Research Activities, October 2012, No. 386
Arora, V.M., Fazal, A.Z., Zee, P.C., and Knutson, K.L. (2011, November). "Objective sleep duration and quality in hospitalized older adults: Associations with blood pressure and mood." (AHRQ grant HS16967). Journal of the American Geriatric Society 59(11), pp. 2185-2186.
This study of 40 nights of sleep sampled from 20 inpatients aimed to characterize sleep duration and quality in hospitalized older adults. It found that hospitalization represents a period of clinically significant sleep loss that may be associated with higher morning blood pressure.
Bayliss, E.A., Ellis, J.L., Shoup, J.A., and others (2012, April). "Association of patient-centered outcomes with patient-reported and ICD-9-based morbidity measures." (AHRQ grant HS18404). Annals of Family Medicine 10(2), pp. 126-133.
This study compared the contributions of self-reported morbidity and morbidity measured using administrative diagnosis data for both patient-reported outcomes and health care utilization outcomes. Higher morbidity measured by ICD-9 diagnoses was independently associated with less favorable levels of seven of nine clinical outcomes. Higher self-reported disease burden was significantly associated with less favorable levels of eight of the outcomes.
Bennett, W.L., Odelola, O.A., Wilson, L.M., and others (2012, January). "Evaluation of guideline recommendations on oral medications for type 2 diabetes mellitus." (AHRQ Contract No. 290-02-0018). Annals of Internal Medicine 156(1) Part 1, pp. 27-36.
In this systematic review of clinical practice guidelines on treating type 2 diabetes with oral medications, the authors identified 11 guidelines that had been published during the 4 years after the 2007 review on medications for type 2 diabetes by the same authors. Most diabetes guidelines had multiple recommendations that were consistent with the evidence-based conclusions from the earlier review. There were no guidelines with contradictory conclusions.
Curtis, J.R., Baddley, J.W., Yang, S., and others (2011). "Derivation and preliminary validation of an administrative claims-based algorithm for the effectiveness of medications for rheumatoid arthritis." (AHRQ grant HS18517). Arthritis Research & Therapy 13, R155.
Administrative claims data have not commonly been used to study the clinical effectiveness of medications for rheumatoid arthritis (RA) because of the lack of a validated algorithm for this outcome. The authors created and tested a claims-based algorithm to serve as a proxy for the clinical effectiveness of RA medications. They concluded that administrative claims data may be useful in evaluating the effectiveness of medications for RA.
Fehr, J.J., Boulet, J.R., Waldrop, W.B., and others (2011, December). "Simulation-based assessment of pediatric anesthesia skills." (AHRQ grant HS18734). Anesthesiology 115(6), pp. 1308-1315.
The purpose of this study was to develop a set of relevant simulated pediatric perioperative scenarios and to determine their effectiveness in the assessment of anesthesia residents and pediatric anesthesia fellows. The scores obtained from the assessment indicated that the content was relevant and that raters could reliably score the scenarios. Additional measures of validity obtained from comparisons with clinical performance are needed to establish this approach as a method to evaluate competence.
Fernald, D.H., Coombs, L., DeAlleaume, L., and others (2012). "An assessment of the Hawthorne Effect in practice-based research." (AHRQ Contract No. 290-07-10008). Journal of the American Board of Family Medicine 25, pp. 83-86.
As part of a larger practical intervention designed to improve the clinical management of skin and soft tissue infections, the researchers examined the potential for a Hawthorne Effect from the extra attention some clinicians received when completing follow-up case reviews with the research team. They did not find evidence suggestive of a Hawthorne Effect related to the prescription of antibiotics or in the selection of antibiotics that cover MRSA (methicillin-resistent Staphylococcus aureus).
Fitzgibbon, M.L., Tussing-Humphreys, L.M., Porter, J.S., and others (2011). "Weight loss and African-American women: A systematic review of the behavioural weight loss intervention literature." (AHRQ grant T32 HS00078). Obesity Reviews 13, pp. 193-213.
The authors conducted a systematic review of all behavioral weight-loss intervention trials published between 1990 and 2010, which reported results separately for black women. Twenty–five studies met inclusion criteria. Their findings suggest that more intensive randomized behavioral weight-loss trials with medically at-risk populations offer the most promising results.
Gierisch, J.M., Bastian, L.A., Calhoun, P.S., and others (2012). "Smoking cessation interventions for patients with depression: A systematic review and meta-analysis." (AHRQ grant T32 HS00079). Journal of General Internal Medicine 27(3), pp. 351-360.
