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
Topics
- COVID-19 (1)
- Dementia (1)
- Elderly (2)
- Electronic Health Records (EHRs) (1)
- Healthcare Delivery (1)
- (-) Health Information Technology (HIT) (13)
- (-) Long-Term Care (13)
- Neurological Disorders (1)
- (-) Nursing Homes (13)
- Primary Care (1)
- Provider Performance (1)
- Quality Improvement (1)
- Quality Measures (2)
- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- Research Methodologies (1)
- Telehealth (2)
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 13 of 13 Research Studies DisplayedPowell KR, Farmer M, Liu J
A survey of technology abandonment in US nursing homes.
This study examined abandonment of health information technology (HIT) by US nursing homes (NHs) and its association with organizational characteristics among a national sample of US NHs. This longitudinal, retrospective analysis used data from 2 sources: the HIT Maturity Survey and Staging model and public data from the Care Compare database. The authors used a random sample of 299 NHs representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019-August 2020 and year 2 (Y2) was June 2020-August 2021. The primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain; and independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. Results were that over the 2-year period HIT abandonment occurred in 28% of NHs compared with 44% that experienced growth in HIT systems. Capabilities in resident care was abandoned most frequently. They found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. They concluded that technology abandonment can increase strain on scarce resources and may impact administrators' ability to oversee clinical operations, especially in large NHs.
AHRQ-funded; HS022497.
Citation: Powell KR, Farmer M, Liu J .
A survey of technology abandonment in US nursing homes.
J Am Med Dir Assoc 2024 Jan; 25(1):6-11. doi: 10.1016/j.jamda.2023.09.002..
Keywords: Nursing Homes, Health Information Technology (HIT), Long-Term Care
Hua Y, Temkin-Greener H, Cai S
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
The purpose of this study was to explore primary care telemedicine use among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) who resided in Assisted Living Facilities (Als) during the early stage of the COVID-19 pandemic, with a focus on possible racial and socioeconomic differences. The study found that at the start of the pandemic in quarter 2 of 2020, Black residents were less likely to have telemedicine visits than their White counterparts. In the following two quarters, Black residents were more likely to receive primary care via telemedicine than White residents; a similar difference was observed between Hispanic and White residents, but with smaller effect sizes. Compared with nondual residents, dual residents were more likely to receive primary care via telemedicine in Q3. In addition, residents in AL communities with a higher proportion of dual residents, compared with those in low-dual ALs, were less likely to receive primary care via telemedicine throughout the study period. However, the difference in telemedicine use between higher vs lower dual ALs narrowed over time.
AHRQ-funded; HS026893.
Citation: Hua Y, Temkin-Greener H, Cai S .
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
J Am Med Dir Assoc 2023 Aug; 24(8):1157-58.e3. doi: 10.1016/j.jamda.2023.05.005..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Racial and Ethnic Minorities, Elderly
Hakimjavadi R, Karunananthan S, Alexander G
What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol.
As the number of Canadians aged 75 years and older is projected to double in the next two decades, long-term care (LTC) systems will face increasing pressure. Health information technology (IT) has demonstrated its ability to enhance the quality, safety, and efficiency of care across various clinical environments and could potentially improve LTC for residents. The purpose of this cross-sectional study will be to thoroughly assess the extent of health IT adoption in Ontario's LTC homes and establish a baseline comprehension for future planning. The researchers will utilize the LTC IT Maturity Instrument to evaluate IT capabilities, the extent of IT usage, and the degree of internal/external IT integration across the domains of resident care, clinical support, and administrative activities. All LTC homes in Ontario will be invited to participate.
AHRQ-funded; HS022497.
Citation: Hakimjavadi R, Karunananthan S, Alexander G .
What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol.
BMJ Open 2023 Feb 10; 13(2):e064745. doi: 10.1136/bmjopen-2022-064745..
Keywords: Health Information Technology (HIT), Long-Term Care, Nursing Homes
Alexander GL, Deroche CB, Powell KR
Development and pilot analysis of the nursing home health information technology maturity survey and staging model.
The purpose of this study was the development, psychometric testing, and analysis of a survey instrument and staging model for nursing home health information technology (HIT). The nursing homes (NH) were selected for inclusion in the study based on their HIT scores from a prior study. Researchers recruited 121 NH administrators from January to May 2019 from primarily for-profit, metropolitan nursing homes with medium bed size. The researchers reported that all dimensions and domains were significantly correlated, with the exception of the variables of integration in administrative activities and HIT capabilities. All items loaded intuitively onto four components, explaining 80% of the variance. The researchers concluded that the HIT maturity survey can be used to make reliable assumptions about nursing home health information technology.
