martes, 5 de febrero de 2013

Research Activities, February 2013: Research Briefs

Research Activities, February 2013: Research Briefs
Agency for Healthcare Research Quality

Research Briefs

Baskin, R.M., Sangl, J., and Zodet, M.W. (2012). "Effect of different imputation methods on factor analyses of CAHPS Nursing Home Survey." Proceedings of the Federal Commission on Statistical Methodology 2012 Research Conference, pp. 10-12. Reprints (AHRQ Publication No. 13-R007) are available from the AHRQ Publications Clearinghouse.
The authors discuss validation of a five-factor analysis model using CAHPS (Consumer Assessment of Healthcare Providers and Systems) Nursing Home Survey data on recently discharged short-stay residents. The data used came from a survey of 1,828 recently discharged short-stay residents conducted by the State of Maryland. The results indicate the quality of the questions does not allow a determination if the five- or four-factor model is more appropriate.

Birken, S.A., Lee, S.-Y.D., and Weiner, B.J. (2012). "Uncovering middle managers' role in healthcare innovation implementation." (AHRQ grant HS19107). Implementation Science 7, p. 28.

The authors suggest that the role of middle managers in healthcare innovation implementation has been overlooked. They present a theory of middle managers' role in this process to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in health care organizations.

Boyce, R.D., Hanlon, J.T., Karp, J.F., and others (2012). "A review of the effectiveness of antidepressant medications for depressed nursing home residents." (AHRQ grant HS19461). Journal of the American Medical Directors Association 13, pp. 326-331.

The limited amount of available evidence from randomized and non-randomized open-label trials suggests that depressed nursing home residents have a modest response to antidepressant medications. This conclusion is based on a review of 11 studies, only 4 of which were randomized.

Chang, S.M., Carey, T.S., Kato, E.U., and others (2012). "Identifying research needs for improving health care." Annals of Internal Medicine 157, pp. 439-445. Reprints (AHRQ Publication No. 13-R004) are available from the AHRQ Publications Clearinghouse.

To encourage patient-centered research, in 2010 the Agency for Healthcare Research and Quality initiated a new effort to better define patient-centered research needs from selected systematic reviews. These stand-alone reports on future research needs span multiple topic areas. This article describes the challenges and lessons learned from this initial effort in developing a systematic approach to identifying and prioritizing future research needs.

Clancy, C.M. (2012). "National Health IT Week: Celebrating HIT as an essential tool." Government HealthIT at: Reprints (AHRQ Publication No. 13-R005) are available from the AHRQ Publications Clearinghouse.

In this article, Carolyn M. Clancy, M.D., director of the Agency for Healthcare Research and Quality (AHRQ), briefly reviews the Agency's commitment to health information technology (IT). She discusses several AHRQ-funded projects, Project ECHO, Project RED, and the Active Aging Research Center as well as several recently released AHRQ products: the Workflow Assessment for Health IT Toolkit, the Toolset for E-Prescribing Implementation in Physician Offices, and an Interactive Preventive Care Record.

Clancy, C.M. (2012). "More hospitals begin to apply lessons from seven pillars process." Perspectives. Reprints (AHRQ Publication No. 13-R010) are available from the AHRQ Publications Clearinghouse.

Carolyn M. Clancy, M.D., director of the Agency for Healthcare Research and Quality (AHRQ), describes the Seven Pillars process, a full-disclosure alternative to the medical liability system. Following a 2-year pilot test at the University of Illinois, AHRQ is supporting a 3-year demonstration project in 10 Chicago-area hospitals. The process seeks to prevent patient harm by reporting and correcting flaws in processes that can undercut the work of clinicians.

Clancy, C.M. (2012). "Reducing hospital readmissions: Aligning financial and quality incentives." American Journal of Medical Quality 27(5), pp. 441-443. Reprints (AHRQ Publication No. 13-R005) are available from the AHRQ Publications Clearinghouse.

