National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Alcohol Use (1)
- Ambulatory Care and Surgery (1)
- Behavioral Health (2)
- Cancer (1)
- Cardiovascular Conditions (4)
- Care Coordination (1)
- Case Study (1)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Communication (2)
- Depression (2)
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- Elderly (2)
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- Organizational Change (3)
- (-) Patient-Centered Healthcare (26)
- Patient-Centered Outcomes Research (6)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Payment (1)
- Policy (2)
- Practice Improvement (2)
- Practice Patterns (1)
- Prevention (3)
- (-) Primary Care (26)
- Primary Care: Models of Care (5)
- Provider (2)
- Provider: Clinician (1)
- Provider: Physician (1)
- Quality Improvement (5)
- Quality of Care (4)
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- Shared Decision Making (2)
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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 25 of 26 Research Studies DisplayedChan B, Edwards ST, Devoe M
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. In this paper, the authors present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research.
AHRQ-funded; HS022981.
Citation: Chan B, Edwards ST, Devoe M .
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Addict Sci Clin Pract 2018 Dec 14;13(1):27. doi: 10.1186/s13722-018-0128-y..
Keywords: Primary Care, Healthcare Delivery, Patient-Centered Healthcare, Vulnerable Populations, Chronic Conditions
Moise N, Falzon L, Obi M
Interventions to increase depression treatment initiation in primary care patients: a systematic review.
Researchers investigated interventions for increasing depression treatment initiation in primary care settings. They found that collaborative/integrated care, preference treatment matching, and case management strategies had the best evidence for improving depression treatment initiation, but none of the strategies had high strength of evidence. While primary care settings can consider using some of these strategies when referring depressed patients to treatment, their review highlights the need for further rigorous research in this area.
AHRQ-funded; HS025198.
Citation: Moise N, Falzon L, Obi M .
Interventions to increase depression treatment initiation in primary care patients: a systematic review.
J Gen Intern Med 2018 Nov;33(11):1978-89. doi: 10.1007/s11606-018-4554-z..
Keywords: Patient-Centered Healthcare, Depression, Primary Care, Behavioral Health, Patient and Family Engagement
Misra-Hebert AD, Perzynski A, Rothberg MB
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
This mixed-methods comparative case study examined the implementation of team-based primary care models in a large integrated health system. Field observations of 9 practices were conducted along with 75 interviews and provider and staff surveys. The 9 practices were categorized into 3 groups: high, partial, and low update of the new models. Ability of the practices to implement the new team-based model depended on their ability to adapt to change and to adapt team roles in workflow.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Perzynski A, Rothberg MB .
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
J Gen Intern Med 2018 Nov;33(11):1928-36. doi: 10.1007/s11606-018-4611-7..
Keywords: Case Study, Health Systems, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Wagner EH, LeRoy L, Schaefer J
AHRQ Author: Zhan C, Meyers D.
How do innovative primary care practices achieve the quadruple aim?
The Patient-Centered Medical Home (PCMH) defines excellent primary care but there is little empiric evidence that helps practices, payers, or policy makers understand how high-performing practices have improved outcomes. This paper reports findings from 38 high-performing practices. The authors describe how these practices execute 8 functions that collectively meet patient needs.
AHRQ-authored.
Citation: Wagner EH, LeRoy L, Schaefer J .
How do innovative primary care practices achieve the quadruple aim?
J Ambul Care Manage 2018 Oct/Dec;41(4):288-97. doi: 10.1097/jac.0000000000000249..
Keywords: Primary Care, Patient-Centered Healthcare, Practice Improvement, Organizational Change, Patient-Centered Outcomes Research
McDonald KM, Rodriguez HP, Shortell SM
Organizational influences on time pressure stressors and potential patient consequences in primary care.
This study examines organizational determinants and patient consequences of time pressure, theorizing two types of time pressure and based on analysis of data from surveys of care team members and their patients. Measures of the two types - encounter-level and practice-level - were not correlated, nor predicted, which supported the hypothesis. Different organizational factors are associated with each type.
AHRQ-funded; HS024075.
Citation: McDonald KM, Rodriguez HP, Shortell SM .
Organizational influences on time pressure stressors and potential patient consequences in primary care.
Med Care 2018 Oct;56(10):822-30. doi: 10.1097/mlr.0000000000000974..
Keywords: Organizational Change, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care
Fraze TK, Fisher ES, Tomaino MR
Comparison of populations served in hospital service areas with and without comprehensive primary care plus medical homes.
The purpose of this comparative cross sectional study was to describe practices that joined the Comprehensive Primary Care Plus (CPC+) model and compare hospital service areas with and without CPC+ practices. The authors concluded that according to this study, although a diverse set of practices joined the CPC+ program, practices in areas characterized by patient populations with greater advantage were more likely to join, which may affect access to advanced primary care medical home models such as CPC+, by vulnerable populations.
AHRQ-funded; HS024075.
Citation: Fraze TK, Fisher ES, Tomaino MR .
Comparison of populations served in hospital service areas with and without comprehensive primary care plus medical homes.
JAMA Netw Open 2018 Sep 7;1(5):e182169. doi: 10.1001/jamanetworkopen.2018.2169..
Keywords: Primary Care, Patient-Centered Healthcare, Primary Care: Models of Care, Healthcare Delivery, Access to Care
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Saleem JJ, Weiler DT, Satterly T
Field investigation of ambulatory clinic exam room design with respect to computing devices: a pilot study.
The authors of this paper conducted observations and interviews with primary care providers and their patients from three locations within the Phoenix VA Health Care System, in a pilot study comparing the new exam room design standard with the older legacy exam rooms. The study results suggested that the new exam room design did contribute to a greater degree of patient centeredness, though more thorough evaluations are required to support these preliminary results.
AHRQ-funded; HS024488.
Citation: Saleem JJ, Weiler DT, Satterly T .
Field investigation of ambulatory clinic exam room design with respect to computing devices: a pilot study.
Proc Hum Factors Ergon Soc Annu Meet 2018 Sep;62(1):518-22. doi: 10.1177/1541931218621118..
Keywords: Ambulatory Care and Surgery, Patient-Centered Healthcare, Primary Care
Glass JE, Bobb JF, Lee AL
Study protocol: a cluster-randomized trial implementing Sustained Patient-centered Alcohol-related Care (SPARC trial).
Implementation researchers and clinical leaders at Kaiser Permanente Washington (KPWA) partnered to design a high-quality program of evidence-based care for unhealthy alcohol use: the Sustained Patient-centered Alcohol-related Care (SPARC) program. This paper describes the cluster-randomized trial implementing SPARC.
AHRQ-funded; HS023173.
Citation: Glass JE, Bobb JF, Lee AL .
Study protocol: a cluster-randomized trial implementing Sustained Patient-centered Alcohol-related Care (SPARC trial).
Implement Sci 2018 Aug 6;13(1):108. doi: 10.1186/s13012-018-0795-9..
Keywords: Alcohol Use, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care
Yonek JC, Jordan N, Dunlop D
Patient-centered medical home care for adolescents in need of mental health treatment.
The patient-centered medical home (PCMH) has emerged as an optimal primary care model for all youth; however, little is known about the extent to which adolescents in need of mental health (MH) treatment receive care consistent with the PCMH. This study assessed (1) 10-year trends in PCMH care among U.S. adolescents according to MH need and (2) variations in PCMH care and its subcomponents among adolescents with MH need, by individual and family characteristics.
AHRQ-funded; HS024183.
Citation: Yonek JC, Jordan N, Dunlop D .
Patient-centered medical home care for adolescents in need of mental health treatment.
J Adolesc Health 2018 Aug;63(2):172-80. doi: 10.1016/j.jadohealth.2018.02.006..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Behavioral Health, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care
Howard J, Miller WL, Willard-Grace R
Creating and sustaining care teams in primary care: perspectives from innovative patient-centered medical homes.
