National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (1)
- Ambulatory Care and Surgery (2)
- Back Health and Pain (1)
- Behavioral Health (1)
- Cancer (1)
- Cardiovascular Conditions (1)
- Care Coordination (1)
- Care Management (1)
- Children/Adolescents (1)
- (-) Chronic Conditions (17)
- Clinician-Patient Communication (12)
- (-) Communication (17)
- COVID-19 (1)
- Diagnostic Safety and Quality (1)
- Dialysis (1)
- Digestive Disease and Health (1)
- Education: Patient and Caregiver (1)
- Electronic Health Records (EHRs) (1)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (4)
- Heart Disease and Health (1)
- Hospital Discharge (1)
- Imaging (1)
- Kidney Disease and Health (1)
- Lifestyle Changes (1)
- Medical Errors (1)
- Medication (2)
- Nursing (1)
- Nutrition (1)
- Opioids (1)
- Pain (4)
- Palliative Care (1)
- Patient-Centered Healthcare (4)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (2)
- Patient Experience (1)
- Patient Safety (1)
- Patient Self-Management (2)
- Primary Care (3)
- Primary Care: Models of Care (1)
- Provider (1)
- Provider: Nurse (1)
- Quality of Care (1)
- Respiratory Conditions (1)
- Shared Decision Making (3)
- Sickle Cell Disease (1)
- Social Media (1)
- Teams (1)
- Transitions of Care (1)
- Treatments (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 17 of 17 Research Studies DisplayedSchuttner L, Hockett Sherlock S, Simons CE
My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity.
This study’s goal was to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. The authors conducted semi-structured telephone interviews from April to July 2020 with 23 physicians across 20 clinical sites, with most being female (61%). Facilitators included: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care.
AHRQ-funded; HS026369.
Citation: Schuttner L, Hockett Sherlock S, Simons CE .
My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity.
J Gen Intern Med 2022 Dec;37(16):4189-96. doi: 10.1007/s11606-022-07533-1..
Keywords: Patient-Centered Healthcare, Healthcare Delivery, Chronic Conditions, Clinician-Patient Communication, Communication, Patient and Family Engagement
Fisher KA, Kennedy K, Bloomstone S
Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD.
The purpose of this study was to explore the effect of physicians sharing their clinical notes with patients with chronic obstructive pulmonary disease (COPD) and assess the impact on patient-physician communication and patient self-management. The researchers conducted interviews with 30 patients with COPD, asking them to review their clinic notes. The participants were primarily White (93.3%) with an average age of 65.5 years; more than 50% reported having a high school degree or less, almost half reported sometimes requiring help to read medical materials, and half had challenges understanding spoken information. The study found that patients reported that having the clinic notes gave them an opportunity to learn more about their condition, and encouraged their self-management by reminding them of their action steps, serving as prompts for seeking information, and motivating them. Patients indicated positive reactions to those physician notes that implied their clinician considered them as a person, listened to them, and noticed details about them. The majority of patients reported negative reactions to incorrect information in the notes, wording that they considered disapproving, and medical terms. The study concluded that the act of providers sharing their clinical notes with their patients can serve multiple purposes, including encouraging the exchange of information and self-management, and improving the relationship between patients and providers.
AHRQ-funded; HS024596.
Citation: Fisher KA, Kennedy K, Bloomstone S .
Can sharing clinic notes improve communication and promote self-management? A qualitative study of patients with COPD.
Patient Educ Couns 2022 Mar;105(3):726-33. doi: 10.1016/j.pec.2021.06.004..
Keywords: Respiratory Conditions, Chronic Conditions, Clinician-Patient Communication, Communication, Patient Self-Management
Morrone KA, Manwani D, Cabana MD
Efficient clinical counseling for sickle cell disease.
Sickle cell anemia (SCA) is a chronic illness that requires frequent health care visits for preventative management. Aims of this overview were to review challenges faced in outpatient subspecialty medicine and describe evidence-based techniques for more effective communication for patients with sickle cell anemia.
AHRQ-funded; HS025297.
Citation: Morrone KA, Manwani D, Cabana MD .
Efficient clinical counseling for sickle cell disease.