Preventing hospital readmissions is a high priority for health care organizations across the United States. Carolyn M. Clancy, director of the Agency for Healthcare Research and Quality (AHRQ), discusses efforts by various public and private health care organizations to address factors leading to frequent readmissions. Her discussion of AHRQ's contributions includes Project RED (Re-Engineered Discharge), Patient Safety Organizations, and Common Formats.

Concannon, T.W., Meissner, P., Grunbaum, J.A., and others (2012). "A new taxonomy for stakeholder engagement in patient-centered outcomes research." (AHRQ grants HS17726, HS19464). Journal of General Internal Medicine 27(8), pp. 985-991.

To date, no common taxonomy exists to guide researchers and stakeholders into a new era of stakeholder-engaged research. The authors set out to develop such a taxonomy by answering three key questions: (1) Who are the stakeholders in patient-centered outcomes research (PCOR) and comparative effectiveness research (CER)? (2) What roles and responsibilities can stakeholders have in PCOR and CER? (3) How can researchers start engaging stakeholders?

Crews, D.C., Greer, R.C., Fadrowski, J.J., and others (2012). "Setting an agenda for comparative effectiveness systematic reviews in CKD care." (AHRQ Contract No. 290-07-10061). BMC Nephrology 13, p.74.

There has been, thus far, little effort to identify priorities for comparative effectiveness research (CER) among stakeholders in the chronic kidney disease (CKD) community and to share this with the CKD community at large, note these authors. They engaged stakeholders within the CKD community to identify and prioritize topics for future CER systematic reviews and to help set an agenda for future primary CER studies of CKD care.

Croswell, J. and Costello, A. (2012). "Screening for cervical cancer." American Family Physician 86(6), pp. 561-564. Reprints (AHRQ Publication No. 13-R012) are available from the AHRQ Publications Clearinghouse.

This article presents a case study of a 45-year-old woman who comes to the office for a routine well-woman examination. She asks the doctor to perform an annual Pap smear. Her medical records are available to consult. The study asks three questions (with multiple choice answers) about this case. Correct answers about proper screening for cervical cancer are given at the end.

Cummins, M.R., Crouch, B.I., Gesteland, P., and others (2012). "Electronic information exchange between emergency departments and poison control centers." (AHRQ grant HS18773). Clinical Toxicology 50, pp. 503-513.

As Federal initiatives push to increase clinical health information exchange, it is essential to assess the readiness of U.S. poison control centers. The authors conducted a nationwide Delphi study to determine consensus on legal, operational, and clinical considerations that are important for electronic information exchange between emergency departments and poison control centers.

de Cordova, P.B., Phibbs, C.S., Bartel, A.P., and Stone, P.W. (2012). "Twenty-four/seven: A mixed-method systematic review of the off-shift literature." (AHRQ grant HS18216). Journal of Advanced Nursing 68(7), pp. 1454-1468.

The authors conducted a systematic review aimed at synthesizing qualitative and quantitative evidence of ‘off-shifts' (nights, weekends, holidays) on quality and employee outcomes in hospitals. One conclusion was that patients are more likely to not receive necessary procedures and to die on weekends. Also, employees who work at night are more likely to suffer from fatigue than daytime employees.

Dossett, L.A., Fox, E.E., del Junco, D.J., and others (2012). "Don't forget the posters! Quality and content variables associated with accepted abstracts at a national trauma meeting." (AHRQ grant T32 HS13833). Journal of Trauma 72(5), pp. 1429-1434.

Since the methodological quality of abstracts submitted to national surgical meetings has not been previously described, it is uncertain to what degree they achieve scientific merit and research quality. After reviewing all abstracts accepted for a 2009 meeting of trauma surgeons, the authors found that the methodological quality of accepted poster abstracts equals and sometimes exceeds that of oral abstracts.

Goeschl, C.A., Weiss, W.M., and Pronovost, P.J. (2012). "Using a logic model to design and evaluate quality and patient safety improvement programs." (AHRQ grant HS14246). International Journal for Quality 24(4), pp. 330-337.

