Research Activities, February 2012, No. 378
Ancker, J.S., Weber, E.U., and Kukafka, R. (2011, February). "Effect of arrangement of stick figures on estimates of proportion in risk graphics." (AHRQ grant HS16333). Medical Decision Making 31(1), pp.143-50.
Stick-figure graphics are frequently used to illustrate health risks in educational and decision support materials for patients and consumers. In a test with a 10-second deadline, a heterogeneous group of 165 health consumers was able to estimate proportions depicted by these graphics with fair accuracy, although individual estimates varied widely.
Ancker, J.S., Weber, E.U., and Kukafka, R. (2011, February). "Effect of game-like interactive graphics on risk perceptions and decisions." (AHRQ grant HS16333). Medical Decision Making 31(1), pp. 130-142.
The researchers tested the effects of interactive graphics on risk perceptions and decisions in a group of 165 respondents. They found that the game-like interactive computer graphics had no main effect on risk perceptions, but did reduce differences in risk feelings based on numeracy. In one condition, the game-like graphic increased concern about rare risks.
Bell, S.K., Delbanco, T., Anderson-Shaw, L., and others (2011, August). "Accountability for Medical Error." (AHRQ grant HS16506). Chest 140(2), pp. 519-526.
The authors describe the mismatch between how we view errors (systems) and how we apportion blame (individuals) by using an example of a delayed lung cancer diagnosis. They discuss "collective accountability," suggesting that this construct may offer a way to balance a "just culture" and a doctor's specific responsibilities within the framework of team delivery of care.
Berlowitz, D.R., and Stineman, M. (2011). "Risk adjustment in rehabilitation quality improvement." (AHRQ grant HS 18540). Topics in Stroke Rehabilitation 17(4), pp. 252-261.
Risk adjustment is an essential tool for monitoring and improving stroke rehabilitation care. Risk adjustment systems such as the FIM-function-related groups are now being used to monitor the quality of stroke rehabilitation. The authors demonstrate a specific application of this risk-adjustment system.
Chou, R., Croswell, J.M., Dana, T., and others (2011). "Screening for prostate cancer: A review of the evidence for the U.S. Preventive Services Task Force." (AHRQ grant HS18540). Annals of Internal Medicine 155(11), pp. 762-771.
The authors updated the 2002 and 2008 U.S. Preventive Services Task Force evidence reviews on screening and treatment for prostate cancer. Of five screening trials, the two largest and highest-quality studies reported conflicting results. They concluded that prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments.
Dorsey, E.R., and Meltzer, D.O. (2011). "The economics of comparative effectiveness research." (AHRQ grant HS16967). Neurology 75, pp. 492-493.
The authors examine whether and how comparative effectiveness research (CER) may affect both the level and growth of health care expenditures. By identifying cost-effective ways to deliver care, CER may reduce the level of health care spending. By comparing the benefits and costs of new technologies to existing alternatives, CER has the potential to align better the economic interests of firms with societal interest in improving health, thus reducing the rate of spending growth.
Fusco, D.N., Downs, J.A., Satlin, M.J., and others (2011). "Case report: Non-oral treatment with ivermectin for disseminated strongyloidiasis." (AHRQ grant T32 HS00066). American Journal of Tropical Medicine Hygiene 83(4), pp. 879-883.
In patients who are critically ill with disseminated strongyloidiasis (a parasitic intestinal infection), absorption of oral ivermectin is likely to be suboptimal. The authors report on four patients, believed to be unable to absorb oral therapy, who were treated by parenteral and/or subcutaneous administration. Access to parenteral ivermectin is difficult under the best of circumstances and more pharmacological data on the overall efficacy of ivermectin is needed to guide the use of this treatment approach.
Gierisch, J.M., Reiter, P.L., Rimer, B.K., and others (2010). "Standard definitions for infrequent yet repeated health behaviors." (AHRQ grant T32 HS00079). American Journal of Health Behavior 34(6), pp. 669-679.
In order to present a common language for defining adherence to infrequent yet repeated health behaviors, the authors advocate use of three standard definitions of adherence: initiation of behavior, adherence to most recent opportunity, and timely adherence across multiple opportunities. Methodological and conceptual issues are illustrated through the examples of human papillomavirus vaccination and screening mammography study data.
Govindarajan, P., Larkin, G.L., Rhodes, K.V., and others (2011). "Patient-centered integrated networks of emergency care: Consensus-based recommendations and future research priorities." (AHRQ grant HS17965). Academic Emergency Medicine 17, pp. 1322-1329.
A working group associated with the 2010 Academic Emergency Medicine Consensus Conference was tasked with developing recommendations for providing patient-centered emergency care, together with a related set of research priorities. The authors present four recommendations on the following themes: enhancing communication and patient advocacy in emergency departments; facilitating care coordination after discharge; defining metrics for patient-centered care; and giving patients control of medical information.
Graham, J.L., Giordano, T.P., Grimes, R.M., and others (2010, November). "Influence of trust on HIV diagnosis and care practices: A literature review." (AHRQ grant HS16093). Journal of the International Association of Physicians in AIDS Care 9(6), pp. 346-252.
Trust is conceptualized in several studies as a vital component of the physician-patient relationship. It benefits the patient by improving health status and outcomes, while distrust leads to decreased health status and may serve as a barrier to care. The authors review various studies of trust as a concept and the effect of patient trust on the receipt of health care, specifically care for HIV infection.
Hoenig, H., Lee, J., and Stineman, M. (2011). "Conceptual overview of frameworks for measuring quality in rehabilitation." (AHRQ grant HS18540). Topics in Stroke Rehabilitation 17(4), pp. 239-21.
The authors review conceptual models pertinent to evaluating quality of care in rehabilitation, with a focus on the seminal Donabedian model of structure, process, and outcome. Topics discussed include: applying the Donabedian framework to rehabilitation services; recent innovations in quality improvement; linguistic problems and solutions in rehabilitation quality of care; and complexities related to the interface between structure and process.
Issel, L.M., and Bekemeier, B. (2011). "Safe practice of population-focused nursing care: Development of a public health nursing concept." (AHRQ grant HS18852). Nursing Outlook 58, pp. 226-232.
Public health nursing is distinguished by its focus on providing care focused at the population level. The authors seek to define safe provisions of care when the nursing practice is population-focused and, subsequently, how safe practice of population-based care might affect health outcomes of population patients. Key literature on patient safety is reviewed. Practice, research, and policy implications are explored.
Jhaveri, R., Byington, C.L., Klein, J.O., and Shapiro, E.D. (2011). "Management of the non-toxic-appearing acutely febrile child: A 21st century approach." (AHRQ grant HS18034). Journal of Pediatrics 159(2), pp. 181-186.
The risk of serious bacterial infection (SBIs) in the immediate neonatal period and during the first months of life is increased in preterm infants. Infants less than 60 days old continue to have the highest risk of SBI and pose a challenge to practitioners about how extensive an evaluation to perform in a non-toxic appearing child. Recommendations to simplify the management of these febrile infants and children are needed.
Kilbourne, A.M., Keyser, D., and Pincus, H.A. (2010, September). "Challenges and opportunities in measuring the quality of mental health care." (AHRQ grant HS16097). Canadian Journal of Psychiatry 55(9), pp. 549-557.
The authors delineate the barriers to mental health quality measurement and identify strategies to enhance the development and use of quality measures by mental health providers, programs, payers, and other stakeholders. The goal is to improve outcomes for people with mental health disorders and substance use disorders. Included is a discussion of what other countries are doing in this area.
Laiteerapong, N., and Huang, E.S. (2010, September). "The public health implications of the cost-effectiveness of bariatric surgery for diabetes." (AHRQ grant T32 HS00084). Diabetes Care 33(9), pp. 2126-2127.
Understanding the cost-effectiveness of bariatric surgery for diabetes is critical for policy discussions regarding any ongoing or additional public health investment in bariatric surgery. In this editorial, the authors discuss a new study in the same issue of the journal that provides a strong argument for the economic value of bariatric surgery as a treatment for diabetes. However, they conclude that because of increases in overall costs, limited bariatric surgeons, and uncertain public health support, bariatric surgery is unlikely to be the sustainable treatment for diabetes and obesity for future generations.
LeBlanc, E.S., O'Connor, E., Whitlock, E.P., and others (2011, October). "Effectiveness of primary-care relevant treatments for obesity in adults: A systematic evidence review for the U.S. Preventive Services Task Force." (AHRQ Contract No. 290-07-10057). Annals of Internal Medicine 155(7), pp. 434-447.
The authors undertook a systematic review to help update recommendations of the U.S. Preventive Services Task Force regarding the use of counseling and/or behavioral interventions to promote sustained weight loss. They found that behavioral weight-loss interventions with or without orlistat or metformin yielded clinically meaningful weight loss; however, health outcomes data were sparse.
Li, D.-K., Yang, C., Andrade, S., and others (2011, October). "Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: A retrospective cohort study." British Medical Journal 343, p 5931.
This study did not confirm a previously reported unique association between use of angiotensin-converting enzyme inhibitors in the first trimester and risk of malformations in offspring. Instead, its findings suggest that the underlying hypertension, rather than the use of antihypertensive drugs in the first trimester, increases the risk of malformation in offspring. It evaluated a population of 465,000 mother-infant pairs in a large HMO between 1995 and 2008.
Memtsoudis, S.G., Salvati, E.A., Go, G., and others (2010, October). "Perioperative pulmonary circulatory changes during bilateral total hip arthroplasty under regional anesthesia." (AHRQ CERT grant HS00514). Regional Anesthesia and Pain Medicine 35(5), pp. 417-421.
