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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 22 of 22 Research Studies DisplayedChisolm DJ, Dugan JA, Figueroa JF
Improving health equity through health care systems research.
This study’s objective was to describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes. This project was conducted as a component of the AHRQ stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. The stakeholders included experts from academia, health care organizations, industry, and government. Five priority themes were derived iteratively through experts from academia, health care organizations, industry, and government. They identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. They also suggested cross-cutting themes regarding research workforce and research timelines.
AHRQ-funded.
Citation: Chisolm DJ, Dugan JA, Figueroa JF .
Improving health equity through health care systems research.
Health Serv Res 2023 Dec; 58(suppl 3):289-99. doi: 10.1111/1475-6773.14192..
Keywords: Health Systems, Disparities, Social Determinants of Health, Healthcare Delivery
Bierman AS, Mistry KB
AHRQ Author: Bierman AS, Mistry KB
Commentary: Achieving health equity - the role of learning health systems.
The article discussed learning health systems and their role in achieving health equity. Issues considered were prioritization of health equity, development and implementation of models of care, partnerships with patients and communities, research on the effectiveness of interventions across diverse populations, integration strategies, and multisector collaborations to address social needs. The authors concluded that by considering these issues, learning health systems can play a pivotal role in eliminating health inequities.
AHRQ-authored.
Citation: Bierman AS, Mistry KB .
Commentary: Achieving health equity - the role of learning health systems.
Healthc Policy 2023 Nov; 19(2):21-27. doi: 10.12927/hcpol.2023.27236..
Keywords: Learning Health Systems, Health Systems, Disparities
Ganguli I, Mackwood MB, Yang CW
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
The objective of this retrospective cohort study was to characterize racial differences in receipt of low-value care among older Medicare beneficiaries overall and within U.S. health systems. Medicare fee-for-service administrative data was used for Black and White Medicare patients who were at least 65 as of 2016. Findings showed that, of the 40 low value services examined, Black patients had a higher adjusted receipt of 9 services and lower receipt of 20 services than White patients. Differences were generally small and largely due to differential care within health systems, but the authors concluded that their findings suggested potential factors that researchers, policymakers, and health system leaders might investigate to improve health care quality and equity.
AHRQ-funded; HS024930.
Citation: Ganguli I, Mackwood MB, Yang CW .
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
BMJ 2023 Oct 25; 383:e074908. doi: 10.1136/bmj-2023-074908..
Keywords: Elderly, Racial and Ethnic Minorities, Medicare, Health Systems
Kim B, Cruden G, Crable EL
A structured approach to applying systems analysis methods for examining implementation mechanisms.
This article delineated a structured approach to applying systems analysis methods to examining implementation mechanisms. This approach included steps for selecting, tailoring, and evaluating an implementation strategy. The authors illustrated the approach by using an example case, then discussed the strengths and limitations of this approach, when each step might be appropriate. They suggested work that might extend systems analysis methods to the implementation mechanisms research.
AHRQ-funded; HS025632.
Citation: Kim B, Cruden G, Crable EL .
A structured approach to applying systems analysis methods for examining implementation mechanisms.
Implement Sci Commun 2023 Oct 19; 4(1):127. doi: 10.1186/s43058-023-00504-5..
Keywords: Implementation, Evidence-Based Practice, Health Systems
Simpson SA, Loh R, Elliott L
A mortality surveillance collaboration between a health system and public health department.
The authors described a collaboration between a health system and public health department to create a mortality surveillance system that enabled the health system to identify more than six times the number of deaths identified through local system medical records. They concluded that this epidemiological process that combined nuanced data captured through clinical care in health systems with subsequent data on mortality can be of particular benefit to underserved communities.
AHRQ-funded; HS027389.
Citation: Simpson SA, Loh R, Elliott L .
A mortality surveillance collaboration between a health system and public health department.
Am J Public Health 2023 Sep; 113(9):943-46. doi: 10.2105/ajph.2023.307335..
Keywords: Public Health, Health Systems
Johnson PT, Conway SJ, Berkowitz SA
Transforming health care from volume to value: a health system implementation road map.