The authors conducted a systematic literature review of smoking cessation interventions for patients with histories of depressive disorders or current significant depressive symptoms. They identified 16 unique randomized controlled trials, only three of which recruited participants with current depression. They found that several promising interventions exist, especially smoking-cessation services that include nicotine replacement therapy and behavioral mood management.
Goetzel, R.Z., Schoenman, J.A., Chapman, L.S., and others (2011). "Strategies for strengthening the evidence base for employee health promotion programs." (AHRQ grant HS18132). American Journal of Health Promotion 26(1), pp. TAHP-1-TAHP-8.
This article summarizes key themes developed by 36 health promotion practitioners, researchers, employers, health insurance representatives, government officials, and other stakeholders who were convened by the National Institute for Health Care Management with funding from the Agency for Healthcare Research and Quality. The purpose was to develop a research agenda to guide future efforts aimed at strengthening the evidence base for worksite health promotion programs.
Haynes, K., Bilker, W.B., TenHave, T.R., and others (2011). "Temporal and within practice variability in the health improvement network." (AHRQ grant HS10399). Pharmacoepidemiology and Drug Safety 20, pp. 948-955.
Using the Health Improvement Network (THIN) database, a primary care electronic medical record database in the United Kingdom, researchers analyzed mortality rates, cancer incidence rates, prescribing rates, and encounter rates across 415 practices from 2000 to 2007. They found significant variability among practices, of which 40 percent or less is explained by practice-level factors. They also found increases in rates of cancer, prescriptions per patient, and encounters per patient along with significant declines in mortality rates.
Holden, R.J. (2011, December). "What stands in the way of technology-mediated patient safety improvements? A study of facilitators and barriers to physicians' use of electronic health records." (AHRQ grant T32 HS000083). Journal of Patient Safety 7(4), pp. 193-203.
The existence of electronic health records (EHRs) does not guarantee successful use of the systems or of their specific functions. EHR use requires the presence of certain user and system attributes, support from others, and numerous organizational and environmental facilitators. This study identifies and describes 19 categories of facilitators and barriers based on the perceptions of 20 attending physicians using EHR systems at 2 community hospitals.
Kong, M.H., Al-Khatib, S.M., Sanders, G.D., and others (2011). "Use of implantable cardioverter-defibrillators for primary prevention in older patients: A systematic literature review and meta-analysis." (AHRQ grant HS16964). Cardiology Journal18(50), pp. 503-514.
The findings of this study contrast with a previously published age-specific meta-analysis that demonstrated a lack of implantable cardioverter-defibrillator (ICD) efficacy for the secondary prevention of sudden cardiac death (SCD) in patients 75 and over. This meta-analysis of ICD use for primary prevention of SCD suggests that ICDs may be beneficial for older patients, including those over age 75.
LaFleur, J., Nelson, R.E., Sauer, B.C., and Nebeker, J.R. (2011). "Overestimation of the effects of adherence on outcomes: A case study in healthy user bias and hypertension." (AHRQ grant HS18582). Heart 97, pp. 1862-1869.
This study found that the associations between poor adherence to antihypertensive medications and outcomes such as hospitalization, heart attack, and death are largely independent of the pharmacological effects of these drugs on blood pressure control. The study adjusted for patient demographics, disease severity, and comorbidity. This suggests that other unmeasured confounders such as healthy user bias must explain most of the association between patient medication adherence and outcomes.
Lee, J.S., Primack, B.A., Mor, M.K., and others (2011). "Processes of care and outcomes for community-acquired pneumonia." (AHRQ grant HS10049). American Journal of Medicine 124, pp. 1175.e5-1175.e17.
This study of 2,076 patients hospitalized with pneumonia found no associations between processes of care and mortality or hospital readmissions within 30 days. The lack of consistent evidence associating performance of pneumonia processes of care with improved patient outcomes, coupled with the high national levels of performance for these measures, casts doubts on their continued utility as care quality proxies for pneumonia.
M'ikanatha, N.M., Dettinger, L.A., Perry, A., and others (2012, March). "Culturing stool specimens for Campylobacter spp., Pennsylvania, USA." Emerging Infectious Diseases 18(3), pp. 484-487.
This study surveyed 176 clinical laboratories in Pennsylvania about selected characteristics of stool-testing practices, including the types of testing for routine stool specimen workup, use of transport media for stool samples, specimen-processing time, and specific testing practices for Campylobacter spp. The researchers suggest that variations in laboratory practices are a potential problem in surveillance of Campylobacter spp. in Pennsylvania and possibly elsewhere.
Newcomer, S.R., Steiner, J.F., and Bayliss, E.A. (2011). "Identifying subgroups of complex patients with cluster analysis." (AHRQ grant HS15476). American Journal of Managed Care 17(8), pp. 3324-3332.
This study demonstrates how cluster analysis can be used to identify homogeneous groups of complex patients from a large heterogeneous population. This cluster analysis of a large group of individuals with many illnesses suggests that complex patients with high health care use represent a highly diverse group of individuals. The researchers suggest that data mining methods like cluster analysis can be applied in other settings where electronic diagnosis data are readily available.
Rich, E.C., Lipson, Libersky, J., and others (2012). "Organizing care for complex patients in the patient-centered medical home." (AHRQ Contract No. 290-09-00019). Annals of Family Medicine 10, pp. 60-62. Reprints (AHRQ Publication No. 12-R076) are available from the AHRQ Publications Clearinghouse.
This report summarizes strategies to help typical, smaller primary care practices transform into effective medical homes that appropriately serve patients with complex needs. It draws on the experience of five programs around the country that illustrate promising approaches for supporting and collaborating with smaller, independent primary care practices serving these challenging patients.
Santaguida, P., Oremus, M., Walker, K., and others (2012). "Systematic review identifies important methodological flaws in stroke rehabilitation therapy primary studies: Review of reviews." Journal of Clinical Epidemiology 65, pp. 358-367. Reprints (AHRQ Publication No. 12-R066) are available from the AHRQ Publications Clearinghouse.
This review of 38 systematic reviews found most to be of high methodological quality. However, the authors' evaluation of the primary studies within the reviews shows consistent problems with randomization, allocation concealment, and blinding. Most of the reviews did not evaluate baseline comparability, adverse events, and cointervention or contamination of the primary studies.
Schneeweiss, S., Seeger, J.D., and Smith, S.R. (2012). "Methods for developing and analyzing clinically rich data for patient-centered outcomes research: An overview." (AHRQ Contract No. 290-05-0016). Pharmacoepidemiology and Drug Safety21(S2), pp. 1-5.
This article introduces a group of presentations drawn from an AHRQ-sponsored conference on research methods for comparative effectiveness research and patient-centered outcomes research. The aim of the conference was to explore methodological options for enhancing secondary data sources or prospectively designed registry studies and randomized trials that reflect routine care as much as possible.
Seida, J.C., Schouitne, J.R., Boylan, K., and others (2012). "Antipsychotics for children and young adults: A comparative effectiveness review." (AHRQ Contract No. 290-07-10021). Pediatrics 129(3), pp. e771-e784.
This is the first comprehensive review comparing the effectiveness and safety across the range of antipsychotics for children and young adults. The researchers find that the evidence on the comparative benefits and harms of antipsychotics within and across classes is limited. Some second-generation antipsychotics (SGAs) have a better profile than other SGAs.
Sills, M.R., Fairclough, D., Ranade, D., and others (2011). "Emergency department crowding is associated with decreased quality of care for children." (AHRQ grant HS16418). Pediatric Emergency Care 27(9), pp. 837-845.
This is the first study to associate emergency department (ED) crowding measures with quality of emergency care for children. It found that the key crowding factors are global and input measures, indicating that crowding is multifactorial and cannot be mitigated by ED providers simply working harder.
Singh, R., Anderson, D., McLean-Plunkett, E., and others (2012). "IT-enabled systems engineering approach to monitoring and reducing ADEs." (AHRQ grant HS01702). American Journal of Managed Care 18(3), pp. 169-175.
This study pilot-tested a Web-based implementation of a self-empowering team resource management (TRM) intervention aimed at improving medication safety in primary care settings. The intervention sites showed a significant reduction in adverse drug events. The study suggests that the Web-based TRM has the potential to improve medication safety in busy primary care offices.
Sprung, J., Flick, R.P., Katusic, S.K. and others (2012). "Attention-deficit/hyperactivity disorder after early exposure to procedures requiring general anesthesia." (AHRQ grant (HS29745). Mayo Clinic Procedures 87(2), pp. 120-129.
This study examined the effects of exposure to general anesthesia before the age of 2 on the incidence of attention deficit/hyperactivity disorder (ADHD). The researchers found that children repeatedly exposed to procedures requiring general anesthesia before age 2 are at increased risk for the later development of ADHD.
Starmer, A.M., Spector, N.D., Srivastava, R., and others (2012, March). "I-PASS, a mnemonic to standardize verbal handoffs." (AHRQ grant HS19456). Pediatrics 129(2), pp. 201-204.
The novel mnemonic, I-PASS, was developed from best handoff practices cited in the literature, resident feedback from a pilot study, and observations made by faculty of the handoff process. The easy-to-remember mnemonic was developed to ensure that key information is imparted during each patient handoff (I – illness severity; P – patient summary; A – action list for the next team; S – situation awareness and contingency plans; S – synthesis and "read-back" of the information). The multisite I-PASS study will test the effectiveness of the resident handoff bundle, including the I-PASS mnemonic, on medical errors in ten pediatric institutions.
Suri, P., Miyakoshi, A., Hunter, D.J., and others (2011). "Does lumbar spinal degeneration begin with the anterior structures? A study of the observed epidemiology in a community-based population." (AHRQ grant HS19222). BMC Musculoskeletal Disorders 12, pp. 202-208.
This study examined whether the view that spinal degeneration begins with the anterior spinal structures is supported by epidemiologic observation. The researchers concluded that this view was accurate for a majority of individuals. However, some individuals exhibit atypical patterns of degeneration, beginning in the posterior joints. Increased age, body mass index, and female sex may be related to posterior degeneration in these individuals.
Taylor, B.D., Darville, T., Ferrell, R.E., and others (2012, February). "Variants in toll-like receptor 1 and 4 genes are associated with Chlamydia trachomatis among women with pelvic inflammatory disease." (AHRQ grant HS08358). Journal of Infectious Diseases 205(4), pp. 603-609.
In a sample of 205 black women with pelvic inflammatory disease (PID), those who carried a particular single-nucleotide polymorphism (SNP) in their TLR4 gene were 3.7 times more likely to harbor Chlamydia infection than those with the most common DNA sequence at that site. Similarly, women with PID who carried a particular SNP in their TLR1 gene were 2.8 times more likely to have a Chlamydia infection than women with the commonest sequence at that site.
Toledo, P. (2011, December). "What's new in obstetric anesthesia? The 2011 Gerard W. Ostheimer Lecture." (AHRQ grant HS20122). Anesthesia & Analgesia 113(6), pp. 1450-1456.
This review summarizes the most relevant publications on obstetric anesthesia during 2010. It focuses on innovations relevant to the initiation, management, and maintenance of labor analgesia; anesthetic management of cesarean deliveries; changes in obstetric management affecting the practice of obstetric anesthesiology; and advances in neonatal resuscitation.
Trogdon, J.G., Finkelstein, E.A., Feagan, C.W., and Cohen, J.W. (2012, January). "State- and payer-specific estimates of annual medical expenditures attributable to obesity," Obesity 20(1), pp. 214-220. Reprints (AHRQ Publication No. 11-R063) are available from the AHRQ Publications Clearinghouse.
In the absence of obesity, annual medical expenditures would be between 7 and 11 percent lower across all States, concludes this study. The researchers calculated obesity-attributable fractions (OAF) of annual medical expenditures for each State. Across all payers, Colorado had the lowest OAF at 7 percent and West Virginia had the highest at 11 percent. In addition, West Virginia had the highest prevalence of obesity across all States (32.2 percent).
Vistnes, J., and Selden, T. (2011). "Premium growth and its effect on employer-sponsored insurance." International Journal of Health Care Finance and Economics 11, pp. 55-81, 2011. Reprints (AHRQ Publication No. 11-R064) are available from the AHRQ Publications Clearinghouse.
Employers and employees alike face rising health care costs and insurance premiums. As premiums rise, employers often pass the costs onto their employees in the form of higher premium contributions and deductible levels, according to a new study. The findings of this study demonstrate the financial burdens and challenges faced by employers in their attempts to provide and maintain coverage for employees and their families.
Wagner, J., and Halpern, S.D. (2012, March). "Deferred admission to the intensive care unit. Rationing critical care or expediting care transitions?" (AHRQ grant HS18406). Archives of Internal Medicine 172(6), pp. 474-476.
The authors comment on a study finding that in-hospital mortality was not affected by the availability of intensive care unit (ICU) beds. They point out that the influence of various factors on decisionmaking with respect to ICU admissions suggests that many ICU admissions are unnecessary, either because the patient is too well or too sick to benefit. It appears that clinicians can allocate beds efficiently by eliminating nonbeneficial admissions when scarcity forces them to do so.
Ward, M.M., Clabaugh G., Evans, T.C., and Herwaldt, L. (2011). "A successful, voluntary, multicomponent statewide effort to reduce health care-associated infections." (AHRQ Contract No. 290-06-000021). American Journal of Medical Quality27(1), pp. 67-73.
The authors describe a statewide multicomponent approach to reduce health care-associated infections that was implemented in Iowa. The Iowa Healthcare Collaborative (IHC) was successful in developing a reporting system, involving all Iowa hospitals in the 5 Million Lives Campaign, and significantly improving the rate of influenza immunization among health care workers. IHC's approach to health care improvement is a model for other States.
Williams, C.D., Whitley, B.M., Hoyo, C., and others (2011). "A high ratio of dietary n-6/n-3 polyunsaturated fatty acids is associated with increased risk of prostate cancer." (AHRQ grant T32 HS00079). Nutrition Research 31, pp. 1-8.
This study found no significant link between specific dietary intake of omega 3 (n-3) and omega 6 (n-6) polyunsaturated fatty acids and prostate cancer risk. However, the highest dietary ratio of n-6/n-3 was associated with nearly 3.6 times more elevated risk of high-grade, prostate cancer. This ratio was not associated with low-grade prostate cancer.
Willis, C.D., Elshaug, A.G., Milverton, J.L., and others (2011). "Diagnostic performance of serum cobalamin tests: A systematic review and meta-analysis." Pathology 43(5), pp. 473-481. Reprints (AHRQ Publication No. 11-R067) are available from the AHRQ Publications Clearinghouse.
Vitamin B12 or serum cobalamin (cbl) deficiency is a widely prevalent, potentially debilitating, yet often treatable condition. A blood test of cbl has remained the most commonly employed tool to investigate suspected B12 deficiencies. However, false results from this test are common. An international team of researchers, who reviewed 54 studies on the diagnostic accuracy for serum cbl tests across patient subgroups, found that serum cbl tests rated poorly.
Witt W.P., Wisk L.E., Cheng E.R., and others (2011). "Poor prepregnancy and antepartum mental health predicts postpartum mental health problems among U.S. women: A nationally representative population-based study." (AHRQ grant T32 HS00083). Women's Health Issues 21(4), pp. 304-313.
Researchers found that nearly a tenth (9.5 percent) of the women studied reported experiencing mental health problems after giving birth, and women who had poor prepregnancy mental health were twice as likely as those with good prepregnancy mental health to have poor postpartum mental health. The odds for poor postpartum mental health were 11-fold higher for women reporting poor, as opposed to good, mental health during pregnancy.
Yoder, J.C., Staisunas, P.G., Meltzer, D.O., and others (2012). "Noise and sleep among adult medical inpatients: Far from a quiet night." (AHRQ grant HS16967). Archives of Internal Medicine 172(1), pp. 68-69.
This study measure noised and sleep duration in adult medical ward patients. It found that hospital noise levels in patient rooms are markedly higher than recommended levels and associated with significant sleep loss among hospitalized patients. The most common sources of noise disruption reported by patients: staff conversations, roommates, alarms, intercoms, and pagers.
Yu, Z., and Liu, L. (2011). "A joint model of recurrent events and a terminal event with a nonparametric covariate function." (AHRQ grant HS16543). Statistics in Medicine 30, pp. 2683-2695.
This work further extends the flexibility of current joint models by incorporating into these models semiparametric components for the potential nonlinear predictors. The simulation study shows that the proposed estimates are generally unbiased for parametric coefficients and nonlinear function. The inference based on the proposed covariate is close to nominal level too. In summary, the estimation and inference procedures were shown to be valid.
Zimmerman, S., Love, K., Sloan, P.D., and others (2011). "Medication administration errors in assisted living: Scope, characteristics, and the importance of staff training." (AHRQ grant HS16171). Journal of the American Geriatrics Society 59(6), pp. 1060-1068.
More than 75 percent of the residents of assisted living facilities, many with dementia or cognitive impairment, need assistance with taking medications. Unlike nursing homes, which require nurses to administer medications, assisted living facilities also use medication assistants and other staff for this job. This study reveals that medication aides do not make more medication errors than nurses. However, personnel who are not nurses or medication aides commit more errors than nurses and medication aides.
Zuvekas, S.H. (2011). "The effects of recall length and reporting aids on household reporting of health care events in the Medical Expenditure Panel Survey." Journal of Economic and Social Measurement 36, pp. 321-343.
Consistent with his previous study of Medicare beneficiaries in the Medical Expenditure Panel Survey (MEPS), the researcher found that household respondents imperfectly recall emergency department and office-based visits. The findings suggest that the length of recall period is an important factor in determining the level of recall. As the recall period increased, the agreement between MEP's respondents reports of use and Medicare claims widened.