National Healthcare Quality and Disparities Report
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Topics
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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
1 to 22 of 22 Research Studies DisplayedMcAlearney AS, Hefner JL, MacEwan SR
Care Team perspectives about an inpatient portal: benefits and challenges of patients' portal use during hospitalization.
This study’s goal was to get care team member’s point of view on the benefits and challenges of inpatient portal implementation and use. Brief in-person interviews with 433 care team members across a six-hospital health system were held to explore opinions about patients’ use. The Inpatient Portal Evaluation Framework was used to characterize benefits and challenges of portal use that care team members reported affected patients, themselves, and the collaborative work of those care teams with their patients.
AHRQ-funded; HS024379; HS024091; HS024767.
Citation: McAlearney AS, Hefner JL, MacEwan SR .
Care Team perspectives about an inpatient portal: benefits and challenges of patients' portal use during hospitalization.
Med Care Res Rev 2021 Oct;78(5):537-47. doi: 10.1177/1077558720925296..
Keywords: Teams, Health Information Technology (HIT), Inpatient Care
Atkinson MK, Singer SJ
Managing organizational constraints in innovation teams: a qualitative study across four health systems.
This study examined how interdisciplinary teams are affected by and manage external constraints over the lifecycle of their innovation project. The authors used a multimethod qualitative approach consisting of over 3 years of participant observation data to analyze how four interdisciplinary teams across different health system experienced and managed constraints as they pursued process innovations. Their findings point to several practical implications concerning innovation processes in healthcare: 1) how conditions in the organizational context, or constraints, can impede team progress at different stages of innovation; and 2) the collective efforts, or tactics, teams use to manage or work around those constraints to further progress on their innovations.
AHRQ-funded; HS024453.
Citation: Atkinson MK, Singer SJ .
Managing organizational constraints in innovation teams: a qualitative study across four health systems.
Med Care Res Rev 2021 Oct;78(5):521-36. doi: 10.1177/1077558720925993..
Keywords: Learning Health Systems, Health Systems, Teams
Sosa T, Sitterding M, Dewan M
Optimizing situation awareness to reduce emergency transfers in hospitalized children.
Interventions to improve care team situation awareness (SA) are associated with reduced rates of unrecognized clinical deterioration in hospitalized children. By addressing themes from recent safety events and emerging corruptors to SA in their system, the investigators aimed to decrease emergency transfers (ETs) to the ICU by 50% over 10 months. The investigators concluded that an innovative, proactive, and reliable process to predict, prevent, and respond to clinical deterioration was associated with a nearly 70% reduction in ETs.
AHRQ-funded; HS026975.
Citation: Sosa T, Sitterding M, Dewan M .
Optimizing situation awareness to reduce emergency transfers in hospitalized children.
Pediatrics 2021 Oct;148(4). doi: 10.1542/peds.2020-034603..
Keywords: Children/Adolescents, Emergency Department, Teams
Mathis MR, Yule S, Wu X
The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
The authors hypothesized that familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. They found that high team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk and high-risk patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality. They concluded that team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
AHRQ-funded; HS026003.
Citation: Mathis MR, Yule S, Wu X .
The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
Surgery 2021 Oct;170(4):1031-38. doi: 10.1016/j.surg.2021.05.020..
Keywords: Teams, Surgery, Heart Disease and Health, Cardiovascular Conditions, Outcomes
McGuier EA, Kolko DJ, Klem M
Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol.
Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review identified and summarized empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings.
AHRQ-funded; HS026862.
Citation: McGuier EA, Kolko DJ, Klem M .
Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol.
Syst Rev 2021 Jun 26;10(1):189. doi: 10.1186/s13643-021-01747-w..
Keywords: Teams, Implementation, Evidence-Based Practice
Manges KA, Wallace AS, Groves PS
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. The objective of this study was to determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments.
AHRQ-funded; HS026116.
Citation: Manges KA, Wallace AS, Groves PS .
