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Reports in Progress

ESP ReportsESP Topic NominationESP Reports in Progress

The following reports are under development at one of the four ESP sites. If you would like to provide comments about the topic under development, serve as a peer reviewer for the draft report, or know the timeline for completion, please contact the ESP Coordinating Center.

To review the most up-to-date protocols, please visit the PROSPERO website. Protocol registration numbers for an individual project can be found along with the brief abstract for the project, below.




Screening for Male Osteoporosis

Key Questions

KQ1: Among males, is there a clinical risk tool (eg, FRAX) that identify patients at highest risk of osteoporosis or major osteoporotic fracture?

KQ2: Among male Veterans, is there a combination of risk factors that identify patients at highest risk of osteoporosis or major osteoporotic fracture?

KQ3: What systems level interventions improve uptake of osteoporosis screening?

PICOTS

Populations:
KQ 1: Adult men, KQ 2: Adult male Veterans, KQ 3: Health care providers, adult patients, health system administrators and/or staff.

In studies that recruit populations with and without facture histories, 80% of recruited study population should have no prior identified low-trauma fracture.

For studies with mixed populations of men and women, we will include them if they conduct a subgroup analysis of men only.

Interventions:
KQ 1: Clinical risk assessment or fracture risk predations tools (eg, FRAX, GARVAN FRC, Q fracture, fracture risk calculator, Osteoporosis Screening tool [OST], male osteoporosis screening tool [MOST], Male Osteoporosis Risk Estimation Score [MORES]); combination of assessment tools and screening tests (eg, dual-energy x-ray absorptiometry-DXA)

KQ 2: Risk factor for osteoporosis (eg, medication use, smoking, body mass index) and clinical risk assessment or fracture risk predations tools.

KQ 3: System-level approaches targeting provider behaviors or systems operations to optimize uptake of osteoporosis screening (eg, clinical reminder systems; bone health clinics; provider education; tailored and/or bi-directional patient education such as IVR assessing individual risk scores; remote consultation; nurse/physician/pharmacist led interventions; clinician incentives, academic detailing; patient self-referral system)

Comparators:
KQ 1 & KQ 2: other risk assessment tools, bone mineral density testing via validated approach (eg, dual-energy x-ray absorptiometry-DXA)

KQ 3: usual care, other system-level approached, patient-focused interventions

Outcomes:
KQ 1 & KQ 2: fracture rates; bone mineral density

KQ 3: fracture rates, screening rates

Setting: Outpatient general medical settings (eg, geriatrics, family medicine, general internal medicine, integrative medicine, urgent care, emergency departments) or inpatient health care settings

General Search Strategy

We will conduct a primary search from inception to the current date of MEDLINE® (via PubMed®), Embase, and CINAHL. We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert librarian. We will also hand search key references for relevant citations that may not be captured by our database search.

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Developing Culture of Innovation: A Systematic Review

Key Questions

KQ1: How is culture of innovation defined in the literature?

KQ2a: What are key characteristics of programs to improve or establish a culture of innovation?

KQ2b: In assessments of these programs, what metrics are used to capture culture of innovation?

KQ2c: In assessments of these programs, what other outcomes or impacts are described?

PICOTS

Interventions: Programs designed to improve or establish a culture of innovation

Outcome(s): Culture of innovation, organizational innovation, organizational or workforce outcomes

Setting: Large healthcare systems in high-income countries

General Search Strategy

We will procure literature from databases including Ovid Medline, Business Source Complete, and PsycInfo using terms related to culture of innovation (eg, culture, climate, innovation, creativity).

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Population and Community-Based Interventions to Prevent Suicide

Key Questions

Key Question #1: What are the effects of population and community-based prevention interventions on suicide attempts and suicide deaths?

Key Question #1a. What are the key/common components of the most effective interventions?

Key Question #1b: What strategies have been used to deliver, sustain, and improve the quality of the most effective interventions?

Key Question #1c: How do the effects vary by differences in community/setting and characteristics of individuals targeted?

Key Question #2: What are the potential unintended consequences of population and community-based prevention interventions?

PICOTS

Population(s): Veteran and non-Veteran populations of high school age or older

Interventions: Population and community-based interventions to prevent suicide

Excluding: (a) pharmacotherapy, (b) psychotherapy and therapeutic interventions that can be delivered only by licensed health care professionals, (c) legislation enacted to reduce suicide risk factors (eg, firearms, affordable housing, employment opportunities), and also excluding multi-component interventions that include (a) or (b) or (c) unless we can determine specific results of an eligible intervention alone or the add-on effects.

Comparator: Pre-intervention or concurrent comparative intervention or other control group

Outcome(s): Suicide attempts, suicide deaths, stigma, caregiver burden, healthcare utilization/help-seeking, switching suicide means, cost associated with developing and delivering the intervention

Exclude: only reports suicidal ideation

Setting: Community-based settings such as schools, workplace, prisons, and suicide hotspots in countries with very high Human Development Index

General Search Strategy

We will search MEDLINE, Embase, PsycINFO, Sociological Abstracts, and the Cochrane Database of Systematic Reviews.

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Tele-urgent Care for Low Acuity Conditions: A Systematic Review of a Complex Intervention

Key Questions

KQ1:

a.) Among adults, what are the effects of tele-urgent care for low acuity conditions on key clinical and health systems outcomes (ie, patient satisfaction, health care access, health care utilization, case resolution, cost, patient safety)?

b.) Does the impact of tele-urgent care for low acuity conditions differ by

1.) provider characteristics (ie, specialty, amount of telehealth experience, training) or

2.)mode of delivery (ie, telephone, video, web, short message service [SMS])?

KQ2:

a.) Among adults, what are the adverse effects (ie, inappropriate treatment, misdiagnosis, or delayed diagnosis; provider burnout) of tele-urgent care for low acuity conditions?

b.) Do the adverse effects of low acuity conditions differ by

1.) provider characteristics (ie, specialty, amount of telehealth experience, training) or

2.) mode of delivery (ie, telephone, video, web, short message service [SMS])?

PICOTS

Population(s): KQ1 & KQ2: Adults with low acuity but urgent conditions (≥18 years of age) and their families and caregivers.

KQ2 ONLY: Tele-urgent care providers (if included in harms)

Interventions: Tele-urgent care for low acuity conditions is defined as remotely delivered (eg, telephone, video conferencing) medical services indented to provide on-demand, initial treatment of illnesses or injuries of a less serious nature than those constituting emergencies (ie, urgent care, not routine primary care) and is initiated by a patient with a provider

Comparator: KQ1: Usual care/standard of care, waitlist control, other active comparator (eg, in-person care

KQ 2: No comparator required

Outcome(s): KQ1: Patient, provider, system outcomes (eg, patient satisfaction, health care access, health care utilization, case resolution, cost, and patient safety)

KQ 2: Key adverse effects associated with telehealth (eg, inappropriate treatment, misdiagnosis, delayed diagnosis, increase in resource costs; provider burnout)

General Search Strategy

We will conduct a primary search from inception to the current date of MEDLINE® (via Ovid®), EMBASE (via Elsevier), CINAHL Complete (via EBSCO). We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert librarian. We will hand search previous systematic reviews conducted on this or a related topic for potential inclusion.

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Robotic-Assisted Procedures in Thoracic Surgery

Key Questions

KQ1: What is the clinical effectiveness of robot-assisted surgery compared to open surgery or thoracoscopic/laparoscopic surgery for esophagectomy for cancer?

KQ2: What is the cost-effectiveness of robot-assisted surgery compared to open surgery or thoracoscopic/laparoscopic surgery for esophagectomy for cancer?

PICOTS

Population(s): Adults undergoing esophagectomy for malignant disease

Interventions: Robot-assisted surgery

Comparator: Open surgery, laparoscopic, and/or thoracoscopic surgery

Outcome(s): Intraoperative (complications, estimated blood loss, operating room time); pathologic (margins, lymph node harvest); short-term (duration of hospitalization, reoperations, readmissions, complications); long-term (cancer-specific outcomes, quality of life); and cost.

General Search Strategy

We conducted broad searches using terms relating to “robotic surgery” or “esophagectomy” or “cancer.” We searched PubMed (1/1/13-5/5/20), Cochrane (1/1/13-5/11/20), Ovid Medline (1/1/13-5/5/20), and Embase (1/1/13-5/6/20).

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Evidence Brief: COVID-19 Post-acute Care Major Organ Damage

Key Questions

KQ1: What is the post-acute care prevalence of major organ damage among adults hospitalized with proven or suspected COVID-19 disease?

KQ2: Does the post-acute care prevalence of major organ damage among adults with COVID-19 disease vary by patient characteristics (age, sex, race/ethnicity, preexisting co-morbidities, etc), COVID-19 disease severity, or other factors (eg, treatment for COVID-19)?

KQ3: What are the short (< 3 months) and long-term (≥ 3 months) healthcare or service use needs of adults surviving COVID-19 disease with major organ damage?

PICOTS

Population(s): Adults

Interventions: Discharge from hospitalization after admission for proven or suspected COVID-19

Comparator: Discharge from hospitalization for individuals without COVID-19 (ideally another respiratory condition); a comparator will not be required

Outcome(s): Prevalence and severity of major organ damage (respiratory, renal, cardiovascular, hematologic, neurologic, metabolic/endocrine, gastrointestinal, and rheumatologic/musculoskeletal); healthcare or service use needs

Timing: Short-term (< 3 months) and long-term (≥ 3 months) post-discharge

Setting: Any post-discharge setting (eg, home, rehabilitation or long-term care facility); may include re-hospitalization

Study Design: Any; we may prioritize articles using a best-evidence approach (ie, study designs of lower risk of bias, studies with larger sample sizes) to accommodate the timeline for the review

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Evidence Brief: Mental Health Outcomes of Adults Hospitalized with COVID-19

Registration number: CRD42020199557

Key Questions

KQ1: What is the prevalence of MH disorders among adults who have been hospitalized for COVID-19?

  1. a) What is the comparative prevalence of MH disorders among adults who have been hospitalized for COVID-19 vs the same population before hospitalization?
  2. b) What is the comparative prevalence of MH disorders among adults who have been hospitalized for COVID-19 vs a comparable population (in terms of demographics and comorbidities) not hospitalized for COVID-19?

KQ2: Does the prevalence of MH disorders among adults hospitalized for COVID-19 vary by patient characteristics (eg, age, sex, race/ethnicity, comorbidities, etc), COVID-19 disease severity, or other factors?

KQ3: What are the rates of mental health care utilization among adults who have been hospitalized for COVID-19?

  1. a) How do rates of mental health care utilization compare among adults hospitalized for COVID-19 before vs after hospitalization?
  2. b) How do rates compare among adults hospitalized for COVID-19 vs a comparable population (in terms of demographics and comorbidities)?
  3. c) How do rates compare among adults hospitalized for COVID-19 with vs. without pre-existing MH diagnoses or other key demographics (eg, age, sex, race/ethnicity, comorbidities, etc)?

KQ4: What are the self-reported mental healthcare resource needs among adults who have been hospitalized for COVID-19?

PICOTS

Population(s): Adults who have been hospitalized for COVID-19

Interventions: None

Comparator: KQ1: No comparator

KQ1a: Adults hospitalized with COVID-19 vs. the same population before hospitalization

KQ1b: Adults hospitalized with COVID-19 vs. a comparable (in terms of demographics and comorbidities) population not hospitalized for COVID-19

KQ2: Subgroups of adults hospitalized for COVID-19 vs. each other

KQ3: No comparator

KQ3a: Adults hospitalized with COVID-19 vs. the same population before hospitalization

KQ3b: Adults hospitalized with COVID-19 vs. a comparable (in terms of demographics and comorbidities) population not hospitalized for COVID-19

KQ3c: Subgroups of adults hospitalized for COVID-19 vs. each other

KQ4: No comparator

Outcome(s): KQ1&2: Prevalence of mental health disorders (including mood disorders, anxiety disorders, trauma-related disorders, psychotic disorders, and substance use disorders; excluding cognitive disorders such as delirium, dementia, and post intensive care syndrome [PICS])

KQ3: Health care utilization (eg, healthcare appointments, medications filled, etc)

KQ4: Mental healthcare resource needs identified by patients or caregivers.

Timing: 2019-2020

Setting: Any

Study Design: Including cohort studies and cross-sectional studies, excluding case series and case reports

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United States Health Inequalities in COVID-19 and Past Epidemics and Pandemics

Registration number: CRD42020187078

Key Questions

KQ1: In the COVID-19 pandemic in the United States:

  1. a) What health inequalities have been described?
  2. b) What factors have contributed to health inequalities?
  3. c) What is the effectiveness of interventions used to address health inequalities?

KQ2: What factors contribute to disparate infection rates and health-related outcomes among different segments of the population during infectious disease epidemics or pandemics in the United States?

KQ3: What interventions or intervention components have been used to reduce health inequalities (or identified in preliminary studies) in infectious disease transmission or health outcomes in disasters, or infectious disease epidemics or pandemics in the United States?

We will examine first generation studies to address KQ1a, second generation studies to address KQs 1b and 2, and third generation studies to address KQs 1c and 3.

PICOTS

Population(s): Adult Subgroups: race or ethnicity, socioeconomic status, disability, geographic location (eg, urban/rural, high density neighborhoods)

Interventions:

For KQ1 a and b:

Risk of exposure: Structural (employment, urban/rural, living arrangement, crowding); Work-related inability to social distance; Other measures of inability to social distance (childcare access, need for public transport, language or cultural barriers); Access to clean water and sanitation.

Susceptibility: Comorbid chronic diseases; Immunosuppression; Psychologic and nutritional stress

Access to care: Regular health care provider; Insurance; Quality of health care

Discrimination

Trust in the healthcare system

For KQ1 c:

Emergency preparedness

Messaging/communication

Employment, telework

Childcare

Health care access

For KQ2:

Risk of exposure: Structural (employment, urban/rural, living arrangement, crowding); Work-related inability to social distance; Other measures of inability to social distance (childcare access, need for public transport, language or cultural barriers); Access to clean water and sanitation.

Susceptibility: Comorbid chronic diseases; Immunosuppression; Psychologic and nutritional stress

Access to care: Regular health care provider; Insurance; Quality of health care

Discrimination

For KQ3:

Emergency preparedness

Messaging/communication

Employment, telework

Childcare

Health care access

Comparator:

For KQ1 a and b:

Comparison group within the same group

Comparison to other groups relevant to the population

For KQ1 c:

Standard public health response

No intervention or pre-intervention

Other interventions

For KQ2:

Comparison group within the same group

Comparison to other groups relevant to the population

For KQ3:

Standard public health response

No intervention or pre-intervention

Other interventions

No comparator necessary for pre-intervention studies

Outcome(s): For KQ1:

COVID-19 infection

Severity of COVID-19 illness at time of diagnosis

Severity of COVID-19 illness course

Testing/healthcare utilization access

Mortality

Infectious-disease-related hospitalizations

Burden of illness

Loss of job due to COVID-19

For KQ2 and KQ3:

Mortality

Health care utilization and access

Infectious-disease-related hospitalizations

Burden of illness

Severity of illness

Loss of job due to epidemic/pandemic/disaster

Timing:

For KQ1:

COVID-19 pandemic

For KQ2:

Related to an infectious disease pandemic or epidemic

For KQ3:

Related to an infectious disease pandemic or epidemic, or disaster

Setting: United States and Territories

Study Design: Trials, quasi-experimental, observational, descriptive, case series (depending on search yield), qualitative. Systematic reviews will be included if they directly address key questions. If not, reference lists will be pearled.

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Primary Care Engagement among Veterans with Housing Instability and Serious Mental Illness

Key Questions

KQ1: What intervention strategies have been studied among adults who are homeless or at high risk of becoming homeless and who have serious mental illness (SMI) to promote engagement in primary care?

KQ2: What measures have been used to evaluate interventions among adults who are homeless or at high risk of becoming homeless and who have SMI to promote engagement in primary care?

PICOTS

Population(s): Ambulatory adults (18 years and older) who are currently homeless or at high risk of becoming homeless:

  • Homeless as defined as lacking a fixed, regular, and adequate night-time residence, including people living in supervised shelters, supported housing, or places not intended for human habitation; and, those at risk for losing their housing and lacking resources to obtain other permanent housing, and/or who are receiving housing support services.

AND who have serious mental illness (SMI) as determined by meeting one of the following criteria:

  • Primary SMI definition = at least a one-time diagnosis of schizophrenia, bipolar disorder, or other psychotic disorder; OR
  • Secondary SMI definition = above diagnoses, Major Depressive Disorder (MDD) or Post-Traumatic Stress Disorder (PTSD); OR
  • The population under study is explicitly labeled as SMI by the study authors even if the operationalized definition of SMI is different (could also be labeled as severe and persistent mental illness or SPMI).

Interventions: Interventions designed to promote structured interaction with a prescribing primary care clinician or with a clinical team member(s) that have a direct linkage to a prescribing primary care clinician AND:

  • are specifically targeted to patients with housing insecurity and SMI

OR,

  • are targeted to patients with housing insecurity – of whom at least 75% have SMI or diagnoses consistent with SMI

OR,

  • are targeted to patients with housing insecurity AND include a subgroup analysis with outcomes reported separately for the group of interest.

Comparator: Any comparator (eg, usual care, active comparator) or no comparator

Outcome(s): Any

Setting: Any setting (eg, clinical, housing services, criminal justice system), OECD countries only

General Search Strategy

We will conduct a primary search from inception to the current date of MEDLINE® (via Ovid®), EMBASE (via Elsevier), and PsycINFO (via Ovid). We will use a combination of MeSH keywords and selected free-text terms to search titles and abstracts. To ensure completeness, search strategies will be developed in consultation with an expert librarian. We will hand-search previous systematic reviews conducted on this or a related topic for potential inclusion.

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