National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (3)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Children/Adolescents (6)
- (-) Clinical Decision Support (CDS) (30)
- Data (2)
- Diagnostic Safety and Quality (1)
- Disabilities (1)
- Elderly (1)
- Electronic Health Records (EHRs) (7)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (1)
- Emergency Medical Services (EMS) (2)
- Genetics (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Delivery (1)
- Health Information Exchange (HIE) (1)
- Health Information Technology (HIT) (16)
- Heart Disease and Health (1)
- Hospitalization (1)
- Hospitals (1)
- Human Immunodeficiency Virus (HIV) (2)
- Imaging (2)
- Infectious Diseases (1)
- Injuries and Wounds (1)
- Inpatient Care (1)
- Long-Term Care (1)
- Medical Errors (2)
- Medication (5)
- Medication: Safety (1)
- Mortality (1)
- Newborns/Infants (1)
- Nursing Homes (2)
- Nutrition (1)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient Safety (7)
- Practice Patterns (1)
- Pressure Ulcers (1)
- Prevention (2)
- Primary Care (4)
- Provider: Health Personnel (1)
- Public Health (1)
- Quality Measures (1)
- Quality of Care (2)
- Respiratory Conditions (2)
- Risk (1)
- Sepsis (1)
- Shared Decision Making (11)
- Urinary Tract Infection (UTI) (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 30 Research Studies DisplayedPress A, Khan S, McCullagh L
Avoiding alert fatigue in pulmonary embolism decision support: a new method to examine 'trigger rates.'
The authors developed a new and innovative usability process named 'sensitivity and specificity trigger analysis' (SSTA) as part of a larger project around a pulmonary embolism decision support tool. They explored a unique methodology, SSTA, used to limit inaccurate triggering of a clinical decision support tool prior to integration into the electronic health record. They concluded that their methodology can be applied to other studies aiming to decrease triggering rates and increase adoption rates of previously validated clinical decision support system tools.
AHRQ-funded; HS022061.
Citation: Press A, Khan S, McCullagh L .
Avoiding alert fatigue in pulmonary embolism decision support: a new method to examine 'trigger rates.'
Evid Based Med 2016 Dec;21(6):203-07. doi: 10.1136/ebmed-2016-110440.
.
.
Keywords: Clinical Decision Support (CDS), Respiratory Conditions, Electronic Health Records (EHRs), Provider: Health Personnel, Patient Safety
Roosan D, Samore M, Jones M
Big-data based decision-support systems to improve clinicians' cognition.
This study focused on answers from the experts on how clinical reasoning can be supported by population-based Big-Data. It found cognitive strategies such as trajectory tracking, perspective taking, and metacognition has the potential to improve clinicians' cognition to deal with complex problems. These cognitive strategies all have important implications for the design of Big-Data based decision-support tools that could be embedded in electronic health records.
AHRQ-funded; HS023349.
Citation: Roosan D, Samore M, Jones M .
Big-data based decision-support systems to improve clinicians' cognition.
IEEE Int Conf Healthc Inform 2016;2016:285-88. doi: 10.1109/ichi.2016.39.
.
.
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Data, Electronic Health Records (EHRs)
Islam R, Weir C, Del Fiol G
Clinical complexity in medicine: a measurement model of task and patient complexity.
The objective of this paper is to develop an integrated approach to understand and measure clinical complexity by incorporating both task and patient complexity components focusing on the infectious disease domain. The proposed clinical complexity model consists of two separate components:1) a clinical task complexity model with 13 clinical complexity-contributing factors and 7 dimensions and 2) a patient complexity model with 11 complexity-contributing factors and 5 dimensions.
AHRQ-funded; HS023349.
Citation: Islam R, Weir C, Del Fiol G .
Clinical complexity in medicine: a measurement model of task and patient complexity.
Methods Inf Med 2016;55(1):14-22. doi: 10.3414/me15-01-0031.
.
.
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT)
Her QL, Amato MG, Seger DL
The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting.
The purpose of this study was to quantify the frequency of inappropriate nonformulary medication (NFM) alert overrides in the inpatient setting and provide insight on how the design of formulary alerts could be improved. The study found that approximately 1 in 5 NFM alert overrides are overridden inappropriately.
AHRQ-funded; HS021094.
Citation: Her QL, Amato MG, Seger DL .
The frequency of inappropriate nonformulary medication alert overrides in the inpatient setting.
J Am Med Inform Assoc 2016 Sep;23(5):924-33. doi: 10.1093/jamia/ocv181..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Inpatient Care, Medication, Patient Safety
Moore CL, Daniels B, Singh D
Ureteral stones: implementation of a reduced-dose CT protocol in patients in the emergency department with moderate to high likelihood of calculi on the basis of STONE score.
The purpose of this paper was to determine if a reduced-dose computed tomography (CT) protocol could effectively help to identify patients in the emergency department (ED) with moderate to high likelihood of calculi who would require urologic intervention within 90 days. The authors found that a CT protocol with over 85% dose reduction can be used in patients with moderate to high likelihood of ureteral stone to safely and effectively identify patients in the ED who will require urologic intervention.
AHRQ-funded; HS018322.
Citation: Moore CL, Daniels B, Singh D .
Ureteral stones: implementation of a reduced-dose CT protocol in patients in the emergency department with moderate to high likelihood of calculi on the basis of STONE score.
Radiology 2016 Sep;280(3):743-51. doi: 10.1148/radiol.2016151691.
.
.
Keywords: Clinical Decision Support (CDS), Emergency Department, Imaging, Patient Safety
Yin MT, Shiau S, Rimland D
Fracture prediction with modified-FRAX in older HIV-infected and uninfected men.
The authors investigated considering HIV as a cause of secondary osteoporosis when calculating FRAX, a clinical fracture risk calculator, in HIV-infected individuals. They found that modified-FRAX underestimated the fracture rates more in older HIV-infected than in otherwise similar uninfected men. and they recommend further studies to determine how to risk stratify for screening and treatment in older HIV-infected individuals.
AHRQ-funded; HS018372.
Citation: Yin MT, Shiau S, Rimland D .
Fracture prediction with modified-FRAX in older HIV-infected and uninfected men.
J Acquir Immune Defic Syndr 2016 Aug 15;72(5):513-20. doi: 10.1097/qai.0000000000000998.
.
.
Keywords: Clinical Decision Support (CDS), Elderly, Injuries and Wounds, Human Immunodeficiency Virus (HIV), Risk
Bonafide CP, Roland D, Brady PW
Rapid response systems 20 years later: new approaches, old challenges.
In this article, the authors propose a set of recommendations for a research agenda aimed at pursuing the work of optimizing the identification of deteriorating children. They recommend that the second generation of pediatric rapid response systems continue to build on past achievements while further optimizing use of the data, tools, and people available at the bedside to take the next leap forward.
AHRQ-funded; HS023827.
Citation: Bonafide CP, Roland D, Brady PW .
Rapid response systems 20 years later: new approaches, old challenges.
JAMA Pediatr 2016 Aug;170(8):729-30. doi: 10.1001/jamapediatrics.2016.0398.
.
.
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Emergency Medical Services (EMS), Hospitals
Roosan D, Del Fiol G, Butler J
Feasibility of population health analytics and data visualization for decision support in the infectious diseases domain: a pilot study.
The objectives of this study were: 1) to explore the feasibility of extracting and displaying population-based information from an actual clinical population's database records, 2) to explore specific design features for improving population display, 3) to explore perceptions of population information displays, and 4) to explore the impact of population information display on cognitive outcomes. It concluded that a population database has great potential for reducing complexity and uncertainty in medicine to improve clinical care.
AHRQ-funded; HS023349.
Citation: Roosan D, Del Fiol G, Butler J .
Feasibility of population health analytics and data visualization for decision support in the infectious diseases domain: a pilot study.
Appl Clin Inform 2016 Jun 29;7(2):604-23. doi: 10.4338/aci-2015-12-ra-0182.
.
.
Keywords: Clinical Decision Support (CDS), Data, Shared Decision Making, Infectious Diseases, Public Health
Wang RC, Bent S, Weber E
The impact of clinical decision rules on computed tomography use and yield for pulmonary embolism: a systematic review and meta-analysis.
The researchers performed a systematic review of impact analyses on clinical decision rules for pulmonary embolism. They found that among participants with suspected pulmonary embolism, implementation of the Wells criteria was associated with a modest increase in CT angiography yield. They concluded that there is a lack of cluster-randomized trials to confirm the efficacy of clinical decision rules for the diagnosis of pulmonary embolism.
AHRQ-funded; HS021281.
Citation: Wang RC, Bent S, Weber E .
The impact of clinical decision rules on computed tomography use and yield for pulmonary embolism: a systematic review and meta-analysis.
Ann Emerg Med 2016 Jun;67(6):693-701.e3. doi: 10.1016/j.annemergmed.2015.11.005.
.
.
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Imaging, Respiratory Conditions
Forster CS, Jerardi KE, Herbst L
Right test, wrong patient: biomarkers and value.
A 2-year-old girl with Pierre Robin sequence, a gastric tube, and a tracheostomy and ventilator was admitted to the hospital medicine service. The care delivered to this patient was not unsafe, and she did well. However, the value of care was almost certainly suboptimal. The continued emphasis on a single laboratory value (the procalcitonin test) rather than her clinical picture was the true driver behind the lower value of care delivered to this patient.
AHRQ-funded; HS023827.
Citation: Forster CS, Jerardi KE, Herbst L .
Right test, wrong patient: biomarkers and value.
Hosp Pediatr 2016 May;6(5):315-7. doi: 10.1542/hpeds.2015-0199.
.
.
Keywords: Quality of Care, Children/Adolescents, Hospitalization, Clinical Decision Support (CDS), Healthcare Delivery
Tilson H, Hines LE, McEvoy G
AHRQ Author: Helwig AL
Recommendations for selecting drug-drug interactions for clinical decision support.
A work group consisting of 20 experts in pharmacology, drug information, and clinical decision support (CDS) from academia, government agencies, health information vendors, and healthcare organizations was convened. It recommended a transparent, systematic, and evidence-driven process with graded recommendations by a consensus panel of experts and oversight by a national organization.
AHRQ-authored.
Citation: Tilson H, Hines LE, McEvoy G .
Recommendations for selecting drug-drug interactions for clinical decision support.
Am J Health Syst Pharm 2016 Apr 15;73(8):576-85. doi: 10.2146/ajhp150565.
.
.
Keywords: Clinical Decision Support (CDS), Adverse Drug Events (ADE), Medication: Safety, Medication, Health Information Technology (HIT)
Bauer NS, Carroll AE, Saha C
Experience with decision support system and comfort with topic predict clinicians' responses to alerts and reminders.
The researchers examined factors associated with clinician response to computer decision support system (CDSS) prompts as part of a larger, ongoing quality improvement effort to optimize CDSS use. They found that clinicians were more likely to respond to topics rated as "easy" to discuss. The position of the prompt on the page, clinician gender, and the patient's age, race/ethnicity, and preferred language were also predictive of prompt response rate.
AHRQ-funded; HS017939; HS020640; HS022681.
Citation: Bauer NS, Carroll AE, Saha C .
Experience with decision support system and comfort with topic predict clinicians' responses to alerts and reminders.
J Am Med Inform Assoc 2016 Apr;23(e1):e125-30. doi: 10.1093/jamia/ocv148.
.
.
Keywords: Clinical Decision Support (CDS), Patient Safety, Children/Adolescents, Health Information Technology (HIT), Children/Adolescents
Taylor RA, Pare JR, Venkatesh AK
Prediction of in-hospital mortality in emergency department patients with sepsis: A local big data-driven, machine learning approach.
In this proof-of-concept study, a local, big data-driven, machine learning approach is compared to existing clinical decision rules (CDRs) and traditional analytic methods using the prediction of sepsis in-hospital mortality as the use case. It concluded that this approach outperformed existing CDRs as well as traditional analytic techniques for predicting in-hospital mortality of ED patients with sepsis.
AHRQ-funded; HS021271.
Citation: Taylor RA, Pare JR, Venkatesh AK .
Prediction of in-hospital mortality in emergency department patients with sepsis: A local big data-driven, machine learning approach.
Acad Emerg Med 2016 Mar;23(3):269-78. doi: 10.1111/acem.12876.
.
.
Keywords: Emergency Medical Services (EMS), Mortality, Clinical Decision Support (CDS), Sepsis, Health Information Technology (HIT)
Khan S, McCullagh L, Press A
Formative assessment and design of a complex clinical decision support tool for pulmonary embolism.
This study sought to determine the general attitude towards clinical decision support (CDS) tool integration and the ideal integration point into the clinical workflow. It highlighted: (1) formative assessment of EHR functionality and clinical environment workflow, (2) focus groups and key informative interviews to incorporate providers' perceptions of CDS and workflow integration and/or (3) the demonstration of proposed workflows through wireframes to help providers visualise design concepts.
AHRQ-funded; HS022061.
Citation: Khan S, McCullagh L, Press A .
Formative assessment and design of a complex clinical decision support tool for pulmonary embolism.
Evid Based Med 2016 Feb;21(1):7-13. doi: 10.1136/ebmed-2015-110214.
.
.
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT)
McCullagh LJ, Sofianou A, Kannry J
User centered clinical decision support tools: adoption across clinician training level.
This study examined the differences in adoption of CDS tools across providers’ training level. It found that the completion rates of the CDS calculator and medication order sets were higher among first year residents compared to all other training levels. Attending physicians were the less likely to accept the initial step of the CDS tool (29.3 percent) or complete the medication order sets (22.4 percent) that guided their prescription decisions.
AHRQ-funded; HS018491.
Citation: McCullagh LJ, Sofianou A, Kannry J .
User centered clinical decision support tools: adoption across clinician training level.
Appl Clin Inform 2014 Dec 17;5(4):1015-25. doi: 10.4338/aci-2014-05-ra-0048.
.
.
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Practice Patterns
Einbinder J, Hebel E, Wright A
The number needed to remind: a measure for assessing CDS effectiveness.
The purpose of this paper is to provide a better understanding of population based clinical decision support (CDS) performance measurement, to identify best practices for designing and implementing CDS, and to introduce two new quality measures, titled Reminder Performance (RP) and the Number Needed to Remind (NNR) for evaluating the effectiveness of clinical reminders in the context of the CDS Dashboards.
AHRQ-funded; 290200810010.
Citation: Einbinder J, Hebel E, Wright A .
The number needed to remind: a measure for assessing CDS effectiveness.
AMIA Annu Symp Proc 2014 Nov 14;2014:506-15..
Keywords: Shared Decision Making, Clinical Decision Support (CDS), Quality Measures, Quality of Care
Boyce RD, Perera S, Nace DA
A survey of nursing home physicians to determine laboratory monitoring adverse drug event alert preferences.
The researchers conducted a survey to learn about the laboratory value thresholds that clinical event monitors should use to generate alerts about potential adverse drug events (ADEs). They found that the majority of physicians surveyed prefer alerting thresholds that would generally lead to fewer alerts than if widely accepted standardized laboratory ranges were used.
AHRQ-funded; HS019461; HS018721.
Citation: Boyce RD, Perera S, Nace DA .
A survey of nursing home physicians to determine laboratory monitoring adverse drug event alert preferences.
Appl Clin Inform 2014 Oct 29;5(4):895-906. doi: 10.4338/aci-2014-06-ra-0053..
Keywords: Nursing Homes, Clinical Decision Support (CDS), Adverse Events
Welch BM, Eilbeck K, Del Fiol G
Technical desiderata for the integration of genomic data with clinical decision support.
The objective of this study is to develop and validate a guiding set of technical desiderata for supporting the clinical use of the whole genome sequence (WGS) through clinical decision support (CDS). A panel of domain experts in genomics and CDS developed a proposed set of seven additional requirements. These additional desiderata provide important guiding principles for the technical development of CDS capabilities for the clinical use of WGS information.
AHRQ-funded; HS018352.
Citation: Welch BM, Eilbeck K, Del Fiol G .
Technical desiderata for the integration of genomic data with clinical decision support.
J Biomed Inform 2014 Oct;51:3-7. doi: 10.1016/j.jbi.2014.05.014..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Genetics, Electronic Health Records (EHRs), Shared Decision Making
Ranji SR, Rennke S, Wachter RM
Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review.
The authors searched AHRQ's Patient Safety Net to identify reviews of the effect of computerised provider order entry (CPOE) combined with clinical decision support systems (CDSS) on adverse drug event (ADE) rates in inpatient and outpatient settings. They found that CPOE+CDSS was consistently reported to reduce prescribing errors, but does not appear to prevent clinical ADEs in either the inpatient or outpatient setting. Implementation of CPOE+CDSS profoundly changes staff workflow, often leading to unintended consequences and new safety issues (such as alert fatigue) which limit the system's safety effects.
AHRQ-funded; 2902007100621.
Citation: Ranji SR, Rennke S, Wachter RM .
Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review.
BMJ Qual Saf 2014 Sep;23(9):773-80. doi: 10.1136/bmjqs-2013-002165.
.
.
Keywords: Adverse Drug Events (ADE), Adverse Events, Medical Errors, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication, Patient Safety
Islam R, Weir C, Del Fiol G
Heuristics in managing complex clinical decision tasks in experts' decision making.
The authors sought to understand how clinicians manage complexity while dealing with complex clinical decision tasks. They found that experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes, and focusing on only the most relevant information.
AHRQ-funded; HS023349.
Citation: Islam R, Weir C, Del Fiol G .
Heuristics in managing complex clinical decision tasks in experts' decision making.
IEEE Int Conf Healthc Inform 2014 Sep;2014:186-93. doi: 10.1109/ichi.2014.32.
.
.
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Patient Safety
Baillie CA, Epps M, Hanish A
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
The researchers evaluated the usability and effectiveness of a computerized clinical decision support (CDS) intervention aimed at reducing the duration of urinary tract catheterizations. They found that usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time periods, as did CAUTIs per 1,000 patient-days. They concluded that the usability of the reminder was highly dependent on its user interface, with a homegrown version of the reminder resulting in higher impact than a stock reminder.
AHRQ-funded; HS016946.
Citation: Baillie CA, Epps M, Hanish A .
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
Infect Control Hosp Epidemiol 2014 Sep;35(9):1147-55. doi: 10.1086/677630.
.
.
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Urinary Tract Infection (UTI)
Carroll AE, Bauer NS, Dugan TM
Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.
A study to determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices found that use of such a system significantly increased the number of children screened at 9, 18, and 30 months of age. It also increased the number of children who ultimately were diagnosed as having a developmental delay.
AHRQ-funded; HS017939
Citation: Carroll AE, Bauer NS, Dugan TM .
Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.
JAMA Pediatr. 2014 Sep;168(9):815-21. doi: 10.1001/jamapediatrics.2014.464..
Keywords: Health Information Technology (HIT), Clinical Decision Support (CDS), Primary Care, Children/Adolescents
Galanter WL, Bryson ML, Falck S
Indication alerts intercept drug name confusion errors during computerized entry of medication orders.
The authors measured whether indication alerts at the time of computerized physician order entry (CPOE) can intercept drug name confusion errors. They found that indication alerts intercepted 1.4 drug name confusion errors per 1000 alerts and recommended that institutions with CPOE consider using indication prompts to intercept drug name confusion errors.
AHRQ-funded; HS021093.
Citation: Galanter WL, Bryson ML, Falck S .
Indication alerts intercept drug name confusion errors during computerized entry of medication orders.
PLoS One 2014 Jul 15;9(7):e101977. doi: 10.1371/journal.pone.0101977.
.
.
Keywords: Clinical Decision Support (CDS), Adverse Drug Events (ADE), Adverse Events, Medical Errors, Health Information Technology (HIT), Medication, Patient Safety
Bennett WE, Jr., Hendrix KS, Thompson-Fleming RT
Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
The researchers used a novel computerized decision support system to gather data from multiple general pediatrics offices.They found an association between the introduction of cow's milk before 1 year of age and the rate of delayed developmental milestones after 1 year of age, adding strength to the recommendations from the AAP and IOM to delay cow's milk introduction until after 1 year of age.
AHRQ-funded; HS017939; HS018453; HS020640.
Citation: Bennett WE, Jr., Hendrix KS, Thompson-Fleming RT .
Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
Eur J Pediatr 2014 Jul;173(7):887-92. doi: 10.1007/s00431-014-2265-y.
.
.
Keywords: Clinical Decision Support (CDS), Disabilities, Health Information Technology (HIT), Newborns/Infants, Nutrition
Crane HM, Heckbert SR, Drozd DR
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
In this study, a team of researchers developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. They found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half the events ultimately determined to be MIs were not identified by clinical diagnoses.
AHRQ-funded; HS019515
Citation: Crane HM, Heckbert SR, Drozd DR .
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
Am J Epidemiol. 2014 Apr 15;179(8):996-1005. doi: 10.1093/aje/kwu010..
Keywords: Human Immunodeficiency Virus (HIV), Heart Disease and Health, Clinical Decision Support (CDS), Diagnostic Safety and Quality