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
J Hosp Med 2021 Jun;16(6):326-32. doi: 10.12788/jhm.3464..
Keywords: Hospital Discharge, Teams, Care Management, Shared Decision Making, Hospitals
Hollingsworth JM, Yu X, Yan PL
Provider care team segregation and operative mortality following coronary artery bypass grafting.
The purpose of this study was to examine whether provider care team segregation within hospitals contributes to the higher mortality rate of Black patients following coronary artery bypass grafting compared to their White counterparts. Using national Medicare data, findings showed that Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
AHRQ-funded; HS026908.
Citation: Hollingsworth JM, Yu X, Yan PL .
Provider care team segregation and operative mortality following coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2021 May;14(5):e007778. doi: 10.1161/circoutcomes.120.007778..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Mortality, Teams, Healthcare Delivery, Racial and Ethnic Minorities
Kuo YF, Agrawal P, Chou LN
Assessing association between team structure and health outcome and cost by social network analysis.
Researchers sought to assess the impact of team structure composition and degree of collaboration among various providers on process and outcomes of primary care. Their findings showed that highly connected primary care practices with high collaborative care and less top-down MD-centered authority have lower odds of hospitalization, fewer emergency room admissions, and lower total spending. They concluded that these findings likely reflect better communication and more coordinated care of older patients.
AHRQ-funded; HS020642.
Citation: Kuo YF, Agrawal P, Chou LN .
Assessing association between team structure and health outcome and cost by social network analysis.
J Am Geriatr Soc 2021 Apr;69(4):946-54. doi: 10.1111/jgs.16962..
Keywords: Elderly, Teams, Healthcare Delivery, Primary Care, Primary Care: Models of Care, Care Coordination
Baloh J, Zhu X, Ward MM
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
This study looked at the influences on sustainment of internal facilitation activities. For two years the authors followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program. Factors the authors examined were the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME), and team continuity (CONTINUITY). Five hospitals sustained facilitation activities and they found that the combination of SMS, MMS, and CONTINUITY was a sufficient condition for sustainment. The five other hospitals that did not sustain facilitation activities either lacked MMS or lacked both TIME and CONTINUITY. They also discussed the implications for research and practice.
AHRQ-funded; HS024112; HS018396.
Citation: Baloh J, Zhu X, Ward MM .
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
Med Care Res Rev 2021 Apr;78(2):146-56. doi: 10.1177/1077558719848267..
Keywords: TeamSTEPPS, Teams, Implementation, Hospitals, Patient Safety, Rural Health, Organizational Change
Rosenman ED, Misisco A, Olenick J
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
This study assessed and compared team leadership and patient care in trauma resuscitations led by male and female physicians. A secondary analysis of data from a larger randomized controlled trial using video recordings of resuscitations at a Level 1 trauma center from April 2016 to December 2017 was conducted. A total of 60 participants and 120 video observations were included in the analysis. There was a weak positive effect for female leaders for both patient care and team leadership. Gender-based advantages to team leadership and clinical care were not conclusive with the exception of rejecting a strong male advantage to team leadership.
AHRQ-funded; HS022458.
Citation: Rosenman ED, Misisco A, Olenick J .
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
J Am Coll Emerg Physicians Open 2021 Feb;2(1):e12348. doi: 10.1002/emp2.12348..
Keywords: Teams, Trauma, Critical Care, Provider: Physician, Provider
Kuo YF, Lin YL, D Jupiter, et al.
How to identify team-based primary care in the United States using Medicare data.
The authors assessed whether analyses using different sets of Medicare data can produce results similar to those from analyses using 100% data from an entire state in identifying primary care teams through social network analysis. They found that, depending on specific study purposes, researchers could use either 100% data from Medicare beneficiaries in randomly selected primary care services areas or data from a 20% national sample of Medicare beneficiaries to study team-based primary care in the United States.
AHRQ-funded; HS020642.
Citation: Kuo YF, Lin YL, D Jupiter, et al..
How to identify team-based primary care in the United States using Medicare data.
