Research Activities, April 2012
Andrade, S.E., Simas, T.A.M., Boudreau, D., and others (2011). "Validation of algorithms to ascertain clinical conditions and medical procedures used during pregnancy." (AHRQ Contract No. 290-05-0033). Pharmacoepidemiology and Drug Safety 20, pp. 1168-1175.
This study evaluated the validity of health plan administrative and claims data to identify two conditions prevalent during pregnancy, diabetes (pre-gestational and gestational) and obesity, as well as one medical procedure, ultrasound, performed during pregnancy. The data were valid for both forms of diabetes and for ultrasound, but not for obesity, which was not consistently coded.
Beasley, J.W., Wetterneck, T.B., Temte, J., and others (2011). "Information chaos in primary care: Implications for physician performance and patient safety." (AHRQ grants HS17115, HS17899). Journal of the American Board of Family Medicine 24, pp. 745-751.
The authors explore the concept of information chaos as it applies to issues of patient safety and physician workload in primary care. They conclude that information chaos is experienced routinely by primary care physicians and that additional research is needed to define methods to measure and eventually reduce information chaos.
Bimberg, J.M., Drum, M.L., Huang, E.S., and others (2011). "Development of a safety net medical home scale for clinics." (AHRQ grant T32 HS00084). Journal of General Internal Medicine 26(12), pp. 1418-1425.
The authors developed a Safety Net Medical Home Scale to evaluate Patient-Centered Medical Home (PCMH) interventions in safety-net clinics. They tested the scale for reliability and convergent validity and used it to describe PCMH adoption in safety-net clinics beginning a PCMH intervention. Finally, the authors determined clinic-level factors associated with PCMH adoption.
Cheng, Y.W., Eden, K.B., Marshall, N., and others (2011). "Delivery after prior Cesarean: Maternal morbidity and mortality." (AHRQ Contract No. 290-07-10057). Clinical Perinatology 38, pp. 297-309.
The appropriate use and safety of cesarean and vaginal birth after cesarean (VBAC) are of concern not only at the individual and clinician level, but they also have far-reaching public health and policy implications at the national level. Building on a recent systematic evidence review, two meta-analyses on prediction of VBAC and associated perinatal outcomes, this paper emphasizes the information that clinicians and patients need to make decisions.
Clancy, C. (2012). "Patient-centered outcomes research and nurse practitioners' role in shared decisionmaking." Journal of the American Academy of Nurse Practitioners 24, pp. 59-61. Reprints (AHRQ Publication No. 12-R034) are available from the AHRQ Publications Clearinghouse.
The author, director of the Agency for Healthcare Research and Quality (AHRQ), offers a brief overview of AHRQ's Effective Healthcare Program. This program supports patient-centered outcomes research and pursues a stepwise approach to addressing basic questions about treatment options. Through this program, AHRQ is building a resource of unbiased, evidence-based clinical information comparing medical interventions for a variety of conditions.
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 and Therapy 13, R155.
The use of administrative data to study the clinical effectiveness of medications for inflammatory arthritis, such as rheumatoid arthritis, has been limited by the lack of a validated algorithm to serve as a proxy for clinical improvements. The researchers derived and tested a claims-based algorithm and found that administrative claims data may be useful in this context.
Davies, S., Romano, P.S., Schmidt, E.M., and others (2011). "Assessment of a novel hybrid Delphi and Nominal Groups technique to evaluate quality indicators." (AHRQ Contract No. 290-04-0020). HSR: Health Services Research 46(6) Part I, pp. 2005-2018.
In order to improve the evaluation of quality indicators, the researchers sought to develop a method that could incorporate the advantages of both Delphi and Nominal Group (NG) techniques and thereby minimize the disadvantages of each. Their paper describes a hybrid Delphi/NG method and presents an evaluation of this method as applied during an assessment of quality indicators.
Du, J., Park, Y.-T., Theera-Ampornpunt, N., McCullough, J.S., and Speedie, S.M. (2012). "The use of count data models in biomedical informatics evaluation research." (AHRQ grant HS16115). Journal of the American Medical Informatics Association 19, pp. 39-44.
The researchers review and discuss count data models and illustrate their value in comparison to ordinary least squares using an example from their study of the impact of an electronic health record on laboratory test orders. They conclude that comprehensive model checking is highly recommended to identify the most appropriate analytic model when the dependent variable being examined contains count data.
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 (SSTIs), the researchers examined the potential for a Hawthorne Effect from the extra attention some clinicians received when completing followup case reviews with the research team. They found no difference in the clinical management of SSTIs between clinicians who participated in followup case reviews versus those who did not.
Go, M.D.A., Emeis, C., Guise, J.-M., and Schelonka, R.L. (2011). "Fetal and neonatal morbidity and mortality following delivery after previous cesarean." (AHRQ Contract No. 290-07-10057). Clinical Perinatology 38, pp. 311-318.
The researchers examine data from a recent systematic evidence review on term deliveries, a meta-analysis of associated perinatal outcomes, and subsequent related publications. They then present a summary of fetal and neonatal outcomes emphasizing information that clinicians and patients need to make decisions regarding the mode of delivery after prior cesarean.