AHRQ-funded; HS022497.
Citation: Alexander GL, Deroche CB, Powell KR .
Development and pilot analysis of the nursing home health information technology maturity survey and staging model.
Res Gerontol Nurs 2022 Mar-Apr;15(2):93-99. doi: 10.3928/19404921-20220218-04..
Keywords: Nursing Homes, Long-Term Care, Health Information Technology (HIT)
Enyioha C, Khairat S, Kistler CE
Adoption of electronic health records by practices of nursing home providers and Wi-Fi availability in nursing homes.
This study evaluated the rate of electronic health record (EHR) adoption by nursing homes (NHs) and nursing home providers and Wi-Fi availability in nursing homes by geographical region. The authors conducted a cross-sectional survey on a convenience sample of NH primary care providers (PCPs) serving 867 NHs recruited from the Medefield Primary Care research panel. They also sought to evaluate the proportion of NHs with Wi-Fi access. The states were categorized into four geographical locations: Midwest, Northeast, South, and West. Participants included a total of 515 physicians, 209 nurse practitioners, and 143 physician assistants. Mean age of participants was 49 years, 56% were male, and 76% white. The mean number of days per week participants worked in a NH was 1.8 and number of hours per week 32.3. Overall, 89.4% reported EHR adoption in their practice, and 73.2% reported Wi-Fi presence in their primary NH. The three most EHRs were EpicCare Ambulatory (24.0%), Vitera (20.4%), and eClinicalWorks (14.4%) Wi-Fi access was highest in the Northeast (78.1%) and lowest in the West (63.9%). Rates of EHR adoption was also highest in the Northeast (94.5%). These differences may help explain continued deficiencies in care coordination between NH and other sites of clinical care.
AHRQ-funded; HS024519.
Citation: Enyioha C, Khairat S, Kistler CE .
Adoption of electronic health records by practices of nursing home providers and Wi-Fi availability in nursing homes.
J Am Med Dir Assoc 2021 Feb;22(2):475-76. doi: 10.1016/j.jamda.2020.09.028..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing Homes, Long-Term Care
Alexander GL, Powell KR, Deroche CB
An evaluation of telehealth expansion in U.S. nursing homes.
This study contains the results of a national survey about telehealth use reported in a random sample of US nursing homes. The sample includes 664 nursing homes that completed surveys about information technology maturity from January 2019 to August 4, 2020. Differences in nursing home telehealth use was examined prior to and after telehealth expansion. A cumulative telehealth score was calculated using survey data from 6 questions about the expansion of telehealth use (score range 0-42). Larger metropolitan nursing homes had greater telehealth use. Ownership type had little effect. Nursing home telehealth use postexpansion used telehealth applications for resident evaluation 11.24 times more than pre-expansion. A wide range of telehealth use was reported, with approximately 16% having no telehealth use and 5% having the maximum amount of telehealth use. Mean telehealth use scores reported by the majority of these nursing homes were on the lower end of the range. However, increasing use will most likely continue due to the current pandemic.
AHRQ-funded; HS022497.
Citation: Alexander GL, Powell KR, Deroche CB .
An evaluation of telehealth expansion in U.S. nursing homes.
J Am Med Inform Assoc 2021 Feb 15;28(2):342-48. doi: 10.1093/jamia/ocaa253..
Keywords: Nursing Homes, Long-Term Care, Telehealth, Health Information Technology (HIT)
Alexander GL, Madsen R, Deroche CB
Ternary trends in nursing home information technology and quality measures in the United States.
This survey investigated whether improvements in nursing home information technology (NH IT) increases quality measures. Nursing home administrators were surveyed from 2014 to 2017. Nine dimensions/domains and total IT sophistication were measured. A total of 815 Year 1 surveys were completed. It was found that for every 10 units increase in administrative activity of IT use, a decrease of 1.3% occurred in the percentage of low-risk long-stay residents with bowel or bladder incontinence.
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen R, Deroche CB .
Ternary trends in nursing home information technology and quality measures in the United States.
J Appl Gerontol 2020 Oct;39(10):1134-43. doi: 10.1177/0733464819862928..
Keywords: Nursing Homes, Health Information Technology (HIT), Quality Measures, Quality Improvement, Long-Term Care, Quality of Care
Powell KR, Alexander GL. KR, Alexander GL
Qualitative validation of the nursing home IT maturity staging model.
The goal of the current study was to qualitatively explore issues of validity, specificity, and sensitivity regarding the nursing home (NH) information technology (IT) maturity survey and staging model. Participants who completed the NH IT maturity survey were recruited during pilot testing of the survey and staging model. Cognitive interviewing was used to collect qualitative data.
AHRQ-funded; HS022497.
Citation: Powell KR, Alexander GL. KR, Alexander GL .
Qualitative validation of the nursing home IT maturity staging model.
AHRQ-funded; HS022497..
Keywords: Nursing Homes, Long-Term Care, Health Information Technology (HIT), Research Methodologies
Powell KR, Deroche CB, Carnahan EJ
Exploring resident care information technology use and nursing home quality.
The purpose of this study was to explore differences in nursing home (NH) information technology (IT) sophistication used in resident care processes based on facility characteristics over 4 consecutive years and to examine the impact on select long-stay NH quality measures. Results indicated that IT systems used in resident care are becoming increasingly sophisticated, with NH bed size, type of ownership, and location being significant predictors of IT score. Results also suggested that as electronic clinical processes and documents increase, more falls with injury were detected.
AHRQ-funded; HS022497.
Citation: Powell KR, Deroche CB, Carnahan EJ .
Exploring resident care information technology use and nursing home quality.
J Gerontol Nurs 2020 Apr;46(4):15-20. doi: 10.3928/00989134-20200303-02..
Keywords: Elderly, Health Information Technology (HIT), Nursing Homes, Long-Term Care
Alexander GL, Deroche C, Powell K
Forecasting content and stage in a nursing home information technology maturity instrument using a Delphi method.
This paper reports the development and testing of a new instrument measuring nursing home information technology maturity and stage of maturity. Findings showed that over 11% of the content items were at the highest maturity stage, which are reflected in nursing homes that have technology available for residents or their representatives and are used extensively in resident care. An instrument to assess nursing home IT maturity and stage of maturity has important implications for understanding health service delivery systems, regulatory efforts, patient safety and quality of care.
AHRQ-funded; HS022497.
Citation: Alexander GL, Deroche C, Powell K .
Forecasting content and stage in a nursing home information technology maturity instrument using a Delphi method.
J Med Syst 2020 Feb 5;44(3):60. doi: 10.1007/s10916-020-1528-6..
Keywords: Nursing Homes, Health Information Technology (HIT), Long-Term Care, Healthcare Delivery
Alexander GL, Powell K, Deroche CB
Building consensus toward a national nursing home information technology maturity model.
This study describes the development of a nursing home information technology (IT) maturity model in 2 phases. The first phase was to develop a preliminary maturity model. Phase II involved 3 rounds of questionnaires using a Delphi panel of expert nursing home administrators. Three Delphi rounds were done, and this evolved the model from 5-stages (stages 1-5) to a 7-stage model (stages 0-6).
AHRQ-funded; HS022497.
Citation: Alexander GL, Powell K, Deroche CB .
Building consensus toward a national nursing home information technology maturity model.
J Am Med Inform Assoc 2019 Jun;26(6):495-505. doi: 10.1093/jamia/ocz006..
Keywords: Health Information Technology (HIT), Long-Term Care, Nursing Homes
Alexander GL, Madsen R
A national report of nursing home quality and information technology: two-year trends.
The authors sought to answer these two research questions: What are the trends in information technology (IT) adoption in US nursing home facilities over 2 years? How are 2-year trends in IT adoption in US nursing homes related to nationally reported quality measures (QMs)? Using surveys of nursing home administrators and data from Nursing Home Compare, they concluded that multiple dimensions of IT sophistication influence QMs in every health care domain, providing an opportunity to design a reporting system that joins these important variables to be assessed on a national scale.
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen R .
A national report of nursing home quality and information technology: two-year trends.
J Nurs Care Qual 2018 Jul/Sep;33(3):200-07. doi: 10.1097/ncq.0000000000000328.
.
.
Keywords: Health Information Technology (HIT), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures, Provider Performance
Alexander GL, Madsen RW, Miller EL
The state of nursing home information technology sophistication in rural and nonrural US markets.
This study tested for significant differences in information technology sophistication (ITS) in US nursing homes (NH) based on location. It found that for every health care domain (resident care, clinical support, and administrative activities) statistical differences in facility ITS occurred. This study represents the most current national assessment of NH IT since 2004.
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen RW, Miller EL .
The state of nursing home information technology sophistication in rural and nonrural US markets.
J Rural Health 2016 Jun;33(3):266-74. doi: 10.1111/jrh.12188.
.
.
Keywords: Long-Term Care, Nursing Homes, Health Information Technology (HIT)