National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (2)
- Ambulatory Care and Surgery (2)
- Antibiotics (2)
- Behavioral Health (1)
- Brain Injury (1)
- Cancer (2)
- Cancer: Cervical Cancer (1)
- Cancer: Colorectal Cancer (1)
- Children/Adolescents (2)
- (-) Clinical Decision Support (CDS) (20)
- Colonoscopy (1)
- Depression (1)
- Diabetes (1)
- Education: Continuing Medical Education (1)
- Electronic Health Records (EHRs) (3)
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- Guidelines (3)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (8)
- Health Services Research (HSR) (1)
- Hospitals (2)
- Imaging (1)
- Inpatient Care (1)
- Kidney Disease and Health (1)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (3)
- Medication: Safety (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (3)
- Prevention (3)
- Primary Care (1)
- Primary Care: Models of Care (1)
- Provider: Health Personnel (1)
- Provider Performance (1)
- Quality Improvement (3)
- Quality Measures (1)
- Quality of Care (1)
- Risk (1)
- Screening (3)
- Shared Decision Making (10)
- Surgery (1)
- Tools & Toolkits (1)
- Transplantation (1)
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 20 of 20 Research Studies DisplayedMagrath M, Yang E, Ahn C
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). Results showed that an EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.
AHRQ-funded; HS022418.
Citation: Magrath M, Yang E, Ahn C .
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
J Natl Compr Canc Netw 2018 Nov;16(11):1321-28. doi: 10.6004/jnccn.2018.7050..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Colonoscopy, Cancer: Colorectal Cancer, Screening, Cancer, Guidelines, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention
Gianfrancesco MA, Tamang S, Yazdany J
Potential biases in machine learning algorithms using electronic health record data.
This Special Communication outlines the potential biases that may be introduced into machine learning-based clinical decision support tools that use electronic health record data and proposes potential solutions to the problems of overreliance on automation, algorithms based on biased data, and algorithms that do not provide information that is clinically meaningful.
AHRQ-funded; HS024412.
Citation: Gianfrancesco MA, Tamang S, Yazdany J .
Potential biases in machine learning algorithms using electronic health record data.
JAMA Intern Med 2018 Nov;178(11):1544-47. doi: 10.1001/jamainternmed.2018.3763..
Keywords: Electronic Health Records (EHRs), Clinical Decision Support (CDS), Health Information Technology (HIT), Shared Decision Making
Leeds IL, Rosenblum AJ, Wise PE
Eye of the beholder: risk calculators and barriers to adoption in surgical trainees.
This study examined barriers to surgical trainees in using risk calculator tools before surgery. A total of 124 surgical residents responded to a survey and most still favored more traditional methods for risk calculation including direct verbal communication, sketch diagrams, and brochures. Only about half or less were familiar with more contemporary tools such as best-worst case scenario framing, case-specific risk calculators, and all-procedure calculators.
AHRQ-funded; HS024736.
Citation: Leeds IL, Rosenblum AJ, Wise PE .
Eye of the beholder: risk calculators and barriers to adoption in surgical trainees.
Surgery 2018 Nov;164(5):1117-23. doi: 10.1016/j.surg.2018.07.002..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Education: Continuing Medical Education, Risk, Surgery
Anand V, Carroll AE, Biondich PG
Pediatric decision support using adapted Arden Syntax.
This study reviewed the use of a medical logic module (MLM) called the Arden Syntax in pediatrics. The Arden Syntax was adapted for the Child Health Improvement through Computer Automation System (CHICA) in waiting rooms. This system is used in pediatrician’s offices to screen patient families and alert physicians during office visits. It has been used in 7 pediatric clinics and has served over 44,000 patients in the last decade. The researchers concluded that it is an effective system for use in routine care and only needs some minor modifications.
AHRQ-funded; HS017939; HS018453.
Citation: Anand V, Carroll AE, Biondich PG .
Pediatric decision support using adapted Arden Syntax.
Artif Intell Med 2018 Nov;92:15-23. doi: 10.1016/j.artmed.2015.09.006..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Health Information Technology (HIT)
Panattoni L, Chan A, Yang Y
Nudging physicians and patients with autopend clinical decision support to improve diabetes management.
This study’s objective was to determine the impact on routine glycalated hemoglobin (A1C) laboratory test completion of incorporating an autopend laboratory order functionality into clinical decision support. The clinical decision support includes 1) routing provider alerts to a separate electronic folder, 2) automatically populating preauthorization forms, and 3) linking the timing and content of electronic patient health maintenance topic (HMT) reminders to the provider authorization. The likelihood of A1C laboratory test completion increased after autopend by between 21% to 33.9%.
AHRQ-funded; HS019167.
Citation: Panattoni L, Chan A, Yang Y .
Nudging physicians and patients with autopend clinical decision support to improve diabetes management.
Am J Manag Care 2018 Oct;24(10):479-83..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT)
Slight SP, Seger DL, Franz C
The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States.
Investigators worked to determine the national cost of adverse drug events (ADEs) in the United States in 2014. They used three different regression models. They used a random sample of 40,990 adult inpatients at the Brigham and Women’s Hospital in Boston with over 1.6 million medication orders. They extrapolated the medication orders using 2014 National Inpatient Sample (NIS) data. They estimated that out of 78.8 million total medication alerts, 5.5 million medication alerts would have been inappropriately overridden resulting in 196,660 ADEs. They estimated it would have cost between $871 million and $1.8 billion for treating these preventable ADEs in the United States.
AHRQ-funded; HS021094.
Citation: Slight SP, Seger DL, Franz C .
The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States.
J Am Med Inform Assoc 2018 Sep;25(9):1183-88. doi: 10.1093/jamia/ocy066..
Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Drug Events (ADE), Adverse Events, Clinical Decision Support (CDS), Health Information Technology (HIT), Healthcare Costs, Medical Errors, Medication
Ray-Barruel G, Cooke M, Mitchell M
Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study.
This study aims to validate an evidence-based peripheral intravenous catheter (PIVC) assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice.
AHRQ-funded; HS022835.
Citation: Ray-Barruel G, Cooke M, Mitchell M .
Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study.
BMJ Open 2018 Jun 4;8(6):e021290. doi: 10.1136/bmjopen-2017-021290..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Patient Safety, Tools & Toolkits
Patterson ES, Dewart CM, Stevenson K
A mixed methods approach to tailoring evidence-based guidance for antibiotic stewardship to one medical system.
The purpose of the study is to operationalize a novel antibiotic advisor, called the personalized weighted incidence syndromic combination antibiogram (pWISCA), intended to help physicians with initial antibiotic choice in hospitals. This paper presents findings from applying a mixed methods approach to identifying and prioritizing antibiotic medications and associated contextual data to display in a clinical decision support tailored to the local hospital.
AHRQ-funded; HS024379.
Citation: Patterson ES, Dewart CM, Stevenson K .
A mixed methods approach to tailoring evidence-based guidance for antibiotic stewardship to one medical system.
Proc Int Symp Hum Factors Ergon Healthc 2018 Jun;7(1):224-31. doi: 10.1177/2327857918071053..
Keywords: Antibiotics, Clinical Decision Support (CDS), Evidence-Based Practice, Health Services Research (HSR), Hospitals
Marcial LH, Richardson JE, Lasater B
AHRQ Author: Lomotan and Al-Showk
The imperative for patient-centered clinical decision support.
This commentary introduces the Patient-Centered Clinical Decision Support (PCCDS) Learning Network, which is collaborating with AcademyHealth to publish "Better Decisions Together" as part of eGEMs. The PCCDS Learning Network has developed a framework, referred to as the Analytic Framework for Action (AFA), to organize thinking and activities around PCCDS. A wide array of activities the PCCDS Learning Network is engaging in to inform and connect stakeholders is discussed.
AHRQ-authored.
Citation: Marcial LH, Richardson JE, Lasater B .
The imperative for patient-centered clinical decision support.
eGEMS 2018 May 30;6(1):12. doi: 10.5334/egems.259..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Patient-Centered Healthcare
Keller SC, Tamma PD, Cosgrove SE
AHRQ Author: Miller MA
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
The authors conducted a systematic review to identify controlled interventions and qualitative studies of ambulatory antibiotic stewardship (AS) interventions and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. They concluded that studies have not focused on clinic-wide approaches to AS.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Tamma PD, Cosgrove SE .
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
J Am Board Fam Med 2018 May-Jun;31(3):417-30. doi: 10.3122/jabfm.2018.03.170225.
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Keywords: Antibiotics, Clinical Decision Support (CDS), Primary Care: Models of Care, Ambulatory Care and Surgery, Patient Safety
MacLaughlin KL, Kessler ME, Komandur Elayavilli R
Impact of patient reminders on Papanicolaou test completion for high-risk patients identified by a clinical decision support system.
The researchers aimed to assess the effect of a complex clinical decision support system, incorporating national guidelines for high-risk patient screening and abnormal result management. They found that the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7 percent than the completion rate at 3.3 percent in the control group.
AHRQ-funded; HS022911.
Citation: MacLaughlin KL, Kessler ME, Komandur Elayavilli R .
Impact of patient reminders on Papanicolaou test completion for high-risk patients identified by a clinical decision support system.
J Womens Health 2018 May;27(5):569-74. doi: 10.1089/jwh.2017.6667.
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Keywords: Cancer, Clinical Decision Support (CDS), Guidelines, Health Information Technology (HIT)
Bowen ME, Bhat D, Fish J
Improving performance on preventive health quality measures using clinical decision support to capture care done elsewhere and patient exceptions.
This before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement.
AHRQ-funded; HS022418.
Citation: Bowen ME, Bhat D, Fish J .
Improving performance on preventive health quality measures using clinical decision support to capture care done elsewhere and patient exceptions.
Am J Med Qual 2018 May/Jun;33(3):237-45. doi: 10.1177/1062860617732830..
Keywords: Clinical Decision Support (CDS), Prevention, Provider Performance, Quality Improvement, Quality Measures, Quality Measures
Nanji KC, Seger DL, Slight SP
Medication-related clinical decision support alert overrides in inpatients.
This study examined the use of medical-related clinical decision support alert overrides by clinicians in hospital inpatient settings. Overall, almost three-quarters of alerts were overridden, with 40% of them not being appropriate. The majority of overrides dealing with duplicate drug, patient allergy or formulary substitution alerts were appropriate but very few for renal- or age-based were. The authors concluded that research should be done to optimize alert types and frequencies to reduce alarm fatigue.
AHRQ-funded; HS024764.
Citation: Nanji KC, Seger DL, Slight SP .
Medication-related clinical decision support alert overrides in inpatients.
J Am Med Inform Assoc 2018 May;25(5):476-81. doi: 10.1093/jamia/ocx115..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Health Information Technology (HIT), Inpatient Care, Medication
Wey A, Salkowski N, Kremers WK
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
The researchers developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and they characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kremers WK .
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
Am J Transplant 2018 Apr;18(4):897-906. doi: 10.1111/ajt.14506.
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Keywords: Clinical Decision Support (CDS), Shared Decision Making, Kidney Disease and Health, Medical Expenditure Panel Survey (MEPS), Transplantation
Grout RW, Cheng ER, Carroll AE
A six-year repeated evaluation of computerized clinical decision support system user acceptability.
This study examined user acceptance patterns over six years of a continuous computerized clinical decision support system (CDSS) integration and updated a long-term, repeated follow-up of user acceptability of a CDSS. It found that favorable opinions of the CDSS were more likely in frequent users, physicians and advanced practitioners, and full-time workers.
AHRQ-funded; HS017939; HS018453; HS020640.
Citation: Grout RW, Cheng ER, Carroll AE .
A six-year repeated evaluation of computerized clinical decision support system user acceptability.
Int J Med Inform 2018 Apr;112:74-81. doi: 10.1016/j.ijmedinf.2018.01.011.
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Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Provider: Health Personnel, Health Information Technology (HIT), Quality Improvement
Aldina S, Goldhaber-Fiebert SN, Hannenberg AA
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
This study examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. It found that small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation. Completing more implementation steps was also significantly associated with more successful implementation.
AHRQ-funded; HS024235.
Citation: Aldina S, Goldhaber-Fiebert SN, Hannenberg AA .
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
Implement Sci 2018 Mar 26;13(1):50. doi: 10.1186/s13012-018-0739-4.
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Keywords: Adverse Events, Ambulatory Care and Surgery, Patient Safety, Quality Improvement, Quality of Care, Hospitals, Shared Decision Making, Clinical Decision Support (CDS)
Wong A, Seger DL, Slight SP
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
The aim of this study was to determine the rate of anaphylaxis overrides, the reasons for these overrides, whether the overrides were appropriate, and if harm occurred from overrides. Overrides of 'definite' anaphylaxis drug-allergy interactions were common and often appropriate. Most overrides were due to desensitizations.
AHRQ-funded; HS021094.
Citation: Wong A, Seger DL, Slight SP .
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
Drug Saf 2018 Mar;41(3):297-302. doi: 10.1007/s40264-017-0615-1.
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Keywords: Adverse Drug Events (ADE), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Medication: Safety, Medication
Etter DJ, McCord A, Ouyang F
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. The authors concluded that incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care was feasible and well utilized by providers.
AHRQ-funded; HS022681.
Citation: Etter DJ, McCord A, Ouyang F .
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
J Adolesc Health 2018 Feb;62(2):191-97. doi: 10.1016/j.jadohealth.2017.08.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Depression, Behavioral Health, Primary Care, Screening
Sharp AL, Huang BZ, Tang T
Implementation of the Canadian CT Head Rule and Its association with use of computed tomography among patients with head injury.
The researchers evaluated the association of implementation of the Canadian CT Head Rule on head computed tomography (CT) imaging in community emergency departments (EDs). They found that a multicomponent implementation of the Canadian CT Head Rule was associated with a modest reduction in CT use and an increased diagnostic yield of head CTs for adult trauma encounters in community EDs.
AHRQ-funded; HS021271.
Citation: Sharp AL, Huang BZ, Tang T .
Implementation of the Canadian CT Head Rule and Its association with use of computed tomography among patients with head injury.
Ann Emerg Med 2018 Jan;71(1):54-63.e2. doi: 10.1016/j.annemergmed.2017.06.022.
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Keywords: Brain Injury, Clinical Decision Support (CDS), Shared Decision Making, Emergency Department, Guidelines, Healthcare Utilization, Imaging
Ravikumar KE, MacLaughlin KL, Scheitel MR
Improving the accuracy of a clinical decision support system for cervical cancer screening and surveillance.
Researchers sought to enhance a clinical decision support system (CDSS) by improving its accuracy and incorporating changes to reflect the latest revision of the guidelines. The recommendation accuracy of the enhanced CDSS improved to 93 percent, which is a substantial improvement over the 84 percent reported previously. A detailed analysis of errors is presented in this article.
AHRQ-funded; HS022911.
Citation: Ravikumar KE, MacLaughlin KL, Scheitel MR .
Improving the accuracy of a clinical decision support system for cervical cancer screening and surveillance.
Appl Clin Inform 2018 Jan;9(1):62-71. doi: 10.1055/s-0037-1617451.
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Keywords: Cancer: Cervical Cancer, Clinical Decision Support (CDS), Prevention, Screening