National Healthcare Quality and Disparities Report
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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
26 to 50 of 113 Research Studies DisplayedAncker JS, Hafeez B, Kaushal R
Socioeconomic disparities in adoption of personal health records over time.
The authors sought to track personal health record (PHR) adoption and differences by sociodemographic group over time. Using data from the Empire State Poll, they found that during a 4-year period in which federal policies incentivized medical organizations to give medical record access to patients through PHRs and electronic portals, rates of PHR use increased rapidly in all sociodemographic groups, but with a digital divide remaining, linked to Hispanic ethnicity and lower income.
AHRQ-funded; HS021531.
Citation: Ancker JS, Hafeez B, Kaushal R .
Socioeconomic disparities in adoption of personal health records over time.
Am J Manag Care 2016 Aug;22(8):539-40.
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Keywords: Disparities, Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Social Determinants of Health
Asan O, Holden RJ, Flynn KE
Provider use of a novel EHR display in the pediatric intensive care unit. Large Customizable Interactive Monitor (LCIM).
The purpose of this study was to explore providers' perspectives on the use of a novel technology, "Large Customizable Interactive Monitor" (LCIM), a novel application of the electronic health record system implemented in a Pediatric Intensive Care Unit. The study revealed this next generation HIT might have great potential for family-centered rounds, team education during rounds, and family education/engagement in their child's health in the patient room.
AHRQ-funded; HS023626.
Citation: Asan O, Holden RJ, Flynn KE .
Provider use of a novel EHR display in the pediatric intensive care unit. Large Customizable Interactive Monitor (LCIM).
Appl Clin Inform 2016 Jul 20;7(3):682-92. doi: 10.4338/aci-2016-02-ra-0030.
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Keywords: Children/Adolescents, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient and Family Engagement, Children/Adolescents
Richesson RL, Sun J, Pathak J
Clinical phenotyping in selected national networks: demonstrating the need for high-throughput, portable, and computational methods.
The authors sought to use electronic health records data to advance understanding of disease risk and drug response, and to support the practice of precision medicine on a national scale. They found that machine learning approaches that generate phenotype definitions from patient features and clinical profiles will result in truly computational phenotypes, as it comes from data rather than experts. They suggested that research networks and phenotype developers cooperate to develop methods, collaboration platforms, and data standards that will enable computational phenotyping and modernize biomedical research.
AHRQ-funded; HS023921; HS023077.
Citation: Richesson RL, Sun J, Pathak J .
Clinical phenotyping in selected national networks: demonstrating the need for high-throughput, portable, and computational methods.
Artif Intell Med 2016 Jul;71:57-61. doi: 10.1016/j.artmed.2016.05.005.
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Keywords: Data, Electronic Health Records (EHRs), Genetics, Patient-Centered Healthcare
Cato KD, Bockting W, Larson E
Did I tell you that? Ethical issues related to using computational methods to discover non-disclosed patient characteristics.
Using the Belmont Report's principles of respect for persons, beneficence, and justice as a framework, the authors examined the ethical issues posed by electronic phenotyping. Ethical issues identified include the ability of the patient to consent for the use of their information, the ability to suppress pediatric information, and ensuring that the potential benefits justify the risks of harm to patients.
AHRQ-funded; HS022961.
Citation: Cato KD, Bockting W, Larson E .
Did I tell you that? Ethical issues related to using computational methods to discover non-disclosed patient characteristics.
J Empir Res Hum Res Ethics 2016 Jul;11(3):214-9. doi: 10.1177/1556264616661611.
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Keywords: Clinician-Patient Communication, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Outcomes Research, Registries, Research Methodologies
Melvin CL, Saef SH, Pierce HO
Health information exchange in the ED: what do ED clinicians think?
The researchers investigated reasons for low Carolina eHealth Alliance health information exchange (CeHA-HIE)utilization. They found that most emergency department clinicians believed the system added value to their work but preferred better integration with their electronic medical records systems.
AHRQ-funded; HS019339; HS023047.
Citation: Melvin CL, Saef SH, Pierce HO .
Health information exchange in the ED: what do ED clinicians think?
South Med J 2016 Jul;109(7):419-26. doi: 10.14423/smj.0000000000000466.
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Keywords: Health Information Exchange (HIE), Emergency Department, Electronic Health Records (EHRs), Emergency Medical Services (EMS)
Nguyen OK, Makam AN, Clark C
Predicting all-cause readmissions using electronic health record data from the entire hospitalization: model development and comparison.
The purpose of this study was to develop an all-cause readmissions risk-prediction model incorporating electronic health record (EHR) data from the full hospital stay, and to compare "full-stay" model performance to a "first day" and 2 other validated models. It found that incorporating clinically granular EHR data from the full hospital stay modestly improves prediction of 30-day readmissions.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Makam AN, Clark C .