The mission of the High Value Practice Academic Alliance is to 1) rapidly disseminate effective value-based performance improvement processes to safely decrease the cost of care for patients, and 2) train the next generation of physicians in principles of high value practice. The organization convened 100 academic medical center partners, and after 5 years of practice, opened membership to any medical center and became the High Value Practice Alliance. In 2021 and 2022, directors of the alliance devoted educational programs of the annual conference to developing a care delivery roadmap identifying the strategies and programs required to maximize resource use, clinical effectiveness, and care coordination. The group is now publishing the “playbook” as a series of focused articles, a comprehensive framework to improve the health care value in a delivery system. This playbook includes 3 performance improvement approaches: 1) resource focused, 2) infrastructure focused, and 3) condition focused. The Transforming Healthcare from Volume to Value: a Health System Implementation RoadMap manuscript series will address each of the strategies and relevant programs.
AHRQ-funded; HS029151; HS026350.
Citation: Johnson PT, Conway SJ, Berkowitz SA .
Transforming health care from volume to value: a health system implementation road map.
Am J Med 2023 Aug; 136(8):763-67. doi: 10.1016/j.amjmed.2023.04.030..
Keywords: Health Systems, Implementation, Healthcare Delivery
Ong T, Albon D, Amin RS
Establishing a Cystic Fibrosis Learning Network: interventions to promote collaboration and data-driven improvement at scale.
This paper describes the Cystic Fibrosis Learning Network (CFLN), which was designed to improve medical outcomes and quality of life through an intentional focus on achieving reliable evidence-based chronic care delivery and creating a system for data-driven collaborative learning. The authors described the development and growth of the CFLN considering six domains of a Network Maturity Grid: system leadership; governance and policy management; quality improvement (QI); engagement and community building; data and analytics; and research. The CFLN represents 36 accredited care centers in the CF Foundation Care Center Network caring for over 6300 patients, with 77% of 6779 patient clinical care visits/quarter entering into the Registry within 30 days. Almost all CFLN teams (94%) have a patient/family partner (PFP), and 74% of PFPs indicate they are actively participating, taking ownership of, or leading QI initiatives with the interdisciplinary care team. In 2022, most (97%) centers reported completing 1-13 improvement cycles per month, and 82% contributed to monthly QI progress reports to share learning.
AHRQ-funded; HS02639.
Citation: Ong T, Albon D, Amin RS .
Establishing a Cystic Fibrosis Learning Network: interventions to promote collaboration and data-driven improvement at scale.
Learn Health Syst 2023 Jul; 7(3):e10354. doi: 10.1002/lrh2.10354..
Keywords: Learning Health Systems, Health Systems
Harrison MI, Borsky AE
AHRQ Author: Harrison MI
How alignment between health systems and their embedded research units contributes to system learning.
This AHRQ-authored paper examined the organization of learning health system (LHS) research units and conditions affecting their contributions to system improvement and learning. The authors conducted 12 key-informant and 44 semi-structured interviews in six delivery systems engaged in LHS research. Using rapid qualitative analysis, they identified themes and compared successful versus challenging projects; LHS units and other research units in the same system; and LHS units in different systems. They found that LHS units operate both independently and as subunits within larger research centers. Key alignment factors identified were availability of internal (system) funding directing researchers' work toward system priorities; researchers' skills and experiences that fit a system's operational needs; LHS unit subculture supporting system improvement and collaboration with clinicians and other internal stakeholders; applications of external funding to system priorities; and executive leadership for system-wide learning. Direct consultation between LHS unit leaders and system executives and engagement of researchers in clinical and operational activities fostered mutual understanding and collaboration between researchers, clinicians, and leaders.
AHRQ-authored.
Citation: Harrison MI, Borsky AE .
How alignment between health systems and their embedded research units contributes to system learning.
Healthc 2023 Jun; 11(2):100688. doi: 10.1016/j.hjdsi.2023.100688..
Keywords: Health Systems, Learning Health Systems
Beaulieu ND, Chernew ME, McWilliams JM
Organization and performance of US health systems.
The objectives of this evidence review were to identify and describe health systems in the US, to assess differences between physicians and hospitals in and outside of health systems, and to compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. A total of 580 health systems in a great variety of sizes were identified; prices for physician, hospital services, and total spending were assessed in 2018 commercial claims data. Health system physicians and hospitals were shown to deliver a large portion of medical services. Clinical quality performance and patient experience measures were slightly better in systems; however, spending and prices were significantly higher, especially in small practices. The authors concluded that slight quality differentials in combination with large price differentials suggested that health systems have not realized their potential for better care at equal or lower cost.
AHRQ-funded; HS024072.
Citation: Beaulieu ND, Chernew ME, McWilliams JM .
Organization and performance of US health systems.
JAMA 2023 Jan 24; 329(4):325-35. doi: 10.1001/jama.2022.24032..
Keywords: Health Systems, Healthcare Delivery, Provider Performance, Quality Measures, Quality of Care, Hospitals
Sirkin JT, Flanagan E, Tong ST
AHRQ Author: Tong ST, McNellis RJ, Bierman AS
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
The purpose of this paper was to review the Agency for Healthcare Research and Quality’s (AHRQ) learning community organized to engage and support primary care in responding to COVID-19 and provide an opportunity for participants to communicate learning and peer support, improve understanding of the stressors and challenges faced by practices, determine needs, and identify possible solutions to challenges of the pandemic. The researchers identified challenges, responses, and innovations that occurred through the engagement and information sharing of the learning community and categorized them across 5 domains, including: patient-centeredness, clinician and practice, systems and infrastructure, community and public health; and health equity which cut across each of the other domains. The authors concluded that the learning community provided valuable insights for future research and policy, primary care delivery improvement, and ensuring greater preparedness for future challenges.
AHRQ-authored.
Citation: Sirkin JT, Flanagan E, Tong ST .
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
Ann Fam Med 2023 Jan-Feb; 21(1):76-82. doi: 10.1370/afm.2904..
Keywords: COVID-19, Primary Care, Learning Health Systems, Health Systems, Evidence-Based Practice, Public Health
Sheetz KH, Dimick JB, Nathan H
Centralization of high-risk cancer surgery within existing hospital systems.
Centralization is often proposed as a strategy to improve the quality of certain high-risk health care services. In this study, the investigators evaluated the extent to which existing hospital systems centralize high-risk cancer surgery and whether centralization is associated with short-term clinical outcomes. The investigators concluded that greater centralization of complex cancer surgery within existing hospital systems was associated with better outcomes.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Dimick JB, Nathan H .
Centralization of high-risk cancer surgery within existing hospital systems.
J Clin Oncol 2019 Dec 1;37(34):3234-42. doi: 10.1200/jco.18.02035..
Keywords: Surgery, Cancer, Risk, Hospitals, Health Systems, Quality Improvement, Quality Indicators (QIs), Quality of Care, Outcomes
Stadnick NA, Sadler E, Sandall J
Comparative case studies in integrated care implementation from across the globe: a quest for action.
There are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. In this paper, the investigators use a multiple case study design to highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and to synthesize the shared and unique challenges and successes across studies using the EPIS framework.
AHRQ-funded; HS024192.
Citation: Stadnick NA, Sadler E, Sandall J .
Comparative case studies in integrated care implementation from across the globe: a quest for action.
BMC Health Serv Res 2019 Nov 27;19(1):899. doi: 10.1186/s12913-019-4661-5..
Keywords: Healthcare Delivery, Health Services Research (HSR), Health Systems, Implementation, Case Study
Wood SJ, Albertson EM, Conrad DA
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
This study used key informant interviews with health care executives representing 5 large health systems contracted with the Washington State Health Care Authority to provide accountable care network services under the State Innovation Model initiative. Two rounds of semistructured interviews were conducted, and results indicated the need to present a modified conceptual model aligned better with accountable care program (ACP) implementation.
AHRQ-funded; HS013853.
Citation: Wood SJ, Albertson EM, Conrad DA .
Accountable care program implementation and effects on participating health care systems in Washington state: a conceptual model.
J Ambul Care Manage 2019 Oct/Dec;42(4):321-36. doi: 10.1097/jac.0000000000000302..
Keywords: Health Systems, Provider Performance, Organizational Change, Health Services Research (HSR), Payment, Health Insurance, Implementation
White CM, Coleman CI, Jackman K
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
This paper analyzed ways to enhance usability of AHRQ’s Evidence-based Practice Center (EPC) reports. The reports are often lengthy and difficult for users to navigate. A quality measure index was created to allow health systems to more efficiently access relevant information. A test was created where two tables were embedded in an EPC report. The first identified quality measures covered by the report descriptively. The second contained page numbers in the executive summary which hyperlinked to those pages with the quality measures. An exercise with two health system-targeted scenarios was then created. The participants were timed how long it took to find answers to scenario questions and gave feedback. It was found that it took 63.4% less time to find quality measure information with the hyperlinked indexing tables than without. The participants felt that the tables were easy to use and more user friendly to health systems.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002.
Citation: White CM, Coleman CI, Jackman K .
AHRQ series on improving translation of evidence: linking evidence reports and performance measures to help learning health systems use new information for improvement.
Jt Comm J Qual Patient Saf 2019 Oct;45(10):706-10. doi: 10.1016/j.jcjq.2019.05.002..
Keywords: Implementation, Evidence-Based Practice, Health Systems, Learning Health Systems, Patient-Centered Outcomes Research, Provider Performance, Quality Measures, Quality Improvement, Quality of Care
Vest JR, Unruh MA, Freedman S
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. The investigators concluded that reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggested that HIE technologies can better support the aim of higher quality care.
AHRQ-funded; HS024717.
Citation: Vest JR, Unruh MA, Freedman S .
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
J Am Med Inform Assoc 2019 Oct;26(10):989-98. doi: 10.1093/jamia/ocz116..
Keywords: Health Systems, Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT), Hospital Readmissions, Hospitals
Vest JR, Unruh MA, Shapiro JS
The associations between query-based and directed health information exchange with potentially avoidable use of health care services.
This study quantified the impact of directed and query-based approaches to health information exchange (HIE) on potentially avoidable use of health care services. Data from Medicare fee-for-service claims was examined from 2008 to 2014 from providers in the Rochester Regional Health Organization (RHIO). There were very small reductions in the probability of ambulatory care sensitive hospitalization with either approach.
AHRQ-funded; HS024556.
Citation: Vest JR, Unruh MA, Shapiro JS .
The associations between query-based and directed health information exchange with potentially avoidable use of health care services.
Health Serv Res 2019 Oct;54(5):981-93. doi: 10.1111/1475-6773.13169..
Keywords: Health Information Exchange (HIE), Health Systems, Health Information Technology (HIT)
Lee BY, Wedlock PT, Mitgang EA
How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India.
Researchers developed a computational simulation model of Bihar, India's routine immunization supply chain where coping occurs to evaluate the broader impact of coping. They conclude that their results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.
AHRQ-funded; HS023317.
Citation: Lee BY, Wedlock PT, Mitgang EA .
How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India.
BMJ Glob Health 2019 Sep 5;4(5):e001609. doi: 10.1136/bmjgh-2019-001609..
Keywords: Vaccination, System Design, Health Systems, Healthcare Delivery
Rangachari P, Dellsperger KC, Rethemeyer RK
A health system's pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
Similar to issues faced in health systems across USA, AU Health, based in Augusta, Georgia, faced a scenario of low physician engagement in, and limited-use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which translated to high rates of medication discrepancies and low accuracy of the patient's active medication list, during transitions of care. This paper describes AU Health’s pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P, Dellsperger KC, Rethemeyer RK .
A health system's pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
J Hosp Manag Health Policy 2019 Sep;3(22). doi: 10.21037/jhmhp.2019.08.01..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Health Systems
DeCamp M, Dukhanin V, Hebert LC
Patients' views about patient engagement and representation in healthcare governance.
Researchers used surveys to assess the importance of patient representation. Their analysis of free-text responses illuminated why patient representatives are important, keys to successful engagement, and reasons behind the skepticism. They conclude that most patients believe representation in health system governance is important, and that realizing its potential requires engagement activities that improve general patients' awareness of, and interaction with, their representatives.
AHRQ-funded; HS023684.
Citation: DeCamp M, Dukhanin V, Hebert LC .
Patients' views about patient engagement and representation in healthcare governance.
J Healthc Manag 2019 Sep-Oct;64(5):332-46. doi: 10.1097/jhm-d-18-00152..
Keywords: Patient and Family Engagement, Health Systems, Healthcare Delivery
Adler-Milstein J, Nong P, Friedman CP
AHRQ Author: Adler-Milstein J
Preparing healthcare delivery organizations for managing computable knowledge.
This article describes results of an AHRQ-funded conference where a group of experts from a range of fields examined the current state of knowledge management in healthcare delivery organizations. Conference presentations and discussions were recorded and analyzed by the authors in order to identify foundational concepts. The concepts identified are: the current state of knowledge management in healthcare delivery organizations is reliant upon an outdated biomedical library model, and only a small number of organizations have developed management approaches to push knowledge in computable form to frontline decisions; Learning Health Systems create a need for scalable computable knowledge management approaches; the ability to represent data science discoveries in computable form that are findable, accessible, interoperable, and reusable is fundamental to spreading knowledge at scale.
AHRQ-funded; HS025316.
Citation: Adler-Milstein J, Nong P, Friedman CP .
Preparing healthcare delivery organizations for managing computable knowledge.
Learn Health Syst 2019 Apr;3(2):e10070. doi: 10.1002/lrh2.10070..
Keywords: Healthcare Delivery, Learning Health Systems, Organizational Change, Health Systems
Misra-Hebert AD, Rose S, Clayton C
Implementation of patient and family advisory councils in primary care practices in a large, integrated health system.
This paper was presented as part of a poster presentation at the Comprehensive Primary Care Plus national meeting in Baltimore, MD on May 8, 2018. It describes the formation of patient and family advisory councils (PFAC) at the Cleveland Clinic Health System (CCHS). A steering committee was first created and then staff and patients were recruited. Patients were recruited through a survey and provider nominations. No monetary incentives were provided. Forty PFAC meetings were conducted between July and December 2017. A total of 151 patients were included, but there was only 35% retention of patient advisors in both quarters. Most meetings were held at the practice sites, although they were first offered at hub sites. The CFACs included a volunteer clinic lead and a group facilitator. Topics discussed varied by site but included communication with the office between visits, team-based care, access to care, financial issues, and clinical decisions such as antibiotic use. The authors concluded that these meetings were successful and they will continue to hold quarter meetings. Work will be done to improve patient recruitment and retention along with better representation of patient populations.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Rose S, Clayton C .
Implementation of patient and family advisory councils in primary care practices in a large, integrated health system.
J Gen Intern Med 2019 Feb;34(2):190-91. doi: 10.1007/s11606-018-4660-y..
Keywords: Health Systems, Patient-Centered Healthcare, Patient and Family Engagement, Primary Care
Norton PT, Rodriguez HP, Shortell SM
Organizational influences on healthcare system adoption and use of advanced health information technology capabilities.
The purpose of this study was to identify characteristics that may drive the variability of adopting of advanced health IT capabilities, such as predictive analytic functions and patient access to records, among health systems. Responses from the 2017/2018 National Survey of Healthcare Organizations and Systems were used to assess the extent to which healthcare system organizational structure, electronic health record standardization, and resource allocation practices were associated with the use of advanced health IT capabilities. Measures of adoption, organizational structure, and resource allocation were developed based on survey responses. Results suggest that health systems that standardize their electronic health records and that own and manage hospitals and medical groups have higher rates of advanced health IT adoption and use.
AHRQ-funded; HS024075.
Citation: Norton PT, Rodriguez HP, Shortell SM .
Organizational influences on healthcare system adoption and use of advanced health information technology capabilities.
Am J Manag Care 2019 Jan;25(1):e21-e25..
Keywords: Health Systems, Health Information Technology (HIT), Healthcare Delivery