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Outcomes Research

Outcomes & Effectiveness

Center for Outcomes and Evidence
The Outcome of Outcomes Research at AHCPR: Final Report
Outcomes Research Fact Sheet
Research Initiative in Clinical Economics

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Centers for Education and Research on Therapeutics (CERTs)

CERTs Research: Child Health
Medicaid Uses of Research from CERTs
Medicare Uses of Research from CERTs

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Evidence Reports

Evidence Report/Technology Assessment, No. 160:
Impact of Gene Expression Profiling Tests on Breast Cancer Outcomes
Evidence Report/Technology Assessment, No. 180:
Outcomes of Genetic Testing in Adults with a History of Venous Thromboembolism
Evidence Report/Technology Assessment, No. 181:
Outcomes of Community Health Worker Interventions
Evidence Report/Technology Assessment, No. 183:
Vitamin D and Calcium: Systematic Review of Health Outcomes
Evidence Report/Technology Assessment, No. 199:
Health Literacy Interventions and Outcomes, Update
Evidence Report/Technology Assessment, No. 208:
Quality Improvement Measurement of Outcomes for People With Disabilities
Closing the Quality Gap: Revisiting the State of the Science Series

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Patient Outcomes Research Team (PORT) Reports

Routine Preoperative Testing Before Cataract Surgery
Patterns of Usual Care for Schizophrenia
Schizophrenia PORT Treatment Recommendations
Stroke Prevention: Recommendations
What You Should Know About Stroke Prevention

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Research Findings

Research Activities, February 2013:
Process improvements in family practice lead to some improvements in intermediate outcomes
Abnormal electrocardiogram results nearly double the risk of cardiovascular-related death for patients without heart disease
Bevacizumab, when added to chemotherapy regimen for elderly patients with lung cancer, does not increase survival rates
Benefits of case management for chronic illness limited
Older women with breast cancer experience more complications with brachytherapy than whole breast irradiation
Giving birth to a small gestational age infant increases likelihood of later maternal ischemic heart disease
Using a terbutaline pump to prevent preterm birth may be beneficial, but evidence suggests caution

Research Activities, January 2013:
Aldosterone antagonist therapy at hospital discharge linked to modest reduced risk of rehospitalization for heart failure
Study is first to show improved outcomes with postpartum depression screening and care
Quality improvement collaborative improves outcomes in children with inflammatory bowel disease
Partial kidney removal offers survival advantage for elderly patients with small tumors
Computerized clinical decision support produces only modest savings for nursing home residents with impaired kidney function

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Research Activities, December 2012:
Certain hospital strategies lower mortality rates for heart attack patients
Continuing beta blockers after noncardiac surgery improves patient outcomes and lowers mortality
A few preoperative factors can be used to predict inpatient deaths following surgery at resource-limited hospitals
Patients transferred to the intensive care unit within 24 hours of admission to a hospital room have high risk of dying
Antipsychotic medications linked to occurrence of diabetes in children
Genetic risk for obesity in children boosts risk for obesity in adulthood
Quality improvement collaborative improves outcomes in children with inflammatory bowel disease
Surgery for ureter congenital abnormality results in efficacy and long-term durability for children
Minimally invasive prostatectomy in young men has fewer complications than standard prostatectomy
Review looks at outcomes of patients at different types of long-term care facilities
Physical therapy may improve outcomes for adults with knee pain
AHRQ Stats: AHRQ publishes statistics on hospital stays among obese adults and children and hospital stays for hip and knee replacement

Research Activities, November 2012:
Patient decision aids can reduce uncertainty in decisions about whether to undergo total knee replacement
Helicopter transport to trauma centers improves patient survival over ambulance transport
Bariatric surgery is not linked to lower costs among individuals with diabetes
Consolidating blood draws may help reduce blood loss in critically ill children
Intensity-modulated radiation therapy for localized prostate cancer yields fewer side effects than other radiation treatments
Patients treated for heart failure in the emergency department fare better if there is an electronic health record available
Procalcitonin guidance may lead to decreased antibiotic usage
Progestogens effective for preventing preterm births in single pregnancies

