National Healthcare Quality and Disparities Report
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Topics
- Ambulatory Care and Surgery (1)
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- Community-Based Practice (1)
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- (-) Electronic Health Records (EHRs) (21)
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- Practice Patterns (1)
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- Quality Improvement (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (2)
- Research Methodologies (5)
- Respiratory Conditions (1)
- Sex Factors (1)
- Surgery (1)
- Training (1)
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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 21 of 21 Research Studies DisplayedHuo T, Glueck DH, Shenkman EA
Stratified split sampling of electronic health records
Data extracted from electronic health records may require very different approaches for model building and analysis than data from clinical research. Because electronic health record data is designed for clinical use, researchers need to engage in the iterative process of defining and provide clear definitions of outcome and predictor variables and assessing associations. This process can increase Type I error rates and decrease the chance of replicability. Failure to consider subgroups may mask heterogeneous relationships between predictor and outcome by subgroups, thus decreasing the generalizability of the findings. To improve the likelihood of both replicability and generalizability, the researchers recommended utilizing a stratified split sample approach for studies using electronic health records. The researchers illustrate the approach through an electronic health record study of the relationships between socio-demographic factors and uptake of hepatic cancer screening, and potential heterogeneity of association in subgroups defined by gender, self-identified race and ethnicity, census-tract level poverty and insurance type.
AHRQ-funded; HS028283.
Citation: Huo T, Glueck DH, Shenkman EA .
Stratified split sampling of electronic health records
BMC Med Res Methodol 2023 May 25; 23(1):128. doi: 10.1186/s12874-023-01938-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, Health Services Research (HSR)
Rodriguez PJ, Ward ZJ, Long MW
Applied methods for estimating transition probabilities from electronic health record data.
This study examined the usefulness of electronic health records (EHRs) in estimating transition probabilities for state-transition models. No guidelines exist on appropriate methods. The authors used 3 potential methods to estimate transition probabilities for EHR data, using pediatric eating disorders (EDs) as a case study. They mapped diagnoses to 3 ED health states: anorexia nervous, bulimia nervosa, and other specified feeding or eating disorder using data from PEDsnet, which includes 8 US children’s hospitals. They used 3 approaches: simple first-last proportions, a multistate Markov (MSM) model, and independent survival models. The first-last proportion approach estimated higher probabilities of remaining the same health state, while the other two approaches estimated higher probabilities of transitioning to a different health state. Published literature differed substantially from these estimates. Further research is needed to improve methods for using EHR data to inform transition probabilities.
AHRQ-funded; HS013853.
Citation: Rodriguez PJ, Ward ZJ, Long MW .
Applied methods for estimating transition probabilities from electronic health record data.
Med Decis Making 2021 Feb;41(2):143-52. doi: 10.1177/0272989x20985752..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Research Methodologies
Thompson HM
Stakeholder experiences with gender identity data capture in electronic health records: implementation effectiveness and a visibility paradox.
Advocates have endorsed transgender visibility via gender identity (GI) data capture with the advent of the Affordable Care Act and electronic health record (EHR) requirements. Visibility in data in order to enumerate a population contrasts with ways in which other LGBT and public health scholars have deployed these concepts. This article aims to assess the effectiveness of GI data capture in EHRs and implications for trans health care quality improvements and research.
AHRQ-funded; HS026385.
Citation: Thompson HM .
Stakeholder experiences with gender identity data capture in electronic health records: implementation effectiveness and a visibility paradox.
Health Educ Behav 2021 Feb;48(1):93-101. doi: 10.1177/1090198120963102.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Vulnerable Populations, Sex Factors
Heintzman J, Marino M, Clark K
Using electronic health record data to study Latino immigrant populations in health services research.
The purpose of this study was to validate an electronic health record (EHR)-based algorithm that could serve as a safe proxy for self-reported immigration status for health services researchers. Researchers developed an EHR algorithm to classify a population of patients as likely undocumented or recent Latino immigrants and validated this algorithm by conducting semi-structured interviews of staff. They concluded that the EHR has potential for studying immigration status in health services research, although more study is needed to determine the accuracy and utility of EHRs for this purpose.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Clark K .
Using electronic health record data to study Latino immigrant populations in health services research.