Med Care 2021 Feb;59(2):118-22. doi: 10.1097/mlr.0000000000001478.
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Keywords: Teams, Primary Care: Models of Care, Primary Care, Medicare, Health Services Research (HSR), Healthcare Delivery
Hung DY, Truong QA, Liang SY
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
Investigators examined 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. They found that Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks, thus supporting the use of Lean techniques to engage teams in routine aspects of patient care. They recommended more research to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.
AHRQ-funded; HS024529.
Citation: Hung DY, Truong QA, Liang SY .
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
J Gen Intern Med 2021 Feb;36(2):274-79. doi: 10.1007/s11606-020-06317-9..
Keywords: Primary Care, Quality Improvement, Quality of Care, Primary Care: Models of Care, Primary Care, Implementation, Workflow, Teams, Healthcare Delivery
Wang G, Wignall J, Kinard D
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
In this study, the investigators aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC). They conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. The investigators concluded that utilizing the management strategies, described in the article, when implementing cloud-based LCPs had the potential to improve team-based care across settings.
AHRQ-funded; HS024299.
Citation: Wang G, Wignall J, Kinard D .
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
J Am Med Inform Assoc 2021 Jan 15;28(1):23-32. doi: 10.1093/jamia/ocaa207..
Keywords: Children/Adolescents, Implementation, Chronic Conditions, Care Management, Care Coordination, Health Information Exchange (HIE), Health Information Technology (HIT), Teams
Pestka DL, Paterson NL, Benedict KA
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
As part of a population health-focused primary care transformation, in 2019 a health system in Minnesota developed a primary care team to exclusively care for high-cost high-need patients. Through its development and implementation, the team has discovered several key lessons in delivering care to complex patients. In this paper, the authors discuss lessons learned from their research.
AHRQ-funded; HS026379.
Citation: Pestka DL, Paterson NL, Benedict KA .
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
J Prim Care Community Health 2021 Jan-Dec;12:21501327211023888. doi: 10.1177/21501327211023888..
Keywords: Primary Care, Primary Care: Models of Care, Healthcare Delivery, Teams, Communication, Implementation
Miller-Rosales C, Rodriguez HP
Interdisciplinary primary care team expertise and diabetes care management.
Researchers examined whether care team role expertise is associated with patients' experiences of chronic care for type 2 diabetes and whether the relationship is stronger for small community health center (CHC) sites. Results of surveys conducted with adults with diabetes that assessed nonphysician team roles involved in managing their chronic care were integrated with clinical and administrative data from 14 CHCs. They found that patients with access to care team expertise in self-management support, including diabetes educators, nutritionists, community health workers, and other general staff report better experiences of chronic care. They concluded that these team roles may reduce barriers to patient self-management and improve patients' overall experiences of chronic care, particularly in small CHC sites.
Citation: Miller-Rosales C, Rodriguez HP .
Interdisciplinary primary care team expertise and diabetes care management.
J Am Board Fam Med 2021 Jan-Feb;34(1):151-61. doi: 10.3122/jabfm.2021.01.200187..
Keywords: Primary Care, Diabetes, Teams, Care Management, Community-Based Practice
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
Parchman ML, Von Korff M, Baldwin LM
Primary care clinic re-design for prescription opioid management.
The researchers describe a framework comprised of 6 Building Blocks to guide efforts within the primary care clinic setting to address the use of opioids for chronic pain. In response to prescription opioid overuse and the resulting epidemic of overdose and addiction, primary care clinics are making improvements driven by a common set of best practices that address complex challenges of managing chronic opioid therapy patients in primary care settings.
AHRQ-funded; HS023750.
Citation: Parchman ML, Von Korff M, Baldwin LM .
Primary care clinic re-design for prescription opioid management.
J Am Board Fam Med 2017 Jan-Feb;30(1):44-51. doi: 10.3122/jabfm.2017.01.160183.
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Keywords: Chronic Conditions, Opioids, Pain, Substance Abuse, Teams