Predicting all-cause readmissions using electronic health record data from the entire hospitalization: model development and comparison.
J Hosp Med 2016 Jul;11(7):473-80. doi: 10.1002/jhm.2568.
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Keywords: Electronic Health Records (EHRs), Hospital Readmissions, Hospitalization, Risk
Menon S, Murphy DR, SIngh H
Workarounds and test results follow-up in electronic health record-based primary care.
This study sought to understand why primary care practitioners use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management. It concluded that workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs.
AHRQ-funded; HS022901; HS022087.
Citation: Menon S, Murphy DR, SIngh H .
Workarounds and test results follow-up in electronic health record-based primary care.
Appl Clin Inform 2016 Jun 22;7(2):543-59. doi: 10.4338/aci-2015-10-ra-0135.
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Keywords: Communication, Electronic Health Records (EHRs), Primary Care, Workflow
Hultman G, Marquard J, Arsoniadis E
Usability testing of two ambulatory EHR navigators.
Researchers sought to understand if redesigning an EHR-based navigation tool with clinician input improved user performance and satisfaction. A usability evaluation was conducted to compare two versions of a redesigned ambulatory navigator. The version of navigator did not affect perceived workload, and time to complete tasks was longer in the redesigned navigator. Preferences for EHR navigation structures appeared to be individualized.
AHRQ-funded; HS022085.
Citation: Hultman G, Marquard J, Arsoniadis E .
Usability testing of two ambulatory EHR navigators.
Appl Clin Inform 2016 Jun 15;7(2):502-15. doi: 10.4338/aci-2015-10-ra-0129.
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Keywords: Education: Patient and Caregiver, Electronic Health Records (EHRs), Ambulatory Care and Surgery, Patient Experience
Rizvi RF, Harder KA, Hultman GM
A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians.
The researchers sought to understand physicians' usage of inpatient notes in two Electronic Health Record (EHR) systems. They found that the highest variability was observed with progress notes and the least variability was within discharge summaries, while note-writing styles were most consistent for history and physical notes. Physician preference for adopting a certain reading/retrieval order appeared to be a function of what best fits their workflow while fulfilling the stimulus demands. They also found that time spent entering history and physical, discharge summaries, and progress notes were similar in both EHRs.
AHRQ-funded; HS022085.
Citation: Rizvi RF, Harder KA, Hultman GM .
A comparative observational study of inpatient clinical note-entry and reading/retrieval styles adopted by physicians.
Int J Med Inform 2016 Jun;90:1-11. doi: 10.1016/j.ijmedinf.2016.02.011.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Health Personnel, Practice Patterns
Vock DM, Wolfson J, Bandyopadhyay S
Adapting machine learning techniques to censored time-to-event health record data: a general-purpose approach using inverse probability of censoring weighting.
In this paper, the authors present a general-purpose approach to account for right-censored outcomes using inverse probability of censoring weighting (IPCW). They illustrate how IPCW can easily be incorporated into a number of existing machine learning algorithms used to mine big health care data including Bayesian networks, k-nearest neighbors, decision trees, and generalized additive models.
AHRQ-funded; HS017622.
Citation: Vock DM, Wolfson J, Bandyopadhyay S .
Adapting machine learning techniques to censored time-to-event health record data: a general-purpose approach using inverse probability of censoring weighting.
J Biomed Inform 2016 Jun;61:119-31. doi: 10.1016/j.jbi.2016.03.009.
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Keywords: Data, Electronic Health Records (EHRs), Health Information Technology (HIT)
Dugas AF, Kirsch TD, Toerper M
An electronic emergency triage system to improve patient distribution by critical outcomes.
This study derives and validates a computer-based electronic triage system (ETS) to improve patient acuity distribution based on serious patient outcomes. The authors found improved differentiation of patients compared to the current standard Emergency Severity Index.
AHRQ-funded; HS023641.
Citation: Dugas AF, Kirsch TD, Toerper M .
An electronic emergency triage system to improve patient distribution by critical outcomes.
J Emerg Med 2016 Jun;50(6):910-8. doi: 10.1016/j.jemermed.2016.02.026.
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Keywords: Care Management, Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Healthcare Delivery
Stockwell MS, Natarajan K, Ramakrishnan R
Immunization data exchange with electronic health records.
The researchers assessed the impact of exchange of immunization information between an immunization information system (IIS) and an electronic health record on up-to-date rates, overimmunization, and immunization record completeness for low-income, urban children and adolescents. Their findings demonstrated that data exchange can improve child and adolescent immunization status.
AHRQ-funded; HS022667.
Citation: Stockwell MS, Natarajan K, Ramakrishnan R .
Immunization data exchange with electronic health records.
Pediatrics 2016 Jun;137(6). doi: 10.1542/peds.2015-4335.
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Keywords: Children/Adolescents, Communication, Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Vaccination
Woollen J, Prey J, Wilcox L
Patient experiences using an inpatient personal health record.
Researchers investigated post-operative cardiac surgical patients' experience using an inpatient personal health record (PHR) on a tablet computer to increase engagement in their hospital care. They found that patients reported high satisfaction with being able to view their hospital medications and access educational materials related to their medical conditions. Patients also reported a desire to view daily progress reports about their hospital stay.
AHRQ-funded; HS021816.
Citation: Woollen J, Prey J, Wilcox L .
Patient experiences using an inpatient personal health record.
Appl Clin Inform 2016 Jun 1;7(2):446-60. doi: 10.4338/aci-2015-10-ra-0130.
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Keywords: Cardiovascular Conditions, Electronic Health Records (EHRs), Hospitalization, Patient Experience, Patient Experience
Rangachari P
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
In this paper, Rangachari 1) conducted a narrative review of the literature on "technology use," to understand how technologies-in-practice may be transformed from limited use to meaningful use; 2) conducted a narrative review of the literature on "organizational change implementation," to understand how changes in technology use could be successfully implemented and sustained in a healthcare organizational context; and 3) applied lessons learned from the narrative literature reviews to identify strategies for the meaningful use and successful implementation of EHR Medication Reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
J Hosp Adm 2016 Jun;5(3):98-106. doi: 10.5430/jha.v5n3p98.
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Keywords: Health Systems, Medication, Hospitals, Organizational Change, Electronic Health Records (EHRs)
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Lee SJ, Grobe JE, Tiro JA
Assessing race and ethnicity data quality across cancer registries and EMRs in two hospitals.
The objective of this study was to characterize the quality of race/ethnicity data collection efforts. The authors assessed race and ethnicity data quality across cancer registries and electronic medical records in two hospitals. Their findings suggested that high-quality race/ethnicity data are attainable. Many of the "errors" in race/ethnicity data were caused by missing or "Unknown" data values.
AHRQ-funded; HS022418.
Citation: Lee SJ, Grobe JE, Tiro JA .
Assessing race and ethnicity data quality across cancer registries and EMRs in two hospitals.
J Am Med Inform Assoc 2016 May;23(3):627-34. doi: 10.1093/jamia/ocv156..
Keywords: Cancer, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Racial and Ethnic Minorities, Registries
Yanamadala S, Morrison D, Curtin C
Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications.
The authors assessed the relationship between electronic health records (EHR) adoption and patient outcomes. Their results indicate that patients receiving medical and surgical care at hospitals with no EHR system have similar outcomes compared to patients seeking care at hospitals with a full EHR system. They concluded that EHRs may play a smaller role than expected in patient outcomes and overall quality of care.
AHRQ-funded; HS024096.
Citation: Yanamadala S, Morrison D, Curtin C .
Electronic health records and quality of care: an observational study modeling impact on mortality, readmissions, and complications.
Medicine (Baltimore) 2016 May;95(19):e3332. doi: 10.1097/md.0000000000003332.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Electronic Health Records (EHRs), Quality of Care, Mortality, Hospitals
Bailey SR, Marino M, Hoopes M
Healthcare utilization after a children's health insurance program expansion in Oregon.
This study used electornic health record data from 154 Oregon community health centers to evaluate children's healthcare utilization after the Children's Health Insurance Program (CHIP) expansion. The authors found that utilization among the newly-insured remained higher than the uninsured group. This finding confirms that Children's Health Insurance Program expansions are associated with increased utilization of essential pediatric primary and preventive care.
AHRQ-funded; HS021522; HS018569.
Citation: Bailey SR, Marino M, Hoopes M .
Healthcare utilization after a children's health insurance program expansion in Oregon.
Matern Child Health J 2016 May;20(5):946-54. doi: 10.1007/s10995-016-1971-7.
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Keywords: Children's Health Insurance Program (CHIP), Electronic Health Records (EHRs), Healthcare Utilization, Children/Adolescents, Access to Care
Bajracharya AS, Crotty BH, Kowaloff HB
Improving health care proxy documentation using a web-based interview through a patient portal.
The authors sought to develop and evaluate a web-based interview to assist patients with health care proxy documentation to be included in the patients' electronic health record. They implemented the interview within the patient portal of an academic health system and analyzed the experience of the first 200 patients to complete it. The patients found the online interview convenient and helpful in establishing a healthcare proxy.