J Immigr Minor Health 2020 Aug;22(4):754-61. doi: 10.1007/s10903-019-00925-2..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Health Services Research (HSR)
Di Tosto G, McAlearney AS, Fareed N
Metrics for outpatient portal use based on log file analysis: algorithm development.
This study’s goal was to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. The authors developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. They found that function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. They hope to promote the replicability of their study at other institutions and to contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.
AHRQ-funded; HS024091; HS024349; HS024379.
Citation: Di Tosto G, McAlearney AS, Fareed N .
Metrics for outpatient portal use based on log file analysis: algorithm development.
J Med Internet Res 2020 Jun 12;22(6):e16849. doi: 10.2196/16849..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Health Services Research (HSR), Research Methodologies
Weng Y, Tian L, Tedesco D
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Postoperative pain scores are widely monitored and collected in the electronic health record, yet current methods fail to fully leverage the data with fast implementation. This article describes a trajectory analysis for postoperative pain using electronic health records. A robust linear regression was fitted to describe the association between the log-scaled pain score and time from discharge after total knee replacement.
AHRQ-funded; HS024096.
Citation: Weng Y, Tian L, Tedesco D .
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Health Informatics J 2020 Jun;26(2):1404-18. doi: 10.1177/1460458219881339..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Pain, Surgery, Orthopedics, Research Methodologies, Health Services Research (HSR)
Adler-Milstein J, Adelman JS, Tai-Seale M
EHR audit logs: a new goldmine for health services research?
This article discusses the possible usefulness of electronic health record (EHR) audit log data to support health services research and for those studying healthcare processes and outcomes. The authors offer a framework for the potential uses in quality domains as defined by the National Academy of Medicine. The article also discusses challenges of working with audit log data.
AHRQ-funded; HS022670; HS023704; HS024538; HS019167.
Citation: Adler-Milstein J, Adelman JS, Tai-Seale M .
EHR audit logs: a new goldmine for health services research?
J Biomed Inform 2020 Jan;101:103343. doi: 10.1016/j.jbi.2019.103343..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Polubriaginof FCG, Ryan P, Salmasian H
Challenges with quality of race and ethnicity data in observational databases.
This study assessed the quality of race and ethnicity information in observational health databases as well as electronic health records (EHRs) and to propose patient self-recording as a way to improve accuracy. Data from the Healthcare Cost and Utilization Project (HCUP) and Optum Labs, and from a single New York City healthcare system’s EHR was compared. Among 160 million patients in the HCUP database, no race or ethnicity data was recorded for 25% of the records. Among the 2.4 million patients in the New York City HER, race or ethnicity was unknown for 57%. However, when patients were allowed to directly record their race and ethnicity, percentages rose to 86%.
AHRQ-funded; HS021816; HS023704; HS024713.
Citation: Polubriaginof FCG, Ryan P, Salmasian H .
Challenges with quality of race and ethnicity data in observational databases.
J Am Med Inform Assoc 2019 Aug;26(8-9):730-36. doi: 10.1093/jamia/ocz113..
Keywords: Healthcare Cost and Utilization Project (HCUP), Data, Racial and Ethnic Minorities, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Althoff KN, Wong C, Hogan B
Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data.
Under the hypothesis that use of electronic health records in health research may lead to false assumptions of complete event ascertainment, the authors of this article estimated "observation windows" (OWs) as a quality-control approach to reduce the likelihood of false assumption. The impact of OWs on estimating rates of type II diabetes mellitus from HIV clinical cohorts are demonstrated. Data from 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence. The authors conclude that OWs have utility as a quality-control approach to complete event ascertainment and help to improve the accuracy of estimates.
AHRQ-funded; 90047713.
Citation: Althoff KN, Wong C, Hogan B .
Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data.
Ann Epidemiol 2019 May;33:54-63. doi: 10.1016/j.annepidem.2019.01.015..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Quality of Care
Vemulakonda VM, Bush RA, Kahn MG
"Minimally invasive research?" Use of the electronic health record to facilitate research in pediatric urology.
