National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Burnout (1)
- Care Management (1)
- Chronic Conditions (1)
- (-) Clinical Decision Support (CDS) (10)
- Dementia (1)
- Diagnostic Safety and Quality (3)
- Electronic Health Records (EHRs) (5)
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- (-) Health Information Technology (HIT) (10)
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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 10 of 10 Research Studies DisplayedCurran RL, Kukhareva PV, Taft T
Integrated displays to improve chronic disease management in ambulatory care: a SMART on FHIR application informed by mixed-methods user testing.
This study’s objective was to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. The authors designed an application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). They used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Two patient scenarios were presented to the participants using the regular EHR with and without access to their prototype. Results measured was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. The 13 participants complete more recommended care using the prototype (81% vs 48%) and recommended tasks per minute over long sessions. Keystrokes per task were also lower with the prototype (6 vs 18). While there was a learning curve for this application, it will increase efficiency and patient care with practice.
AHRQ-funded; HS026198.
Citation: Curran RL, Kukhareva PV, Taft T .
Integrated displays to improve chronic disease management in ambulatory care: a SMART on FHIR application informed by mixed-methods user testing.
J Am Med Inform Assoc 2020 Aug;27(8):1225-34. doi: 10.1093/jamia/ocaa099..
Keywords: Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Care Management, Ambulatory Care and Surgery, Clinical Decision Support (CDS), Shared Decision Making
Co Z, Holmgren AJ, Classen DC
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
This study evaluated the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in 2017 and 2018 and compared performances for fatal orders and nuisance orders each year. The authors evaluated 1599 hospitals that took the test by using their overall percentage scores along with the percentage of fatal orders appropriately alerted on and the percentage of nuisance orders incorrectly alerted on. Overall hospital scores improved from 58.1% in 2017 to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0%, but there no very little change in nuisance order performance (89.0% to 89.7%). Conclusions were that perhaps hospitals are not targeting the deadliest orders first and some hospitals may be achieving higher scores by over-alerting. This has the potential to cause clinician burnout and even worsen patient safety.
AHRQ-funded; HS023696.
Citation: Co Z, Holmgren AJ, Classen DC .
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
J Am Med Inform Assoc 2020 Aug;27(8):1252-58. doi: 10.1093/jamia/ocaa098..
Keywords: Medication: Safety, Medication, Patient Safety, Clinical Decision Support (CDS), Shared Decision Making, Burnout, Hospitals, Health Information Technology (HIT), Quality of Care
Wang L, Blackley SV, Blumenthal KG
A dynamic reaction picklist for improving allergy reaction documentation in the electronic health record.
Incomplete and static reaction picklists in the allergy module led to free-text and missing entries that inhibit the clinical decision support intended to prevent adverse drug reactions. In this study, the investigators developed a novel, data-driven, "dynamic" reaction picklist to improve allergy documentation in the electronic health record (EHR). The investigators concluded that their dynamic reaction picklist was superior to the static picklist and suggested proper reactions for allergy documentation.
AHRQ-funded; HS025375.
Citation: Wang L, Blackley SV, Blumenthal KG .
A dynamic reaction picklist for improving allergy reaction documentation in the electronic health record.
J Am Med Inform Assoc 2020 Jun;27(6):917-23. doi: 10.1093/jamia/ocaa042..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Clinical Decision Support (CDS)
Classen DC, Holmgren AJ, Co Z
National trends in the safety performance of electronic health record systems from 2009 to 2018.
This study examined trends in the safety performance of electronic health records (EHRs) in hospitals from 2009 to 2018. The Leapfrog Health IT Safety Measure test was administered by the Leapfrog Group from July 2018 to December 1, 2019. Overall mean performance scores increased from 53.9% in 2009 to 65.6% in 2018. Mean hospital scores for categories representing basic clinical decision support increased from 69.8% in 2009 to 85.6% in 2018. Advanced decision clinical support also increased from 29.5% in 2009 to 46.1%. These results showed great improvement, but there is still substantial safety risk in current hospital EHR systems.
AHRQ-funded; HS023696.
Citation: Classen DC, Holmgren AJ, Co Z .
National trends in the safety performance of electronic health record systems from 2009 to 2018.
JAMA Netw Open 2020 May;3(5):e205547. doi: 10.1001/jamanetworkopen.2020.5547..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Patient Safety, Quality Measures, Clinical Decision Support (CDS), Quality Indicators (QIs)
Carayon P, Hoonakker P, Hundt AS
Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study.
This study used a scenario-based simulation to compare a human factor (HF)-based clinician decision support (CDS) with a web-based CDS (MDCalc) for clinicians to diagnose pulmonary embolism (PE) in the emergency department. A total of 32 emergency physicians participated using both CDS types. Emergency physicians made more appropriate diagnoses decisions with the PE-Dx CDS (94%) than with the web-based CDS (84%). Experimental tasks were also performed faster (average 96 seconds per scenario versus 117 seconds). They also reported lower workload and higher satisfaction with the HF-based CDS.
AHRQ-funded; HS024342; HS024558; HS022086.
Citation: Carayon P, Hoonakker P, Hundt AS .
Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study.
BMJ Qual Saf 2020 Apr;29(4):329-40. doi: 10.1136/bmjqs-2019-009857..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT), Diagnostic Safety and Quality, Emergency Department
Meyer AND, Giardina TD, Spitzmueller C
Patient perspectives on the usefulness of an artificial intelligence-assisted symptom checker: cross-sectional survey study.
This study examined patients’ experiences using an artificial intelligence (AI)-assisted online symptom checker and their doctors’ reactions to that use. From March 2 through March 15, 2018 an online survey was conducted of US users of the Isabel Symptom Checker within 6 months of their use. The majority of users were women, white, and had a mean age of 48. Overall, patients had a positive experience with the symptom checker and felt they would use it again (91.4%). About 48% discussed the findings with their physician and felt about 40% of their physicians were interested. Patients who had previously experienced diagnostic errors were more likely to use the symptom checker to determine if they should seek care.
AHRQ-funded; HS025474; HS027363.
Citation: Meyer AND, Giardina TD, Spitzmueller C .
Patient perspectives on the usefulness of an artificial intelligence-assisted symptom checker: cross-sectional survey study.
J Med Internet Res 2020 Jan 30;22(1):e14679. doi: 10.2196/14679..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Diagnostic Safety and Quality, Patient Safety
Holmgren AJ, Co Z, Newmark L
Assessing the safety of electronic health records: a national longitudinal study of medication-related decision support.
The authors tested how well EHRs prevented medication errors with the potential for patient harm. Data from a national, longitudinal sample of 1527 hospitals in the US from 2009-16 who took a safety performance assessment test using simulated medication orders was used. The authors found that hospital medication order safety performance improved over time. They conclude that intentional quality improvement efforts appear to be a critical part of high safety performance and may indicate the importance of a culture of safety.
AHRQ-funded; HS023696.
Citation: Holmgren AJ, Co Z, Newmark L .
Assessing the safety of electronic health records: a national longitudinal study of medication-related decision support.
BMJ Qual Saf 2020 Jan;29(1):52-59. doi: 10.1136/bmjqs-2019-009609..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Medication, Electronic Prescribing (E-Prescribing), Medication: Safety, Clinical Decision Support (CDS), Shared Decision Making
Barnes DE, Zhou J, Walker RL
Development and validation of eRADAR: a tool using EHR Data to detect unrecognized dementia.
The goal of this retrospective cohort study was to develop and validate an electronic health record (EHR)-based tool to help detect patients with unrecognized dementia. The tool was named EHR Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR). This study was conducted at Kaiser Permanente Washington (KPWA) using participants in the Adult Changes in Thought (ACT) study who undergo comprehensive testing every 2 years to detect and diagnose dementia and have linked KPWA EHR data. Overall, 1015 ACT visits resulted in a diagnosis of incident dementia, of which 49% were previously unrecognized in the EHR. The final 31-predictor model included markers of dementia-related symptoms, healthcare utilization patterns, and dementia risk factors. The study showed good discrimination in the development interval and validation samples.
AHRQ-funded; HS022982.
Citation: Barnes DE, Zhou J, Walker RL .
Development and validation of eRADAR: a tool using EHR Data to detect unrecognized dementia.
J Am Geriatr Soc 2020 Jan;68(1):103-11. doi: 10.1111/jgs.16182..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Dementia, Neurological Disorders, Diagnostic Safety and Quality, Clinical Decision Support (CDS), Shared Decision Making
Wissel BD, Greiner TA, Holland-Bouley KD
Prospective validation of a machine learning model that uses provider notes to identify candidates for resective epilepsy surgery.
Delay to resective epilepsy surgery results in avoidable disease burden and increased risk of mortality. The objective of this study was to prospectively validate a natural language processing (NLP) application that uses provider notes to assign epilepsy surgery candidacy scores. The authors suggest that an electronic health record-integrated NLP application can accurately assign surgical candidacy scores to patients in a clinical setting.
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner TA, Holland-Bouley KD .
Prospective validation of a machine learning model that uses provider notes to identify candidates for resective epilepsy surgery.
Epilepsia 2020 Jan;61(1):39-48. doi: 10.1111/epi.16398..
Keywords: Neurological Disorders, Surgery, Health Information Technology (HIT), Clinical Decision Support (CDS), Shared Decision Making
Lomotan EA, Meadows G, Michaels M
AHRQ Author: Lomotan EA
To share is human! Advancing evidence into practice through a national repository of interoperable clinical decision support.
The purpose of this study was to describe how a national repository of clinical decision support (CDS) can serve as a public resource for healthcare systems, academic researchers, and informaticists seeking to share and reuse CDS knowledge resources. AHRQ’s CDS Connect has provided a functional platform where CDS developers are actively sharing their work. CDS sharing may lead to improved implementation efficiency through numerous pathways, and further research is ongoing to quantify efficiencies gained.
AHRQ-authored; AHRQ-funded; 290201600001U; 233201500022I.
Citation: Lomotan EA, Meadows G, Michaels M .
To share is human! Advancing evidence into practice through a national repository of interoperable clinical decision support.
Appl Clin Inform 2020 Jan;11(1):112-21. doi: 10.1055/s-0040-1701253..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Patient-Centered Outcomes Research, Evidence-Based Practice, Registries, Health Information Technology (HIT)