Comparative Effectiveness Research / PCORI

The analysis of the relative effectiveness of different medical treatments. The Patient-Centered Outcomes Research Institute (PCORI) is a government-sponsored organization set up to fund this analysis.  

Considering the Harms of Our Habits: The Reflexive Urine Drug Screen in Opioid Use Disorder Treatment

Dec. 19, 2020

Utsha G. Khatri, Shoshana V. Aronowitz

Abstract [from journal]

The COVID-19 pandemic has led to abrupt changes in the delivery of substance use treatment, notably the adoption of telehealth services and a departure from mandatory urine drug screens (UDS). Amid current circumstances, the UDS, which had evolved to signal a "successful" recovery, no longer seems feasible, safe, or necessary. Even prior to the pandemic, the UDS had notable drawbacks, including sending a message of mistrust and hierarchy, potentially causing psychological trauma, and incentivizing falsification. Nonetheless, certain

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The Stanford Integrated Psychosocial Assessment for Transplant Is Associated With Outcomes Before and After Liver Transplantation

Dec. 15, 2020

Sasha Deutsch-Link, Ethan M. Weinberg, Therese Bitterman, Mackenzie McDougal, Aniket Dhariwal, Lauren S. Jones, Robert M. Weinrieb, Arpita G. Banerjee, Senayish Addis, Marina Serper

Abstract [from journal]

Background: The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized psychosocial evaluation tool used in liver transplant (LT) evaluation. Study aims were to assess the impact of the SIPAT score and sub-score domains on transplant waitlisting decisions and post-LT outcomes including immunosuppression (IS) non-adherence, biopsy-proven rejection, and mortality/graft failure.

Methods: We conducted a single center observational cohort study of 1430 patients

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Effect of Remote Monitoring on Discharge to Home, Return to Activity, and Rehospitalization After Hip and Knee Arthroplasty: A Randomized Clinical Trial

Dec. 1, 2020

Shivan J. MehtaEric HumeAndrea B. Troxel, Catherine Reitz, Laurie Norton, Hannah Lacko, Caitlin McDonald, Jason Freeman, Noora Marcus, Kevin G. VolppDavid A. Asch

Abstract [from journal]

Importance: Hip and knee arthroplasty are the most common inpatient surgical procedures for Medicare beneficiaries in the US, with substantial variation in cost and quality. Whether remote monitoring incorporating insights from behavioral science might help improve outcomes and increase value of care remains unknown.

Objective: To evaluate the effect of activity monitoring and bidirectional text messaging on the rate of discharge to home and clinical outcomes in patients receiving hip or knee

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An Increase in Multi-Site Practices: The Shifting Paradigm for Gynecologic Cancer Care Delivery

Nov. 24, 2020

Katherine Hicks-CourantGenevieve P. Kanter, Robert L. Giuntoli II, Marilyn M. SchapiraJustin E. BekelmanNawar A. Latif, Ashley F. Haggerty, Mark A. Morgan, Robert Burger, Emily M. Ko 

Abstract [from journal]

Objective: To assess whether the number of practice sites per gynecologic oncologist (GO) and geographic access to GOs has changed over time.

Methods: This is a retrospective repeated cross-sectional study using the 2015-2019 Physician Compare National File. All GOs in the 50 United States and Washington, DC, who had completed at least one year of practice were included in the study. All practice sites with complete addresses were included. Linear regression analyses estimated trends in GOs'

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Using Clinical Trial Data to Estimate the Costs of Behavioral Interventions for Potential Adopters: A Guide for Trialists

Nov. 20, 2020

Louise B. Russell, Laurie A. Norton, David Pagnotti, Christianne Sevinc, Sophia Anderson, Darra Finnerty Bigelow, Lauren G. Iannotte, Michael Josephs, Ryan McGilloway, Iwan Barankay, Mary E. Putt, Peter P. ReeseDavid A. Asch, Lee R. Goldberg...