Marquard, J.L., and Zayas-Caban, T. (2012). Commercial off-the-shelf consumer health informatics interventions: Recommendations for their design, evaluation, and redesign." Journal of the American Medical Informatics Association 19, pp. 137-142. Reprints (AHRQ Publication No. 11-R075) are available from the AHRQ Publications Clearinghouse.
The goal of this paper is to apply a case-based human factors evaluation approach to evaluate patient and provider proxies' use of inexpensive, commercial off-the-shelf consumer health informatics interventions. These interventions were aimed at supporting two lay populations—individuals with diabetes and high blood pressure as well as post-bariatric surgery patients.
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. e324-e332.
The researchers demonstrate the use of cluster analysis as a method for identifying clusters of patients with high health care use that may suggest opportunities for enhanced care management in a managed care setting. Ward's algorithm identified ten clinically relevant clusters grouped around single or multiple "anchoring conditions." Mental health conditions were prevalent in all clusters.
O'Neill, S.M., Hempel, S., Lim, Y.-W., and others (2011). "Identifying continuous quality improvement publications: What makes an improvement intervention �CQI'? BMJ Quality and Satisfaction 20, pp. 1011-1019.
In order to improve continuous quality improvement (CQI) evidence reviews, the authors used expert panel methods to identify key CQI definitional features and to develop and test a screening instrument for reliably identifying articles with the key features. In the final step, the researchers operationalized the highest-scoring consensus-based CQI features as an assessment form and applied it to the quality improvement intervention article set.
Sege, R., Flaherty, E., Jones, R., and others (2011). "To report or not to report: Examination of the initial primary care management of suspicious childhood injuries." (AHRQ grant HS10746). Academic Pediatrics 11, pp. 460-466.
This is the first study to examine the validity of decisions by primary care health providers (PCHPs) to suspect child abuse as the etiology of an injury and their decisions to report a suspicious injury to child protective services (CPS). The study found that PCHPs reported one-third fewer cases than the expert reviewers would have recommended. Patients did not appear to be lost to followup after CPS reports by their PCHPs.
Shiffman, R.N., Michel, G., Rosenfeld, R.M., and Davidson, C. (2012). "Building better guidelines with BRIDGE-Wiz: Development and evaluation of a software assistant to promote clarity, transparency, and implementability." (Co-operative agreement between AHRQ and the National Library of Medicine). Journal of the American Medical Informatics Association 19, pp. 94-101.
The authors describe a novel software application intended to support and facilitate the development of clinical practice guidelines. They describe the need for such an application and the environment in which its development and testing occurred, present key design objectives, describe the function of the BRIDGE-Wiz application, report the evaluation of the program's usefulness, and discuss lessons learned from the deployment of the application.
Song, X., and Zhou, X.-H. (2011). "Evaluating markers for treatment selection based on survival time." (AHRQ grant HS13105). Statistics in Medicine 30, pp. 2251-2264.
In the case of colon cancer patients who may be treated by surgery alone or surgery plus chemotherapy, the c-myc gene expression level may be used as a biomarker for treatment selection. In order to quantify directly the potential impact on the population of using this marker to select treatment, the selection impact (SI) curve proposed by Song and Pepe for binary outcomes is a useful tool. In this paper, the authors extend the SI curve for general outcomes, with a specific focus on survival time.
Thompson, C.A., Charlson, M.E., Schenkein, E., and others (2010, November). "Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors." (AHRQ grant T32 HS00066). Annals of Oncology 21, pp. 2262-2266.
In this study of long-term survivors of aggressive lymphoma, the researchers found a 37 percent incidence of clinically significant anxiety symptoms and a fear of recurrence that became especially prevalent in the time leading up to surveillance scans, based on qualitative interviews of 30 patients. They recommend strategies to minimize followup imaging and to improve doctor-patient communication.
Thompson, D.O., Hurtado, T.R., Liao, M.M., and others (2011). "Validation of the simplified motor score in the out-of-hospital setting for the prediction of outcomes after traumatic brain injury." (AHRQ grants HS18123, HS17526). Annals of Emergency Medicine 58, pp. 417-425.
The Glasgow Coma Scale (GCS), widely used to assess patients with head injury, has been criticized for its complexity and poor interrater reliability. These researchers chose to externally validate a less complex alternative, the Simplified Motor Score (SMS), in the out-of-hospital setting. Since the SMS performed similarly and is much simpler, the researchers suggest that it can replace the GCS.
Vesco, K.K., Whitlock, E.P., Eder, M., and others (2011, November 15). "Risk factors and other epidemiologic considerations for cervical cancer screening: A narrative review for the U.S. Preventive Services Task Force." (AHRQ Contract No. 290-2007-10057). Annals of Internal Medicine 155(10), pp. 698-705.
This review aims to inform decisions about when cervical cancer screening should begin and end. It finds that the available evidence suggests that cervical cancer screening should not begin before 21 years of age, because cervical cancer is rare in this age group and the potential for harm due to treatment is not trivial. The evidence also suggests that discontinuation of screening can be considered for women aged 65 years or older without a history of cervical intraepithelial neoplasia or cervical cancer and have had a recent negative cervical cancer screening.