The pulmonary embolization of fat, bone debris, and cement during total hip arthroplasty (THA) can sometimes be of major clinical significance. The researchers studied the hemodynamic changes of 24 patients undergoing elective, cemented bilateral THA. They found that the embolization of material during bilateral THA is associated with prolonged increases in pulmonary artery pressures and vascular resistance, particularly after completion of the second side.
Sarkar, U., Lopez, A., Black, K., and Schillinger, D. (2011, October). "The wrong tool for the job: Diabetes public health programs and practice guidelines." (AHRQ grant HS17594). Research and Practice 101(10), pp. 1871-1873.
The researchers surveyed federally funded diabetes prevention and control programs (DPCPs) in all 50 U.S. States and 7 Territories in order to explore DPCPs' perceptions about and use of diabetes practice guidelines. The survey addressed the extent of guideline dissemination, use of various organizations' guidelines, resource availability to deliver guideline-concordant care, prioritization and perceived cost-effectiveness of individual recommendations within guidelines, and other topics.
Spaeth-Rublee, B., Pincus, H.A., and Huynh, P.T. (2010, September). "Measuring quality of mental health care: A review of initiatives and programs in selected countries." (AHRQ grant HS16097). Canadian Journal of Psychiatry 55(9), pp. 539-548.
This article presents a systematic review of literature describing current initiatives that assess the quality of mental health care in participating countries. The authors plan to pilot a process for making cross-country comparisons of selected key clinical and outcomes measures available. The long-term goal is to develop and implement a framework for the comparison of quality measures across the 12 participating countries.
Stineman, M.G., Charles, J., and Kurichi, J.E. (2010). "Grading: An annotated "pen and paper" approach to multidimensional case-mix-adjusted continuous quality improvement." Topics in Stroke Rehabilitation 17(4), pp. 262-270.
The authors present a multidimensional approach to case-mix adjustment that can be used without sophisticated statistical or computer programs. Their objectives are to synthesize and offer examples of practical applications of the principles provided in the other articles in the same issue of this journal. Their approach applies functional grading to show how to evaluate the impact on patient outcomes after major changes in the structural aspects of an integrated rehabilitation program.
Sun, E., Dexter, F., and Macario, A. (2010, October). "Can an acute pain service be cost-effective?" (AHRQ grant T32 HS00046). Anesthesia & Analgesia 111(4), pp. 841-844.
An Acute Pain Service is an anesthesiologist-led, nurse-based team charged with managing intravenous patient-controlled analgesia in the period following surgery. In this editorial, the authors estimate the number of surgical patients who could benefit from an Acute Pain Service, define possible structures and functions of such a service, and outline research questions deserving further study.
Trochim, W., Kane, C., Graham, M.J., and Pincus, H.A. (2011). "Evaluating translational research: A process marker model." (AHRQ grant HS16097). Clinical Translational Science 4, pp. 153-162.
This paper examines the concept of translational research from the perspective of evaluators charged with assessing translational efforts. The authors consider the most prominent models of translational research that have been offered and synthesize the major features that are shared across these models. They also suggest a new synthetic framework for evaluating progress in enhancing research translation that is consistent with existing models, but avoids some of the current major problems.
Vesco, K.K., Whitlock, E.P., Eded, M., and others (2011, November). "Risk factors and other epidemiologic considerations for cervical cancer screening: A narrative review for the U.S. Preventive Services Task Force." (AHRQ Contract No. 290-07-10057). Annals of Internal Medicine 155(10), pp. 698-705.
To assist the U.S. Preventive Services Task Force (USPSTF) in updating its recommendation on cervical cancer screening, the authors performed a systematic review summarizing specific technological methods to improve screening test performance. This concurrent narrative review uses the USPSTF's methods for assessing contextual questions to explore and critique various epidemiological and contextual data on cervical cancer screening.
Weinick, R.M., and Hasnain-Wynia, R. (2011). "Quality improvement efforts under health reform: How to ensure that they help reduce disparities—not increase them." Health Affairs 30(10), pp. 1837-1842.
The authors provide a brief overview of how efforts to reduce racial and ethnic disparities came to focus on quality improvement activities. They then highlight five challenges to ensuring that quality improvement activities are integrated with efforts to reduce disparities. Finally, they conclude with a call for incorporating two types of analyses into quality improvement efforts and Affordable Care Act implementation activities, with the explicit goal of ensuring that such efforts focus on reducing disparities.
Whitlock, E.P., Vesco, K.K., Eder, M., and others (2011, November). "Liquid-based cytology and human papillomavirus testing to screen for cervical cancer: A systematic review for the U.S. Preventive Services Task Force." (AHRQ Contract No. 290-07-10057). Annals of Internal Medicine 155(10), pp. 687-697.
The purpose of this article is to systematically review the evidence on liquid-based cytology (LBC) and high-risk human papillomavirus (HPV) screening for U.S. Preventive Services Task Force use in updating its 2003 recommendation. The review found that evidence supports the use of LBC or conventional cytology for cervical cancer screening, but more complete evidence is needed before HPV-enhanced primary screening is widely adopted for women aged 30 years or older.