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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
126 to 150 of 1440 Research Studies DisplayedHalliday TM, McFadden M, Cedillo M
Lifestyle strategies after intentional weight loss: results from the MAINTAIN-pc randomized trial.
The aim of this study was to explore the strategies related with successful long-term weight loss maintenance. Researchers analyzed data from the 24-month Maintaining Activity and Nutrition Through Technology-Assisted Innovation in Primary Care (MAINTAIN-pc) trial. MAINTAIN-pc recruited 194 adults with recent intentional weight loss and randomized participants a group using tracking tools plus coaching (i.e., coaching group) or tracking tools without coaching (i.e., tracking-only group). The participants reported the lifestyle strategies they utilized in the previous 6 months, including self-monitoring, group support, behavioral skills, and professional support. The study found that at baseline, 100% used behavioral skills, 73% used group support, 69% used self-monitoring, and 68% used professional support in the past 6 months; at 24 months, the rates were 98%, 60%, 75%, and 61%, respectively. The number of participants using individual strategies did not vary significantly over time, but the overall number of strategies participants reported decreased. A greater number of strategies were utilized at baseline and 6 months compared to 12- and 24-month follow-ups. The coaching group utilized a greater number of strategies at months 6 and 12 than the tracking-only group. Consistent utilization of professional support strategies over the 24-month study period was related with less weight regain.
AHRQ-funded; HS021162.
Citation: Halliday TM, McFadden M, Cedillo M .
Lifestyle strategies after intentional weight loss: results from the MAINTAIN-pc randomized trial.
Transl J Am Coll Sports Med 2023 Spring; 8(2). doi: 10.1249/tjx.0000000000000220..
Keywords: Lifestyle Changes, Obesity, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT)
Franco MI, Staab EM, Zhu M
Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-Depression study.
Utilizing patient portals in a population health framework for depression screening presents a potentially effective method for proactively engaging and identifying individuals with depression. The purpose of this study was to evaluate the efficacy of a population health-based depression screening compared to in-clinic screening alone in detecting patients with depression. A practical clinical trial conducted at an urban, academic, tertiary care center's adult internal medicine outpatient clinic included a total of 2713 eligible adult patients due for depression screening with active portal accounts. Patients with known depression or bipolar disorder, and those who had been screened within the previous year were excluded. Participants were randomly allocated to receive either usual care (n = 1372) or population health care (n = 1341). In the usual care group, medical assistants screened patients during clinic visits. In the population health care group, patients were sent portal-based letters inviting them to complete an online screener, irrespective of appointment status. The Computerized Adaptive Test for Mental Health (CAT-MH™) was used for both in-clinic and portal-based screenings. The study found that the population health care group displayed a higher depression screening rate compared to the usual care group (43% (n = 578) vs. 33% (n = 459), p < 0.0001). Additionally, the rate of positive screens was greater in the population health care group than in the usual care group (10% (n = 58) vs. 4% (n = 17), p < 0.001).
AHRQ-funded; HS26151
Citation: Franco MI, Staab EM, Zhu M .
Pragmatic clinical trial of population health, portal-based depression screening: the PORTAL-Depression study.
J Gen Intern Med 2023 Mar;38(4):857-64. doi: 10.1007/s11606-022-07779-9.
Keywords: Depression, Behavioral Health, Screening, Health Information Technology (HIT)
Ingraham NE, Jones EK, King S
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
This scoping review explored surgical literature to determine frequency and rigor of clinical decision support (CDS) equity assessments and offer recommendations to improve CDS equity by appending existing frameworks. The authors performed a scoping review of PubMed and Google Scholar and identified 1,415 citations with 229 abstracts meeting criteria for review. A total of 84 papers underwent full review after 145 were excluded if they did not assess outcomes of an electronic CDS tool or have a surgical use case. Only 6% of surgical CDS systems reported equity analyses, suggesting that current methods for optimizing equity in surgical CDS are inadequate. The authors proposed revising the RE-AIM framework to include an Equity element (RE2-AIM) specifying that CDS foundational analyses and algorithms are performed or trained on balanced datasets with sociodemographic characteristics that accurately represent the CDS target population and are assessed by sensitivity analyses focused on vulnerable subpopulations.