AHRQ-funded; HS021495.
Citation: Bajracharya AS, Crotty BH, Kowaloff HB .
Improving health care proxy documentation using a web-based interview through a patient portal.
J Am Med Inform Assoc 2016 May;23(3):580-7. doi: 10.1093/jamia/ocv133.
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Keywords: Web-Based, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bae J, Encinosa WE
AHRQ Author: Encinosa WE
National estimates of the impact of electronic health records on the workload of primary care physicians.
This study examines whether electronic health records (EHR) is associated with increases in face time with the patient per visit and increases in the physician's patient volume per week. It found that among young physicians, EHR use is associated with a decline in weekly patient volume, while EHR use among older physicians is associated with an increase in volume, regardless of initial practice size.
AHRQ-authored.
Citation: Bae J, Encinosa WE .
National estimates of the impact of electronic health records on the workload of primary care physicians.
BMC Health Serv Res 2016 May 10;16(1):172. doi: 10.1186/s12913-016-1422-6.
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Keywords: Primary Care, Electronic Health Records (EHRs), Clinician-Patient Communication, Health Information Technology (HIT)
Topaz M, Seger DL, Slight SP
Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience.
The authors aimed to explore the common drug allergy alerts over the last 10 years and the reasons why providers tend to override these alerts. They found that alarmingly, alerts for immune mediated and life threatening reactions with definite allergen and prescribed medication matches were overridden 72.8 percent and 74.1 percent of the time, respectively.
AHRQ-funded; HS022728.
Citation: Topaz M, Seger DL, Slight SP .
Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience.
J Am Med Inform Assoc 2016 May;23(3):601-8. doi: 10.1093/jamia/ocv143.
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Keywords: Electronic Health Records (EHRs), Adverse Drug Events (ADE), Medication, Medication: Safety, Patient Safety
Ryu E, Chamberlain AM, Pendergraft RS
Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records.
In this study, the researchers aimed to quantify the relative contribution of selected chronic conditions to identify the conditions most influential to major depressive disorder (MDD) risk in adults and identify differences by age. Their results suggest that specific chronic conditions such as diabetes mellitus and rheumatoid arthritis/osteoarthritis may have greater influence than others on the risk of MDD.
AHRQ-funded; HS023077.
Citation: Ryu E, Chamberlain AM, Pendergraft RS .
Quantifying the impact of chronic conditions on a diagnosis of major depressive disorder in adults: a cohort study using linked electronic medical records.
BMC Psychiatry 2016 Apr 26;16:114. doi: 10.1186/s12888-016-0821-x.
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Keywords: Chronic Conditions, Depression, Electronic Health Records (EHRs), Primary Care
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Taslimitehrani V, Dong G, Pereira NL
Developing EHR-driven heart failure risk prediction models using CPXR(Log) with the probabilistic loss function.
The authors proposed to apply a classification algorithm, Contrast Pattern Aided Logistic Regression (CPXR(Log)) with the probabilistic loss function, to develop and validate prognostic risk models to predict 1, 2, and 5 year survival in heart failure (HF). They found that the new loss function used in the algorithm outperforms other functions used in previous studies and that HF is a highly heterogeneous disease (different subgroups of patients require different types of considerations with their diagnosis and treatment). They concluded that logistic risk models often make systematic prediction errors and that it is prudent to use subgroup based prediction models such as those given by CPXR(Log) when investigating heterogeneous diseases.
AHRQ-funded; HS023077.
Citation: Taslimitehrani V, Dong G, Pereira NL .
Developing EHR-driven heart failure risk prediction models using CPXR(Log) with the probabilistic loss function.
J Biomed Inform 2016 Apr;60:260-9. doi: 10.1016/j.jbi.2016.01.009.
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Keywords: Electronic Health Records (EHRs), Heart Disease and Health, Health Information Technology (HIT), Risk
Plasek JM, Goss FR, Lai KH
Food entries in a large allergy data repository.
This study examined, encoded, and grouped foods that caused any adverse sensitivity in a large allergy repository using natural language processing and standard terminologies. It identified 158,552 food allergen records (2,140 unique terms) in the Partners repository, corresponding to 672 food allergen concepts. High-frequency groups included shellfish (19.3 percent), fruits or vegetables (18.4 percent), dairy (9.0 percent), and peanuts (8.5 percent).
AHRQ-funded; HS022728.
Citation: Plasek JM, Goss FR, Lai KH .
Food entries in a large allergy data repository.
J Am Med Inform Assoc 2016 Apr;23(e1):e79-87. doi: 10.1093/jamia/ocv128.
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Keywords: Data, Health Information Technology (HIT), Electronic Health Records (EHRs), Patient Safety