J Natl Med Assoc 2021 Aug;113(4):382-87. doi: 10.1016/j.jnma.2021.01.006..
Keywords: Sickle Cell Disease, Chronic Conditions, Clinician-Patient Communication, Communication, Patient Adherence/Compliance
Nair D, Malhotra S, Lupu D
Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings.
This paper uses case vignettes to highlight challenges in communication, prognostication, and medical decision-making that have been exacerbated by the COVD-19 pandemic for patients with kidney disease. The authors include best practice recommendations to mitigate those issues and conclude with implications for interdisciplinary models of care in crisis settings. Concerns about certain biomarkers, demographics, and medical comorbidities that can predict an increased risk for mortality among patients with COVID-19 and kidney disease are discussed, because there may be communication barriers related to physical exposure and conservation of personal protective equipment with those at-risk patients.
AHRQ-funded; HS026395.
Citation: Nair D, Malhotra S, Lupu D .
Challenges in communication, prognostication and dialysis decision-making in the COVID-19 pandemic: implications for interdisciplinary care during crisis settings.
Curr Opin Nephrol Hypertens 2021 Mar 1;30(2):190-97. doi: 10.1097/mnh.0000000000000689..
Keywords: COVID-19, Dialysis, Kidney Disease and Health, Shared Decision Making, Clinician-Patient Communication, Communication, Chronic Conditions
Fenton JJ, Jerant A, Franks P
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
This paper describes the protocol that will be used for an upcoming randomized control trial to determine the effectiveness of teaching clinicians how to advise watchful waiting when patients request low-value spinal imaging for acute low back pain. The authors will recruit 8-10 primary care and urgent care clinics in Sacramento, California. The study will last 3-6 months and during this time clinicians in the intervention group with receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain. The SPIs will instruct clinicians in a 3-step model emphasizing trust, empathic communication, and negotiation of a watchful waiting approach. The primary outcome looked for will a decreased post-intervention rate of spinal imaging among actual patients with acute back pain compared to the rate of imaging during the baseline period. Secondary outcomes will include use of targeted communication techniques during a follow-up visit with an SP.
AHRQ-funded; HS026415.
Citation: Fenton JJ, Jerant A, Franks P .
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
Trials 2021 Feb 27;22(1):167. doi: 10.1186/s13063-021-05106-x..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Imaging, Diagnostic Safety and Quality, Clinician-Patient Communication, Communication
Hood-Medland EA, White AEC, Kravitz RL
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
This study looked at primary care visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience with patients taking opioids for chronic pain. The study analyzed 83 video-recorded US primary care visits at a single academic medical center in California. A total of 49 family medicine and internal resident physicians and 83 patients were filmed. The authors developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discusses. They identified 2 visit opening styles with agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda opening styles (open-ended question, patient launch, physician launch). Only 11% of visits included agenda setting and was associated with fewer surprise patient topics than visits without agenda setting.
AHRQ-funded; HS022236.
Citation: Hood-Medland EA, White AEC, Kravitz RL .
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
BMC Fam Pract 2021 Jan 4;22(1):4. doi: 10.1186/s12875-020-01317-4..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Clinician-Patient Communication, Communication, Ambulatory Care and Surgery
Hadler RA, Curtis BR, Ikejiani DZ
"I'd have to basically be on my deathbed": heart failure patients' perceptions of and preferences for palliative care.
This cohort study examined individuals with New York Heart Association Class II-IV disease attitude towards palliative care (PC). Participants were recruited from inpatient and outpatient settings at an academic quaternary care hospital. They were given semistructured interviews discussing perceptions, knowledge, and preferences regarding PC, and also barriers to to PC delivery by facilitators. They interviewed 27 adults with heart failure (mean age 63, 85% white, 63% male). Participants frequently confused PC with hospice but once corrected they expressed variable preferences for primary versus specialist services. Preferences for primary versus specialist PC were based on different factors. Although there was more understanding of PC after the interviews, triggers for initiation remained focused on late-stage disease.
AHRQ-funded; HS022989.
Citation: Hadler RA, Curtis BR, Ikejiani DZ .
"I'd have to basically be on my deathbed": heart failure patients' perceptions of and preferences for palliative care.