Research Activities, October 2012:
Drug discontinuation effects are not limited to psychoactive drugs, but may be important for cardiovascular drugs as well
Electronic health records improve diabetes care and outcomes
Electronic medical records reduce negative outcomes and related costs after patient safety events occur
Nuclear kidney scans in children with urinary tract infections increase costs and radiation exposure
Noninvasive positive pressure ventilation improves COPD patient outcomes
More research needed on coronary artery disease treatments for women

Research Activities, September 2012:
AHRQ-funded medical liability and patient safety initiative shows promise for reducing patient harm, lawsuits, and costs
Hospital volume does not predict mortality for patients undergoing lung cancer surgery
Response to etanercept for rheumatoid arthritis can be predicted by 12 weeks
No link found between stimulant treatment of youth with ADHD and cardiovascular problems
Study fails to find link between guideline-based emergency treatment for pediatric asthma and patient outcomes
Telemedicine dermatology consultations change diagnoses and improve outcomes
Increased fluid and supplemental treatments may reduce recurrence of kidney stones

Research Activities, August 2012:
Outcomes of trauma patients depend heavily on whether recommended practices are followed
Patients hospitalized for burn injuries in New York have comparable outcomes at major burn centers
Ways to reduce contrast-induced acute kidney injury from imaging procedures in patients with cardiovascular disease
Discharge to skilled nursing facilities after a heart attack or heart failure explains little of variation in hospital readmissions
Complications increase mortality of trauma patients
Liver transplant patients who taper off or do not take corticosteroids after transplantation have better quality of life
Effects of antidepressants on suicidal thoughts and behavior differ by age group
Insulin pump and glucose monitoring improve blood-sugar control for diabetes patients
Single-lung transplantation for COPD improves access to transplantation without jeopardizing survival
Fewer patients with primary sclerosing cholangitis die while awaiting liver transplants than those with other liver diseases
Certain medications are associated with functional decline in the elderly
Bowel incontinence and other clinical factors predict the development of pressure ulcers
No significant link found between treatments used for juvenile idiopathic arthritis and development of cancer

Research Activities, July 2012:
Complications and in-hospital deaths more frequent among patients who undergo anterior rather than posterior spine fusion
Large vessel occlusion after a mini stroke predicts functional decline
Tumor necrosis factor-antagonists in patients with autoimmune diseases showed no overall increased risk of hospitalizations for serious infections than non-biologic drugs
Limited evidence prevents firm conclusions on rheumatoid arthritis drug therapies

Research Activities, June 2012:
A hospital's ability to rescue patients from complications after high-risk surgery determines mortality rates
Paper previsit reminders for doctors do not add value to electronic reminders from an electronic health record system
Use of pulmonary artery catheters provides no patient benefit and increases costs
Risk of venous thromboembolism low for young trauma patients without a central venous catheter
No evidence of serious cardiovascular events in children and young adults using medications for ADHD
Risks high for elderly patients receiving angioplasty to fix narrowed heart artery
Patients recovering from stroke tend to continue using secondary preventive medications
Men more likely to be readmitted to hospital after discharge

Research Activities, May 2012:
Clinical inertia may represent good clinical judgment in hypertension telemanagement
Teenage body size does not predict heart failure in older adults
Modeling inequalities helps to develop cervical cancer screening strategies that can improve outcomes and reduce disparities
Children whose parents lack a usual source of care are more likely to have unmet medical needs
Kidney-sparing surgery for children with renal tumors has equivalent in-hospital results to kidney removal surgery

