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
1 to 25 of 40 Research Studies DisplayedCampione JR, Mardon RE, McDonald KM
Patient safety culture, health information technology implementation, and medical office problems that could lead to diagnostic error.
Researchers investigated the relationship between patient safety culture, health information technology (IT) implementation, and the frequency of problems that could lead to diagnostic errors in the medical office setting. Using survey data from the 2012 Agency for Healthcare Research and Quality Medical Office Surveys on Patient Safety Culture database, they found that the most frequent problem was "results from a lab or imaging test were not available when needed," with 15% of respondents reporting that it happened daily or weekly. Higher overall culture scores were significantly associated with fewer occurrences of each problem assessed, and offices in the process of health IT implementation had higher frequency of problems.
AHRQ-funded; 290201200003I.
Citation: Campione JR, Mardon RE, McDonald KM .
Patient safety culture, health information technology implementation, and medical office problems that could lead to diagnostic error.
J Patient Saf 2019 Dec;15(4):267-73. doi: 10.1097/pts.0000000000000531..
Keywords: Surveys on Patient Safety Culture, Health Information Technology (HIT), Diagnostic Safety and Quality, Patient Safety, Ambulatory Care and Surgery
Chan B, Hulen E, Edwards S
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
AHRQ-funded; HS022981.
Citation: Chan B, Hulen E, Edwards S .
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
Ann Fam Med 2019 Nov;17(6):495-501. doi: 10.1370/afm.2464..
Keywords: Primary Care, Primary Care: Models of Care, Ambulatory Care and Surgery, Vulnerable Populations, Patient-Centered Healthcare, Healthcare Delivery
Paredes AZ, Malik AT, Cluse M
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Emergency general surgery can have a profound impact on the functional status of even previously independent patients. In this study, the investigators examined the role and influence of discharging a patient to a skilled nursing facility. They concluded that after accounting for patient severity and perioperative course, discharge to a skilled nursing facility was an independent risk factor for death, readmission, and postdischarge complications.
AHRQ-funded; HS022694.
Citation: Paredes AZ, Malik AT, Cluse M .
Discharge disposition to skilled nursing facility after emergent general surgery predicts a poor prognosis.
Surgery 2019 Oct;166(4):489-95. doi: 10.1016/j.surg.2019.04.034..
Keywords: Nursing Homes, Hospital Discharge, Elderly, Ambulatory Care and Surgery, Emergency Department, Outcomes, Hospital Readmissions, Outcomes, Risk
Howard SD, Lee KL, Nathan AG
Healthcare experiences of transgender people of color.
Researchers investigated how transgender people of color (TPOC) healthcare experiences are shaped by both race/ethnicity and gender identity. Using interviews and focus groups with participants in the Chicago area, they found that all participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender-friendly in an effort to avoid discrimination, but feared experiencing racism there. When describing positive healthcare experiences, participants were most likely to highlight providers' respect for their gender identity. The researchers concluded that TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities and recommended that providers improve understanding of intersectional experiences of TPOC to improve quality of care.
AHRQ-funded; HS023050.
Citation: Howard SD, Lee KL, Nathan AG .
Healthcare experiences of transgender people of color.
J Gen Intern Med 2019 Oct;34(10):2068-74. doi: 10.1007/s11606-019-05179-0..
Keywords: Patient Experience, Vulnerable Populations, Cultural Competence, Racial and Ethnic Minorities, Primary Care, Ambulatory Care and Surgery
Holderness H, Angier H, Huguet N
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
The purpose of this study was to understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act Medicaid expansion (emergency department, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization. Results showed that most newly and returning-insured Medicaid enrollees sought primary care rather than emergency department services and most became established with primary care, suggesting that both insurance and primary care continuity play a role in where patients seek health care services.
AHRQ-funded; HS024270.
Citation: Holderness H, Angier H, Huguet N .
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
Med Care 2019 Oct;57(10):788-94. doi: 10.1097/mlr.0000000000001189..
Keywords: Access to Care, Ambulatory Care and Surgery, Health Insurance, Healthcare Utilization, Medicaid, Policy
McKernan LC, Lenert MC, Crofford LJ
Outpatient engagement and predicted risk of suicide attempts in fibromyalgia.