J Palliat Med 2020 Jul;23(7):915-21. doi: 10.1089/jpm.2019.0451..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Palliative Care, Clinician-Patient Communication, Communication, Chronic Conditions
Lafferty M, Fauer A, Wright N
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care. The authors identified four primary themes from the analysis that affect delays. They suggest future investigations to examine nurses' communication practices in the context of timely chemotherapy administration since communication and documentation technologies within healthcare settings continuously evolve.
AHRQ-funded; HS024914.
Citation: Lafferty M, Fauer A, Wright N .
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
Oncol Nurs Forum 2020 Jul 1;47(4):417-27. doi: 10.1188/20.Onf.417-427..
Keywords: Treatments, Cancer, Ambulatory Care and Surgery, Quality of Care, Clinician-Patient Communication, Communication, Provider: Nurse, Provider, Nursing, Chronic Conditions
Ronis SD, Kleinman LC, Stange KC
A learning loop model of collaborative decision-making in chronic illness.
In this article, the authors discuss their learning loop model, which posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians.
AHRQ-funded; HS024433.
Citation: Ronis SD, Kleinman LC, Stange KC .
A learning loop model of collaborative decision-making in chronic illness.
Acad Pediatr 2019 Jul;19(5):497-503. doi: 10.1016/j.acap.2019.04.006..
Keywords: Children/Adolescents, Chronic Conditions, Shared Decision Making, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Clinician-Patient Communication, Communication
Wyatt DL
AHRQ Author: Wyatt DL
Employing technology to make care transitions safer.
This commentary discusses the potential for errors in patient handoffs; important information about medications and instructions regarding patient care may be overlooked when the patient is referred to special care, moved to a new hospital setting, or discharged. The problem is especially acute for patients with multiple chronic conditions who often undergo frequent transitions to new care settings and healthcare providers. The author describes AHRQ’s funding opportunities for health information technology interventions that aim to improve communication and coordination during care transitions, such as location-based smartphone alerts, a patient-centered discharge toolkit, and a ‘smart pillbox’ electronic medication adherence reporting project.
AHRQ-authored.
Citation: Wyatt DL .
Employing technology to make care transitions safer.
J Nurs Care Qual 2019 Jul/Sep;34(3):185-88. doi: 10.1097/ncq.0000000000000417..
Keywords: Adverse Events, Care Coordination, Chronic Conditions, Communication, Health Information Technology (HIT), Healthcare Delivery, Hospital Discharge, Medical Errors, Medication, Patient Safety, Transitions of Care
Rolbiecki AJ, Teti M, Crenshaw B
Exploring lived experiences of chronic pain through photo-elicitation and social networking.
The purpose of this study was to understand how patients' use of photo-elicitation and online social networks (Facebook) enhances their understanding of what it means to live with pain. The investigators concluded that photo-elicitation is an innovative way to shed light on patients' lived experience with chronic pain. Despite some technical challenges, Facebook support groups utilizing photo-elicitation can provide a readily available platform that can facilitate interchange of patient experiences and might help patients communicate with their providers.
AHRQ-funded; HS022140.
Citation: Rolbiecki AJ, Teti M, Crenshaw B .
Exploring lived experiences of chronic pain through photo-elicitation and social networking.
Pain Med 2019 Jun;20(6):1202-11. doi: 10.1093/pm/pny175..
Keywords: Pain, Chronic Conditions, Social Media, Communication
Pavlo AJ, O'Connell M, Olsen S
Missing ingredients in shared decision-making?
This article discusses the practice of shared decision making (SDM) for clinicians when making decisions in health care. This widespread practice is considered the best approach for person-centered care, but for individuals diagnosed with serious mental illness there are still many barriers to effective collaboration. The authors suggest that more emphasis needs to be placed on the doctor-patient relationship itself conducting SDM.
AHRQ-funded; HS023000.
Citation: Pavlo AJ, O'Connell M, Olsen S .
Missing ingredients in shared decision-making?
Psychiatr Q 2019 Jun;90(2):333-38. doi: 10.1007/s11126-019-9624-9..
Keywords: Chronic Conditions, Clinician-Patient Communication, Communication, Shared Decision Making, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient and Family Engagement
Chung CF, Wang Q, Schroeder J
Identifying and planning for individualized change: patient-provider collaboration using lightweight food diaries in healthy eating and irritable bowel syndrome.
This study examined if the use of a photo-based food diary app will help patients with irritable bowel syndrome (IBS) help gather food and symptom data to help their doctors with disease management. The investigators designed and developed Foodprint which includes a mobile and web app and pre-visit note to go to experts which communicate an individual’s expectations and questions. A control group and a group with IBS were used to determine the effectiveness of Foodprint.
AHRQ-funded; HS023654.
Citation: Chung CF, Wang Q, Schroeder J .
Identifying and planning for individualized change: patient-provider collaboration using lightweight food diaries in healthy eating and irritable bowel syndrome.
Proc ACM Interact Mob Wearable Ubiquitous Technol 2019 Mar;3(1). doi: 10.1145/3314394..
Keywords: Chronic Conditions, Clinician-Patient Communication, Communication, Digestive Disease and Health, Health Information Technology (HIT), Lifestyle Changes, Nutrition, Patient Self-Management
Jonassaint CR, Rao N, Sciuto A
Abstract animations for the communication and assessment of pain in adults: cross-sectional feasibility study.
The aim of this study was to develop and test Painimation, a novel tool that uses graphic visualizations and animations instead of words or numeric scales to assess pain quality, intensity, and course. The study concluded that using animations may be a faster and more patient-centered method for assessing pain and is not limited by age, literacy level, or language; however, more data are needed to assess the validity of this approach.
AHRQ-funded; HS022989.
Citation: Jonassaint CR, Rao N, Sciuto A .
Abstract animations for the communication and assessment of pain in adults: cross-sectional feasibility study.
J Med Internet Res 2018 Aug 3;20(8):e10056. doi: 10.2196/10056..
Keywords: Chronic Conditions, Communication, Pain, Patient-Centered Healthcare
Holtrop JS, Ruland S, Diaz S
Using social network analysis to examine the effect of care management structure on chronic disease management communication within primary care.
The investigators examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. They sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Using surveys, they found that social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. They concluded that structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.
AHRQ-funded; HS022690.
Citation: Holtrop JS, Ruland S, Diaz S .
Using social network analysis to examine the effect of care management structure on chronic disease management communication within primary care.
J Gen Intern Med 2018 May;33(5):612-20. doi: 10.1007/s11606-017-4247-z.
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Keywords: Care Management, Chronic Conditions, Communication, Primary Care, Teams
Ratanawongsa N, Barton JL, Lyles CR
Association between clinician computer use and communication with patients in safety-net clinics.
The researchers studied associations between clinician computer use and communication with patients with diverse chronic diseases in safety-net clinics. They found that high computer use by clinicians in safety-net clinics was associated with lower patient satisfaction and observable communication differences.
AHRQ-funded; HS022561; HS022408.
Citation: Ratanawongsa N, Barton JL, Lyles CR .
Association between clinician computer use and communication with patients in safety-net clinics.
JAMA Intern Med 2016 Jan;176(1):125-8. doi: 10.1001/jamainternmed.2015.6186.
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Keywords: Clinician-Patient Communication, Communication, Chronic Conditions, Patient Experience, Electronic Health Records (EHRs), Health Information Technology (HIT)
Valdez RS, Brennan PF
Exploring patients' health information communication practices with social network members as a foundation for consumer health IT design.
The purpose of this study was to inform the broader design of consumer health IT by characterizing patients’ existing health information communication practices with their social network members. It found that participants’ rationales for health information communication reflected various themes including characteristics and circumstances of the person, characteristics and circumstances of the relationship, and structure and composition of the social network.
AHRQ-funded; HS018809.
Citation: Valdez RS, Brennan PF .
Exploring patients' health information communication practices with social network members as a foundation for consumer health IT design.
Int J Med Inform 2015 May;84(5):363-74. doi: 10.1016/j.ijmedinf.2015.01.014..
Keywords: Chronic Conditions, Communication, Education: Patient and Caregiver, Health Information Technology (HIT)