Research Activities, April 2012:
Performance measures for gastroenterology can lead to improved accountability
Drug-eluting stents appear safe for older patients with chronic kidney disease
Blood pressure control persists after physician-pharmacist intervention ends
Physician personality factors do not seem to influence whether patients with symptoms undergo extended diagnostic evaluations
C-reactive protein testing is not more effective than an educational intervention to decrease antibiotic prescriptions for patients seen for acute cough
Accuracy of ultrasound for ectopic pregnancy in the emergency department is not helped by measuring a key pregnancy hormone
Performance measures for gastroenterology can lead to improved accountability
Clinical algorithm can identify and locate serious internal bleeding related to oral anticoagulant use

Research Activities, March 2012:
Trauma patients with hospital-acquired infections have poor outcomes, including increased mortality risk
Evaluation of TeamSTEPPS® implementation finds improved teamwork and clinical outcomes
EMS transport is underused by patients with a certain type of heart attack
Study characterizes patients receiving out-of-hospital endotracheal intubation
Patients with hepatitis C virus infection who adhere to their drug regimen are more likely to show long-term benefit
Older patients with chronic conditions have greater risk of problems and death following bilateral knee replacement
Nine percent of adults with hypertension have resistant hypertension
More research needed to evaluate self-measured blood pressure monitoring

Research Activities, February 2012:
Newer antidepressants equally effective in treating major depressive disorder
Older medications for epilepsy obtain better control but have more adverse effects
Benefits of active surveillance therapy for localized prostate cancer not yet demonstrated
Posttraumatic stress disorder (PTSD) associated with elevated hemoglobin A1c levels in low-income blacks with diabetes
Increasing body mass index lowers quality of life in obese individuals
HIV outcomes and medication use are similar between rural and urban HIV patients

Research Activities, January 2012:
No greater risk or mortality observed for endoscopic vein harvesting for coronary bypass surgery
Leg compression devices are not a significant factor in in-hospital falls
ADHD medications don't increase serious heart risks in children or adults
Evidence lacking on optimal transition-of-care programs for heart attack and stroke patients following hospitalization

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Research Activities, December 2011:
For-profit dialysis chains have higher mortality rates than non-profit dialysis chain
Patients with myelodysplastic syndrome have shorter survival times if they have coexisting medical conditions
Increased estradiol levels during critical illness are associated with higher mortality
Hospital lung cancer surgery volume is not correlated with lower mortality
Financial performance has modest effect on nursing home quality improvement
Birth defects may be linked to high blood pressure, not use of ACE inhibitors in early pregnancy

Research Activities, October 2011:
Minimally invasive heart treatments have reduced bypass surgeries and influenced valve repair and replacement
A structured goal-setting approach can improve care outcomes for patients with type 2 diabetes
Heart attack victims should use emergency transport services, not self or family to get to the hospital
More research is needed on outcomes after maternal-fetal surgery

Research Activities, September 2011:
Metformin just as effective as other medications for treating type 2 diabetes
Surgical risk score does not work well for knee and hip replacement operations
Patients with sepsis fare better when admitted via the emergency department rather than directly to the hospital
Patients with sepsis fare better when admitted via the emergency department rather than directly to the hospital
Blacks who receive heart transplants have poorer survival than other racial groups
Minority status has no effect on patient outcomes in the intensive care unit

Research Activities, August 2011:
High performance on quality measures linked to financial benefits for nursing homes
Drugs to treat hepatitis B may not prevent patients from liver disease later
Primary anterior cervical fusion has lower in-hospital complication rates and deaths than posterior cervical fusion

Research Activities, July 2011:
Immersive simulation training for CPR shows no benefit over standard training
Patients who suffer strokes and are seen at designated stroke centers fare better in the short and long run
Two approaches help identify cardiac surgery patients at risk for postoperative kidney failure
Some patients hospitalized for stroke more likely to keep taking drugs to prevent another stroke
Sleep apnea and pulmonary hypertension affect in-hospital outcomes of noncardiac surgery
Certain factors linked to risk of early death of intensive care patients after discharge
Physicians more reluctant to deactivate some life-sustaining devices than others
Mandated increases in nurse staffing levels unevenly affect uncompensated care growth rates in California hospitals
No link found between chemotherapy in older women with breast cancer and later cognitive impairment
Women's self-reported stress seems to jibe with a common stress biomarker
U.S.-born Mexican women who have adopted U.S. culture may be more at risk for cervical cancer
Connecting local providers to academic medical centers using video improved hepatitis C outcomes

Research Activities, June 2011:
Patient gender does not influence the management or diagnosis of acute abdominal pain in the elderly, but affects outcome
Organizational culture distinguishes top-performing hospitals in patient outcomes from heart attack
No consistent association found between volume or quality and outcomes of complex surgeries for cancer
Chemotherapy and radiation therapy for lung cancer linked to cardiac disorders
Combination diuretic therapy for heart failure appears useful, but needs a stronger evidence base
Patients with sickle cell disease employ various strategies to control their pain
Dilators more cost-effective than surgery for correcting congenital condition in females
Older persons with chronic kidney disease and lower systolic blood pressure have higher mortality rates

Research Activities, May 2011:
Patient Web portals improve diabetes care and outcomes
Genotype information can make the predicted therapeutic dose of warfarin more accurate
Emergency department patients and visitors are most interested in education about stress and depression
Nurse survey identifies important but underused end-of-life care skills
Practice setting, ownership, and specialty all affect volume of charity care provided by physicians
Performing cardiac catheterization and heart surgery on different hospital admissions may reduce risk of kidney damage
Treatments show promise in reducing autism-related behaviors, but some have significant side effects

Research Activities, April 2011:
Hospital Compare data may not help surgical patients find hospitals with better outcomes
Obese patients with hypertension and diabetes have a greater risk of dying after noncardiac surgery
Provider's communication style boosts results for acupuncture on arthritic knees
Certain hospital characteristics influence mortality after complications following high-risk surgery
Various factors influence the adoption of ergonomics in health care organizations
Electronic health record decision support improves the care of children with ADHD
Rates of pneumonia dramatically reduced in patients on ventilators in Michigan intensive care units

Research Activities, March 2011:
Better adherence to diabetes medications means fewer hospitalizations and emergency department visits
Hospitals with more patients who receive angioplasty within 90 minutes of a heart attack have lower mortality rates;
Hospitalizations for bacterial pneumonia in Texas towns bordering Mexico three times higher than the national average
Colony-stimulating factor is effective in reducing infection for elderly patients with non-Hodgkin's lymphoma on chemotherapy
Bariatric surgery before pregnancy reduces the risk of gestational diabetes in obese women
Better hospital quality of care for the elderly is associated with lower mortality after discharge
HIV treatment costs much more when patients start treatment later in the disease
Landmark initiative to reduce healthcare-associated infections cuts deaths among Medicare patients in Michigan ICUs
AHRQ report finds unclear value of pretesting autoimmune disorder patients before prescribing thiopurine drugs
Innovations show the benefits of using phone-based care management

Research Activities, February 2011:
Research comparing diabetes medications helps patients and clinicians choose the right one
Hospitals vary greatly in the quality of their trauma care
Routing ambulances to cardiac surgery-equipped hospitals more cost effective than building more such hospitals
Vaginal births after cesarean are safe for most women
Cardiac procedures can lead to substantial radiation exposure for patients
Contrast-enhanced CT scans do not increase the risk of kidney failure in patients with acute stroke
Arterial and perfusion imaging help guide treatment for stroke patients when symptom onset is unknown
Higher in-hospital complication rate for primary posterior versus primary anterior cervical fusion
Pre-existing cardiovascular conditions linked to lower stimulant prescribing rates for adults with ADHD
One in 16 women hospitalized for childbirth has diabetes

Research Activities, January 2011:
Serious complications from bariatric surgery are fewer when done by high-volume hospitals and surgeons
Treatment for blocked carotid arteries varies depending on where you live - Hospital care, cost, and use; Managed care: Quality of care
Community hospitals care for psychiatric patients in medical-surgical beds when psychiatric units are full