Patients with fibromyalgia (FM) are 10 times more likely to die by suicide than the general population. The purpose of this study was to externally validate published models predicting suicidal ideation and suicide attempts in patients with FM and to identify interpretable risk and protective factors for suicidality unique to FM. This was the first study to successfully apply machine learning to reliably detect suicidality in patients with FM, identifying novel risk factors for suicidality and highlighting outpatient engagement as a protective factor against suicide.
AHRQ-funded; HS022990.
Citation: McKernan LC, Lenert MC, Crofford LJ .
Outpatient engagement and predicted risk of suicide attempts in fibromyalgia.
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Keywords: Patient and Family Engagement, Risk, Behavioral Health, Ambulatory Care and Surgery
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Emani S, Sequist TD, Lacson R
Ambulatory safety nets to reduce missed and delayed diagnoses of cancer.
An ambulatory safety net (ASN) is an innovative organizational intervention for addressing patient safety related to missed and delayed diagnoses of abnormal test results. ASNs consist of a set of tools, reports and registries, and associated work flows to create a high-reliability system for abnormal test result management. In this paper, two ASNs implemented at an academic medical center are described, one focusing on colon cancer and the other on lung cancer.
AHRQ-funded; HS024722.
Citation: Emani S, Sequist TD, Lacson R .
Ambulatory safety nets to reduce missed and delayed diagnoses of cancer.
Jt Comm J Qual Patient Saf 2019 Aug;45(8):552-57. doi: 10.1016/j.jcjq.2019.05.010.
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Keywords: Cancer, Diagnostic Safety and Quality, Cancer: Lung Cancer, Cancer: Colorectal Cancer, Ambulatory Care and Surgery
Carey K, Mitchell JM
Specialization as an organizing principle: the case of ambulatory surgery centers.
The authors conducted an empirical investigation of the relative cost of production in ambulatory surgical centers (ASCs) over varying degrees of specialization. They found that for the majority of ASCs, focus on a specialty was associated with lower facility costs and ASCs appeared to be capturing economies of scale over a broad range of service volume. The authors concluded that these results support the focused factory model of production in the ASC sector.
AHRQ-funded; HS023768.
Citation: Carey K, Mitchell JM .
Specialization as an organizing principle: the case of ambulatory surgery centers.
Med Care Res Rev 2019 Aug;76(4):386-402. doi: 10.1177/1077558717729228..
Keywords: Ambulatory Care and Surgery, Surgery, Healthcare Costs
Abara NO, Huang N, Raji MA
Effect of retail clinic use on continuity of care among Medicare beneficiaries.
Researchers examined the relationship between retail clinic use and primary care physician (PCP) continuity among Medicare enrollees in the Houston metropolitan area. They found that retail clinic use was lower in the elderly population, compared with the previously published rate in the younger populations. The lower rate of continuity of care observed among retail clinic users was an issue of concern, especially for those with chronic medical conditions.
AHRQ-funded; HS020642.
Citation: Abara NO, Huang N, Raji MA .
Effect of retail clinic use on continuity of care among Medicare beneficiaries.
J Am Board Fam Med 2019 Jul-Aug;32(4):531-38. doi: 10.3122/jabfm.2019.04.180349..
Keywords: Medicare, Transitions of Care, Ambulatory Care and Surgery, Primary Care
Feemster K, Localio R, Grundmeier R
Incidence of healthcare-associated influenza-like illness after a primary care encounter among young children.
The authors evaluated whether exposure to a pediatric clinic visit was associated with subsequent influenza-like illness (ILI) using electronic health record data. They found that pediatric clinic visits during a respiratory virus season were significantly associated with an increased incidence of subsequent ILI among children aged 2 to 6 years but not among those aged less than 2 years. They concluded that their findings support the hypothesis that respiratory virus transmission in a pediatric clinic can result in healthcare-associated ILI in young children.
AHRQ-funded; HS020939.
Citation: Feemster K, Localio R, Grundmeier R .
Incidence of healthcare-associated influenza-like illness after a primary care encounter among young children.
J Pediatric Infect Dis Soc 2019 Jul 1;8(3):191-96. doi: 10.1093/jpids/piy023..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Infectious Diseases, Influenza, Primary Care, Healthcare Delivery, Ambulatory Care and Surgery, Respiratory Conditions
Grout RW, Cheng ER, Aalsma MC
Let them speak for themselves: improving adolescent self-report rate on pre-visit screening.
This study examined the effect of an automated alert during electronic pre-visit electronic tablet screening on the adolescent self-report rate at pediatric ambulatory clinics. The goal was to increase self-reporting as opposed to parents or caregivers filling out the screening information.bAn interventional study was conducted over a 16 month period. Preintervention rates were low for adolescents, with parents or caregivers completing the pre-visit reports at a high rate. After intervention, self-reporting by younger adolescents nearly doubled and among older adolescents the stable baseline rate of 53.6% increased by 9.2 absolute percentage points.
AHRQ-funded; HS017939; HS018453; HS020640; HS022681.
Citation: Grout RW, Cheng ER, Aalsma MC .
Let them speak for themselves: improving adolescent self-report rate on pre-visit screening.
Acad Pediatr 2019 Jul;19(5):581-88. doi: 10.1016/j.acap.2019.04.010..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Communication, Clinician-Patient Communication
Huguet N, Valenzuela S, Marino M
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
The authors assessed ambulatory care use and diagnosed health conditions among a cohort of community health center (CHC) patients uninsured before enactment of the Affordable Care Act (ACA) and followed them after enactment. They found that, post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The authors concluded that a significant percentage of CHC patients remained uninsured; that many who remained uninsured had diagnosed health conditions; and that one-half continued to have three or more visits to CHCs, which continue to be essential providers for uninsured patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Valenzuela S, Marino M .
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
Ann Fam Med 2019 Jul;17(4):336-44. doi: 10.1370/afm.2385..
Keywords: Access to Care, Ambulatory Care and Surgery, Community-Based Practice, Health Insurance, Healthcare Delivery, Medicaid, Policy, Uninsured
Brummett CM, Steiger R, Englesbe M
Effect of an activated charcoal bag on disposal of unused opioids after an outpatient surgical procedure: a randomized clinical trial.
In this randomized clinical trial, researchers examined the effect of an activated charcoal bag that allows for in-home opioid disposal on the probability of disposal after a surgical procedure, compared with usual care or educational materials detailing disposal resources. They found that receiving such a bag was associated with an adjusted 3.8-fold increase in self-reported disposal among adults who underwent elective surgical procedure, compared with receiving usual care. These findings suggest that simple, low-cost interventions, such as in-home deactivation methods, could reduce the number of unused opioids available for diversion.
AHRQ-funded; HS023313.
Citation: Brummett CM, Steiger R, Englesbe M .
Effect of an activated charcoal bag on disposal of unused opioids after an outpatient surgical procedure: a randomized clinical trial.
JAMA Surg 2019 Jun;154(6):558-61. doi: 10.1001/jamasurg.2019.0155..
Keywords: Opioids, Medication, Ambulatory Care and Surgery, Surgery
Hongs S AS, Froehlich T, Clayton Hobbs S
Impact of a cancer urgent care clinic on regional emergency department visits.
In this study, the researchers investigated whether the creation of an urgent care clinic specifically for patients with cancer affected emergency department visits among adults newly diagnosed with cancer? They concluded that although only one in eight emergency department-visiting patients also used the urgent care clinic, the growth rate of emergency department visits fell by half after the urgent care clinic was established.
AHRQ-funded; HS022418.
Citation: Hongs S AS, Froehlich T, Clayton Hobbs S .
Impact of a cancer urgent care clinic on regional emergency department visits.
J Oncol Pract 2019 Jun;15(6):e501-e09. doi: 10.1200/jop.18.00743..
Keywords: Cancer, Emergency Department, Hospitalization, Healthcare Utilization, Ambulatory Care and Surgery
Links AR, Callon W, Wasserman C
Surgeon use of medical jargon with parents in the outpatient setting.
This study analyzed the use of unexplained medical jargon with parents whose children have sleep-disordered breathing and their consultations with otolaryngologists in a pediatric surgical setting. Participants (64 parents and 8 otolaryngologists) completed questionnaires that evaluated demographics, clinical features and parental role in decision-making. Unexplained medical jargon was commonly used by physicians (mean total utterances per visit = 28.9) while parents used jargon a mean of 4.3 times. Clinicians used more jargon when they felt that parents had greater involvement in decision-making or when parents used more jargon themselves. These results will be incorporated into communication training for clinicians.