This literature study examined the use of electronic health records (EHRs) to facilitate research in pediatric urology. The use of EHRs has been strongly encouraged by US federal agencies, including AHRQ. The researchers found that EHR use for research has strengths and weaknesses and more collaboration is needed to identify the method that best suits incorporation of research-oriented data collection into routine pediatric urologic clinical practice.
AHRQ-funded; HS024597; HS022404.
Citation: Vemulakonda VM, Bush RA, Kahn MG .
"Minimally invasive research?" Use of the electronic health record to facilitate research in pediatric urology.
J Pediatr Urol 2018 Oct;14(5):374-81. doi: 10.1016/j.jpurol.2018.04.033..
Keywords: Electronic Health Records (EHRs), Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Research Methodologies
Marino M, Angier H, Valenzuela S
Medicaid coverage accuracy in electronic health records.
The objective of the study was to evaluate the validity of electronic health record (EHR) data for monitoring longitudinal Medicaid coverage and assess variation by patient demographics, visit types, and clinic characteristics. The researchers conducted a retrospective, observational study comparing Medicaid status agreement between Oregon community health center EHR data linked at the patient-level to Medicaid enrollment data (gold standard).
AHRQ-funded; HS024270.
Citation: Marino M, Angier H, Valenzuela S .
Medicaid coverage accuracy in electronic health records.
Prev Med Rep 2018 Sep;11:297-304. doi: 10.1016/j.pmedr.2018.07.009..
Keywords: Electronic Health Records (EHRs), Health Insurance, Health Services Research (HSR), Medicaid, Policy
Walker DM, Hefner JL, Sieck CJ
Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective.
Inpatient portals are emerging as an important tool to support patient care and are increasingly being adopted in hospitals. However, best practices concerning the implementation, use, and impact of these portals are poorly understood. To improve evaluation and implementation efforts, this paper develops a logic model that can help researchers and hospital managers in deploying and assessing the impact of inpatient portals.
AHRQ-funded; HS024349; HS024091.
Citation: Walker DM, Hefner JL, Sieck CJ .
Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective.
J Med Syst 2018 Jul 16;42(9):158. doi: 10.1007/s10916-018-1009-3..
Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Hospitals, Web-Based
Sarkhel R, Socha JJ, Mount-Campbell A
HOW nurses identify hospitalized patients on their personal notes: findings from analyzing 'brains' headers with multiple raters.
Many nurses use handwritten notes in order to avoid using electronic health records to access information about patients. At the top of these notes are patient identifiers. By identifying aspects of good and suboptimal headers, the authors began to form a model of how to effectively support identifying patients during assessments and care activities. The primary finding was that nurses use room number as the primary patient identifier in the hospital setting, not the patient's last name.
AHRQ-funded; HS024379.
Citation: Sarkhel R, Socha JJ, Mount-Campbell A .
HOW nurses identify hospitalized patients on their personal notes: findings from analyzing 'brains' headers with multiple raters.
Proc Int Symp Hum Factors Ergon Healthc 2018 Jun;7(1):205-09. doi: 10.1177/2327857918071045..
Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Inpatient Care, Nursing
Mohan V, Scholl G, Gold JA
Use of EHR-based simulation to diagnose aetiology of information gathering issues in struggling learners: a proof of concept study.
The researchers previously documented that high-fidelity EHR-based simulation improves EHR usability and, when combined with eye and screen tracking, generates important measures of usability. They hypothesised that the same simulation exercise could help distinguish whether learners had difficulty in knowledge, information gathering or information processing. In this paper, they report the results of the first three struggling learners who participated in this exercise.
AHRQ-funded; HS023793; HS021637.
Citation: Mohan V, Scholl G, Gold JA .
Use of EHR-based simulation to diagnose aetiology of information gathering issues in struggling learners: a proof of concept study.
BMJ Simul Technol Enhanc Learn 2018 Apr;4(2):92-94. doi: 10.1136/bmjstel-2017-000217.
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Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Services Research (HSR), Training
Murphy DR, Meyer A AND, Vaghani V
Development and validation of trigger algorithms to identify delays in diagnostic evaluation of gastroenterological cancer.
This study’s authors developed, refined, and tested trigger algorithms that identify patients with delayed follow-up evaluation of findings suspicious of colorectal cancer (CRC) or hepatocellular cancer (HCC). Using data from the Veterans Affairs electronic health record database, the researchers developed an algorithm that greatly reduces the number of record reviews necessary to identify delays in follow-up evaluations for patients with suspected CRC or HCC.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer A AND, Vaghani V .
Development and validation of trigger algorithms to identify delays in diagnostic evaluation of gastroenterological cancer.
Clin Gastroenterol Hepatol 2018 Jan;16(1):90-98. doi: 10.1016/j.cgh.2017.08.007..
Keywords: Cancer, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Services Research (HSR)
Murphy DR, Meyer A AND, Vaghani V
Development and validation of trigger algorithms to identify delays in diagnostic evaluation of gastroenterological cancer.
This study’s authors developed, refined, and tested trigger algorithms that identify patients with delayed follow-up evaluation of findings suspicious of colorectal cancer (CRC) or hepatocellular cancer (HCC). Using data from the Veterans Affairs electronic health record database, the researchers developed an algorithm that greatly reduces the number of record reviews necessary to identify delays in follow-up evaluations for patients with suspected CRC or HCC.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer A AND, Vaghani V .
Development and validation of trigger algorithms to identify delays in diagnostic evaluation of gastroenterological cancer.
Clin Gastroenterol Hepatol 2018 Jan;16(1):90-98. doi: 10.1016/j.cgh.2017.08.007..
Keywords: Cancer, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Services Research (HSR)
Senathirajah Y, Wang J, Borycki E
Mapping the electronic health record: a method to study display fragmentation.
Electronic health records have often been criticized for poor interaction design. The authors describe a method for evaluating and depicting the extent of display fragmentation and discuss its potential uses in comparing systems, identifying navigation pathways and information juxtaposition, and improving EHR interaction design.
AHRQ-funded; HS023708.
Citation: Senathirajah Y, Wang J, Borycki E .
Mapping the electronic health record: a method to study display fragmentation.
Stud Health Technol Inform 2017;245:1138-42.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Ratwani R
Electronic health records and improved patient care: opportunities for applied psychology.
There have been numerous challenges that have been largely centered on the technology not meeting the cognitive needs of the clinical end-users. There is a significant opportunity for applied psychologists to address many of these challenges. The author highlights three key areas: studying and modeling clinician needs, applying theoretically grounded design principles, and developing technology to support teamwork and communication.
AHRQ-funded; HS023701.
Citation: Ratwani R .
Electronic health records and improved patient care: opportunities for applied psychology.
Curr Dir Psychol Sci 2017 Aug;26(4):359-65. doi: 10.1177/0963721417700691.
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Keywords: Electronic Health Records (EHRs), Behavioral Health, Health Services Research (HSR)
Russo E, Sittig DF, Murphy DR
Challenges in patient safety improvement research in the era of electronic health records.
The researchers used a case study involving a project on missed or delayed follow-up of test results to discuss real-world challenges in using electronic health records data for patient safety research. They suggested that many current data access and security policies and procedures must be rewritten and standardized across health care organization sin order to advance progress toward safer health care.
AHRQ-funded; HS022901.
Citation: Russo E, Sittig DF, Murphy DR .
Challenges in patient safety improvement research in the era of electronic health records.
Healthc 2016 Dec;4(4):285-90. doi: 10.1016/j.hjdsi.2016.06.005.
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Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Health Information Technology (HIT), Patient Safety, Quality Improvement
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
Wittie M, Ngo-Metzger Q, Lebrun-Harris L
AHRQ Author: Ngo-Metzger Q
Enabling quality: electronic health record adoption and meaningful use readiness in federally funded health centers.
This study analyzed cross-sectional data from all 1,128 health centers in 2011, which served over 20 million patients during that year. As of 2011, 80 percent of health centers reported using an electronic health record (EHR), and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic composition, physician staffing, or health center funding.
AHRQ-authored.
Citation: Wittie M, Ngo-Metzger Q, Lebrun-Harris L .
Enabling quality: electronic health record adoption and meaningful use readiness in federally funded health centers.
J Healthc Qual 2016 Jan-Feb;38(1):42-51. doi: 10.1111/jhq.12067.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Community-Based Practice, Health Services Research (HSR)