The purpose of this study was to learn from the experiences of innovative primary care practices that have successfully developed care teams. The authors assert that team-based care is possible and valuable in primary care but that it is difficult to develop and sustain, and requires dedicated time and resources. They suggest that the challenges described by the highly motivated practices, in their paper, raised the question of feasibility for more average practices in the current funding environment.
AHRQ-funded.
Citation: Howard J, Miller WL, Willard-Grace R .
Creating and sustaining care teams in primary care: perspectives from innovative patient-centered medical homes.
Qual Manag Health Care 2018 Jul/Sep;27(3):123-29. doi: 10.1097/qmh.0000000000000176..
Keywords: Primary Care, Patient-Centered Healthcare, Teams, Healthcare Delivery
Hoff T, DePuccio M
Medical home implementation gaps for seniors: perceptions and experiences of primary care medical practices.
The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation.
AHRQ-funded; HS020931.
Citation: Hoff T, DePuccio M .
Medical home implementation gaps for seniors: perceptions and experiences of primary care medical practices.
J Appl Gerontol 2018 Jul;37(7):817-39. doi: 10.1177/0733464816637850..
Keywords: Elderly, Patient-Centered Healthcare, Primary Care
Annis AM, Harris M, Kim HM
Trends in primary care encounters across professional roles in PCMH.
Evaluation measures of team-based care models are often reported at a clinic or primary care provider (PCP) level, creating challenges in describing and analyzing the use and impact of non-PCP clinician team members. This study aimed to measure clinician-specific care delivery trends and determine whether trends were responsive to system wide patient centered medical home implementation.
AHRQ-funded;
Citation: Annis AM, Harris M, Kim HM .
Trends in primary care encounters across professional roles in PCMH.
Am J Manag Care 2018 Jul;24(7):e222-e29..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Teams
Chou AF, Homco JB, Nagykaldi Z
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma.
The Healthy Hearts for Oklahoma (H2O) Study proposes to build a quality improvement (QI) infrastructure by (1) constructing a sustainable Oklahoma Primary Healthcare Improvement Collaborative (OPHIC) to support dissemination and implementation (D&I) of QI methods; and (2) providing QI support in primary care practices to better manage patients at risk for cardiovascular disease (CVD) events. H2O has 263 small primary care practices across Oklahoma that receive the bundled QI intervention to improve ABCS (aspirin therapy, blood pressure control, cholesterol management, and smoking cessation) performance. The infrastructure established as a result of this funding will help reach medically underserved Oklahomans, particularly among rural and tribal populations.
AHRQ-funded; HS023919.
Citation: Chou AF, Homco JB, Nagykaldi Z .
Disseminating, implementing, and evaluating patient-centered outcomes to improve cardiovascular care using a stepped-wedge design: healthy hearts for Oklahoma.
BMC Health Serv Res 2018 Jun 4;18(1):404. doi: 10.1186/s12913-018-3189-4.
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Keywords: Cardiovascular Conditions, Communication, Heart Disease and Health, Healthcare Delivery, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Prevention, Quality of Care, Quality Improvement
Aysola J, Schapira MM, Huo H
Organizational processes and patient experiences in the patient-centered medical home.
The objective of this study was to examine associations between organizational processes that practices adopt to become patient-centered medical home (PCMH) and patient experiences with care. The researchers concluded that although some organizational processes related to patients' experiences with care irrespective of the background of the patient, further efforts are needed to align practice efforts with patient experience.
AHRQ-funded; HS021706.
Citation: Aysola J, Schapira MM, Huo H .
Organizational processes and patient experiences in the patient-centered medical home.
Med Care 2018 Jun;56(6):497-504. doi: 10.1097/mlr.0000000000000910.
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Keywords: Patient-Centered Healthcare, Patient Experience, Primary Care: Models of Care, Primary Care
Halle AD, Mroz TM, Fogelberg DJ
Occupational therapy and primary care: updates and trends.
This paper identifies new initiatives and opportunities in primary care, explores common challenges to integrating occupational therapy in primary care environments, and highlights international works that can support the authors’ efforts.
AHRQ-funded; HS022907.
Citation: Halle AD, Mroz TM, Fogelberg DJ .
Occupational therapy and primary care: updates and trends.
Am J Occup Ther 2018 May/Jun;72(3):7203090010p1-10p6. doi: 10.5014/ajot.2018.723001..
Keywords: Healthcare Delivery, Primary Care, Policy, Patient-Centered Healthcare
Meyers D, Miller T, Genevro J
AHRQ Author: Meyers D, Miller T, Genevro J, Zhan C, De La Mare J, Fournier A, Bennett H, McNellis RJ
EvidenceNOW: Balancing primary care implementation and implementation research.
In 2015, AHRQ invested in the largest primary care research project in its history. EvidenceNOW is a $112 million effort to disseminate and implement patient-centered outcomes research evidence in more than 1,500 primary care practices and to study how quality-improvement support can build the capacity of primary care practices to understand and apply evidence. EvidenceNOW comprises 7 implementation research grants, each funded to provide external quality-improvement support to primary care practices to implement evidence-based cardiovascular care and to conduct rigorous internal evaluations of their work.
AHRQ-authored.
Citation: Meyers D, Miller T, Genevro J .
EvidenceNOW: Balancing primary care implementation and implementation research.
Ann Fam Med 2018 Apr;16(Suppl 1):S5-s11. doi: 10.1370/afm.2196.
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Keywords: Cardiovascular Conditions, Communication, Evidence-Based Practice, Heart Disease and Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention, Primary Care, Quality of Care, Quality Improvement, Implementation
da Graca B, Ogola GO, Fullerton C
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
The purpose of this study was to examine potential offsets through commercial payer per-member-per-month (PMPM) payments and the Medicare Merit-based Incentive Payment System (MIPS). The researchers found that with PMPM, breaking even required that 2.4% to 6.4% of commercially insured patients per physician to be covered; with MIPS incentive payments, they would exceed PCMH costs by 2022.
AHRQ-funded; HS022621.
Citation: da Graca B, Ogola GO, Fullerton C .
Offsetting patient-centered medical homes investment costs through per-member-per-month or Medicare merit-based incentive payment system incentive payments.
J Ambul Care Manage 2018 Apr/Jun;41(2):105-13. doi: 10.1097/jac.0000000000000224..
Keywords: Healthcare Costs, Medicare, Patient-Centered Healthcare, Payment, Primary Care
Casalino LP
Technical assistance for primary care practice transformation: free help to perform unpaid labor?
This issue of the Annals of Family Medicine includes articles reporting early information from the implementation of AHRQ’s initiative EvidenceNOW: Advancing Heart Health in Primary care. EvidenceNOW raises many important questions — the author focuses on three. Why should anyone care about small primary care practices? Why should small primary care practices transform the ways they provide care? What might it take for small primary care practice to transform?
AHRQ-funded; 290201200019I.
Citation: Casalino LP .
Technical assistance for primary care practice transformation: free help to perform unpaid labor?
Ann Fam Med 2018 Apr;16(Suppl 1):S12-s15. doi: 10.1370/afm.2226.
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Keywords: Cardiovascular Conditions, Evidence-Based Practice, Patient-Centered Healthcare, Primary Care, Quality Improvement
Mold JW, Walsh M, Chou AF
The alarming rate of major disruptive events in primary care practices in Oklahoma.
This study documented the rates of major disruptive events in a cohort of primary care practices in Oklahoma. During the first year of the project, 89 major disruptive events occurred in 67 (32 percent) practices, with 20 practices experiencing multiple events. The major disruptive events reported most often during both periods were loss of personnel and implementation of electronic health records and billing systems.
AHRQ-funded; HS023919.
Citation: Mold JW, Walsh M, Chou AF .
The alarming rate of major disruptive events in primary care practices in Oklahoma.
Ann Fam Med 2018 Apr;16(Suppl 1):S52-s57. doi: 10.1370/afm.2201.
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Keywords: Electronic Health Records (EHRs), Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Quality Improvement
Green LA, Chang HC, Markovitz AR
The reduction in ED and hospital admissions in medical home practices is specific to primary care-sensitive chronic conditions.
The purpose of this quantitative observational study was to determine whether the Patient-Centered Medical Home (PCMH) transformation reduces hospital and ED utilization, and whether the effect is specific to chronic conditions targeted for management by the PCMH in the study setting. The investigators found that PCMH transformation reduces hospital and ED use, and the majority of the effect was specific to PCMH-targeted conditions.
AHRQ-funded; HS019147.
Citation: Green LA, Chang HC, Markovitz AR .
The reduction in ED and hospital admissions in medical home practices is specific to primary care-sensitive chronic conditions.
Health Serv Res 2018 Apr;53(2):1163-79. doi: 10.1111/1475-6773.12674..
Keywords: Chronic Conditions, Emergency Department, Patient-Centered Healthcare, Primary Care
McCreedy EM, Kane RL, Gollust SE
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explored how patient characteristics associated with a high risk-to-benefit ratio with hypoglycemia medications affected decision making by primary care clinicians. The investigators found that primary care clinicians often chose to intensify glycemic control despite individual patient factors that warranted higher glycemic targets based on existing guidelines.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Kane RL, Gollust SE .
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
J Am Board Fam Med 2018 Mar-Apr;31(2):192-200. doi: 10.3122/jabfm.2018.02.170141..
Keywords: Diabetes, Elderly, Patient-Centered Healthcare, Guidelines, Evidence-Based Practice, Shared Decision Making, Medication, Primary Care, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Tomoaia-Cotisel A, Farrell TW, Solberg LI
AHRQ Author: Harrison MI, Genevro JL
Implementation of care management: an analysis of recent AHRQ research.
This article describes care management (CM) implementation and associated lessons from 12 Agency for Healthcare Research and Quality-sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s).
AHRQ-authored; AHRQ-funded; HS021933; 2902007.
Citation: Tomoaia-Cotisel A, Farrell TW, Solberg LI .
Implementation of care management: an analysis of recent AHRQ research.
Med Care Res Rev 2018 Feb;75(1):46-65. doi: 10.1177/1077558716673459.
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Keywords: Care Coordination, Patient-Centered Healthcare, Primary Care, Implementation
Hines AL, Roter D, Ghods Dinoso BK
Informed and patient-centered decision-making in the primary care visits of African Americans with depression.
This study examined the prevalence and extent of informed decision-making (IDM) and patient-centered decision-making (PCDM) in primary care visits of African Americans with depression. It concluded that the associations between IDM and PCDM with interpersonal ratings were moderated by overall patient-centeredness of the visit, which may be indicative of broader cross-cultural communication issues. Strengthening partnerships between depressed African Americans and their clinicians may improve patient-engaged decision-making.
AHRQ-funded; HS013645.
Citation: Hines AL, Roter D, Ghods Dinoso BK .
Informed and patient-centered decision-making in the primary care visits of African Americans with depression.
Patient Educ Couns 2018 Feb;101(2):233-40. doi: 10.1016/j.pec.2017.07.027.
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Keywords: Shared Decision Making, Depression, Patient-Centered Healthcare, Primary Care, Racial and Ethnic Minorities
Ono SS, Crabtree BF, Hemler JR
Taking innovation to scale in primary care practices: the functions of health care extension.
Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. This article describes how cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement.
AHRQ-funded; HS023940.
Citation: Ono SS, Crabtree BF, Hemler JR .
Taking innovation to scale in primary care practices: the functions of health care extension.
Health Aff 2018 Feb;37(2):222-30. doi: 10.1377/hlthaff.2017.1100.
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Keywords: Primary Care, Implementation, Cardiovascular Conditions, Evidence-Based Practice, Healthcare Delivery, Practice Improvement, Quality Improvement, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention