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Topics
- Cardiovascular Conditions (2)
- Caregiving (1)
- Clinical Decision Support (CDS) (2)
- Clinician-Patient Communication (1)
- Communication (1)
- Comparative Effectiveness (1)
- COVID-19 (1)
- Diagnostic Safety and Quality (2)
- Electronic Health Records (EHRs) (6)
- (-) Emergency Department (14)
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- (-) Health Information Technology (HIT) (14)
- Heart Disease and Health (1)
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- Implementation (1)
- Newborns/Infants (1)
- Patient-Centered Healthcare (1)
- Patient and Family Engagement (1)
- Patient Safety (2)
- Payment (1)
- Policy (1)
- Provider: Physician (1)
- Risk (1)
- Rural Health (1)
- Sepsis (2)
- Shared Decision Making (2)
- Stroke (1)
- Telehealth (5)
- Workflow (2)
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 14 of 14 Research Studies DisplayedPruitt ZM, Howe JL, Hettinger AZ
Emergency physician perceptions of electronic health record usability and safety.
Investigators sought to identify emergency physicians' perceived electronic health record (EHR) usability and safety strengths and shortcomings across major EHR vendor products. They found that the 3 most commonly discussed usability topics were Workflow Support (shortcoming), Visual Display (strength), and Data Entry. Fourteen cross-hospital/cross-vendor themes, 6 vendor-specific themes, and 4 hospital-specific themes emerged as well.
AHRQ-funded; HS025136.
Citation: Pruitt ZM, Howe JL, Hettinger AZ .
Emergency physician perceptions of electronic health record usability and safety.
J Patient Saf 2021 Dec 1;17(8):e983-e87. doi: 10.1097/pts.0000000000000849..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Hayden EM, Davis C, Clark S
Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in emergency medicine (EM) and telehealth created a research agenda to explore how EM should intersect with telehealth. The multiyear process resulted in consensus with a final set of 24 important research questions. The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. The consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps.
AHRQ-funded; HS027528.
Citation: Hayden EM, Davis C, Clark S .
Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
Acad Emerg Med 2021 Dec;28(12):1452-74. doi: 10.1111/acem.14330..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, COVID-19
Chartash D, Sharifi M, Emerson B
Documentation of shared decisionmaking in the emergency department.
Patient-centered communication and shared decision making is a vital element of clinical practice, but little is known about its impact or value in the emergency department (ED) setting. The researchers of this study developed a natural language processing tool using regular expressions to identify shared decision making, patient-centered communications, and to describe visit-, site-, and temporal-level patterns within a large health system. The study took place in two parts: part 1 was the development and validation of the natural language processing tool, and part 2 was a retrospective analysis of shared decision making and patient discussion using the processing tool to assess ED physician and advanced practitioner documentation from 2013 to 2020. Compared to chart review of 600 ED notes, the accuracy rates of the natural language processing tool were 96.7% and 88.9% respectively. Between 2013 to 2020 the researchers observed greater likelihood of shared decision-making documentation among physicians vs advanced practice providers, higher likelihood among female vs male patients, and lower likelihood of shared decision-making in Black patients compared with White patients. The researchers also found that patient discussion and shared decision-making were associated with higher levels of commercial insurance status and level of triage. The study concluded that a natural language processing tool was developed, validated, and utilized to identify incidences of shared decision making from ED documentation, with the researchers finding multiple possible factors which contribute to variation in shared decision making.
AHRQ-funded; HS025701.
Citation: Chartash D, Sharifi M, Emerson B .
Documentation of shared decisionmaking in the emergency department.
Ann Emerg Med 2021 Nov;78(5):637-49. doi: 10.1016/j.annemergmed.2021.04.038..
Keywords: Shared Decision Making, Emergency Department, Patient-Centered Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Salwei ME, Carayon P, Hoonakker PLT
Workflow integration analysis of a human factors-based clinical decision support in the emergency department.
Numerous challenges with the implementation, acceptance, and use of health IT are related to poor usability and a lack of integration of the technologies into clinical workflow, and have, therefore, limited the potential of these technologies to improve patient safety. In this paper, the investigators propose a definition and conceptual model of health IT workflow integration. Using interviews of 12 emergency department (ED) physicians, they identified 134 excerpts of barriers and facilitators to workflow integration of a human factors (HF)-based clinical decision support (CDS) implemented in the ED.
AHRQ-funded; HS022086.
Citation: Salwei ME, Carayon P, Hoonakker PLT .
Workflow integration analysis of a human factors-based clinical decision support in the emergency department.
Appl Ergon 2021 Nov;97:103498. doi: 10.1016/j.apergo.2021.103498..
Keywords: Emergency Department, Workflow, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation
Mohr NM, Campbell KD, Swanson MB
Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments.
Sepsis is a life-threatening emergency. Together, early recognition and intervention decreases mortality. Protocol-based resuscitation in the emergency department (ED) has improved survival in sepsis patients, but guideline-adherent care is less common in low-volume EDs. This study examined the association between provider-to-provider telemedicine and adherence with sepsis bundle components in rural community hospitals. The investigators found that telemedicine patients were more likely to receive initial blood lactate measurement, timely broad-spectrum antibiotics, and adequate fluid resuscitation.
AHRQ-funded; HS025753.
Citation: Mohr NM, Campbell KD, Swanson MB .
Provider-to-provider telemedicine improves adherence to sepsis bundle care in community emergency departments.
J Telemed Telecare 2021 Sep;27(8):518-26. doi: 10.1177/1357633x19896667..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Sepsis
Soares WE, Knee A, Gemme SR
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
The HEART score is a risk stratification aid that may safely reduce chest pain admissions for emergency department patients. However, differences in interpretation of subjective components potentially alters the performance of the score. In this study, the investigators compared agreement between HEART scores determined during clinical practice with research-generated scores and estimated their accuracy in predicting 30-day major adverse cardiac events.
AHRQ-funded; HS024815.
Citation: Soares WE, Knee A, Gemme SR .
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
Ann Emerg Med 2021 Aug;78(2):231-41. doi: 10.1016/j.annemergmed.2021.03.024..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Emergency Department, Diagnostic Safety and Quality, Clinical Decision Support (CDS), Health Information Technology (HIT)
Swanson MB, Miller AC, Ward MM MM
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
Telemedicine can improve access to emergency stroke care in rural areas, but the benefit of telemedicine across different types and models of telemedicine networks is unknown. The objectives of this study were to (1) identify the impact of telemedicine on ED stroke care, (2) identify if telemedicine impact varied by network, and (3) describe the variation in process outcomes by telemedicine across EDs.
AHRQ-funded; HS025753.
Citation: Swanson MB, Miller AC, Ward MM MM .
Emergency department telemedicine consults decrease time to interpret computed tomography of the head in a multi-network cohort.
J Telemed Telecare 2021 Jul;27(6):343-52. doi: 10.1177/1357633x19877746..
Keywords: Emergency Department, Telehealth, Health Information Technology (HIT), Imaging, Stroke, Cardiovascular Conditions
Wang X, Blumenthal HJ, Hoffman D
Modeling patient-related workload in the emergency department using electronic health record data.
Understanding and managing clinician workload is important for clinician (nurses, physicians and advanced practice providers) occupational health as well as patient safety. Efforts have been made to develop strategies for managing clinician workload by improving patient assignment. The goal of the current study was to use electronic health record (EHR) data to predict the amount of work that individual patients contributed to clinician workload (patient-related workload).
AHRQ-funded; HS022542.
Citation: Wang X, Blumenthal HJ, Hoffman D .
Modeling patient-related workload in the emergency department using electronic health record data.
Int J Med Inform 2021 Jun;150:104451. doi: 10.1016/j.ijmedinf.2021.104451..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Enayati M, Sir M, Zhang X
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
This study’s objective will be to identify variables associated with diagnostic errors in emergency departments using large-scale EHR data and machine learning techniques. It will use trigger algorithms with electronic health record (EHR) data repositories to generate a large data set of records that are labeled trigger-positive or trigger-negative, depending on if they meet certain criteria. This study will be conducted by 2 academic medical centers with affiliated community hospitals.
AHRQ-funded; HS027363; HS026622.
Citation: Enayati M, Sir M, Zhang X .
Monitoring diagnostic safety risks in emergency departments: protocol for a machine learning study.
JMIR Res Protoc 2021 Jun 14;10(6):e24642. doi: 10.2196/24642..
Keywords: Emergency Department, Diagnostic Safety and Quality, Patient Safety, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Korach ZT, Gradwohl S, Messinger A
Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.
Investigators compared knowledge-based and unsupervised statistical methods for ranking electronic health record (EHR) information by relevancy to a chief complaint of chest or back pain among emergency department patients. They found that a fully unsupervised statistical method can provide a reasonably accurate, low-effort, and scalable means for situation-specific ranking of clinical information within the EHR.
AHRQ-funded; HS024541.
Citation: Korach ZT, Gradwohl S, Messinger A .
Unsupervised clinical relevancy ranking of structured medical records to retrieve condition-specific information in the emergency department.
Int J Med Inform 2021 May;149:104410. doi: 10.1016/j.ijmedinf.2021.104410.
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Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT)
Zachrison KS, Boggs KM, Cash RE
Are state telemedicine parity laws associated with greater use of telemedicine in the emergency department?
Telemedicine is a valuable tool to improve access to specialty care in emergency departments (EDs), and states have passed telemedicine parity laws requiring insurers to reimburse for telemedicine visits. The objective of this study was to determine if there was an association between such laws and the use of telemedicine in an ED. The investigators concluded that telemedicine parity laws were not associated with use of telemedicine in the ED.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Boggs KM, Cash RE .
Are state telemedicine parity laws associated with greater use of telemedicine in the emergency department?
J Am Coll Emerg Physicians Open 2021 Feb;2(1):e212359. doi: 10.1002/emp2.12359..
Keywords: Telehealth, Emergency Department, Health Information Technology (HIT), Policy, Payment
Mohr NM, Harland KK, Okoro UE
TELEmedicine as an Intervention for Sepsis in Emergency Departments: a multicenter, comparative effectiveness study (TELEvISED Study).
Sepsis is a life-threatening infection that affects over 1.7 million Americans annually. Low-volume rural hospitals have worse sepsis outcomes, and emergency department (ED)-based telemedicine (tele-ED) has been one promising strategy for improving rural sepsis care. The objective of this study was to evaluate the impact of tele-ED consultation on sepsis care and outcomes in rural ED patients.
AHRQ-funded; HS025753.
Citation: Mohr NM, Harland KK, Okoro UE .
TELEmedicine as an Intervention for Sepsis in Emergency Departments: a multicenter, comparative effectiveness study (TELEvISED Study).
J Comp Eff Res 2021 Feb;10(2):77-91. doi: 10.2217/cer-2020-0141..
Keywords: Sepsis, Telehealth, Health Information Technology (HIT), Emergency Department, Comparative Effectiveness, Evidence-Based Practice, Rural Health, Healthcare Delivery
Aronson PL, Politi MC, Schaeffer P
Development of an app to facilitate communication and shared decision-making with parents of febrile infants ≤ 60 days old.
This study’s aim was to develop and test a tool to engage parents of febrile infants 60 days or less of age evaluated in the emergency department (ED). The tool was designed to improve communication between parents and healthcare providers and to support shared decision-making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age. The authors conducted a multi-phase development and testing process including individual, semi-structured interviews with parents and clinicians; design of a “storyboard” of the tool with design impression testing; development of a software application prototype called e-Care; and usability testing of e-Care using qualitative assessment and the System Usability Scale (SUS). The authors interviewed 27 parents and 23 clinicians. After the interviews, they developed separate versions of e-Care for infants aged 28 days or less and 29 to 60 days of age in both English and Spanish. e-Care is divided into 4 sections: 1) homepage; 2) why testing is done; 3) what tests are done; and 4) what happens after testing. The mean SUS score given by parents and clinicians was 90.3 representing “excellent” usability.
AHRQ-funded; HS026006.
Citation: Aronson PL, Politi MC, Schaeffer P .
Development of an app to facilitate communication and shared decision-making with parents of febrile infants ≤ 60 days old.
Acad Emerg Med 2021 Jan;28(1):46-59. doi: 10.1111/acem.14082..
Keywords: Clinician-Patient Communication, Communication, Newborns/Infants, Caregiving, Shared Decision Making, Patient and Family Engagement, Emergency Department, Health Information Technology (HIT)
Patel VL, Denton CA, Soni HC
Physician workflow in two distinctive emergency departments: an observational study.
In this study, the investigators characterized physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) were explored within the context of organizational complexity for the delivery of care. The investigators concluded that 1.) the nature of the clinical practice and EHR-mediated workflow reflected the ED work practices; 2.) physicians in more complex organizations may be less efficient because of the fragmented workflow- however these effects could be mitigated by effort distribution through team communication, which affords inherent safety checks.
AHRQ-funded; HS022670.
Citation: Patel VL, Denton CA, Soni HC .
Physician workflow in two distinctive emergency departments: an observational study.
Appl Clin Inform 2021 Jan;12(1):141-52. doi: 10.1055/s-0040-1722615..
Keywords: Emergency Department, Workflow, Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT)