National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Ambulatory Care and Surgery (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Behavioral Health (1)
- Care Coordination (1)
- Children/Adolescents (2)
- Community-Based Practice (1)
- Data (1)
- Diabetes (1)
- Electronic Health Records (EHRs) (14)
- Evidence-Based Practice (1)
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- (-) Health Information Technology (HIT) (24)
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- Hospital Discharge (1)
- Medical Errors (1)
- Medication (1)
- Nursing (1)
- Orthopedics (1)
- Outcomes (2)
- Pain (1)
- Patient-Centered Outcomes Research (3)
- Patient and Family Engagement (1)
- Patient Safety (2)
- Practice Patterns (1)
- Primary Care (1)
- Provider (2)
- Provider: Nurse (1)
- Provider: Pharmacist (1)
- Public Health (1)
- Quality Improvement (1)
- Quality of Care (3)
- Racial and Ethnic Minorities (2)
- Research Methodologies (8)
- Respiratory Conditions (1)
- Sex Factors (1)
- Surgery (1)
- Telehealth (1)
- Transitions of Care (1)
- Vulnerable Populations (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 24 of 24 Research Studies DisplayedHuo T, Glueck DH, Shenkman EA
Stratified split sampling of electronic health records
Data extracted from electronic health records may require very different approaches for model building and analysis than data from clinical research. Because electronic health record data is designed for clinical use, researchers need to engage in the iterative process of defining and provide clear definitions of outcome and predictor variables and assessing associations. This process can increase Type I error rates and decrease the chance of replicability. Failure to consider subgroups may mask heterogeneous relationships between predictor and outcome by subgroups, thus decreasing the generalizability of the findings. To improve the likelihood of both replicability and generalizability, the researchers recommended utilizing a stratified split sample approach for studies using electronic health records. The researchers illustrate the approach through an electronic health record study of the relationships between socio-demographic factors and uptake of hepatic cancer screening, and potential heterogeneity of association in subgroups defined by gender, self-identified race and ethnicity, census-tract level poverty and insurance type.
AHRQ-funded; HS028283.
Citation: Huo T, Glueck DH, Shenkman EA .
Stratified split sampling of electronic health records
BMC Med Res Methodol 2023 May 25; 23(1):128. doi: 10.1186/s12874-023-01938-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, Health Services Research (HSR)
Rodriguez PJ, Ward ZJ, Long MW
Applied methods for estimating transition probabilities from electronic health record data.
This study examined the usefulness of electronic health records (EHRs) in estimating transition probabilities for state-transition models. No guidelines exist on appropriate methods. The authors used 3 potential methods to estimate transition probabilities for EHR data, using pediatric eating disorders (EDs) as a case study. They mapped diagnoses to 3 ED health states: anorexia nervous, bulimia nervosa, and other specified feeding or eating disorder using data from PEDsnet, which includes 8 US children’s hospitals. They used 3 approaches: simple first-last proportions, a multistate Markov (MSM) model, and independent survival models. The first-last proportion approach estimated higher probabilities of remaining the same health state, while the other two approaches estimated higher probabilities of transitioning to a different health state. Published literature differed substantially from these estimates. Further research is needed to improve methods for using EHR data to inform transition probabilities.
AHRQ-funded; HS013853.
Citation: Rodriguez PJ, Ward ZJ, Long MW .
Applied methods for estimating transition probabilities from electronic health record data.
Med Decis Making 2021 Feb;41(2):143-52. doi: 10.1177/0272989x20985752..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Research Methodologies
Thompson HM
Stakeholder experiences with gender identity data capture in electronic health records: implementation effectiveness and a visibility paradox.
Advocates have endorsed transgender visibility via gender identity (GI) data capture with the advent of the Affordable Care Act and electronic health record (EHR) requirements. Visibility in data in order to enumerate a population contrasts with ways in which other LGBT and public health scholars have deployed these concepts. This article aims to assess the effectiveness of GI data capture in EHRs and implications for trans health care quality improvements and research.
AHRQ-funded; HS026385.
Citation: Thompson HM .
Stakeholder experiences with gender identity data capture in electronic health records: implementation effectiveness and a visibility paradox.
Health Educ Behav 2021 Feb;48(1):93-101. doi: 10.1177/1090198120963102.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Vulnerable Populations, Sex Factors
Ward TM, Skubic M, Rantz M
Human-centered approaches that integrate sensor technology across the lifespan: opportunities and challenges.
Children, parents, older adults, and caregivers routinely use sensor technology as a source of health information and health monitoring. The purpose of this paper was to describe three exemplars of research that used a human-centered approach to engage participants in the development, design, and usability of interventions that integrate technology to promote health. The exemplars were based on current research studies that integrated sensor technology into pediatric, adult, and older adult populations living with a chronic health condition.
AHRQ-funded; HS018477.
Citation: Ward TM, Skubic M, Rantz M .
Human-centered approaches that integrate sensor technology across the lifespan: opportunities and challenges.
Nurs Outlook 2020 Nov-Dec;68(6):734-44. doi: 10.1016/j.outlook.2020.05.004..
Keywords: Health Information Technology (HIT), Patient and Family Engagement, Health Services Research (HSR), Research Methodologies
Gance-Cleveland B, McDonald CC, Walker RK
Use of theory to guide development and application of sensor technologies in nursing.
In this paper, three nurse scientists summarize their presentations at the Council for the Advancement of Nursing Science 2019 Advanced Methods Conference on Expanding Science of Sensor Technology in Research discussing the theoretical underpinnings of sensor technologies development and use in nursing research and practice.
AHRQ-funded; HS024738; HS018646.
Citation: Gance-Cleveland B, McDonald CC, Walker RK .
Use of theory to guide development and application of sensor technologies in nursing.
Nurs Outlook 2020 Nov-Dec;68(6):698-710. doi: 10.1016/j.outlook.2020.04.007..
Keywords: Health Information Technology (HIT), Nursing, Health Services Research (HSR), Research Methodologies
Heintzman J, Marino M, Clark K
Using electronic health record data to study Latino immigrant populations in health services research.
The purpose of this study was to validate an electronic health record (EHR)-based algorithm that could serve as a safe proxy for self-reported immigration status for health services researchers. Researchers developed an EHR algorithm to classify a population of patients as likely undocumented or recent Latino immigrants and validated this algorithm by conducting semi-structured interviews of staff. They concluded that the EHR has potential for studying immigration status in health services research, although more study is needed to determine the accuracy and utility of EHRs for this purpose.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Clark K .
Using electronic health record data to study Latino immigrant populations in health services research.
J Immigr Minor Health 2020 Aug;22(4):754-61. doi: 10.1007/s10903-019-00925-2..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Health Services Research (HSR)
Di Tosto G, McAlearney AS, Fareed N
Metrics for outpatient portal use based on log file analysis: algorithm development.
This study’s goal was to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. The authors developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. They found that function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. They hope to promote the replicability of their study at other institutions and to contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.
AHRQ-funded; HS024091; HS024349; HS024379.
Citation: Di Tosto G, McAlearney AS, Fareed N .
Metrics for outpatient portal use based on log file analysis: algorithm development.
J Med Internet Res 2020 Jun 12;22(6):e16849. doi: 10.2196/16849..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Health Services Research (HSR), Research Methodologies
Weng Y, Tian L, Tedesco D
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Postoperative pain scores are widely monitored and collected in the electronic health record, yet current methods fail to fully leverage the data with fast implementation. This article describes a trajectory analysis for postoperative pain using electronic health records. A robust linear regression was fitted to describe the association between the log-scaled pain score and time from discharge after total knee replacement.
AHRQ-funded; HS024096.
Citation: Weng Y, Tian L, Tedesco D .
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Health Informatics J 2020 Jun;26(2):1404-18. doi: 10.1177/1460458219881339..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Pain, Surgery, Orthopedics, Research Methodologies, Health Services Research (HSR)
Gernant SA, Adeoye-Olatunde OA, Murawski MM
Experiences applying technology to overcome common challenges in pharmacy practice-based research in the United States.
Despite the importance of pharmacy practice-based research in generating knowledge that results in better outcomes for patients, health systems and society alike, common challenges to PPBR persist. In this paper, the authors described PPBR challenges their research teams have encountered, and their experiences using technology-driven solutions to overcome such challenges. The authors describe the technology driven solutions they have used to address PPBR challenges.
AHRQ-funded; HS025943.
Citation: Gernant SA, Adeoye-Olatunde OA, Murawski MM .
Experiences applying technology to overcome common challenges in pharmacy practice-based research in the United States.
Pharmacy 2020 May 30;8(2):93. doi: 10.3390/pharmacy8020093..
Keywords: Provider: Pharmacist, Provider, Health Information Technology (HIT), Patient-Centered Outcomes Research, Evidence-Based Practice, Health Services Research (HSR)
Adler-Milstein J, Adelman JS, Tai-Seale M
EHR audit logs: a new goldmine for health services research?
This article discusses the possible usefulness of electronic health record (EHR) audit log data to support health services research and for those studying healthcare processes and outcomes. The authors offer a framework for the potential uses in quality domains as defined by the National Academy of Medicine. The article also discusses challenges of working with audit log data.
AHRQ-funded; HS022670; HS023704; HS024538; HS019167.
Citation: Adler-Milstein J, Adelman JS, Tai-Seale M .
EHR audit logs: a new goldmine for health services research?
J Biomed Inform 2020 Jan;101:103343. doi: 10.1016/j.jbi.2019.103343..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Polubriaginof FCG, Ryan P, Salmasian H
Challenges with quality of race and ethnicity data in observational databases.
This study assessed the quality of race and ethnicity information in observational health databases as well as electronic health records (EHRs) and to propose patient self-recording as a way to improve accuracy. Data from the Healthcare Cost and Utilization Project (HCUP) and Optum Labs, and from a single New York City healthcare system’s EHR was compared. Among 160 million patients in the HCUP database, no race or ethnicity data was recorded for 25% of the records. Among the 2.4 million patients in the New York City HER, race or ethnicity was unknown for 57%. However, when patients were allowed to directly record their race and ethnicity, percentages rose to 86%.
AHRQ-funded; HS021816; HS023704; HS024713.
Citation: Polubriaginof FCG, Ryan P, Salmasian H .
Challenges with quality of race and ethnicity data in observational databases.
J Am Med Inform Assoc 2019 Aug;26(8-9):730-36. doi: 10.1093/jamia/ocz113..
Keywords: Healthcare Cost and Utilization Project (HCUP), Data, Racial and Ethnic Minorities, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Althoff KN, Wong C, Hogan B
Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data.
Under the hypothesis that use of electronic health records in health research may lead to false assumptions of complete event ascertainment, the authors of this article estimated "observation windows" (OWs) as a quality-control approach to reduce the likelihood of false assumption. The impact of OWs on estimating rates of type II diabetes mellitus from HIV clinical cohorts are demonstrated. Data from 16 HIV clinical cohorts to the NA-ACCORD were used to identify and evaluate OWs for an operationalized definition of diabetes occurrence. The authors conclude that OWs have utility as a quality-control approach to complete event ascertainment and help to improve the accuracy of estimates.
AHRQ-funded; 90047713.
Citation: Althoff KN, Wong C, Hogan B .
Mind the gap: observation windows to define periods of event ascertainment as a quality control method for longitudinal electronic health record data.
Ann Epidemiol 2019 May;33:54-63. doi: 10.1016/j.annepidem.2019.01.015..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Quality of Care
Schroeder J, Karkar R, Fogarty J
A patient-centered proposal for bayesian analysis of self-experiments for health.
This article describes the types of questions people want to answer via self-experimentation in order to develop a complementary patient-centered perspective on the potential benefits of Bayesian analysis. Information was gathered via the authors’ experiences in engaging with irritable bowel syndrome patients and their healthcare providers and a survey that investigated what questions individuals want to answer about their health and wellness. The authors find that the majority of the questions people want to answer with self-tracking data are better answered with Bayesian methods than with frequentist methods. Examples of how those questions might be answered using frequentist null hypothesis significance testing, frequentist estimation, and Bayesian estimation and prediction, as well as design recommendations for analyses and visualizations to help people answer and interpret such questions are also provided.
AHRQ-funded; HS023654.
Citation: Schroeder J, Karkar R, Fogarty J .
A patient-centered proposal for bayesian analysis of self-experiments for health.
J Healthc Inform Res 2019 Mar;3(1):124-55. doi: 10.1007/s41666-018-0033-x..
Keywords: Health Information Technology (HIT), Health Services Research (HSR)
Vemulakonda VM, Bush RA, Kahn MG
"Minimally invasive research?" Use of the electronic health record to facilitate research in pediatric urology.
This literature study examined the use of electronic health records (EHRs) to facilitate research in pediatric urology. The use of EHRs has been strongly encouraged by US federal agencies, including AHRQ. The researchers found that EHR use for research has strengths and weaknesses and more collaboration is needed to identify the method that best suits incorporation of research-oriented data collection into routine pediatric urologic clinical practice.
AHRQ-funded; HS024597; HS022404.
Citation: Vemulakonda VM, Bush RA, Kahn MG .
"Minimally invasive research?" Use of the electronic health record to facilitate research in pediatric urology.
J Pediatr Urol 2018 Oct;14(5):374-81. doi: 10.1016/j.jpurol.2018.04.033..
Keywords: Electronic Health Records (EHRs), Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Research Methodologies
Auger KA, Shah SS, Tubbs-Cooley HL
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
The purpose of this study was to determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. The investigators concluded that although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, the method showed promise to bolster postdischarge education.
AHRQ-funded; HS024735.
Citation: Auger KA, Shah SS, Tubbs-Cooley HL .
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
JAMA Pediatr 2018 Sep;172(9):e181482. doi: 10.1001/jamapediatrics.2018.1482..
Keywords: Care Coordination, Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Healthcare Delivery, Healthcare Utilization, Hospital Discharge, Outcomes, Provider, Provider: Nurse, Telehealth, Transitions of Care
Lyles CR, Lunn MR, Obedin-Maliver J
The new era of precision population health: insights for the All of Us Research Program and beyond.
This paper addresses the new era of precision population health. Although precision medicine has made advances in individualized patient treatments, the authors assert that there needs to be continued attention on tailored population health and prevention strategies. They provide specific recommendations from the All of Us Research Program and the Precision Public Health Summit as examples for moving this field forward.
AHRQ-funded; HS022408.
Citation: Lyles CR, Lunn MR, Obedin-Maliver J .
The new era of precision population health: insights for the All of Us Research Program and beyond.
J Transl Med 2018 Jul 27;16(1):211. doi: 10.1186/s12967-018-1585-5..
Keywords: Health Information Technology (HIT), Health Services Research (HSR), Patient-Centered Outcomes Research, Public Health
Zhou L, Blackley SV, Kowalski L
Analysis of errors in dictated clinical documents assisted by speech recognition software and professional transcriptionists.
The purpose of this study was to identify and analyze errors at each stage of the speech recognition (SR) assisted dictation process. The study concluded that seven in 100 words in SR-generated documents contain errors; many errors involve clinical information. That most errors were corrected before notes were signed demonstrates the importance of manual review, quality assurance, and auditing.
AHRQ-funded; HS024264.
Citation: Zhou L, Blackley SV, Kowalski L .
Analysis of errors in dictated clinical documents assisted by speech recognition software and professional transcriptionists.
JAMA Network Open 2018 Jul;1(3):e180530. doi: 10.1001/jamanetworkopen.2018.1627..
Keywords: Quality of Care, Health Information Technology (HIT), Health Services Research (HSR), Medical Errors, Patient Safety
Senathirajah Y, Wang J, Borycki E
Mapping the electronic health record: a method to study display fragmentation.
Electronic health records have often been criticized for poor interaction design. The authors describe a method for evaluating and depicting the extent of display fragmentation and discuss its potential uses in comparing systems, identifying navigation pathways and information juxtaposition, and improving EHR interaction design.
AHRQ-funded; HS023708.
Citation: Senathirajah Y, Wang J, Borycki E .
Mapping the electronic health record: a method to study display fragmentation.
Stud Health Technol Inform 2017;245:1138-42.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Payne P, Lele O, Johnson B
Enabling open science for health research: Collaborative Informatics Environment for Learning on Health Outcomes (CIELO).
AcademyHealth's Electronic Data Methods (EDM) Forum implemented a proof-of-concept open science platform for health research called the Collaborative Informatics Environment for Learning on Health Outcomes (CIELO). This provided the basis for a vigorous dialogue between stakeholder community members regarding the capabilities that will add the greatest value to an open science platform for the health research community.
AHRQ-funded; HS022789.
Citation: Payne P, Lele O, Johnson B .
Enabling open science for health research: Collaborative Informatics Environment for Learning on Health Outcomes (CIELO).
J Med Internet Res 2017 Jul 31;19(7):e276. doi: 10.2196/jmir.6937.
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Keywords: Health Services Research (HSR), Health Information Technology (HIT), Outcomes, Patient-Centered Outcomes Research
Russo E, Sittig DF, Murphy DR
Challenges in patient safety improvement research in the era of electronic health records.
The researchers used a case study involving a project on missed or delayed follow-up of test results to discuss real-world challenges in using electronic health records data for patient safety research. They suggested that many current data access and security policies and procedures must be rewritten and standardized across health care organization sin order to advance progress toward safer health care.
AHRQ-funded; HS022901.
Citation: Russo E, Sittig DF, Murphy DR .
Challenges in patient safety improvement research in the era of electronic health records.
Healthc 2016 Dec;4(4):285-90. doi: 10.1016/j.hjdsi.2016.06.005.
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Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Health Information Technology (HIT), Patient Safety, Quality Improvement
Sockolow P, Dowding D, Randell R
Using mixed methods in health information technology evaluation.
The authors illustrated some of the benefits and challenges of using mixed methods in evaluation. The diversity of the informatics scholars' research experience provides a broad overview of approaches in combining robust analysis of outcome data with qualitative methods that provide an understanding of the processes through which, and the contexts in which, those outcomes are achieved.
AHRQ-funded; HS021008.
Citation: Sockolow P, Dowding D, Randell R .
Using mixed methods in health information technology evaluation.
Stud Health Technol Inform 2016;225:83-7.
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Keywords: Health Information Technology (HIT), Health Services Research (HSR), Research Methodologies
Gidengil CA, Linder JA, Beach S
Using clinical vignettes to assess quality of care for acute respiratory infections.
Overprescribing of antibiotics for acute respiratory infections (ARIs) is common. The objective of this study was to develop and validate a vignette-based method to estimate clinician ARI antibiotic prescribing. The researchers concluded that responses to 3 clinical vignettes can identify clinicians with relatively poor quality ARI antibiotic prescribing. Vignettes may be a mechanism to target clinicians for quality improvement efforts.
AHRQ-funded; HS018419.
Citation: Gidengil CA, Linder JA, Beach S .
Using clinical vignettes to assess quality of care for acute respiratory infections.
Inquiry 2016 Apr 20;53:pii: 0046958016636531. doi: 10.1177/0046958016636531..
Keywords: Antibiotics, Antimicrobial Stewardship, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Medication, Practice Patterns, Primary Care, Quality of Care, Respiratory Conditions
Wittie M, Ngo-Metzger Q, Lebrun-Harris L
AHRQ Author: Ngo-Metzger Q
Enabling quality: electronic health record adoption and meaningful use readiness in federally funded health centers.
This study analyzed cross-sectional data from all 1,128 health centers in 2011, which served over 20 million patients during that year. As of 2011, 80 percent of health centers reported using an electronic health record (EHR), and high proportions reported using many advanced EHR functionalities. There were no indications of disparities in EHR adoption by census region, urban/rural location, patient sociodemographic composition, physician staffing, or health center funding.
AHRQ-authored.
Citation: Wittie M, Ngo-Metzger Q, Lebrun-Harris L .
Enabling quality: electronic health record adoption and meaningful use readiness in federally funded health centers.
J Healthc Qual 2016 Jan-Feb;38(1):42-51. doi: 10.1111/jhq.12067.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Community-Based Practice, Health Services Research (HSR)
Chambers DA, Haim A, Mullican CA
AHRQ Author: Mullican CA
Health information technology and mental health services research: a path forward.
This article reports on the AHRQ- and NIMH-organized November 2010 workshop, “Health Information Technology and Mental Health: The Way Forward.” The primary workshop goal was to bring together experts in mental health services and interventions research, practitioners, consumers, and technologists to discuss emerging opportunities in uniting all aspects of health IT and mental health research. The workshop resulted in a four-paper series, envisioning a future mental health system in which health IT is fully integrated within mental health service systems, for patient, clinician, and system levels.
AHRQ-authored.
Citation: Chambers DA, Haim A, Mullican CA .
Health information technology and mental health services research: a path forward.
Gen Hosp Psychiatry 2013 Jul-Aug;35(4):329-31. doi: 10.1016/j.genhosppsych.2013.03.006.
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Keywords: Access to Care, Health Information Technology (HIT), Health Services Research (HSR), Health Information Technology (HIT), Behavioral Health