AHRQ-funded; HS026379; HS024532.
Citation: Ingraham NE, Jones EK, King S .
Re-aiming equity evaluation in clinical decision support: a scoping review of equity assessments in surgical decision support systems.
Ann Surg 2023 Mar; 277(3):359-64. doi: 10.1097/sla.0000000000005661..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Disparities, Surgery
Cochran A, Rayo MF
Toward joint activity design: augmenting user-centered design with heuristics for supporting joint activity.
This paper discusses the development of a clinical decision support application for preventing hospital-acquired infection called GeoHAI, which has yielded positive results in early usability testing and is expected to test positively in supporting joint activity, which will be measured through the novel implementation of Joint Activity Monitoring. The design and implementation of this application will help to unify the work of Human-Centered Design and Cognitive Systems Engineering through demonstration of the possibilities and necessities. The authors are calling this unified process Joint Activity Design, which supports designing for machines to be good team players.
AHRQ-funded; HS027200.
Citation: Cochran A, Rayo MF .
Toward joint activity design: augmenting user-centered design with heuristics for supporting joint activity.
Proc Int Symp Hum Factors Ergon Healthc 2023 Mar; 12(1):19-23. doi: 10.1177/2327857923121006..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Orthopedics
Shear K, Rice H, Garabedian PM
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
The purpose of this study was to conduct usability testing of the ASPIRE fall risk management tool for use in divergent primary care clinics. Participants recruited from two sites with different electronic health records and clinical organizations used ASPIRE across two clinical scenarios; they rated ASPIRE usability as above average, based on usability benchmarks. Time spent on tasks decreased significantly between the first and second scenarios, indicating ease of learnability. The authors conclude that ASPIRE could be integrated into diverse organizations, since it allows a tailored implementation without the need to build a new system for each organization. ASPIRE is therefore well positioned to impact the challenge of falls at scale.
AHRQ-funded; HS027557.
Citation: Shear K, Rice H, Garabedian PM .
Usability testing of an interoperable computerized clinical decision support tool for fall risk management in primary care.
Appl Clin Inform 2023 Mar;14(2):212-26. doi: 10.1055/a-2006-4936.
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT), Falls, Primary Care, Risk, Prevention
Schnall R, Sanabria G, Jia R, Sanabria G, Jia H
Efficacy of an mHealth self-management intervention for persons living with HIV: the WiseApp randomized clinical trial.
This study’s objective was to determine the efficacy of WiseApp, a user-centered design mHealth intervention to improve antiretroviral therapy (ART) adherence and viral suppression in persons living with HIV (PLWH). This randomized case-control trial had two study arms: a randomized controlled efficacy trial arm (n = 99) and an attention control intervention arm (n = 101) among PLWH living in New York City. The authors found a significant improvement in ART adherence in the intervention arm compared to the attention control arm from day 1 (69.7% vs 48.3%) to day 59 (51.2% vs 37.2%) of the study period. From day 60 to 120, the intervention had higher but not statistically significant adherence rates. Secondary analyses showed no difference in change from baseline to 3 or 6 months between the 2 study arms.
AHRQ-funded; HS025071.
Citation: Schnall R, Sanabria G, Jia R, Sanabria G, Jia H .
Efficacy of an mHealth self-management intervention for persons living with HIV: the WiseApp randomized clinical trial.
J Am Med Inform Assoc 2023 Feb 16; 30(3):418-26. doi: 10.1093/jamia/ocac233..
Keywords: Telehealth, Patient Self-Management, Human Immunodeficiency Virus (HIV), Chronic Conditions, Health Information Technology (HIT)
Hakimjavadi R, Karunananthan S, Alexander G
What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol.
As the number of Canadians aged 75 years and older is projected to double in the next two decades, long-term care (LTC) systems will face increasing pressure. Health information technology (IT) has demonstrated its ability to enhance the quality, safety, and efficiency of care across various clinical environments and could potentially improve LTC for residents. The purpose of this cross-sectional study will be to thoroughly assess the extent of health IT adoption in Ontario's LTC homes and establish a baseline comprehension for future planning. The researchers will utilize the LTC IT Maturity Instrument to evaluate IT capabilities, the extent of IT usage, and the degree of internal/external IT integration across the domains of resident care, clinical support, and administrative activities. All LTC homes in Ontario will be invited to participate.
AHRQ-funded; HS022497.
Citation: Hakimjavadi R, Karunananthan S, Alexander G .
What is the level of information technology maturity in Ontario's long-term care homes? A cross-sectional survey study protocol.
BMJ Open 2023 Feb 10; 13(2):e064745. doi: 10.1136/bmjopen-2022-064745..
Keywords: Health Information Technology (HIT), Long-Term Care, Nursing Homes
Harle CA, Wu W, Vest JR
Accuracy of electronic health record food insecurity, housing instability, and financial strain screening in adult primary care.
The objective of this study was to assess the accuracy of electronic health record–based multidomain screening questionnaires on social risk factors. Researchers used single-domain questionnaires on individual factors such as food insecurity, housing instability, and financial strain as external standards.
AHRQ-funded; HS028636.
Citation: Harle CA, Wu W, Vest JR .
Accuracy of electronic health record food insecurity, housing instability, and financial strain screening in adult primary care.
JAMA 2023 Feb 7; 329(5):423-24. doi: 10.1001/jama.2022.23631..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Screening, Social Determinants of Health
Konnyu KJ, Danilack VA, Adam GP
Changes to prenatal care visit frequency and telehealth: a systematic review of qualitative evidence.
This study systematically reviewed patient, partner or family, and clinician perspectives, preferences, and experiences related to prenatal care visit schedules and televisits for routine prenatal care. This review is a subset of a larger review on both the qualitative experiences and quantitative benefits and harms of reduced prenatal care visit schedules and televisits for routine prenatal care that was produced by the Brown Evidence-based Practice Center for AHRQ. The authors synthesized barriers and facilitators to the implementation of reduced care visits or of televisits into 1 of 14 domains defined by the Theoretical Domains Framework (TDF) and a Best Fit Framework approach and summarized themes within TDF domains. They assessed their confidence in the summary statements using the GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-Confidence in Evidence from Reviews of Qualitative research) tool. They found four studies that addressed the number of scheduled routine prenatal visits, and five studies that addressed televisits. These studies found that health care professionals believed fewer routine visits may be more convenient for patients and may increase clinic capacity to provide additional care for patients with high-risk pregnancies. But both patients and clinicians had concerns about potential lesser care with fewer visits, including concerns about quality of care and challenges with implementing new delivery-of-care models.
AHRQ-funded; 290201500002I.
Citation: Konnyu KJ, Danilack VA, Adam GP .
Changes to prenatal care visit frequency and telehealth: a systematic review of qualitative evidence.
Obstet Gynecol 2023 Feb;141(2):299-323. doi: 10.1097/aog.0000000000005046.
Keywords: Maternal Care, Pregnancy, Women, Telehealth, Health Information Technology (HIT)
Hsueh L, Huang J, Millman AK
Cross-sectional association of patient language and patient-provider language concordance with video telemedicine use among patients with limited English proficiency.
The surge in telemedicine use during the COVID-19 pandemic underscores the need to address gaps in patient care, particularly for individuals with limited English proficiency. The purpose of this study was to investigate the relationship between patient language, patient-provider language alignment, and the type of telemedicine visit (video or phone consultation). The researchers conducted a cross-sectional analysis using automated data from primary care telemedicine appointments scheduled between March 16, 2020, and October 31, 2020 within a comprehensive healthcare delivery system in Northern California. A total of 22,427 completed primary care telemedicine visits booked by 13,764 patients with limited English proficiency through the patient portal. The study examined the cross-sectional link between electronic health record-documented patient language (with Spanish as the reference) and patient-provider language concordance, considering patient demographics, technology access, and technology familiarity. RESULTS: The study found that among all scheduled appointments, 34.5% (n=7747) were video consultations. The three most common patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). After adjusting for demographic and technology factors, video visit usage was higher for patients speaking Cantonese, Mandarin, or Vietnamese, compared to Spanish-speaking patients, but lower for those who spoke Punjabi. Language concordance was linked to decreased video visit utilization and influenced the relationship between speaking Spanish, Cantonese, and Korean with video visit usage. Furthermore, for all language groups, patients with prior video visit experience were more likely to use video visits again.
