (2011). "A drug-drug interaction knowledge assessment instrument for health professional students: A Rasch analysis of validity evidence." (AHRQ grant HS17001). Research in Social and Administrative Pharmacy 7, pp. 16-26.
The objective of this study was to assess the validity of a drug-drug interaction (DDI) knowledge assessment instrument in a health professional student population. Given 15 medication pairings, students were asked to identify an appropriate management strategy and to identify specific DDIs. The instrument showed good reliability and validity, but the ability of the participants to identify DDIs and select an appropriate management strategy was low.
Weingart, S.N., Zhu, J., Chiapetta, L., and others (2011). "Hospitalized patients' participation and its impact on quality of care and patient safety." (AHRQ grant HS17950). International Journal for Quality in Health Care 23(30), pp. 269-277.
The researchers examined the nature and extent of patient participation and its impact on care by conducting a multi-faceted study of patient safety in U.S. acute care hospitals. They found that most hospitalized patients participated in some aspects of their care, such as assessment of overall quality of care and the presence of adverse events. Participation was strongly correlated with favorable judgments about hospital quality and reduced the risk of experiencing an adverse event.
Werner, R.M., Konezka, R.T., Stuart, E.A., and Polsky, D. (2011, April). "Changes in patient sorting to nursing homes under public reporting: Improved patient matching or provider gaming?" (AHRQ grant HS16478). Health Services Research 46(2), pp. 555�571.
This study found a significant change in patient sorting to skilled nursing homes (SNFs) after public reporting was initiated in nursing homes in 2002. The researchers compared the percentages of short-stay patients at a SNF without moderate to severe pain, without delirium, and whose walking remained independent or improved. Beginning in 2002, there was increased matching of patients for pain risk, with high-risk patients going more often to high-quality SNFs. However, increased matching was not seen for risk of delirium or impaired walking.
Westreich, D., Cole, S.R., Funk, M.J., and others (2011). "The role of the c-statistic in variable selection for propensity score models." (AHRQ grant HS17950). Pharmacoepidemiology and Drug Safety 20, pp. 317-320.
The authors discuss the estimation of the propensity score itself and the use and misuse of the c-statistic in this process. They argue that the c-statistic, neither necessary nor sufficient to ensure the control of confounding, is of limited value for covariate selection into a propensity score model. It provides no certainty that all measured confounders have been balanced between treatment groups, or that interactions among covariates or higher-order terms have been balanced.
Williams, C., Larsen, U., and McCloskey, L.A. (2011). "The impact of childhood sexual abuse and intimate partner violence on sexually transmitted infections." (AHRQ grant HS11088). Violence and Victims 35(6), pp. 787-798.
The researchers investigated how different forms of violence experienced by women across the lifespan are associated with sexually transmitted infections (STIs), building on prior literature considering childhood sexual abuse (CSA) and adult victimization separately. Having an STI was associated with experiencing both CSA and intimate partner violence (IPV). Women who experienced both CSA and IPV were much more likely to have been diagnosed with an STI during their current relationship compared with non-abused women.
Winthrop, K.L., Baxter, R., Liu, L., and others (2011). "The reliability of diagnostic coding and laboratory data to identify tuberculosis and nontuberculous mycobacterial disease among rheumatoid arthritis patients using anti-tumor necrosis factor therapy." (AHRQ grant HS17552). Pharmacoepidemiology and Drug Safety 20, pp. 229-235.
The researchers developed and validated algorithms to identify tuberculosis and nontuberculous mycobacterial disease in an effort to facilitate future drug safety studies assessing these opportunistic infections associated with immunosuppressant therapies used for rheumatoid arthritis and other conditions. Their findings suggest that in health care systems where microbiologic information is electronically recorded, search strategies identifying positive mycobacterial culture results provide highly sensitive and accurate ways to identify these infections.
Zheng, H., Zhang, W., Ayanian, J.Z., and others (2011, June). "Profiling hospitals by survival of patients with colorectal cancer." (AHRQ grant HS09869). HSR: Health Services Research 46(3), pp. 729-746.
The study's objective was to profile hospitals by survival rates of colorectal cancer patients in multiple periods after initial treatment. The researchers found that the quality of care provided by a hospital system is somewhat consistent across the immediate postoperative and long-term follow-up periods. They concluded that combining mortality profiles across longer periods may improve the statistical reliability of outcome comparisons.