National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Arthritis (3)
- Caregiving (2)
- Children/Adolescents (2)
- (-) Clinician-Patient Communication (20)
- Communication (13)
- Cultural Competence (2)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (4)
- Electronic Health Records (EHRs) (4)
- Evidence-Based Practice (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (8)
- (-) Health Literacy (20)
- Hospital Discharge (1)
- Hospitals (1)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (3)
- Medication: Safety (2)
- Neurological Disorders (1)
- Opioids (1)
- Patient-Centered Healthcare (2)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (7)
- Patient Experience (1)
- Patient Safety (1)
- Primary Care (2)
- Provider (1)
- Provider: Clinician (1)
- Quality Improvement (1)
- Racial and Ethnic Minorities (2)
- Shared Decision Making (4)
- Tools & Toolkits (1)
- Training (1)
- Transplantation (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
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 DisplayedNacht CL, Jacobson N, Shiyanbola O
Perception of physicians' notes among parents of different health literacy levels.
The study explored how parents of varying health literacy levels perceive accessing physicians' notes during pediatric hospitalization. Thematic analysis of interviews with 28 parents revealed benefits like information recall and autonomy, with challenges including receiving bad news before face-to-face communication. The study found that parents with limited literacy found notes especially helpful for understanding the care of the child while reducing worry. Simplifying medical terms could enhance note accessibility for all parents, ensuring equitable access to healthcare information.
AHRQ-funded; HS027214.
Citation: Nacht CL, Jacobson N, Shiyanbola O .
Perception of physicians' notes among parents of different health literacy levels.
Hosp Pediatr 2024 Feb; 14(2):108-15. doi: 10.1542/hpeds.2023-007240.
Keywords: Children/Adolescents, Health Literacy, Caregiving, Clinician-Patient Communication, Communication
Carroll AR, Johnson JA, Stassun JC
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
This study’s objective was to test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. This parallel, randomized clinical trial was conducted from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Observed dosing errors were the main outcome measured, and secondary outcomes included caregiver-reported medication knowledge. Among 198 randomized caregivers (mean age 31.4 years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 percentage points). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group. The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%], and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]).
AHRQ-funded; HS026122.
Citation: Carroll AR, Johnson JA, Stassun JC .
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
JAMA Netw Open 2024 Jan 2; 7(1):e2350969. doi: 10.1001/jamanetworkopen.2023.50969..
Keywords: Children/Adolescents, Health Literacy, Communication, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Clinician-Patient Communication, Hospital Discharge, Medication: Safety
Jacobson CE, Heximer A, Olmeda-Barrientos R
Language accessibility of liver transplantation center websites.
This research letter describes an analysis of language accessibility of liver transplantation center websites. The authors surveyed patient-facing educational websites of all 140 active, accredited US liver transplantation centers. Thirty-eight states and the District of Columbia had websites. Inclusion criteria was that they were using the Organ Procurement and Transplantation Network website. They analyzed each website for non-English content. Excluded were websites from Puerto Rico, as Spanish is the predominant governmental language. A total of 23 states had no transplant websites with online materials in a second language, and 34 sites (24.3%) had resources other than English on their website. California had the highest number of centers with resources in a language other than English, followed by Texas and New York. Spanish was the most common language available at 100% of sites that had resources other than English, followed by Arabic at 38.9% and Mandarin Chinese at 38.9%. A total of 108 different languages were represented among 10 state websites.
AHRQ-funded; HS000053.
Citation: Jacobson CE, Heximer A, Olmeda-Barrientos R .
Language accessibility of liver transplantation center websites.
Liver Transpl 2022 Apr; 28(4):722-24. doi: 10.1002/lt.26343..
Keywords: Transplantation, Clinician-Patient Communication, Communication, Health Information Technology (HIT), Health Literacy
Brown W, Balyan R, Karter AJ
Challenges and solutions to employing natural language processing and machine learning to measure patients' health literacy and physician writing complexity: the ECLIPPSE study.
In the National Library of Medicine-funded ECLIPPSE Project (Employing Computational Linguistics to Improve Patient-Provider Secure Emails exchange), the researchers attempted to create novel, valid, and scalable measures of both patients' health literacy (HL) and physicians' linguistic complexity by employing natural language processing techniques and machine learning. They identified 23 challenges and associated approaches that emerged from three overarching process domains. They suggested that investigators undertaking similar research in HL or using computational linguistic methods to assess patient-clinician exchange may find their solutions helpful when designing and executing health communications research.
Citation: Brown W, Balyan R, Karter AJ .
Challenges and solutions to employing natural language processing and machine learning to measure patients' health literacy and physician writing complexity: the ECLIPPSE study.
AHRQ-funded; HS026383..
Keywords: Health Literacy, Electronic Health Records (EHRs), Health Information Technology (HIT), Communication, Clinician-Patient Communication
Liu LH, Garrett SB, Li J
Patient and clinician perspectives on a patient-facing dashboard that visualizes patient reported outcomes in rheumatoid arthritis.
The authors’ goal was to develop a rheumatoid arthritis (RA) 'dashboard' that could facilitate conversations about patient-reported outcomes (PROs) and that would be acceptable to a wide range of patients, including English and Spanish speakers and patients with adequate or limited health literacy. Using focus groups and principles of human-centered design, they created an RA dashboard that was well-accepted among patients and clinicians. They indicated that the ability to customize the data display was important for tailoring the dashboard to patients with diverse needs and preferences, with special attention to be given to feasibility concerns voiced by clinicians.
AHRQ-funded; HS025405.
Citation: Liu LH, Garrett SB, Li J .
Patient and clinician perspectives on a patient-facing dashboard that visualizes patient reported outcomes in rheumatoid arthritis.
Health Expect 2020 Aug;23(4):846-59. doi: 10.1111/hex.13057..
Keywords: Arthritis, Health Information Technology (HIT), Patient and Family Engagement, Clinician-Patient Communication, Communication, Health Literacy
Lyles CR, Nelson EC, Frampton S
Using electronic health record portals to improve patient engagement: research priorities and best practices.
This literature review identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with electronic health record (EHR) data through patient portals. While 90% of health care systems now offer patient portals, only 15-30% of patients use them to access their physicians or health care systems. Studies reviewed mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Limited health or digital literacy impacted patients’ use of portals. Clinicians reported a lack of workflows to support patient engagement through portals.
AHRQ-funded; HS023558.
Citation: Lyles CR, Nelson EC, Frampton S .
Using electronic health record portals to improve patient engagement: research priorities and best practices.
Ann Intern Med 2020 Jun 2;172(11 Suppl):S123-s29. doi: 10.7326/m19-0876..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient and Family Engagement, Evidence-Based Practice, Health Literacy, Clinician-Patient Communication
Canedo JR, Wilkins CH, Senft N
Barriers and facilitators to dissemination and adoption of precision medicine among Hispanics/Latinos.
This study examined barriers to dissemination and adoption of precision medicine among the Hispanic/Latino population. Six focus groups and a demographic survey in English and Spanish was developed. Forty-one self-identified Hispanics/Latinos from diverse countries participated in the study. The participants had never heard of precision medicine and barriers to adoption and dissemination included lack of health insurance, distrust of government, immigration status, financial burden, limited English proficiency, low literacy levels, lack of information and lack of transportation. Facilitators included family support, information provided in Spanish, use of plain language and graphics and trust in healthcare providers and institutions. The authors recommend culturally- and linguistically-tailored, low-literacy educational material about precision medicine in English and Spanish.
AHRQ-funded; HS026122.
Citation: Canedo JR, Wilkins CH, Senft N .
Barriers and facilitators to dissemination and adoption of precision medicine among Hispanics/Latinos.
BMC Public Health 2020 May 1;20(1):603. doi: 10.1186/s12889-020-08718-1..
Keywords: Racial and Ethnic Minorities, Cultural Competence, Health Literacy, Education: Patient and Caregiver, Clinician-Patient Communication
McCarthy DM, Curtis LM, Courtney DM
A multifaceted intervention to improve patient knowledge and safe use of opioids: results of the ED EMC(2) randomized controlled trial.
Despite increased focus on opioid prescribing, little is known about the influence of prescription opioid medication information given to patients in the emergency department (ED). The objective of this study was to evaluate the effect of an Electronic Medication Complete Communication (EMC(2)) Opioid Strategy on patients' safe use of opioids and knowledge about opioids. The study found that the EMC(2) tools improved demonstrated safe dosing, but these benefits did not translate into actual use based on medication dairies. The text-messaging intervention did result in improved patient knowledge.
AHRQ-funded; HS023459.
Citation: McCarthy DM, Curtis LM, Courtney DM .
A multifaceted intervention to improve patient knowledge and safe use of opioids: results of the ED EMC(2) randomized controlled trial.
Acad Emerg Med 2019 Dec;26(12):1311-25. doi: 10.1111/acem.13860..
Keywords: Opioids, Medication, Medication: Safety, Patient Safety, Health Literacy, Education: Patient and Caregiver, Clinician-Patient Communication, Communication, Health Information Technology (HIT)
Pack AP, Golin CE, Hill LM
Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data.
This study looked into the value of using graphical display prototypes of hypothetical daily drug concentrations measured in hair for patients to assess their medication adherence. Investigators surveyed 30 HIV-positive patients and 29 clinicians to assess their preferences for three different prototypes. Patients and clinicians generally found the prototypes acceptable, but clinicians largely preferred daily drug concentrations in bar graph display. Patients with lower health literacy had trouble understanding the link between medication-taking and drug concentrations in hair and also preferred pictographs over bar or line graphs.
AHRQ-funded; HS000032.
Citation: Pack AP, Golin CE, Hill LM .
Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data.
Patient Educ Couns 2019 Jun;102(6):1090-97. doi: 10.1016/j.pec.2018.12.029..
Keywords: Clinician-Patient Communication, Communication, Health Literacy, Medication, Patient Adherence/Compliance, Provider, Provider: Clinician
Khoong EC, Cherian R, Matta GY
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
The goal of this study was to understand how safety-net patients, including those with limited English proficiency, view clinician electronic health record (EHR) use. Through focus groups in English, Spanish, and Cantonese, results showed that linguistically diverse patients accepted the value of EHR use during outpatient visits but desired more eye contact, verbal warnings before EHR use, and screen-sharing. Support for clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients is recommended.
AHRQ-funded; HS022561; HS023558; HS022408.
Citation: Khoong EC, Cherian R, Matta GY .
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
J Med Internet Res 2019 May 22;21(5):e13131. doi: 10.2196/13131..
Keywords: Cultural Competence, Racial and Ethnic Minorities, Patient Experience, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication, Health Literacy, Communication
Armstrong MJ, Rastgardani T, Gagliardi AR
Barriers and facilitators of communication about off periods in Parkinson's disease: qualitative analysis of patient, carepartner, and physician Interviews.
This article discusses barriers and facilitators of communication with Parkinson’s disease patients, care partners, and their physicians specifically during off periods. Twenty persons with Parkinson’s and their care partners, and 20 physicians participated in interviews using a semi-structured questionnaire. Communication barrier levels were identified as patient-level, caregiver-level, and physician-level. For patients cognitive impairment and reluctance to discuss symptoms was the largest barrier. Caregiver absence was also a barrier. For physicians barriers were distraction by technology and lack of appreciation of off period burdens. Various tools such as home diaries, questionnaires and mobile phone videos can be used to aid communication regarding off periods. Patients and their caregivers stressed the need for more formal educational materials and improved educational tools.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Rastgardani T, Gagliardi AR .
Barriers and facilitators of communication about off periods in Parkinson's disease: qualitative analysis of patient, carepartner, and physician Interviews.
PLoS One 2019 Apr 18;14(4):e0215384. doi: 10.1371/journal.pone.0215384..
Keywords: Communication, Clinician-Patient Communication, Neurological Disorders, Caregiving, Education: Patient and Caregiver, Health Literacy, Patient and Family Engagement
Fisher KA, Tan ASL, Matlock DD
Keeping the patient in the center: common challenges in the practice of shared decision making.
This study examines the practice of shared-decision making (SDM) to achieve patient-centered decisions. It was determined that not all circumstances make it possible for that to happen and there have to be some basic elements present. Those elements include the patients’ health literacy, their emotional state, their relationship with the clinician and the nature of the decision.
AHRQ-funded; HS024596.
Citation: Fisher KA, Tan ASL, Matlock DD .
Keeping the patient in the center: common challenges in the practice of shared decision making.
Patient Educ Couns 2018 Dec;101(12):2195-201. doi: 10.1016/j.pec.2018.08.007..
Keywords: Clinician-Patient Communication, Shared Decision Making, Health Literacy, Patient-Centered Healthcare, Patient and Family Engagement
Shoemaker SJ, Brach C, Edwards A
AHRQ Author: Brach C
Opportunities to improve informed consent with AHRQ training modules.
Patients often do not understand the risks, benefits, and alternatives of undergoing specific interventions, even after signing a consent form. This paper describes a mixed-methods pilot test of two Agency for Healthcare Research and Quality (AHRQ) informed consent training modules that was implemented in four hospitals. The study concluded that many opportunities exist for hospitals to improve their informed consent practices.
AHRQ-authored; AHRQ-funded; 290201000031I.
Citation: Shoemaker SJ, Brach C, Edwards A .
Opportunities to improve informed consent with AHRQ training modules.
Jt Comm J Qual Patient Saf 2018 Jun;44(6):343-52. doi: 10.1016/j.jcjq.2017.11.010..
Keywords: Shared Decision Making, Education: Continuing Medical Education, Health Literacy, Hospitals, Clinician-Patient Communication, Training
Wolinsky FD, Lou Y, Edmonds SW
Activating patients with a tailored bone density test results letter and educational brochure: the PAADRN Randomized Controlled Trial.
This study examined whether a tailored patient-activation letter communicating bone mineral density (BMD) test results plus an educational brochure improved patient activation scores and levels at 12 and 52 wk post-baseline as the mechanism leading to enhanced bone healthcare.
AHRQ-funded; HS023009.
Citation: Wolinsky FD, Lou Y, Edmonds SW .
Activating patients with a tailored bone density test results letter and educational brochure: the PAADRN Randomized Controlled Trial.
J Clin Densitom 2017 Oct/Dec;20(4):464-71. doi: 10.1016/j.jocd.2016.08.012..
Keywords: Education: Patient and Caregiver, Health Literacy, Patient-Centered Healthcare, Patient and Family Engagement, Clinician-Patient Communication
Liang L, Brach C
AHRQ Author: Liang L, Brach C
Health literacy universal precautions are still a distant dream: analysis of U.S. data on health literate practices.
This study sought to examine whether there has been an increase in the delivery of health literate care and whether recommendations for health literacy universal precautions are being followed. It found that the proportion of adults in the U.S. who reported receiving health literate care increased from 2011 to 2014, but fell far short of health literacy universal precautions recommendations of delivering health literate care to everyone.
AHRQ-authored.
Citation: Liang L, Brach C .
Health literacy universal precautions are still a distant dream: analysis of U.S. data on health literate practices.
Health Lit Res Pract 2017 Oct;1(4):e216-e30. doi: 10.3928/24748307-20170929-01.
.
.
Keywords: Healthcare Delivery, Health Literacy, Medical Expenditure Panel Survey (MEPS), Clinician-Patient Communication
Ratanawongsa N, Barton JL, Lyles CR
Computer use, language, and literacy in safety net clinic communication.
The researchers investigated the associations between safety net clinician computer use and patient-provider communication for patients with limited health literacy (LHL) and limited English proficiency (LEP). They found that higher clinician computer use was associated with more biomedical focus with LEP/LHL patients, and clinician verbal dominance and lower ratings with patients with adequate English proficiency and health literacy.
AHRQ-funded; HS022561.
Citation: Ratanawongsa N, Barton JL, Lyles CR .
Computer use, language, and literacy in safety net clinic communication.
J Am Med Inform Assoc 2017 Jan;24(1):106-12. doi: 10.1093/jamia/ocw062.
.
.
Keywords: Communication, Electronic Health Records (EHRs), Health Literacy, Clinician-Patient Communication, Health Information Technology (HIT)
Mabachi NM, Cifuentes M, Barnard J
AHRQ Author: Brach C
Demonstration of the Health Literacy Universal Precautions Toolkit: lessons for quality improvement.
AHRQ’s Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support.
AHRQ-authored.
Citation: Mabachi NM, Cifuentes M, Barnard J .
Demonstration of the Health Literacy Universal Precautions Toolkit: lessons for quality improvement.
J Ambul Care Manage 2016 Jul-Sep;39(3):199-208. doi: 10.1097/jac.0000000000000102..
Keywords: Health Literacy, Quality Improvement, Tools & Toolkits, Primary Care, Clinician-Patient Communication
Mirsky JB, Tieu L, Lyles C
Readability assessment of patient-provider electronic messages in a primary care setting.
The purpose of this study was to generate hypotheses about the readability of patient and provider electronic messages. It found that patients used more words in their initial e-mails compared to providers, but the Flesch-Kincaid Grade Levels (FKGLs) were similar, and 68 percent of provider messages were written below an FKGL = 8.
AHRQ-funded; HS023558; HS022408.
Citation: Mirsky JB, Tieu L, Lyles C .
Readability assessment of patient-provider electronic messages in a primary care setting.
J Am Med Inform Assoc 2016 Jan;23(1):202-6. doi: 10.1093/jamia/ocv087.
.
.
Keywords: Communication, Health Information Technology (HIT), Health Literacy, Primary Care, Clinician-Patient Communication
Barton JL, Trupin L, Tonner C
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
The objective of this study was to examine patterns of perceived communication around decision making in 2 cohorts of adults with rheumatoid arthritis (RA). The investigators found that nearly one-third of subjects reported suboptimal shared decision making communication (SDM) with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts.
AHRQ-funded; HS019209.
Citation: Barton JL, Trupin L, Tonner C .
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
J Rheumatol 2014 Jul;41(7):1290-7. doi: 10.3899/jrheum.131350..
Keywords: Arthritis, Clinician-Patient Communication, Communication, Shared Decision Making, Health Literacy, Patient and Family Engagement
Barton JL, Trupin L, Tonner C
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
The objective of this study was to examine patterns of perceived communication around decision making in 2 cohorts of adults with rheumatoid arthritis (RA). The investigators found that nearly one-third of subjects reported suboptimal shared decision making communication (SDM) with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts.
AHRQ-funded; HS019209.
Citation: Barton JL, Trupin L, Tonner C .
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
J Rheumatol 2014 Jul;41(7):1290-7. doi: 10.3899/jrheum.131350..
Keywords: Arthritis, Clinician-Patient Communication, Communication, Shared Decision Making, Health Literacy, Patient and Family Engagement