AHRQ-funded; HS025189
Citation: Hsueh L, Huang J, Millman AK .
Cross-sectional association of patient language and patient-provider language concordance with video telemedicine use among patients with limited English proficiency.
J Gen Intern Med 2023 Feb;38(3):633-40. doi: 10.1007/s11606-022-07887-6.
Keywords: Telehealth, Health Information Technology (HIT), Cultural Competence, Clinician-Patient Communication, Communication, Healthcare Delivery, COVID-19
Djulbegovic B, Hozo I, Lizarraga D
Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants.
The objective of this study was to assess if delivery of anticoagulant prophylaxis according to an algorithm improved clinical outcomes in patients hospitalized with COVID-19 in comparison with anticoagulant treatment given at individual practitioners' discretion. Findings indicated that the algorithm did not reduce death, venous thromboembolism, nor major bleeding, but helped avoid longer hospital stay and admission to an intensive-care unit.
AHRQ-funded; HS024917.
Citation: Djulbegovic B, Hozo I, Lizarraga D .
Evaluation of a fast-and-frugal clinical decision algorithm ('pathways') on clinical outcomes in hospitalised patients with COVID-19 treated with anticoagulants.
J Eval Clin Pract 2023 Feb; 29(1):3-12. doi: 10.1111/jep.13780..
Keywords: COVID-19, Clinical Decision Support (CDS), Blood Thinners, Medication, Evidence-Based Practice, Health Information Technology (HIT)
Coley RY, Smith JJ, Karliner L RY, Smith JJ, Karliner L
External validation of the eRADAR risk score for detecting undiagnosed dementia in two real-world healthcare systems.
Drupal date: Feb, 2023
It is estimated that half of the individuals with dementia remain undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was designed to detect older adults at risk of undiagnosed dementia using routinely gathered clinical information. The purpose of this retrospective cohort study was to externally validate eRADAR in two real-world healthcare systems, examining its performance over time and across race/ethnicity. The study found a total of 7631 dementia diagnoses were observed at KPWA and 216 at UCSF. The area under the curve was 0.84 (95% confidence interval: 0.84-0.85) at KPWA and 0.79 (0.76-0.82) at UCSF. Using the 90th percentile as the cut point for identifying high-risk patients, sensitivity was 54% (53-56%) at KPWA and 44% (38-51%) at UCSF. Performance was consistent over time, including across the transition from International Classification of Diseases, version 9 (ICD-9) to ICD-10 codes, and across racial/ethnic groups (although small samples limited precision in some groups). The study concluded that eRADAR demonstrated strong external validity for identifying undiagnosed dementia in two healthcare systems with diverse patient populations and varying availability of external healthcare data for risk calculations. This study showed that eRADAR is generalizable from a research sample to real-world clinical populations, transportable across health systems, resilient to temporal changes in healthcare, and exhibits similar performance across major racial/ethnic groups.
It is estimated that half of the individuals with dementia remain undiagnosed. The electronic health record (EHR) Risk of Alzheimer's and Dementia Assessment Rule (eRADAR) was designed to detect older adults at risk of undiagnosed dementia using routinely gathered clinical information. The purpose of this retrospective cohort study was to externally validate eRADAR in two real-world healthcare systems, examining its performance over time and across race/ethnicity. The study found a total of 7631 dementia diagnoses were observed at KPWA and 216 at UCSF. The area under the curve was 0.84 (95% confidence interval: 0.84-0.85) at KPWA and 0.79 (0.76-0.82) at UCSF. Using the 90th percentile as the cut point for identifying high-risk patients, sensitivity was 54% (53-56%) at KPWA and 44% (38-51%) at UCSF. Performance was consistent over time, including across the transition from International Classification of Diseases, version 9 (ICD-9) to ICD-10 codes, and across racial/ethnic groups (although small samples limited precision in some groups). The study concluded that eRADAR demonstrated strong external validity for identifying undiagnosed dementia in two healthcare systems with diverse patient populations and varying availability of external healthcare data for risk calculations. This study showed that eRADAR is generalizable from a research sample to real-world clinical populations, transportable across health systems, resilient to temporal changes in healthcare, and exhibits similar performance across major racial/ethnic groups.