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Research Activities, December 2010:
Surgical infection prevention measures reduce postoperative infections when used together, but not singly
Rescuer experience with out-of-hospital emergency intubation is often associated with improved patient survival
Fever over 100°F following multiple infant vaccinations is rare
For hypertensive patients with diabetes, blood pressure drops quicker with more frequent interactions with clinicians
Despite their helpfulness to guiding care, home blood pressure readings are rarely documented in routine clinical care
Uncontrolled asthma events among Massachusetts patients declined between 2002 and 2007
Antiretroviral switching strategies to treat HIV improve survival and are cost-effective in resource-limited countries
Evidence report finds modest and short-term benefit of complementary and alternative therapy for back and neck pain

Research Activities, November 2010:
Cesarean delivery rates may not be a useful measure of obstetric quality
Clopidogrel increases bleeding risk in cardiac patients with drug-eluting stents
Higher risk of death or heart attack in first 90 days after cardiac patients stop taking clopidogrel
Hospital report cards on coronary bypass surgery are more accurate when based on 2-year data
Colonoscopy is best at diagnosing lower intestinal bleeding
Most adults with lactose intolerance can tolerate the amount of lactose in a cup of milk
Pharmacy intervention for patients with limited literacy evokes positive responses from patients and pharmacists
Human growth hormone shows promise in treating cystic fibrosis symptoms
Prostate cancer deaths drop, but blacks still most likely to die

Research Activities, October 2010:
Quality improvement initiative successful in sustaining reduction in bloodstream infections caused by catheters
Delay in filling a blood-thinner prescription after procedures to implant a drug-eluting stent is risky
Patients with adult-onset diabetes with limited health literacy more likely to suffer hypoglycemic episodes
Laboratory tests can accurately detect two clotting-factor mutations that raise risk of blood clots
A new study links biomarker of brain injury to microemboli occurring during cardiac surgery
The role of hospital care in general medical care has declined over time
Risks, benefits of emerging heart valve replacement technique not fully understood

Research Activities, September 2010:
Impact of anti-arthritis drug on lipid levels in patients with rheumatoid arthritis remains unclear
Being overweight does not have a negative impact on quality of life after a kidney transplant
Evidence-based care processes are associated with improved outcomes for heart failure
Study shows Guided Care benefits family caregivers, chronically ill older adults, and physicians, and may reduce costs
Patients more likely to follow medication regimens if they share their doctor's beliefs about causes of health outcomes
Obstetrician malpractice claims lead to small reduction in inpatient deliveries, but not C-section rates
Satisfaction after hysterectomy linked to quality of life improvements
Benefits of chemotherapy for elderly patients with lung cancer must be weighed against risk of long-term toxicities
Measure of inappropriate prescribing predicts risk of adverse drug events in older adults
Early followup with a physician reduces readmissions for Medicare patients hospitalized for heart failure
New study finds rotator cuff injuries treatable, but evidence unclear whether surgery is preferable

Research Activities, August 2010:
Advanced type of cancer radiation reduces side effects, but impact on cancer control is unclear
Lower mortality rates after surgery at high-volume hospitals due to fewer complications and other factors
Remote supervision of stroke therapy is safe and effective at smaller hospitals
Studies explore rapid treatment of sepsis and cardiac arrest
Instrument that measures quality of life for breast cancer survivors can be used for other cancers
Surgical simulation training improves speed and confidence in residents learning endoscopic sinus surgery
Coronary risk information may improve prescribing practices
Using quitlines with physician support improves smoking cessation
Thoracic surgeons can help patients stop smoking with a brief smoking cessation program
Challenges abundant for practices that use fax referrals to smoking cessation quitlines

Research Activities, July 2010:
Patient outcomes are better than hospital volume for identifying high-quality bariatric surgery centers
New approach reduces microemboli responsible for neurologic injury following open-heart surgery
Implantable heart defibrillator is effective in reducing deaths among older heart failure patients
Body fat distribution in obese trauma patients is not linked to increased inflammation, infections, or mortality
Performance measures requiring antibiotics for pneumonia have not boosted antibiotic use in nonpneumonia patients
Elderly lung cancer patients experience more adverse events during chemotherapy than younger patients
Nearly 9 percent of children experience agitation during sedation for nonsurgical procedures
Computerized provider order entry significantly reduces medication errors in an ambulatory setting
No additional benefit seen with remote offsite monitoring of ICU patients
Hospital heart attack deaths plummet
Using bar-code technology with eMAR reduces medication administration and transcription errors

Research Activities, June 2010:
Home visits help pregnant, Medicaid-insured women alleviate depressive symptoms
Treatment without examination and lab tests appears effective for some women with vaginal symptoms
Socioeconomically disadvantaged blacks have the worst long-term outcomes from work-related low back pain
Physician-pharmacist teams can help lower blood pressure
Personality factors play a role in responsiveness to disease self-management programs
A certain type of stroke increases risk of death and poor outcome
Patients who undergo knee ligament reconstruction do better when the doctor or hospital perform it frequently

Research Activities, May 2010:
Atypical antipsychotic medications increase fracture risk in patients with Parkinson's disease
Combination treatment reduces acute kidney injury due to infusion of contrast dye during cardiac catheterization
Published sources on warfarin interactions with other drugs, food, and supplements tend not to agree
Anti-tumor necrosis factor therapy increases risk for certain mycobacteria infections
Some patients are more satisfied when they are given usually unnecessary antibiotics for upper respiratory infections
Drug monitoring may be improved by the use of health information technology and clinical pharmacists
Health information technology improves the timely availability of diagnostic information
Team-based care of patients with hypertension improves control of blood pressure
Patients who take a proton-pump inhibitor with medicine to prevent blood clots are less likely to be hospitalized for bleeding ulcers

Research Activities, April 2010:
Chemotherapy that contains anthracyclines is associated with later cardiac illness in breast cancer patients
Women's lack of knowledge and mistrust play a role in underuse of breast cancer adjuvant therapy
The stability of a usual source of care is important to the care of low-income children
Providing customized clinical information to patients and physicians does not improve diabetes care
Counseling education does not significantly boost residents' dietary counseling of patients with diabetes
Positive outlooks may bring better outcomes for patients with heart failure
Common sleep disorder contributes to work disability and need to modify work duties
Veterans who use pharmacy services at VA facilities tend to be sicker, poorer, and have no alternative insurance
Primary care patients who see physician assistants and nurse practitioners are as complex as those who see doctors
Caregiver dissatisfaction affects outpatient care for the elderly with dementia
Nursing home users of information technology start to see its benefits
Computer display helps reduce the rates of ventilator-associated pneumonia in surgical intensive care units
New report shows vaginal birth after cesarean is safe for most women

Research Activities, March 2010:
Venous thromboembolism is rare in young trauma patients, but a better understanding of its risk factors is needed
Clinicians should be cautious when prescribing one class of diabetes drugs for patients at high risk for heart attack
Creating networks to provide social support for the homeless may improve health outcomes
Octogenarians fare well after aortic valve replacements

Research Activities, February 2010:
Being overweight prior to transplant surgery slows improvement in the physical functioning of liver transplant patients
COPD drug triad associated with reduced death and hospitalization rates
Demographic and health factors influence the type of prostate cancer screening received by men over age 40
Patients who are treated with empathy during office visits get over colds faster

Research Activities, January 2010:
Fewer public psychiatric hospital beds may lead to higher suicide rates
Longer use of electronic health records is not linked to improved quality of care
Studies examine impact of drug caps and pay for performance on care costs and outcomes
MEPS household survey respondents tend to report some medical conditions more accurately than others
MEPS respondents underreport emergency department and office visits, but accurately report hospital stays
Individuals who seek care for coughs and colds in emergency departments have social support
Two-thirds of people with diabetes miss some critically important exams to manage the disease

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