AHRQ-funded; HS022932.
Citation: Links AR, Callon W, Wasserman C .
Surgeon use of medical jargon with parents in the outpatient setting.
Patient Educ Couns 2019 Jun;102(6):1111-18. doi: 10.1016/j.pec.2019.02.002..
Keywords: Ambulatory Care and Surgery, Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Shared Decision Making, Education: Patient and Caregiver, Provider, Provider: Physician
Vijay A, Rhee TG, Ross JS
U.S. prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department visits from 2006 to 2015.
This retrospective study tracked US prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department (ED) visits from 2006 to 2015. Data from the 2006-2015 National Ambulatory Medical Care Surveys and National Hospital Ambulatory Medical Care Surveys was used. During that time period, 17.4% of office-based outpatient visits and 45% of ED visits listed a pain medication prescription. There was an increase of about 5% from 2006-2007 to 2014-2015 for outpatient visits in which any pain medication was prescribed. Fentanyl prescription rates remained stable but doubled at EDs. There was also an increase in non-opioid pain medications in both settings.
AHRQ-funded; HS022882; HS025164.
Citation: Vijay A, Rhee TG, Ross JS .
U.S. prescribing trends of fentanyl, opioids, and other pain medications in outpatient and emergency department visits from 2006 to 2015.
Prev Med 2019 Jun;123:123-29. doi: 10.1016/j.ypmed.2019.03.022..
Keywords: Ambulatory Care and Surgery, Emergency Department, Hospitals, Medication, Opioids, Pain, Practice Patterns
Newgard CD, Lin A, Eckstrom E
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.
In this study, the investigators evaluated the utility of comorbidities, anticoagulant use, and geriatric-specific physiologic measures to improve the sensitivity of the field triage guidelines for high-risk older adults in the out-of-hospital setting.
AHRQ-funded; HS023796.
Citation: Newgard CD, Lin A, Eckstrom E .
Comorbidities, anticoagulants, and geriatric-specific physiology for the field triage of injured older adults.
J Trauma Acute Care Surg 2019 May;86(5):829-37. doi: 10.1097/ta.0000000000002195
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Keywords: Elderly, Blood Thinners, Medication, Ambulatory Care and Surgery, Injuries and Wounds, Care Management
Kenyon CC, Gruschow SM, Haaland WL
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
The authors’ goal was to assess the relationship between perceived access to timely office-based care and subsequent 30-day pediatric revisits following hospital discharge for asthma, bronchiolitis, croup, and pneumonia. They found that perceived access to timely office-based care was associated with significantly greater odds of subsequent emergency department revisit. They concluded that focusing solely on enhancing timely access to care following discharge for common respiratory illnesses may be insufficient to prevent repeat utilization.
AHRQ-funded; HS024299.
Citation: Kenyon CC, Gruschow SM, Haaland WL .
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
Acad Pediatr 2019 May - Jun;19(4):370-77. doi: 10.1016/j.acap.2018.07.001..
Keywords: Children/Adolescents, Respiratory Conditions, Ambulatory Care and Surgery, Emergency Department, Access to Care, Hospitals
Modi PK, Kaufman SR, Caram MV
Impact of Medicare office visit payment reform on urologic practices.
This study analyzed the impact of the 2019 Medicare Physician Fee Schedule on urologic practices. This new payment system modifies reimbursement for office evaluation and management visits. Researchers used a sample of 20% of National Medicare claims. They identified 2822 practices ranging from solo to multispecialty groups. Solo practices had the least benefit in reimbursement with most practices having a small increase in payment.
AHRQ-funded; HS025707.
Citation: Modi PK, Kaufman SR, Caram MV .
Impact of Medicare office visit payment reform on urologic practices.
Urology 2019 Apr;126:83-88. doi: 10.1016/j.urology.2019.01.013..
Keywords: Medicare, Ambulatory Care and Surgery, Payment, Policy
Grob R, Schlesinger M, Barre LR
What words convey: the potential for patient narratives to inform quality improvement.