AHRQ-funded; HS026369.
Citation: Coley RY, Smith JJ, Karliner L RY, Smith JJ, Karliner L .
External validation of the eRADAR risk score for detecting undiagnosed dementia in two real-world healthcare systems.
J Gen Intern Med 2023 Feb; 38(2):351-60. doi: 10.1007/s11606-022-07736-6..
Keywords: Dementia, Neurological Disorders, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kman NE, Price A, Berezina-Blackburn V
First Responder Virtual Reality Simulator to train and assess emergency personnel for mass casualty response.
This paper describes the First Responder Virtual Reality Simulator, a high-fidelity, fully immersive, automated, programmable virtual reality (VR) simulation designed to train frontline responders to treat and triage victims of mass casualty incidents. First responder trainees wear a wireless VR head-mounted display linked to a compatible desktop computer. Autonomous, interactive victims who are programmed to simulate individuals with injuries consistent with an explosion in an underground space are used. The trainees are armed with a virtual medical kit, who are then tasked with triaging and treating the victims on the scene. Increased challenges can be added such as increasing the environmental chaos, adding patients, or increasing the acuity of patient injuries.
AHRQ-funded; HS025915.
Citation: Kman NE, Price A, Berezina-Blackburn V .
First Responder Virtual Reality Simulator to train and assess emergency personnel for mass casualty response.
J Am Coll Emerg Physicians Open 2023 Feb;4(1):e12903. doi: 10.1002/emp2.12903.
Keywords: Emergency Medical Services (EMS), Simulation, Health Information Technology (HIT), Training, Emergency Preparedness
Hobensack M, Song J, Scharp D
Machine learning applied to electronic health record data in home healthcare: a scoping review.
This literature review aimed to synthesize and appraise the literature describing the application of machine learning to predict adverse outcomes (e.g., hospitalization, mortality) using electronic health record (EHR) data in the home healthcare (HHC) setting. The secondary aim was to evaluate the comprehensiveness of predictors used in the machine learning algorithms guided by the Biopsychosocial Model. Studies were included if they 1) described services provided in the HHC setting, 2) applied machine learning algorithms to predict adverse outcomes, defined as outcomes related to patient deterioration, 3) used EHR data and, 4) focused on the adult population. Predictors were mapped to the Biopsychosocial Model. The final sample included 20 studies, of which 18 used predictors from standardized assessments integrated in the EHR. The most common outcome was hospitalization (55%), followed by mortality (25%). About 35% of studies excluded psychological predictors. Most studies (75%) demonstrated high or unclear risk of bias with tree based algorithms most frequently applied (75%).
AHRQ-funded; HS027742.
Citation: Hobensack M, Song J, Scharp D .
Machine learning applied to electronic health record data in home healthcare: a scoping review.
Int J Med Inform 2023 Feb; 170:104978. doi: 10.1016/j.ijmedinf.2022.104978..
Keywords: Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Gephart SM, Tolentino DA, Quinn MC
Neonatal intensive care workflow analysis informing NEC-Zero clinical decision support design.
The aim of this qualitative descriptive study was to explore the current clinical workflow and sociotechnical processes of clinicians for necrotizing enterocolitis risk awareness, timely discovery of symptoms, and treatment to guide decision support design. The researchers conducted 11 focus groups in two neonatal ICUs. The study found that workflow processes were different for nurses (who observe the signs of necrotizing enterocolitis and inform providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide what actions to take). The researchers reported that clinicians wanted a necrotizing enterocolitis-relevant dashboard with: 1) nutrition tracking and recognition of necrotizing enterocolitis; 2) features to support decision-making; 3) breast milk tracking and feeding clinical decision support; 4) tools for necrotizing enterocolitis surveillance and quality reporting; and 5) general electronic health records improvements to enhance user experience.
AHRQ-funded; HS022908.
Citation: Gephart SM, Tolentino DA, Quinn MC .
Neonatal intensive care workflow analysis informing NEC-Zero clinical decision support design.
Comput Inform Nurs 2023 Feb; 41(2):94-101. doi: 10.1097/cin.0000000000000929..
Keywords: Newborns/Infants, Clinical Decision Support (CDS), Intensive Care Unit (ICU), Workflow, Health Information Technology (HIT)
Kanbar LJ, Dexheimer Jw, Zahner J
Standardizing electronic health record ventilation data in the pediatric long-term mechanical ventilator-dependent population.
This research aimed to create a framework for standardizing mechanical ventilation terminology using ventilator data for a cohort of children who were weaned from mechanical ventilation (MV) to long-term mechanical ventilation (LTMV). Currently there is a lack of data standardization which is a major barrier to data sharing. The authors proposed a framework for standardizing the data using a common data model (CDM) across multiple populations and sites. They extracted and described relevant electronic health record (EHR) ventilation data. They developed a framework for Clinical Ideas into the PEDSnet CDM based on the Observational Medical Outcomes Partnership (OMOP). They identified 78 children with LMTV dependence who were weaned from ventilator support. They found 25 unique device names and 28 unique ventilation mode names used in the cohort. They decided on the following data concepts: device, interface, ventilation mode, settings, measurements, and duration of ventilation usage per day. They used Concepts from the SNOMED-CT vocabulary and integrated an existing ventilator mode taxonomy to create a framework for CDM and OMOP integration.
AHRQ-funded; HS026393.
Citation: Kanbar LJ, Dexheimer Jw, Zahner J .
Standardizing electronic health record ventilation data in the pediatric long-term mechanical ventilator-dependent population.
Pediatr Pulmonol 2023 Feb; 58(2):433-40. doi: 10.1002/ppul.26204..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT)
Conley CC, Wernli KJ, Knerr S
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
The objective of this study was to evaluate direct and indirect effects of a web-based, Protection Motivation Theory (PMT)-informed education and decision support tool for risk-reducing medication and breast MRI among women with high risk of breast cancer. Findings indicated that PMT-informed intervention effected behavioral intentions. No direct intervention effect on intentions for risk-reducing medication or MRI were found, but there were significant indirect effects on risk-reducing medication intentions via perceived risk, self-efficacy, and response efficacy, and on MRI intentions via perceived risk and response efficacy, The authors suggested that future research should extend these findings from intentions to behavior.
AHRQ-funded; HS022982.
Citation: Conley CC, Wernli KJ, Knerr S .
Using protection motivation theory to predict intentions for breast cancer risk management: intervention mechanisms from a randomized controlled trial.
J Cancer Educ 2023 Feb; 38(1):292-300. doi: 10.1007/s13187-021-02114-y..
Keywords: Cancer: Breast Cancer, Cancer, Risk, Education: Patient and Caregiver, Health Information Technology (HIT)
Apathy NC, Hare AJ, Fendrich S
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
The authors analyzed observed reductions in physicians’ note length and documentation time, both of which contribute to EHR burden and burnout. Their study used EHR metadata for ambulatory physician Epic users and examined changes in note composition of physicians who decreased note length and/or documentation time. Their findings showed that note length decreases were primarily attributable to reductions in copy/paste text and templated text, while note time decreases were primarily attributable to reductions in manual text. They concluded that future research should explore scalable burden-reduction initiatives that are responsive to both note bloat and documentation time.
AHRQ-funded; HS026116.
Citation: Apathy NC, Hare AJ, Fendrich S .
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
J Am Med Inform Assoc 2023 Jan18; 30(2):355-60. doi: 10.1093/jamia/ocac211..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Lenoir KM, Sandberg JC, Miller DP
Patient perspectives on a targeted text messaging campaign to encourage screening for diabetes: qualitative study.