Abstract [from journal]

Behavioral interventions involving electronic devices, financial incentives, gamification, and specially trained staff to encourage healthy behaviors are becoming increasingly prevalent and important in health innovation and improvement efforts. Although considerations of cost are key to their wider adoption, cost information is lacking because the resources required cannot be costed using standard administrative billing data. Pragmatic clinical trials that test behavioral interventions are potentially the best and often only source

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Acute Kidney Injury In Deceased Organ Donors And Kidney Transplant Outcomes: A National Cohort Study Using A Novel Data Source

Nov. 13, 2020

Elizabeth M. SonnenbergJesse Y. Hsu, Jordana B. Cohen, Vishnu S. Potluri, Zhi Geng, Matthew H. Levine, Peter L. Abt, Peter P. Reese

Abstract [from journal]

Objective: To determine graft function and survival for kidney transplants from deceased donors with acute kidney injury (AKI) that persists at the time of organ procurement.

Background: Kidneys from donors with AKI are often discarded and may provide an opportunity to selectively expand the donor pool.

Methods: Using OPTN and DonorNet data, we studied adult kidney-only recipients between 5/1/2007-12/31/2016. DonorNet was used to characterize

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Association of Retinal Vascular Occlusion With Women Filling a Prescription for Female Hormone Therapy

Brian L. Vanderbeek, MD, MPH
Nov. 12, 2020

Delu Song, Jennifer Nadelmann, Yinxi Yu, Brian L. VanderBeek

Abstract [from journal]

Importance: Oral contraceptives have been associated with cardiovascular disease, ischemic stroke, venous thromboembolic disease, and breast cancer. Retinal vascular occlusions share the same risk factors as cardiovascular and cerebrovascular disease.

Objective: To determine whether filling a prescription of female hormone therapy (FHT) is associated with an increased risk of retinal artery occlusion (RAO) or retinal vein occlusions (RVO).

Design, setting, and participants: 

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Opioid Prescription For Pain After Osmotic Dilator Placement In Abortion Care: A Randomized Controlled Trial

Nov. 5, 2020

Divyah NagendraSarita Sonalkar, Danielle Schurr, Arden McAllister, Andrea Hsu Roe, Jade M. Shorter, Mary D. Sammel, Courtney A. Schreiber

Abstract [from journal]

Objective: To compare the overnight maximum pain scores after osmotic dilator placement prior to a dilation and evacuation (D&E) procedure in participants assigned to a prescription for ibuprofen alone or to ibuprofen plus oxycodone.

Study design: We conducted a non-blinded pragmatic, randomized controlled trial to evaluate pain management among women undergoing osmotic dilator placement prior to D&E. We randomly assigned 70 participants at 12 weeks 6 days to 23 weeks 6 days gestation

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Embedding A Linkage To Pre-exposure Prophylaxis (PrEP) Care Intervention In Social Network Strategy And Partner Notification Services: Results From A Pilot Randomized Controlled Trial

Daniel Teixeira da Silva
Oct. 22, 2020

Daniel Teixeira da Silva, Alida Bouris, Arthi Ramachandran, Olivia Blocker, Billy Davis, James Harris, Maria Pyra, Laura K. Rusie, Russell Brewer, Jade Pagkas-Bather, Anna Hotton, Jessica P. Ridgway, Moira McNulty, Ramona Bhatia, John A. Schneider

Abstract [from journal]

Background: Increased pre-exposure prophylaxis (PrEP) uptake among Black men who have sex with men and Black transgender women (BMSM/TW) is needed to end the HIV epidemic. Embedding a brief intervention in network services that engage individuals in HIV transmission networks for HIV/STI testing may be an important strategy to accelerate PrEP uptake.

Setting: Partner Services PrEP (PS-PrEP) study is a pilot randomized control trial to improve linkage to PrEP care among BMSM/TW presenting for

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Effect Of Integrating Machine Learning Mortality Estimates With Behavioral Nudges To Clinicians On Serious Illness Conversations Among Patients With Cancer: A Stepped-Wedge Cluster Randomized Clinical Trial

Oct. 15, 2020

Christopher R. Manz, Ravi B. Parikh, Dylan S. Small, Chalanda N. Evans, Corey Chivers, Susan H. Regli, C. William Hanson, Justin E Bekelman, Charles A. L. Rareshide, Nina O'Connor, Lynn M. Schuchter, Lawrence N. Shulman,...

Abstract [from journal]

Importance: Serious illness conversations (SICs) are structured conversations between clinicians and patients about prognosis, treatment goals, and end-of-life preferences. Interventions that increase the rate of SICs between oncology clinicians and patients may improve goal-concordant care and patient outcomes.

Objective: To determine the effect of a clinician-directed intervention integrating machine learning mortality predictions with behavioral nudges on motivating clinician-patient SICs

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Examining The Potential Impact Of Race Multiplier Utilization In Estimated Glomerular Filtration Rate Calculation On African-American Care Outcomes

Oct. 15, 2020

Salman Ahmed, Cameron T. Nutt, Nwamaka D. EneanyaPeter P. Reese, Karthik Sivashanker, Michelle Morse, Thomas Sequist, Mallika L. Mendu

Abstract [from journal]

Background: Advancing health equity entails reducing disparities in care. African-American patients with chronic kidney disease (CKD) have poorer outcomes, including dialysis access placement and transplantation. Estimated glomerular filtration rate (eGFR) equations, which assign higher eGFR values to African-American patients, may be a mechanism for inequitable outcomes. Electronic health record-based registries enable population-based examination of care across racial groups.

Objective: To

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Racial/Ethnic Differences in Maternal Resilience and Associations with Low Birthweight

Diana Montoya-Williams, MD
Oct. 7, 2020

Diana Montoya-Williams, Molly Passarella, William A. Grobman, Scott A. Lorch 

Abstract [from journal]

Objective: Evaluate racial/ethnic differences in maternal resilience and its associations with low birthweight (LBW).

Study design: Retrospective cohort study of 3244 women surveyed in the Longitudinal Study of Adolescent to Adult Health. The Add Health Resilience Instrument assessed resilience. Logistic regression models explored associations between women's resilience and risk of LBW.

Result: Resilience scores were lowest in American Indian women. Women with the

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Association Between A National Insurer's Pay-For-Performance Program For Oncology And Changes In Prescribing Of Evidence-Based Cancer Drugs And Spending

Oct. 6, 2020

Justin E. BekelmanAtul Gupta, Ezra Fishman, David Debono, Michael J. Fisch, Ying Liu, Gosia Sylwestrzak, John Barron, Amol S. Navathe

Abstract [from journal]

Purpose: Cancer drug prescribing by medical oncologists accounts for the greatest variation in practice and the largest portion of spending on cancer care. We evaluated the association between a national commercial insurer's ongoing pay-for-performance (P4P) program for oncology and changes in the prescribing of evidence-based cancer drugs and spending.

Methods: We conducted an observational difference-in-differences study using administrative claims data covering 6.7% of US adults. We

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Early Noninvasive Cardiac Testing After Emergency Department Evaluation For Suspected Acute Coronary Syndrome

Benjamin Sun, MD
Oct. 5, 2020

Aniket A. Kawatkar, Adam L. Sharp, Aileen S. Baecker, Shaw Natsui, Rita F. Redberg, Ming-Sum Lee, Maros Ferencik, Yi-Lin Wu, Ernest Shen, Chengyi Zheng, Visanee V. Musigdilok, Michael K. Gould, Steve Goodacre, Praveen Thokala , Benjamin C. Sun

Abstract [from journal]

Importance: Professional guidelines recommend noninvasive cardiac testing (NIT) within 72 hours of an emergency department (ED) evaluation for suspected acute coronary syndrome. However, there is inexact evidence that this strategy reduces the risk of future death or acute myocardial infarction (MI).

Objective: To evaluate the effectiveness of early NIT in reducing the risk of death or acute MI within 30 days.

Design, setting, and participants: This retrospective,

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A Novel Health-Transportation Partnership Paves The Road For Young Driver Safety Through Virtual Assessment

Oct. 1, 2020

Elizabeth A. Walshe, Daniel Romer, Venkatesh Kandadai, Flaura K. Winston

Abstract [from journal]

Motor vehicle crashes remain the leading cause of adolescent mortality and injury in the United States. For young drivers, crash risk peaks immediately after licensure and declines during the next two years, making the point of licensure an important safety intervention opportunity. Legislation in Ohio established a unique health-transportation partnership among the State of Ohio, Children's Hospital of Philadelphia, and Diagnostic Driving, Inc., to identify underprepared driver license applicants through a virtual driving assessment

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