This article explored the potential of systematically elicited narratives about experiences with outpatient care to enrich quality improvement. The authors concluded that attention to patient experience and rigorously elicited narratives hold substantial promise for improving quality and patients' experiences with care by making concrete what went wrong or right in domains covered by existing surveys, and by expanding our view of what aspects of care matter to patients as articulated in their own words and thus how care can be made more patient-centered.
AHRQ-funded; HS016978; HS016980; HS021858.
Citation: Grob R, Schlesinger M, Barre LR .
What words convey: the potential for patient narratives to inform quality improvement.
Milbank Q 2019 Mar;97(1):176-227. doi: 10.1111/1468-0009.12374..
Keywords: Ambulatory Care and Surgery, Clinician-Patient Communication, Patient Experience, Quality Improvement
Hill CE, Lin CC, Burke JF
Claims data analyses unable to properly characterize the value of neurologists in epilepsy care.
The authors sought to determine the association of a neurologist visit with health care use and cost outcomes for patients with incident epilepsy using health care claims data for individuals insured by United Healthcare from 2001 to 2016. They found that patients with epilepsy who visited a neurologist had greater subsequent health care use, medical costs, and care escalation than controls. They conclude that their comparison using administrative claims was plausibly confounded by case disease severity, as suggested by higher non-epilepsy care costs, and that linking patient-centered outcomes to claims data may provide the clinical resolution to assess care value within a heterogeneous population.
AHRQ-funded; HS017690; HS022258.
Citation: Hill CE, Lin CC, Burke JF .
Claims data analyses unable to properly characterize the value of neurologists in epilepsy care.
Neurology 2019 Feb 26;92(9):e973-e87. doi: 10.1212/wnl.0000000000007004..
Keywords: Neurological Disorders, Ambulatory Care and Surgery, Healthcare Utilization
Brown TT, Atal JP
How robust are reference pricing studies on outpatient medical procedures? Three different preprocessing techniques applied to difference-in differences.
This study assessed the robustness of using preprocessing techniques for difference-in differences in reference pricing studies for outpatient medical procedures. Three different approaches were tested: propensity score reweighting, exact matching, and genetic matching. The three approaches did not yield statistically different results from those previously published.
AHRQ-funded; HS022098.
Citation: Brown TT, Atal JP .
How robust are reference pricing studies on outpatient medical procedures? Three different preprocessing techniques applied to difference-in differences.
Health Econ 2019 Feb;28(2):280-98. doi: 10.1002/hec.3841..
Keywords: Ambulatory Care and Surgery, Healthcare Costs
Gerber JS, Ross RK, Szymczak JE
Infections after pediatric ambulatory surgery: incidence and risk factors.
Investigators studied the prevalence of surgical-site infections (SSIs) in a single pediatric healthcare network between ambulatory surgery facilities and a hospital-based facility. No statistical difference in the number of SSIs was found.
AHRQ-funded; HS020921.
Citation: Gerber JS, Ross RK, Szymczak JE .
Infections after pediatric ambulatory surgery: incidence and risk factors.
Infect Control Hosp Epidemiol 2019 Feb;40(2):150-57. doi: 10.1017/ice.2018.211..
Keywords: Ambulatory Care and Surgery, Children/Adolescents, Healthcare-Associated Infections (HAIs), Patient Safety, Risk, Surgery, Injuries and Wounds
Chua KP, Fischer MA, Linder JA
Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
This study used ICD-10 codes to determine the appropriateness of outpatient antibiotic prescriptions filled in privately insured patients in the US. Determinations were made based on diagnosis whether the prescriptions were “appropriate”, “potentially appropriate”, “inappropriate”, or no diagnosis code found. Among a cohort of over 19 million, only 12.8% were deemed appropriate, 23.2% were inappropriate, 35.5% potentially inappropriate, and 28.% not associated with a diagnosis code.
AHRQ-funded; HS024930; 233201500020I.
Citation: Chua KP, Fischer MA, Linder JA .
Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study.
BMJ 2019 Jan 16;364:k5092. doi: 10.1136/bmj.k5092..
Keywords: Ambulatory Care and Surgery, Antibiotics, Shared Decision Making, Health Insurance, Medication