National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
76 to 100 of 141 Research Studies DisplayedLin W-T, Mayer C, Lee B-O
Validity and reliability of the Teamwork Evaluation of Non-Technical Skills tool.
This study evaluated the use of the assessment tool TENTS (Teamwork Evaluation of Non-Technical Skills) to measure effectiveness of different clinician teams. The tool measures communication, leadership, and crossmonitoring. Researchers used to tool to observe five different events: new admissions, transfers to and from other units, rapid response team events, morning rounds, and medical procedures.
AHRQ-funded; 290200600001I.
Citation: Lin W-T, Mayer C, Lee B-O .
Validity and reliability of the Teamwork Evaluation of Non-Technical Skills tool.
Aust J Adv Nurs 2019 Mar-May;36(3):29-38..
Keywords: Communication, Teams, TeamSTEPPS
Hung DY, Gray CP, Truong QA
AHRQ Author: Harrison MI
Sustainment of lean redesigns for primary care teams.
This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. Results showed that staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. Change ownership and continued availability of time for improvement activities are also critical to the long-term success of Lean implementation in primary care.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Gray CP, Truong QA .
Sustainment of lean redesigns for primary care teams.
Qual Manag Health Care 2019 Jan/Mar;28(1):15-24. doi: 10.1097/qmh.0000000000000200..
Keywords: Primary Care, Workflow, Teams, Organizational Change, Quality Improvement, Quality of Care
Meyers DJ, Chien AT, Nguyen KH
Association of team-based primary care with health care utilization and costs among chronically ill patients.
This study analyzed the value of team-based care practice on the treatment of patients, especially those with multiple chronic conditions. A large study was conducted using data from 18 academically affiliated primary care practices in the Boston, Massachusetts, area between 2011 and 2015. The study included 83,953 patients total with 19% of patients being younger than 18 years and the rest from 19-64 years of age. For patients with multiple chronic conditions, there was a statistically significant reduction in hospitalizations and emergency department visits. Among patients with less than 2 comorbidities, there was an increase in outpatient visits, hospitalizations and ambulatory care hospitalizations.
AHRQ-funded; HS000011.
Citation: Meyers DJ, Chien AT, Nguyen KH .
Association of team-based primary care with health care utilization and costs among chronically ill patients.
JAMA Intern Med 2019 Jan;179(1):54-61. doi: 10.1001/jamainternmed.2018.5118..
Keywords: Chronic Conditions, Emergency Department, Healthcare Costs, Healthcare Utilization, Primary Care, Teams
Rodriguez HP, Friedberg MW, Vargas-Bustamante A
The impact of integrating medical assistants and community health workers on diabetes care management in community health centers.
The purpose of this study was to compare the impact of implementing team-based diabetes care management involving community health workers (CHWs) vs. medical assistants (MA) in community health centers (CHCs) on diabetes care processes, intermediate outcomes, and patients' experiences of chronic care. The investigators found that diabetes care improved in CHCs integrating CHWs and MAs onto primary care teams, but the improvements were no different than improvements observed among matched control group patients.
AHRQ-funded; HS02012001.
Citation: Rodriguez HP, Friedberg MW, Vargas-Bustamante A .
The impact of integrating medical assistants and community health workers on diabetes care management in community health centers.
BMC Health Serv Res 2018 Nov 20;18(1):875. doi: 10.1186/s12913-018-3710-9..
Keywords: Community-Based Practice, Diabetes, Healthcare Delivery, Teams
Misra-Hebert AD, Perzynski A, Rothberg MB
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
This mixed-methods comparative case study examined the implementation of team-based primary care models in a large integrated health system. Field observations of 9 practices were conducted along with 75 interviews and provider and staff surveys. The 9 practices were categorized into 3 groups: high, partial, and low update of the new models. Ability of the practices to implement the new team-based model depended on their ability to adapt to change and to adapt team roles in workflow.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Perzynski A, Rothberg MB .