This study investigated whether patients would be receptive to receiving text messages that alert them to a risk of having an elevated HbA(1c) in direct-to-patient alerts that use cold texting. A total of 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. The investigators displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Participants (n = 36) were generally receptive to the idea of receiving a text-based alert for HbA(1c) screening. The use of plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. The patients’ relationship with their providers and the financial costs associated with texts and screening may affect receptiveness and engagement in this process.
AHRQ-funded; HS026803.
Citation: Lenoir KM, Sandberg JC, Miller DP .
Patient perspectives on a targeted text messaging campaign to encourage screening for diabetes: qualitative study.
JMIR Form Res 2023 Jan 17; 7:e41011. doi: 10.2196/41011..
Keywords: Diabetes, Screening, Prevention, Health Information Technology (HIT)
Pruitt ZM, Kazi S, Weir C
A systematic review of quantitative methods for evaluating electronic medication administration record and bar-coded medication administration usability.
This systematic review’s objective was to identify the impact of electronic medication administration record (eMAR) and bar-coded medication administration (BCMA) on usability, operationalized as efficiency, effectiveness, and satisfaction. Out of 1,922 articles, 41 were included for data extraction. Twenty-four articles (58.5%) investigated BCMA only, 10 (24.4%) eMAR only, and seven (17.1%) both BCMA and eMAR, and 24 articles (58.5%) measured effectiveness, 8 (19.5%) efficiency, and 17 (41.5%) satisfaction. Of the 100 measures across the 41 articles, implementing BCMA and/or eMAR broadly resulted in an increase in measures of effectiveness (52.3%) and satisfaction (62.2%) compared to measures of efficiency (27.3%).
AHRQ-funded; HS025136.
Citation: Pruitt ZM, Kazi S, Weir C .
A systematic review of quantitative methods for evaluating electronic medication administration record and bar-coded medication administration usability.
Appl Clin Inform 2023 Jan;14(1):185-98. doi: 10.1055/s-0043-1761435.
Keywords: Medication, Health Information Technology (HIT)
Fareed N, Swoboda C, Singh P
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
The objective of this study was to develop user specifications for a tailored and integrated technology, patient application (mHealth) and provider dashboard, that provides a complete view of Medicaid-enrolled patients with type 2 diabetes (T2D) during pregnancy and to develop prototypes based on users’ needs. Participating patients and providers stated a core set of expectations for the mHealth and dashboard applications. Participants then provided feedback to improve these applications. The authors concluded that digital health tools could transform health care among Medicaid-enrolled patients with T2D during pregnancy, with the goal of managing their blood glucose levels. Refining the stated needs and preferences of patients and providers to develop applications holds potential for tackling complicated health care issues.
AHRQ-funded; HS028822.
Citation: Fareed N, Swoboda C, Singh P .
Developing and testing an integrated patient mHealth and provider dashboard application system for type 2 diabetes management among Medicaid-enrolled pregnant individuals based on a user-centered approach: mixed-methods study.
Digit Health 2023 Jan-Dec; 9:20552076221144181. doi: 10.1177/20552076221144181..
Keywords: Patient-Centered Healthcare, Telehealth, Diabetes, Pregnancy, Chronic Conditions, Women, Health Information Technology (HIT)
Rodriguez HP, Ciemins EL, Rubio K
Health systems and telemedicine adoption for diabetes and hypertension care.
This study examined differences in telemedicine use for adults with diabetes and/or hypertension across 10 health systems and analyzed practice and patient characteristics associated with greater use. Encounter-level data from the AMGA Optum Data Warehouse for March 13, 2020 to December 31, 2020 were analyzed. This included 3,016,761 clinical encounters from 764,521 adults with diabetes and/or hypertension attributed to 1 of 1207 practice sites with at least 50 system-attributed patients. Telemedicine use time was divided into adoption (weeks 0-4), de-adoption (weeks 5-12), and maintenance (weeks 13-42) periods. Telemedicine use peaked after 4 weeks at 11-42% of weekly encounters. Small practices had lower telemedicine use for adults with diabetes during the maintenance period compared with larger practices, with ownership showing no association with telemedicine use. Practices with higher proportions of Black patients continued their expansion of telemedicine use during the de-adoption and maintenance periods.
Citation: Rodriguez HP, Ciemins EL, Rubio K .
Health systems and telemedicine adoption for diabetes and hypertension care.
Am J Manag Care 2023 Jan; 29(1):42-49. doi: 10.37765/ajmc.2023.89302..
Keywords: Telehealth, Health Information Technology (HIT), Diabetes, Blood Pressure, Chronic Conditions
Rizk S, Kaelin VC, Sim JGC
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
The study’s aim was to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. A mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were conducted and used to share quantitative trial results. All three stakeholder groups identified thematic supports and barriers across multiple constructs within each of four Consolidated Framework for Implementation Research (CFIR) domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) Three themes for "inner setting," and (4) Four themes for "outer setting." Priorities from stakeholders included prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Improving EI access (“outer setting”) using YC-PEM e-PRO results was also articulated by service coordinators and program leadership.
AHRQ-funded; HS027583.
Citation: Rizk S, Kaelin VC, Sim JGC .
Implementing an electronic patient-reported outcome and decision support tool in early intervention.
Appl Clin Inform 2023 Jan; 14(1):91-107. doi: 10.1055/s-0042-1760631..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Children/Adolescents, Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
Hose BZ, Carayon P, Hoonakker PLT
Managing multiple perspectives in the collaborative design process of a team health information technology.
The creation of technology that supports healthcare teams is crucial, and the development of such solutions should encompass various clinical roles. However, our understanding of the actual collaborative process in designing team-based care technologies is limited. The purpose of this study was to delve into the management of diverse perspectives during the development of a health IT solution geared towards meeting the informational needs of clinicians during pediatric trauma care transitions. The researcher’s analysis concentrated on four co-design sessions, which included multiple healthcare professionals involved in pediatric trauma patient care. Employing content analysis and process coding, the researchers analyzed the transcripts of the design sessions, drawing inspiration from Détienne's (2006) co-design framework. By expanding on Détienne's (2006) three collaborative activities, the researchers identified distinct themes and processes that characterized collaboration among care team members during the design process. The study found that the themes and processes showcase the collaborative nature of a team health IT design procedure, ultimately resulting in a highly functional technology.
AHRQ-funded; HS023837
Citation: Hose BZ, Carayon P, Hoonakker PLT .
Managing multiple perspectives in the collaborative design process of a team health information technology.
Appl Ergon 2023 Jan;106:103846. doi: 10.1016/j.apergo.2022.103846.
Keywords: Teams, Health Information Technology (HIT)
Mohr NM, Okoro U, Harland KK
Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: a multicenter cohort study.
The objective of this multicenter cohort study was to test the hypothesis that provider-to-provider tele-emergency department (tele-ED) care is associated with more 28-day hospital-free days and improved Surviving Sepsis Campaign (SSC) guideline adherence in rural emergency departments. Medical records of patients with sepsis were taken from rural hospitals in an established, on-demand, video tele-ED Midwestern network. Findings suggest that tele-ED cases did not have more 28-day hospital-free days or 28-day in-hospital mortality. A subgroup of patients treated by advanced practice providers suggest that mortality was lower in the cohort with tele-ED use in spite of no significant difference in complete SSC adherence. The researchers concluded that rural emergency department patients treated with provider-to-provider tele-ED care in a developed network showed similar clinical outcomes to those treated without.
AHRQ-funded; HS025753.
Citation: Mohr NM, Okoro U, Harland KK .
Outcomes associated with rural emergency department provider-to-provider telehealth for sepsis care: a multicenter cohort study.
Ann Emerg Med 2023 Jan;81(1):1-13. doi: 10.1016/j.annemergmed.2022.07.024..
Keywords: Rural Health, Emergency Department, Telehealth, Health Information Technology (HIT), Sepsis, Outcomes