The authors had previously developed a program to reduce central line-associated bloodstream infections. The program spread across the U.S. and to various foreign countries. This success led them to the development of a logical framework approach (LFA) to guide project management, to incorporate the cultural, clinical, and capacity variations among countries, and to ensure early alignment of the project's design and evaluation. The paper describes the use of the LFA to systematically design, implement, and evaluate large-scale, multi-faceted, quality improvement programs.

Gonzales, A.A., Garroutte, E., Ton, T.G.N., and others (2012). "Effect of tribal language use on colorectal cancer screening among American Indians." (AHRQ grant HS10854). Journal of Immigrant Minority Health published online March 9, 2012.

The researchers examined whether tribal language use by American Indians was associated with knowledge and use of colorectal cancer screening (CRC). They found that participants who primarily spoke English were no more aware of CRC screening tests that those who primarily spoke a tribal language.

Goodwin, J.C., Johnson, T.R., Cohen, T., and others (2012). "Predicting biomedical document access as a function of past use." (AHRQ grant T32 HS17586). Journal of the American Medical Informatics Association 19, pp. 473-478.

The researchers sought to determine whether past access to biomedical documents can predict future document access. They used two document access models, one based on frequency and the other based on frequency and recency. The model based on frequency only had a much higher correlation with empirical data than the other model.

Hacker, K., Penfold, R., Zhang, F., and Soumerai, S.B. (2012, March). "Impact of electronic health record transition on behavioral health screening in a large pediatric practice." Psychiatric Services 65(3), pp. 256-261.

As electronic health records (EHRs) continue to be implemented in health care settings, debate continues as to their actual impact on clinical outcomes. In pediatrics, EHRs have been shown to improve the rates and timeliness of immunizations. Now, a new study investigates how changing over to EHRs affects behavioral health screening. It finds the transition period to be especially difficult, with declines in screening rates. In addition, this disruption took a long time before rates returned back to normal.

Herrinton, L.J., Curtis, J.R., Chen, L. and others (2011, November). "Study Design for a Comprehensive Assessment of Biologic Safety Using Multiple Healthcare Data Systems." (AHRQ grant HS17919). Pharmacoepidemiology and Drug Safety 20(10), pp. 1199-1209.

The Safety Assessment of Biologic Therapy collaborative conducted a cohort study examining risks of seven classes of adverse events in relation to biologic treatments prescribed for seven autoimmune diseases. The cohort included 159,000 individuals with rheumatic diseases, 33,000 with psoriasis, and 46,000 with inflammatory bowel disease. This report summarizes demographic characteristics and drug exposures. Further reports will provide outcome definitions and estimated hazard ratios for adverse events.

Hill, S.C., Zuvekas, S.H., and Zodet, M.W. (2012). "Validity of reported Medicare Part D enrollment in the Medical Expenditure Panel Survey." Medical Care Research and Review 69(6), pp. 737-750. Reprints (AHRQ Publication No. 13-R008) are available from the AHRQ Publications Clearinghouse.

Previously, there have been no studies of the accuracy of reporting Part D coverage in surveys. The authors validate reported Part D coverage in the Medical Expenditure Panel Survey and assess the impact of misreporting on descriptive and behavioral analyses. They find that accuracy varies little by sociodemographic group and that behavioral analyses are largely unaffected by misreporting.

Jonas, D.E., Garbutt, J.C., Amick, H.R. and others (2012, November). "Behavioral counseling after screening for alcohol misuse in primary care: A systematic review and meta-analysis for the U.S. Preventive Services Task Force." (AHRQ contract no. 290-07-10056). Annals of Internal Medicine 157, pp. 645-654.

This review examined the benefits and harms of behavioral counseling interventions for adolescents and adults who misuse alcohol. Based on results from 23 studies, the reviewers concluded that behavioral interventions improve behavioral outcomes for adults with risky drinking. Among these adults, comsumption decreased by 3.6 drinks per week from baseline. Evidence was insufficient to draw conclusions about accidents, injuries, or alcohol-related liver problems.

Kaplan, C.P., Kim, S.E., Wong, S.T., and others (2012). "Willingness to use tamoxifen to prevent breast cancer among diverse women." (AHRQ grant HS10856). Breast Cancer Research and Treatment 133, pp. 357-366.

A goal of this study was to determine whether knowledge of the benefits and risks of tamoxifen affects a woman's willingness to take it to prevent breast cancer. The researchers found that over 40 percent of the women surveyed said they would likely take tamoxifen if determined to be at high risk. Factors affecting women's willingness to take breast cancer chemoprevention drugs are not determined solely by knowledge of risk/benefit or risk perception.

Kesselheim, A.S. (2012, August). "Ethical considerations in orphan drug approval and use." (AHRQ HS18465). Clinical Pharmacology & therapeutics 92(2), pp. 153-155.

The author of this commentary points out that orphan drugs are often approved with more limited premarket testing than that carried out for nonorphan drugs and consequently expose patients to more risk and less certain efficacy. Therefore, he suggests that, based on ethical principles of justice and beneficence, more attention should be paid to informed consent among patients who receive orphan drugs. He also calls for greater investment in postmarket surveillance and confirmational testing.

Kim, H., Park, S.B., Monroe, J.L., and Soho, J.W. (2012). "A new quantification measure of the difference between two organ contours." (AHRQ grant HS17424). Medical Physics 39(8), p. 3678.

Quantifying the geometric difference between two organ/target surfaces is essential for radiation therapy planning and delivery. The researchers succeeded in proving that a new Error-Proof Distance Measure is a robust and accurate way to compare two 2D or 3D surfaces.

Klabunde, C.N., Marcus, P.M., Han, P.J.K., and others (2012). "Lung cancer screening practices of primary care physicians: Results from a national survey." Annals of Family Medicine 10(2), pp. 102-110.

A majority of primary care physicians (72 percent) reported ordering lung cancer screening tests within the past year for patients without symptoms or an extensive history of smoking, a new study reports. The researchers note that the lack of evidence from large randomized, controlled studies has prevented major professional or other expert groups from making recommendations on screening asymptomatic individuals for lung cancer, even if they have histories of heavy or long-term smoking.

Kramer, D.B., Xu, S., and Kesselheim, A.S. (2012). "How does medical device regulation perform in the United States and the European Union? A systematic review." (AHRQ grant HS18465). PLoS Medicine 9(7), p. e1001276.

To answer the question posed in their title, the authors performed a systematic review of 20 empirical studies. They found that these studies of United States and European Union device approval and post-market evaluation performance suggest that policy reforms are necessary for both systems, including improving classification of devices in the United States and promoting transparency and post-market oversight in the European Union.

Kundrapu, S., Sunkesula, V., Jury, L.A., and others (2012, October). "Daily infection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers' hands." (AHRQ grant HS20004). Infection Control and Hospital Epidemiology 33(1), pp. 1039-1042.

This randomized trial demonstrated that daily disinfection of high-touch surfaces in rooms of patients with Clostridium difficile infection and methicillin-resistant Staphylococcus aureus (MRSA) colonization reduced the transmission of these pathogens onto hands of those contacting high-touch surfaces. This approach also reduced contamination of hands of health care workers caring for patients.

Leeman, J., Sommers, J., Vu, M., and others (2012). "An evaluation framework for obesity prevention policy interventions." (AHRQ grant HS19468). Preventing Chronic Disease 9, 1103-1122.

Little is known about policy approaches that are most effective for obesity prevention. The authors present a framework for evaluating policy interventions that was developed by the Center of Excellence for Training and Research Translation to build public health practitioners' capacity to evaluate policy. The framework is designed for use by practitioners working as partners and evaluators in public policy initiatives at the State or local level.

Linder, J.A. (2012, October). "Vitamin D and the cure for the common cold." Journal of the American Medical Association 308(13), pp. 1375-1376.

This editorial discusses a rigorous clinical trial in the same journal issue that looked at whether vitamin D supplementation can reduce upper respiratory tract infections in healthy adults. The investigators used a once-monthly high dose of vitamin D, which has been linked to the lowest risk of respiratory infections in observational studies on healthy adults. The number of upper respiratory infections was not different between the intervention and control groups (both of whom had sufficient levels of vitamin D).

Melnyk, B.M., Grossman, D.C., Chou, R., and others (2012). "USPSTF perspective on evidence-based preventive recommendations for children." Pediatrics 130(2), pp. e399-e3407. Reprints (AHRQ Publication No. 13-R003) are available from the AHRQ Publications Clearinghouse.

In this article, the authors describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process used by the United States Preventive Services Task Force (USPSTF) in making evidence-based screening recommendations, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other guidelines by clinicians.

Morrato, E.H., and Allison, D.B. (2012, September). "FDA approval of obesity drugs: A difference in risk-benefit perceptions." (AHRQ grant HS19464). Journal of the American Medical Association 308(11), pp. 1097-1098.

These authors note that in the past decade, three obesity drugs were removed from the U.S. market, and until last month, only one new obesity drug had been approved since 1999. They suggest that the FDA encourage formal risk-benefit modeling to project the number of adverse health outcomes avoided through weight reduction against the number of serious adverse effects expected. They also encourage more discussion of assumptions about these drugs. Finally, they suggest assigning numerical values of risk-benefit perceptions from surveys of patients and physicians.

Mueller, S.K., Sponsler, K.C., Kripalani, S., and Schnipper, J.L. (2012). "Hospital-based medication reconciliation practices." (AHRQ grant HS19598). Archives of Internal Medicine 172(140), pp. 1057-1069.

This review aims at summarizing available evidence on medication reconciliation interventions in the hospital setting and identifying most effective practices. The authors conclude that rigorously designed studies comparing different medication reconciliation practices and their effects on clinical outcomes are scarce. The available evidence supports reconciliation interventions that heavily use pharmacy staff and focus on patients at high risk for adverse events.

Nichols, G.A., Desai, J., Lafata, J.E., and others (2012). "Construction of a multisite DataLink using electronic health records for the identification, surveillance, prevention, and management of diabetes mellitus: The SUPREME-DM Project." (AHRQ grant HS19859). Preventing Chronic Disease 9, p. 110311.

The objective of this study was to identify the number of people with diabetes from a diabetes DataLink developed as part of the SUPREME-DM (SUrveillance, PREvention, and ManagEment of Diabetes Mellitus) project, a consortium of 11 integrated health systems that use comprehensive electronic health records for research. The 11 health systems had 1,085,947 enrollees who met 1 or more study criteria for diabetes.

Nishisaki, A., Donoghue, A.J., Colborn, S., and others (2012, July). "Development of an instrument for a primary airway provider's performance with an ICU multidisciplinary team in pediatric respiratory failure using simulation." (AHRQ grant HS16678). Respiratory Care 57(7), pp. 1121-1128.

The researchers developed a task-based scoring instrument (the Just-in-Time Pediatric Airway Provider Performance Scale, version 3) for a primary airway provider's performance with a multidisciplinary pediatric intensive care unit team on simulated pediatric respiratory failure. Reliability and validity evaluation supports the developed scale.

Osborn, C.Y., Rosenbloom, S.T., Stenner, S.P., and others (2012). "MyHealthAtVanderbilt: Policies and procedures governing patient portal functionality." (AHRQ grant HS19276, HS18168). Journal of the American Medical Informatics Association 18, pp. i18-i23.

This paper describes procedures and policies directing the functionality of MyHealthAtVanderbilt (MHAV), a patient portal for Vanderbilt University Medical Center. The authors elaborate on popular portal functions and discuss how guiding principles have addressed common user concerns and have facilitated adoption and usage of MHAV.

Overby, C.L., Devine, E.B., Tarczy-Hornoch, P., and Kalet, I.J. (2012). "Deriving rules and assertions from pharmacogenomics knowledge resources in support of patient drug metabolism efficacy predictions." (AHRQ grant HS14379). Journal of the American Medical Informatics Association 19, pp. 840-850.

Pharmacogenomics evaluations of variability in drug metabolic processes may be useful for making individual drug response predictions. The authors implement a knowledge-based model for calculating phenotype scores from patient-specific genotype data. Their model illustrates a knowledge-based approach to predict drug metabolism efficacy given patient genomics data. The utility of the model is demonstrated in a tamoxifen case study.

Park, S.B., Kim, H., Yao, M., and others (2012). "Building deformation error histogram and quality assurance of deformable image registration." (AHRQ grant HS17424). Medical Physics 39(6), p. 3672.

The researchers sought to quantify error of a Deformable Image Registration (DER) system and to establish a quality assurance procedure. They succeeded in building a DER approach to quantify the Deformation Vector Map uncertainty. Their data sets are available for testing other systems on their Web page.

Peterson, K.A., Lipman, P.D., Lange, C.J., and others (2012). "Supporting better science in primary care: A description of practice-based research networks (PBRNs) in 2011." (AHRQ grant HS10037). Journal of the American Board of Family Medicine 25, pp. 565-571.

The Agency for Healthcare Research and Quality (AHRQ) has a long history of supporting primary care research networks. In 2002, AHRQ created the National Practice-Based Research Network (PBRN) Resource Center. Using the Resource Center's 2011 registration data, the authors update the status of PBRNs, explore the relationship between key characteristics of PBRNs and general indicators of research capacity, and provide a perspective on changes over time.

Price, R.C., Huth, D., Smith, J., and others (2012). "Federated queries for comparative effectiveness research: Performance analysis." (AHRQ grant HS19908). HealthGrid Applications and Technologies Meet Science Gateways for Life Sciences, pp. 9-18. Gesing, S., et al. (Eds.) IOS Press.

This paper presents a study of the performance of federated queries implemented in a system that simulates the architecture proposed for the Scalable Architecture for Federated Translational Inquiries Network (SAFTINet). The results show that the caGrid Federated Query Engine is capable and suitable for comparative effectiveness research federated queries given its nearly linear scalability as partner nodes increase in number.

Quinn, M.A., Kats, A.M., Kleinman, K., and others (2012). "The relationship between electronic health records and malpractice claims." (AHRQ grant HS15397). Archives of Internal Medicine 172(13), pp. 1187-1189.

This study of 189 physicians surveyed in 2005 and 2007 found that the rate of malpractice claims when electronic health records (EHRs) were used were about one-sixth the rate when EHRs were not used. While this study includes only a small number of post-EHR claims, it suggests that implementation of EHRs may reduce malpractice claims and, at the least, appears not to increase claims as providers adapt to using EHRs.

Ryan, A., Burgess, J., Strawderman, R., and Dimick, J. (2012). "What is the best way to estimate hospital quality outcomes? A simulation approach." (AHRQ grant HS18546). HSR: Health Services Research 47(40), pp. 1699-1718.

Rigorous research on the relative accuracy of alternative estimators of outcome quality has been extremely limited. In this study, the researchers performed a simulation experiment to test the accuracy of five alternative outcome estimators. The study found significant and substantial variation in the accuracy of the tested outcome estimators. The Dimick and Staiger (DS) estimator was the most accurate for all hospitals.

Schiff, G.D., Galanter, W.L., Duhig, J., and others (2012). "A prescription for improving drug formulary decisionmaking." (AHRQ grant HS16973). PLoS Medicine 9(5), p. e1001220.

The role of hospital drug formularies could be enhanced by a more standardized critical evaluation of drugs proposed for formulary placement. The authors developed a tool based on a project at two U.S. public academic hospitals consisting of a six-domain checklist of questions for evaluating drugs requested to be added to formularies. The tool poses 48 questions related to evidence of need, efficacy, medication safety, misuse potential, cost issues, and decisionmaking process.

Schnipper, J.L., Gandhi, T.K., Wald, J.S., and others (2012). "Effects of an online personal health record on medication accuracy and safety: A cluster-randomized trial." (AHRQ grant HS13660). Journal of the American Medical Informatics Association 19, pp. 728-734.

To determine the effects of a personal health record linked medications module on medication accuracy and safety, researchers tested patients from 11 primary care practices who received access to the online medications module. They found that the proportion of medications per patient with unexplained discrepancies was 42 percent in the intervention group compared to 51 percent in the control group who did not receive access.

Sinaiko A.D., Eastman D., and Rosenthal M.B. (2012). "How report cards on physicians, physician groups, and hospitals can have greater impact on consumer choices." (AHRQ Contract No. 290-07-10022). Health Affairs 31(3), pp. 602-611.

Weaknesses in the content, design, and accessibility of provider report cards have served to disconnect this information from consumer decisions, according to a qualitative survey of leaders in the design and delivery of public reporting on practitioner performance. A set of interviews with 29 leaders in public reporting suggested that current report cards can be improved, but do not need to be thoroughly revamped.

Spindler, K.P., Parker, R.D., Andrish, J.T., and others (2013, January). "Prognosis and predictors of ACL reconstructions using the MOON Cohort: A Model for comparative effectiveness studies." (AHRQ HS16075). Journal of Orthopedic Research 31(1), pp. 2-9.

Primary anterior cruciate ligament (ACL) reconstruction has in general been effective at restoring the functional stability of the knee. These authors looked at patients' modifiable predictors of both short- and long-term validated outcomes and osteoarthritis. They describe results reported by the Multicenter Orthopaedic Outcomes Network consortium, which was established in 2002 to enroll and longitudinally follow a population cohort of ACL reconstructed patients.

Sturm, R. and Hatton, A. (2012, September). "Morbid obesity rates continue to rise rapidly in the United States." (AHRQ grant T32 HS00046). International Journal of Obesity, pp. 1-3.

The paper details time trends for clinically severe or morbid obesity until 2010 using data from the Behavioral Risk Factor Surveillance System. Between 2000 and 2010 the prevalence of severe obesity increased by 70 percent, whereas the prevalence of morbid obesity increased even faster. Although the body mass index rates were higher among Hispanics and blacks at every point in time, there were no significant differences in trends between them and non-Hispanic whites. The growth rate appeared to have slowed down since 2005.

Taylor, J.L., McPheeters, M.L., Sathe, N.A., and others (2012). "A systematic review of vocational interventions for young adults with autism spectrum disorders." (AHRQ Contract No. 290-2007-10065). Pediatrics 130(3), pp. 531-538.

The researchers undertook a systematic review to assess the impact of vocational interventions on teenagers and young adults with autism spectrum disorders. After an extensive search of relevant databases (Medline, PsychINFO, and ERIC) plus hand searches of other sources for articles published between 1980 and December 2011, the researchers identified only 6 papers, representing 5 studies. Because of the poor quality of these studies, no conclusions could be drawn.

Webbe-Janek, H., Lenzmeier, C.R., Ogden, P.E., and others (2012). "Nurses' perceptions of simulation-based interprofessional training program for rapid response and code blue events." (AHRQ grant HS16634). Journal of Nursing Care Quality 27(1), pp. 43-50.

Nurses who underwent 3-week simulation training in rapid response team actions to deal with code blue (resuscitation) events reported a variety of positive experiences as a result. The majority of nurses (203 of 360 nurses participating in the training) responded to an associated qualitative and quantitative survey. The nurses reported finding the hands-on practice the most valuable aspect of the training.

Weng, C., Appelbaum, P., Hripcsak, G., and others (2012). "Using EHRs to integrate research with patient care: Promises and challenges." (AHRQ grant HS19853). Journal of the American Medical Informatics Association 19, pp. 684-687.

Clinical research requires collaboration between clinicians and researchers, but such collaborations are poorly supported. Although the increasing adoption of electronic health records (EHRs) offers the opportunity to increase coordination between patient care and patient-oriented research activities, the authors find that the EHR alone cannot overcome barriers in conducting clinical trials and comparative effectiveness research.

Weng, C., Wu, X., Luo, Z., and others (2012). "EliXR: An approach to eligibility criteria extraction and representation." (AHRQ grant HS19853). Journal of the American Medical Informatics Association 19, pp. i116-i124.

This paper presents an integrated semantic processing framework called eligibility criteria extraction and representation (EliXR) for inducing natural semantic role labels from text. This approach permits the development of a semantic network that aligns well with the top-level information structure in clinical research eligibility criteria text, and demonstrates the feasibility of using the resulting semantic role labels to generate semistructured eligibility criteria with nearly perfect interrater reliability.

Whipple, E.C., Dixon, B.E., and McGowan, J.J. (2012). "Linking health information technology to patient safety and quality outcomes: A bibliometric analysis and review." (AHRQ Contract No. 290-04-0016). Informatics for Health and Social Care, pp. 1-14.

The authors assess the scholarly output of grants funded by the Agency for Healthcare Research and Quality (AHRQ) related to health information technology (IT) on patient safety and quality of care outcomes. They analyze the connection between health IT and patient safety and quality outcomes using bibliometric methods, examining the grantees' contribution to the evidence based on health IT. They compare grant outputs with the original goals of the AHRQ portfolio on Transforming Healthcare Quality through Health IT.

Wong, S.T., Perez-Stable, E.J., Kim, S.E., and others (2012). "Using visual displays to communicate risk of cancer to women from diverse race/ethnic backgrounds." (AHRQ grant HS10856). Patient Education and Counseling 87, pp. 327-335.

The goal of this study was to evaluate how well women from diverse race/ethnic groups were able to take a quantitative cancer risk statistic verbally provided to them and report it in a visual format using either an icon array or a graphic of a magnifying glass. Compared to whites, black and Latina women were significantly less likely to use the icon arrays correctly. Higher education and higher numeracy were associated with correct responses.

Wu, Y., Jiang, X., Kim, J., and Ohno-Machado, L. (2012). "Grid binary Logistic Regression (GLORE): Building shared models without sharing data." (AHRQ grant HS19913). Journal of the American Medical Informatics Association 19, pp. 758-764.

The authors propose a new algorithm (GLORE) to fit a logistic regression (LR) model in a distributed fashion using information from locally hosted databases containing different observations that share the same attributes (i.e., horizontal partitions of data—stackable sets of patient records) without sharing the sensitive original patient data from these databases. The resulting model is calculated in a privacy-preserving manner and performs as well as LR.

Zachariah, M., Phansalkar, S., Seidling, H.M., and others (2012). "Development and preliminary evidence for the validity of an instrument assessing implementation of human-factors principles in medication-related decision-support systems—I-MeDeSA." (AHRQ grant HS16970). Journal of the American Medical Informatics Association 18, pp. i62-i72.

After reviewing human-factors principles for relevance to medication-related decision support alerts, the authors built the Instrument for Evaluating Human-Factors Principles in Medication-Related Decision Support Alerts (I-MeDeSA) in order to assess the extent to which a given interface design incorporates these human-factors principles. The final version of the instrument includes 26 items associated with nine human-factors principles.

Zapka, J., Klabunde, C.N., Taplin, S., and others (2012). "Screening colonoscopy in the US: Attitudes and practices of primary care physicians." (AHRQ Inter-Agency Agreement Nos. Y3-PC-5019-01, Y3-PC-6017-01). Journal of General Internal Medicine 27(9), pp. 1150-1158.

This survey of 1,266 primary care physicians found that a majority (73 percent) reported that colonoscopy volume increased somewhat or substantially. Eighty-six percent strongly agreed that colonoscopy was the best of the available colorectal cancer screening tests. These attitudes were significantly related to substantial increases in colonoscopy ordering.

Zayas-Cabán, T. (2012). "Health information management in the home: A human factors assessment." Work 41, pp. 315-328. Reprints (AHRQ Publication No. 12-R067) are available from the AHRQ Publications Clearinghouse.

The researcher used a series of interviews with four families to collect information about how different families handled health information management. She identified 69 distinct health information management tasks among the four families that took place in nine different locations. The researcher suggests that the commonalities across the households could help designers of consumer health information technology applications tailor their applications to how families work.
Research Activities, February 2013: Research Briefs

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