Purpose: To assess the prevalence, patterns, and consequences of ADHD stimulant medication misuse... more Purpose: To assess the prevalence, patterns, and consequences of ADHD stimulant medication misuse among adults in the United States. Methods: PubMed and PsycINFO were searched for US-based studies from 2004 to 2024. Cross-sectional and longitudinal studies on stimulant medication misuse among adults were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the Quality in Prognosis Studies (QUIPS) tool for longitudinal designs. Data were summarized narratively. Findings: Sixty-four studies met inclusion criteria, including several high-quality federally funded national surveys. Many other incidence and prevalence studies were conducted at universities; these had inconsistent quality due to low response, non-representative samples, or unclear methodology. National surveys show that pastyear misuse among adults is declining, with 2023 estimates ranging from 1.4% to 3.7% among young adults and 1.9% among adults of all ages. Misuse is most prevalent among younger, White, metropolitan-dwelling individuals, and among college students. Misuse is primarily oral and infrequent, although a subset of high-frequency users obtain stimulants from physicians or dealers and exhibit higher rates of polysubstance use. Consequences of misuse may include psychiatric admission, emergency department visits, and illicit drug use. Long-term studies do not support a link between prescribed stimulant treatment in adolescence and later substance use disorder; unfortunately, no studies collected data on long-term physical health consequences. Conclusions: ADHD stimulant medication misuse among adults, although declining, remains a public health concern, particularly among high-frequency users. Research gaps remain, especially regarding long-term health outcomes.
Background: Quality-of-care frameworks are essential for assessing health care system performance... more Background: Quality-of-care frameworks are essential for assessing health care system performance, addressing disparities, and guiding quality improvement. The aim of the project was to identify and appraise such frameworks for health care delivery settings. Methods: A scoping review (protocol: osf.io/cegq3) searched seven research databases for quality-of-care frameworks published through October 2024. We also reviewed websites of health services research organizations and agencies charged with monitoring quality of care and/or health care disparities. Eligible publications addressed quality-of-care measures, indicators, criteria, or benchmarks; included a visualization or structured description differentiating quality domains; and were applicable to health care. Results: We identified 154 frameworks proposed by national and international entities. Critical appraisal showed 49% of frameworks were constructed with input from interest holders, 29% described an evidence-based process, and 36% reported validity testing. Frameworks varied in complexity and scope, and inclusion of disparities as a framework component increased over time. The most frequent framework domains were access, structural capabilities, equity, and effectiveness; however, definitions and conceptualizations varied. Conclusions: Our findings show that there remains much work to be done to refine and operationalize health care quality frameworks to ensure they can be applied effectively across health care settings to drive real-world improvements in quality and equity of care.
This document and trademark(s) contained herein are protected by law. This representation of RAND... more This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial use. For information on reprint and linking permissions, please visit www.rand.org/pubs/permissions.html. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.
Table 6, Inter-rater reliability on risk of bias assessments, by domain and study-level variable*
Figure 6, Other sources of bias (Meta-regression p=0.74)
Supplementary Information for NOS Assessments
Table 10, Evidence Table Intervention Evaluation Wrong Site Surgery – Preoperative Verification, Site Marking, Time Out, Briefing and Checklist Implementations
Figure 3, Blinding (Meta-regression p=0.31)
Table 8, AGREE Items and Domains Including Quality Ratings of the Four Guidelines
Table 12, Inter-rater reliability on risk of bias assessments, comparison across studies
Decision Rules for Application of the Newcastle-Ottawa Scale
This document is in the public domain and may be used and reprinted without permission except tho... more This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders.
Objectives: Systematic evidence reviews (SERs) produced by the U.S. Agency for Healthcare Researc... more Objectives: Systematic evidence reviews (SERs) produced by the U.S. Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program use contextual questions to provide context and background information on the topic. There is currently no standardized approach to address contextual questions in systematic reviews. This study explored the use of publicly available large language models (LLMs) in addressing contextual questions. Study Design: Using a set of 20 published and 5 yet to be published SERs, we selected one contextual question per report and used it as a prompt to elicit answers from an LLM (ChatGPT, Bard, Claude, or Perplexity). Two independent reviewers rated the results using a priori established evaluation criteria (https://osf.io/4k3cu/), comparing the response in the SER to LLMgenerated responses. The study was guided by six research questions addressing feasibility, validity of content, validity of structure, mistakes, congruence between responses, and incremental validity of using LLMs to address contextual questions. Results: Using minimal prompt engineering produced relevant responses and documented the feasibility of LLM-generated answers to contextual questions. Responses differed in content and format and are not reproducible (e.g., LLMs update regularly), but LLMs were able to produce articulate, clinically plausible, and well-structured responses. We detected few factual errors, contradictions, and no instance of suspected bias, but citations supporting LLM-generated responses could often not be produced or could not be verified ('confabulations'). Congruence with human generated responses varied, with LLM-generated responses providing more background on the topic and SERs providing more nuanced answers in response to the contextual question. Results regarding incremental validity were mixed and may depend on the tool. Conclusion: LLMs are potentially helpful in addressing contextual questions in systematic reviews but human expertise remains essential for using the generated information in a meaningful way. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Introduction: Childhood cancer survivors (CCS) experience many long-term health problems that can... more Introduction: Childhood cancer survivors (CCS) experience many long-term health problems that can be alleviated by receiving guideline-concordant survivorship care. However, many CCS encounter barriers to accessing care and do not receive recommended survivorship care. We reviewed the empirical evidence of barriers to and facilitators of survivorship care for CCS. Methods: As part of a larger project on CCS, this systematic review followed a detailed protocol (CRD42021227965) and searched PubMed, CINAHL, and PsycINFO for studies on survivorship care for CCS without date restriction, and abstracted reported barriers and facilitators. Searches identified 8585 citations and 2 independent reviewers screened 2934 publications at full text. We evaluated the risk of bias for individual studies and quality of evidence (QoE) across barriers and facilitators. Results: A total of 49 studies reported barriers and facilitators (survivors N = 33, clinicians N = 19, family members N = 8, and health system leaders N = 7) addressing knowledge (beliefs, autonomy, culture), prioritization (active avoidance, trust, communication), and infrastructure (health system resources, transitions). We found high QoE of barriers including lack of knowledge and inaccurate beliefs (survivorship care not needed or redundant), active avoidance and lack of trust (high level of emotional trauma and anxiety, lack of confidence in care team, no local providers with experience in survivorship care), and gaps in infrastructure (financial toxicity/hardship, lack of insurance coverage, difficulty scheduling appointments, and lack of stable
Purpose: To evaluate the revised framework and revised criteria to prioritize measures for the Na... more Purpose: To evaluate the revised framework and revised criteria to prioritize measures for the National Healthcare Quality and Disparities Report (NHQDR) by applying both to access to care measures. Issue: Both the framework and the criteria to prioritize measures should be tested using concrete measures to determine whether they can be used in practice, whether the framework is useful in placing measures, as well as whether the criteria to prioritize measures can be applied (feasibility) and are useful for prioritizing measures (validity) for the NHQDR. Key findings: Overall, existing NHQDR measures and measures not currently included in the NHQDR were either all addressed or somewhat addressed in the proposed NHQDR framework as well as other prominent care quality and disparities frameworks. Measures varied in the extent that they met the proposed NHQDR criteria or other published prioritization approaches. None of the evaluated measures stood out as a critical gap in the NHQDR. An evaluation undertaking in this topic development brief was feasible and appeared to be useful, but it is resource-intense.
To evaluate the revised framework and revised criteria to prioritize measures for the National He... more To evaluate the revised framework and revised criteria to prioritize measures for the National Healthcare Quality and Disparities Report (NHQDR) by applying both to cancer care measures. Issue: Both the framework and the criteria to prioritize measures should be tested using concrete measures to determine whether they can be used in practice, i.e., to determine whether the framework is useful in placing measures and whether the criteria are applicable (feasibility) and helpful to prioritize measures (validity) for the NHQDR.
To evaluate the proposed revised framework and criteria to prioritize measures for the National H... more To evaluate the proposed revised framework and criteria to prioritize measures for the National Healthcare Quality and Disparities Report (NHQDR) by applying both to diabetes care measures. Issue: Both the framework and the criteria to prioritize measures should be tested using concrete measures to determine whether they can be used in practice, i.e., to determine whether the framework is useful in placing measures and whether the criteria are applicable (feasibility) and helpful to prioritize measures (validity) for the NHQDR.
To evaluate the proposed revised framework and criteria to prioritize measures for the National H... more To evaluate the proposed revised framework and criteria to prioritize measures for the National Healthcare Quality and Disparities Report (NHQDR) by applying both to cardiovascular disease care measures. Issue: Both the framework and the criteria to prioritize measures should be tested using concrete measures to determine whether they can be used in practice, i.e., to determine whether the framework is useful in placing measures and whether the criteria are applicable (feasibility) and helpful to prioritize measures (validity) for the NHQDR.
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Issue: Both the framework and the criteria to prioritize measures should be tested using concrete measures to determine whether they can be used in practice, whether the framework is useful in placing measures, as well as whether the criteria to prioritize measures can be applied (feasibility) and are useful for prioritizing measures (validity) for the NHQDR.
Key findings: Overall, existing NHQDR measures and measures not currently included in the NHQDR were either all addressed or somewhat addressed in the proposed NHQDR framework as well as other prominent care quality and disparities frameworks. Measures varied in the extent that they met the proposed NHQDR criteria or other published prioritization approaches. None of the evaluated measures stood out as a critical gap in the NHQDR. An evaluation undertaking in this topic development brief was feasible and appeared to be useful, but it is resource-intense.