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
J Gen Intern Med 2018 Nov;33(11):1928-36. doi: 10.1007/s11606-018-4611-7..
Keywords: Case Study, Health Systems, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Murray DJ, Boyle WA, Beyatte MB
Decision-making skills improve with critical care training: using simulation to measure progress.
Health care professionals are expected to acquire decision-making skills during their training, but few methods are available to assess progress in acquiring these essential skills. The purpose of this study was to determine whether a simulation methodology could be used to assess whether decision-making skills improve during critical care training. The investigators indicate that their findings provide evidence to support the validity of a simulation-based method to assess progress in decision-making skills.
AHRQ-funded; HS022265.
Citation: Murray DJ, Boyle WA, Beyatte MB .
Decision-making skills improve with critical care training: using simulation to measure progress.
J Crit Care 2018 Oct;47:133-38. doi: 10.1016/j.jcrc.2018.06.021..
Keywords: Critical Care, Education: Continuing Medical Education, Shared Decision Making, Simulation, Teams, Training
Bordley J, Sakata KK, Bierman J
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
The electronic health record is a primary source of information for all professional groups participating in ICU rounds. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, the investigators created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making.
AHRQ-funded; HS023793.
Citation: Bordley J, Sakata KK, Bierman J .
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
Crit Care Med 2018 Oct;46(10):1570-76. doi: 10.1097/ccm.0000000000003302..
Keywords: Shared Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Teams
Meyers D, LeRoy L, Bailit M
AHRQ Author: Meyers D, Zhan C
Workforce configurations to provide high-quality, comprehensive primary care: a mixed-method exploration of staffing for four types of primary care practices.
The aim of this study was to explore the team configurations and associated costs required to deliver high-quality, comprehensive primary care. The study estimates provided health care decision-makers with needed guideposts for considering primary care staffing and financing and informed broader discussions on primary care innovations and the necessary resources to provide high-quality, comprehensive primary care in the USA.
AHRQ-authored; AHRQ-funded; 290201000004I; 29032009T.
Citation: Meyers D, LeRoy L, Bailit M .
Workforce configurations to provide high-quality, comprehensive primary care: a mixed-method exploration of staffing for four types of primary care practices.
J Gen Intern Med 2018 Oct;33(10):1774-79. doi: 10.1007/s11606-018-4530-7..
Keywords: Healthcare Delivery, Quality of Care, Primary Care, Workforce, Teams
Howard J, Miller WL, Willard-Grace R
Creating and sustaining care teams in primary care: perspectives from innovative patient-centered medical homes.
The purpose of this study was to learn from the experiences of innovative primary care practices that have successfully developed care teams. The authors assert that team-based care is possible and valuable in primary care but that it is difficult to develop and sustain, and requires dedicated time and resources. They suggest that the challenges described by the highly motivated practices, in their paper, raised the question of feasibility for more average practices in the current funding environment.
AHRQ-funded.
Citation: Howard J, Miller WL, Willard-Grace R .
Creating and sustaining care teams in primary care: perspectives from innovative patient-centered medical homes.
Qual Manag Health Care 2018 Jul/Sep;27(3):123-29. doi: 10.1097/qmh.0000000000000176..
Keywords: Primary Care, Patient-Centered Healthcare, Teams, Healthcare Delivery
Baloh J, Zhu X, Ward MM
Implementing team huddles in small rural hospitals: how does the Kotter model of change apply?
The purpose of this study was to examine how the process of change prescribed in Kotter's change model applies in implementing team huddles, and to assess the impact of the execution of early change phases on change success in later phases. The investigators found mixed support for the Kotter model.
AHRQ-funded; HS024112.
Citation: Baloh J, Zhu X, Ward MM .
Implementing team huddles in small rural hospitals: how does the Kotter model of change apply?
J Nurs Manag 2018 Jul;26(5):571-78. doi: 10.1111/jonm.12584..
Keywords: Hospitals, Rural Health, Teams, TeamSTEPPS
Annis AM, Harris M, Kim HM
Trends in primary care encounters across professional roles in PCMH.
Evaluation measures of team-based care models are often reported at a clinic or primary care provider (PCP) level, creating challenges in describing and analyzing the use and impact of non-PCP clinician team members. This study aimed to measure clinician-specific care delivery trends and determine whether trends were responsive to system wide patient centered medical home implementation.
AHRQ-funded;
Citation: Annis AM, Harris M, Kim HM .
Trends in primary care encounters across professional roles in PCMH.
Am J Manag Care 2018 Jul;24(7):e222-e29..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Teams
Reiter-Palmon R, Kennel V, Allen J
Good catch! Using interdisciplinary teams and team reflexivity to improve patient safety.
This article considers the role of reflexivity in team innovation implementation and its association with inpatient fall rates. The study it describes examined 16 small rural hospitals in which interdisciplinary teams intended to decrease fall risk were implemented, supported, and evaluated. Team reflexivity was assessed at the start and at the end of the 2-year intervention, and innovation implementation assessed at the end of the intervention. The hospitals reported objective fall event data and patient days throughout the project. Both the theoretical and practical applications of the results are discussed.
AHRQ-funded; HS021429; HS024630.
Citation: Reiter-Palmon R, Kennel V, Allen J .
Good catch! Using interdisciplinary teams and team reflexivity to improve patient safety.
Group & Organization Management 2018 Jun;43(3):414-39. doi: 10.1177/1059601118768163..
Keywords: Teams, Patient Safety, Falls, Prevention, Hospitals, Adverse Events
Bordley J, Sakata KK, Bierman J
Medication history versus point-of-care platelet activity testing in patients with intracerebral hemorrhage.
This study evaluated whether reduced platelet activity detected by point-of-care (POC) testing was a better predictor of hematoma expansion and poor functional outcomes in patients with intracerebral hemorrhage (ICH) than a history of antiplatelet medication exposure. A history of antiplatelet medication use better identified patients at risk for hematoma growth and poor functional outcomes than POC measures of platelet activity after spontaneous ICH.
AHRQ-funded; HS023793.
Citation: Bordley J, Sakata KK, Bierman J .
Medication history versus point-of-care platelet activity testing in patients with intracerebral hemorrhage.
Crit Care Med 2018 Oct;46(10):1570-76. doi: 10.1097/ccm.0000000000003302..
Keywords: Shared Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Teams
Holtrop JS, Ruland S, Diaz S
Using social network analysis to examine the effect of care management structure on chronic disease management communication within primary care.
The investigators examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. They sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Using surveys, they found that social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. They concluded that structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.
AHRQ-funded; HS022690.
Citation: Holtrop JS, Ruland S, Diaz S .
Using social network analysis to examine the effect of care management structure on chronic disease management communication within primary care.
J Gen Intern Med 2018 May;33(5):612-20. doi: 10.1007/s11606-017-4247-z.
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Keywords: Care Management, Chronic Conditions, Communication, Primary Care, Teams
Hung DY, Harrison MI , Truong Q
AHRQ Author: Harrison MI
Experiences of primary care physicians and staff following lean workflow redesign.
The researchers examined the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns. They found that both physicians and nonphysician staff reported higher levels of engagement and teamwork after implementing redesigns. However, the subjects also experienced higher levels of burnout and perceptions of the workplace as stressful.
AHRQ-authored; AHRQ-funded; 290201000022I.
Citation: Hung DY, Harrison MI , Truong Q .
Experiences of primary care physicians and staff following lean workflow redesign.
BMC Health Serv Res 2018 Apr 10;18(1):274. doi: 10.1186/s12913-018-3062-5.
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Keywords: Primary Care, Workflow, Burnout, Organizational Change, Provider: Physician, Teams
Costa DK, Valley TS, Miller MA
AHRQ Author: Miller MA
ICU team composition and its association with ABCDE implementation in a quality collaborative.
Awakening, Breathing Coordination, Delirium, and Early Mobility bundle (ABCDE) should involve an interprofessional team, yet no studies describe what team composition supports implementation. This study found that ABCDE implementation was associated with frequent involvement of team members, suggesting a need for role articulation and coordination.
AHRQ-authored; AHRQ-funded; HS024552.
Citation: Costa DK, Valley TS, Miller MA .
ICU team composition and its association with ABCDE implementation in a quality collaborative.
J Crit Care 2018 Apr;44:1-6. doi: 10.1016/j.jcrc.2017.09.180.
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Keywords: Critical Care, Intensive Care Unit (ICU), Patient Safety, Quality Improvement, Teams
Everson J, Funk RJ, Kaufman SR
Repeated, close physician coronary artery bypass grafting teams associated with greater teamwork.
This study sought to determine whether observed patterns of physician interaction around shared patients are associated with higher levels of teamwork as perceived by physicians. It found that in hospitals where physicians repeatedly cared for patients with the same colleagues, physicians perceived better teamwork. When physicians who worked together also had other colleagues in common, the reported teamwork was stronger.
AHRQ-funded; HS024525; HS024728.
Citation: Everson J, Funk RJ, Kaufman SR .
Repeated, close physician coronary artery bypass grafting teams associated with greater teamwork.
Health Serv Res 2018 Apr;53(2):1025-41. doi: 10.1111/1475-6773.12703.
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Keywords: Cardiovascular Conditions, Care Coordination, Communication, Surgery, Teams
Rosenman ED, Dixon AJ, Webb JM
A simulation-based approach to measuring team situational awareness in emergency medicine: a multicenter, observational study.
This study’s goal was to develop and evaluate a novel approach to the measurement of team situational awareness (TSA) in interprofessional emergency medicine (EM) teams. EM teams, consisting of resident physicians, nurses, and medical students, were recruited from the University of Washington and Wayne State University; each team completed a simulated emergency resuscitation scenario, then completed three measures: a TSA measure, a team perception of shared understanding measure, and a team leader effectiveness measure. The simulations were recorded and coded independently for team performance by using a previously validated measure. Relationships between the TSA measure and other variables were explored. The authors conclude that simulations can provide a platform for TSA research and that their study provides a feasible method for simulation-based assessment of TSA.
AHRQ-funded; HS020295; HS022458.
Citation: Rosenman ED, Dixon AJ, Webb JM .
A simulation-based approach to measuring team situational awareness in emergency medicine: a multicenter, observational study.
Acad Emerg Med 2018 Feb;25(2):196-204. doi: 10.1111/acem.13257..
Keywords: Shared Decision Making, Emergency Department, Simulation, Teams
Rosenman ED, Fernandez R, Wong AH
Changing systems through effective teams: a role for simulation.
The objectives of this research were to explore the antecedents and processes that support team effectiveness, to summarize the role of simulation in the development and understanding team effectiveness, and to identify research targets that further the improvement of team-based training and assessment; the ultimate goal was the improvement of healthcare systems. The authors explore the foundations of team effectiveness, with a focus on team affect and team cognition. They also discuss advanced team processes that build on these foundations. The role of simulation‐based training in targeting these constructs and identifying resources from the team science literature is highlighted. The collaboration between educators and researchers from emergency medicine and the team sciences is emphasized, as is the importance of using a translational science approach to evaluate simulation‐based team training and elucidate the relationship between training and systems‐level outcomes.
AHRQ-funded; HS024820.
Citation: Rosenman ED, Fernandez R, Wong AH .
Changing systems through effective teams: a role for simulation.
Acad Emerg Med 2018 Feb;25(2):128-43. doi: 10.1111/acem.13260.
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Keywords: Emergency Department, Healthcare Delivery, Simulation, Teams
Fehr JJ, McBride ME, Boulet JR
The simulation-based assessment of pediatric rapid response teams.
The researchers created scenarios of simulated decompensating pediatric patients to train pediatric rapid response teams (RRTs) and to determine whether the scenario scores provide a valid assessment of RRT performance with the hypothesis that RRTs led by intensivists-in-training would be better prepared to manage the scenarios than teams led by nurse practitioners. The greater scores achieved by intensivist-in-training-led teams provides some evidence to support the validity of the assessment.
AHRQ-funded; HS018734.
Citation: Fehr JJ, McBride ME, Boulet JR .
The simulation-based assessment of pediatric rapid response teams.
J Pediatr 2017 Sep;188:258-62.e1. doi: 10.1016/j.jpeds.2017.03.030.
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Keywords: Critical Care, Education: Continuing Medical Education, Children/Adolescents, Teams, Training
Fiscella K, Mauksch L, Bodenheimer T
Improving care teams' functioning: recommendations from team science.
In this paper, the authors examine the application of team science to developing and sustaining primary care teams. They highlight six core team elements and conclude that implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief.
AHRQ-funded; HS022440.
Citation: Fiscella K, Mauksch L, Bodenheimer T .
Improving care teams' functioning: recommendations from team science.
Jt Comm J Qual Patient Saf 2017 Jul;43(7):361-68. doi: 10.1016/j.jcjq.2017.03.009..
Keywords: Teams, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care, Provider
Fernandez R, Shah S, Rosenman ED
Developing team cognition: a role for simulation.
Evidence from team science research demonstrates a strong relationship between team cognition and team performance and suggests a role for simulation in the development of this team-level construct. In this article, the researchers synthesize research from the broader team science literature to provide foundational knowledge regarding team cognition and highlight best practices for using simulation to target team cognition.
AHRQ-funded; HS020295; HS022458.
Citation: Fernandez R, Shah S, Rosenman ED .
Developing team cognition: a role for simulation.
Simul Healthc 2017 Apr;12(2):96-103. doi: 10.1097/sih.0000000000000200.
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Keywords: Teams, Training, Provider Performance, Patient Safety
Brooks JV, Gorbenko K, Bosk C
Interactional resources for quality improvement: Learning from participants through a qualitative study.
The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Respondents reported needing the following types of interactional support: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project.
AHRQ-funded; 290201000027I.
Citation: Brooks JV, Gorbenko K, Bosk C .
Interactional resources for quality improvement: Learning from participants through a qualitative study.
Qual Manag Health Care 2017 Apr/Jun;26(2):55-62. doi: 10.1097/qmh.0000000000000128.
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Keywords: Quality Improvement, Quality of Care, Surgery, Hospitals, Teams
Artis KA, Dyer E, Mohan V
Accuracy of laboratory data communication on ICU daily rounds using an electronic health record.
The researchers created a robust but simple methodology to measure the prevalence of inaccurately communicated (misrepresented) data and to characterize data communication failures by type. They found that clinician laboratory data retrieval and communication during ICU rounds at their institution was poor, prone to omissions and inaccuracies, yet largely unrecognized by the rounding team.
AHRQ-funded; HS023793.
Citation: Artis KA, Dyer E, Mohan V .
Accuracy of laboratory data communication on ICU daily rounds using an electronic health record.
Crit Care Med 2017 Feb;45(2):179-86. doi: 10.1097/ccm.0000000000002060.
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Keywords: Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Teams
Quigley DD, Predmore ZS, Chen AY
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Researchers conducted interviews at 14 primary care practices undergoing patient-centered medical home (PCMH) transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. They concluded that full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy.
AHRQ-funded; HS000029.
Citation: Quigley DD, Predmore ZS, Chen AY .
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Qual Manag Health Care 2017 Jan/Mar;26(1):7-14. doi: 10.1097/qmh.0000000000000118.
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Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams