Research Activities, September 2013
Bell, S.K., Smulowitz, P.B., Woodward, A.C., and others (2012). "Disclosure, apology, and offer programs: Stakeholders' views of barriers to and strategies for broad implementation." (AHRQ grant HS19537). Milbank Quarterly 90(4), pp. 682-705.
The Disclosure, Apology, and Offer model, a response to patient injuries caused by medical care, is an alternative to the current inherently adversarial, inefficient, and inequitable medical liability system, note the authors of this paper. Using interviews with key informants, the researchers investigated the potential for more widespread implementation of this model. They believe it holds considerable promise for transforming the current approach to medical liability and patient safety.
Clancy, C.M. (2012, December). "New Patient Safety Improvement Toolkit Builds on Clinical Best Practices, Science of Safety." Infection Control Today. Reprints (AHRQ Publication No. 13-R060) are available from AHRQ.
Carolyn M. Clancy, M.D., director of the Agency for Healthcare Research and Quality, outlines the Comprehensive Unit-based Safety Program (CUSP) Toolkit's components, describes its importance in reducing infections, the critical role played by nurses in implementing its components, and additional areas where CUSP may be useful.
Duke, J.D., Han, X., Wang, Z., and others (2012). "Literature- based drug interaction prediction with clinical assessment using electronic medical records: Novel myopathy associated drug interactions." (AHRQ grant HS19818). PLOS Computational Biology 8(8), p. e1002614.
The authors developed an automated search algorithm, which can predict new drug interactions based on published literature. Using a large electronic medical record database, they then analyzed the correlation between concurrent use of these potentially interacting drugs and the incidence of myopathy as an adverse drug event. Their statistical analysis identified five drug interaction pairs.
Dukhovny, D., Dukhovny, S., Pursley, D.M., and others (2012). "The impact of maternal characteristics on the moderately premature infant: An antenatal maternal transport clinical prediction rule." (AHRQ grant T32 HS00063). Journal of Perinatology 32, pp. 532-538.
The researchers sought to determine the impact of maternal characteristics and antenatal medical management on the early neonatal course of the moderately premature infant. They derived a clinical prediction rule to determine which infants require tertiary neonatal care in the first 24 hours of life, prompting antenatal maternal transfer. They found four antenatal risk factors associated with a requirement for care in a Level III neonatal intensive care unit, defined by the need for surfactant administration.
Escobar, G.J., LaGuardia, J.C., Turk, B.J., and others (2012). "Early detection of impending physiologic deterioration among patients who are not in intensive care: Development of predictive models using data from an automated electronic medical record." (AHRQ grant HS18480). Journal of Hospital Medicine 7(5), pp. 388-395.
The authors describe the development and validation of a complex predictive model suitable for use with ward patients. The objective was to develop a predictive model based on clinical and physiologic data available in real time from a comprehensive electronic medical record (EMR), not a clinically intuitive, manually assigned tool. They concluded that EMR-based detection of impending deterioration outside the intensive care unit is feasible in integrated health care delivery systems.
Govindarajan, P., Desouza, N.T., Pierog, J., and others (2012). "Feasibility study to assess the use of the Cincinnati stroke scale by emergency medical dispatchers: A pilot study." (AHRQ grant HS17965). Emergency Medicine Journal 29, pp. 848-850.
The objective of this pilot study was to determine the feasibility of the application of the Cincinnati stroke scale by emergency medical dispatchers (EMDs) and the ability of EMDs to collect responses from the caller/subject to make a determination of stroke. Although the pilot findings favor the implementation of the stroke scale, the researchers recognize the need for a large-scale study.
Johnson, J.K., Farnan, J.M., Barach, P., and others (2012). "Searching for the missing pieces between the hospital and primary care: Mapping the patient process during care transitions." (AHRQ grant HS17119). BMJ Quality and Safety 21, pp. i97-i105.
The authors present process mapping as an effective tool to assess communication patterns during transition from the inpatient to ambulatory setting and to identify barriers and facilitators to effective communication in six academic health centers in the United States and Europe. They present the similarities and differences between the handover processes used in different nations and settings. They also discuss the methodological strengths of process mapping as a generalizable tool for engaging stakeholders and in redesigning clinical services during care transitions.
Kim, J.M., Labrique, A., West, K.P., and others (2012, December). "Maternal morbidity in early pregnancy in rural northern Bangladesh." (AHRQ grant T32 HS19488). International Journal of Gynecology and Obstetrics 119(3), pp. 227-233.
The researchers used cross-sectional data from 42,896 pregnant women (5–12 weeks of gestation) enrolled in a vitamin A supplementation trial in Bangladesh to determine baseline maternal morbidity in the rural northern region of this poor country. The researchers found significantly increased risk of malnutrition for women with symptoms of anemia (30 percent), vaginal discharge (37 percent), or high-grade fever (23 percent) than among women without these symptoms.
Lacson, R., Andriole, K.P., Prevedello, L.M., and Khoransi, R. (2012). "Information from searching content with an ontology-utilizing toolkit (iSCOUT)." (AHRQ grant HS19635). Journal of Digital Imaging 25, pp. 512-519.
This study aims to implement and demonstrate the use of a toolkit for retrieving radiology reports that describe clinically relevant findings, using the specific clinical case of liver cysts. The toolkit provides several components that can be used alone or in combination, without the need for further customization or programming. Among the core set of modules are the Data Loader, Header Extractor, Terminology Interface, Analyzer, and Reviewer.
Olfson, M., Gerhard, T., Huang, C., and others (2012). "Comparative effectiveness of second-generation antipsychotic medications in early-onset schizophrenia." (AHRQ grants HS17918 and HS16097). Schizophrenia Bulletin 38(4), pp. 845-853.
The researchers found no significant difference in the proportion of children and youths diagnosed with schizophrenia, aged 6–17 years, who discontinue their medication or need inpatient psychiatric hospitalization within 180 days of a new episode of treatment with any one of five commonly prescribed second-generation antipsychotic medicines (risperidone, olanzapine, quetiapine, aripiprazole, or ziprasidone). Data was obtained from a 45-State Medicaid claims file for 2001 through 2005.
Patel, M.B., Guillamondegui, O.D., Ott, M.M., and others (2012). "O' surgery case log data, where art thou?" (AHRQ grant T32 HS13833). Journal of the American College of Surgery 215, pp. 427-431.
Using the American College of Surgeons Case Log, the authors developed a method of data capture, categorization, and reporting of acute care surgery fellows' experiences. Fifteen report types were created, with results viewable via a secure Web application, accessible nationally, and exportable to many formats.
Putzer, G.J., Koro-Ljungberg, M., and Duncan, R.P. (2012, December). "Critical challenges and impediments affecting rural physicians during a public health emergency." (AHRQ grant HS14355). Disaster Medicine and Public Health Preparedness 6(4), pp. 342-348.
The authors of this study analyzed structured interviews with six physicians in five rural Florida counties. They found that the rural physicians identified three primary barriers to emergency preparedness: limited accessibility of health care (including financial barriers and transportation problems), physician–patient communication barriers, and resource barriers, such as a lack of hospitals close to the rural inhabitants.
Sokas, R., Braun, B., Chenven, L., and others (2013, April). "Frontline hospital workers and the worker safety/patient safety nexus." The Joint Commission Journal on Quality and Patient Safety 39(4), pp. 185-192. Reprints (AHRQ Publication No. 13-R058) are available from AHRQ.
The authors summarized presentations and discussions at a 1-day workshop on the relationship between worker safety for frontline—but nonclinician—health care workers and patient safety. One recommendation emerging from the workshop was to develop champions and leaders at hospitals to push for the implementation of "person safety" for anyone entering the facility as a patient, visitor, or health care worker.
Wisk, L.E., and Witt, W.P. (2012, December). "Predictors of delayed or forgone needed health care for families with children." (AHRQ grant T32 HS00083). Pediatrics 130(6), pp. 1027-1037.
The extent to which health care-related financial burden directly influences access to care for families with children is currently unknown. Using a nationally representative, population-based sample, the researchers sought to determine how health care-related financial burden and other need and enabling factors are related to delayed or forgone care for families with children.
Zhu, V. J., Grannis, S.J., Tu, W. and others (2012). "Evaluation of a clinical decision support algorithm for patient-specific childhood immunization." (AHRQ grant T32 HS17588). Artificial Intelligence in Medicine 56(20), pp. 51-57.
This study compares the accuracy of a clinical decision support system (CDSS) algorithm to human experts, using real-world patient data from Wishard Hospital. Specifically, the researchers compared vaccine recommendations from the CDSS for both eligible and recommended timelines, based on the child's date of birth and vaccine history, to recommendations from registered nurses who routinely selected vaccines for administration.