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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 15 of 15 Research Studies DisplayedPowell KR, Winkler AE, Liu J
A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic.
The objective of this study was to investigate the implementation of telehealth in nursing homes during the COVID-19 pandemic. Researchers conducted a secondary analysis of data from a national survey of nursing home administrative leaders using six survey questions and semi-structured interviews. Their conclusions indicate that training, restructuring teams and tasks, and adaptation of work processes to support communication could improve usability and sustainability of telehealth in nursing homes.
AHRQ-funded; HS02249.
Citation: Powell KR, Winkler AE, Liu J .
A mixed-methods analysis of telehealth implementation in nursing homes amidst the COVID-19 pandemic.
J Am Geriatr Soc 2022 Dec;70(12):3493-502. doi: 10.1111/jgs.18020..
Keywords: COVID-19, Elderly, Telehealth, Health Information Technology (HIT), Nursing Homes, Implementation
Lobach DF, Boxwala A, Kashyap N
AHRQ Author: Lomotan EA, Harrison MI, Dymek C, Swiger J
Integrating a patient engagement app into an electronic health record-enabled workflow using interoperability standards.
The authors sought to use interoperability standards to integrate the COVID-19 Tracker, a patient mobile application, with an EHR. Their clinical decision support integration project benefited from a standards-based approach, but they encountered challenges due to issues concerning implementation and experience of the standards-based application programming interface, Health Level 7 Fast Healthcare Interoperability Resources (FHIR) in the EHR. The authors concluded that FHIR standards may provide a promising mechanism for overcoming barriers in the integration of patient engagement apps with EHRs, but that expansion of available FHIR resources will improve workflow integration.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Lobach DF, Boxwala A, Kashyap N .
Integrating a patient engagement app into an electronic health record-enabled workflow using interoperability standards.
Appl Clin Inform 2022 Oct;13(5):1163-71. doi: 10.1055/s-0042-1758736..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient and Family Engagement, Workflow, COVID-19
Beetham T, Fiellin DA, Busch SH
Physician response to COVID-19-driven telehealth flexibility for opioid use disorder.
This study surveyed physicians who provide opioid use disorder (OUD) treatment on their preferences and practices regarding telehealth that have evolved during the COVID-19 pandemic. A total of 1141 physicians who were publicly listed buprenorphine-prescribing physicians were surveyed. Most respondents found telehealth to be effective, with 54% who found it more effective than expected. Overall, 85% were in favor of temporary telehealth flexibility being permanently extended, and 77% would be likely to use telehealth after the COVID-19 pandemic is over.
AHRQ-funded; HS017589.
Citation: Beetham T, Fiellin DA, Busch SH .
Physician response to COVID-19-driven telehealth flexibility for opioid use disorder.
Am J Manag Care 2022 Sep;28(9):456-63. doi: 10.37765/ajmc.2022.89221..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Opioids, Substance Abuse, Behavioral Health, Medication
Jin DP, Samuel S, Bowden K
Just-in-time electronic health record retraining to support clinician redeployment during the COVID-19 surge.
The purpose of this study was to examine the use of training in ICU-specific electronic health record (EHR) workflows prior to redeployment of certified registered nurse anesthetists (CRNAs) as ICU clinicians during the COVID-19 surge. The researchers utilized clinical informatics (CI) fellows to lead a multidisciplinary team to deploy a customized HER curriculum consisting of in-person classes and online video modules. Eighteen CRNAs participated, with 15 completing surveys immediately after the in-person training session, and 12 participants completing a post-deployment survey. The study found that all respondents of the post-training survey thought the training was useful and improved their EHR skills. Of the 12 participants who completed the post-deployment survey, all said that the training both increased their comfort in the ICU and that the concepts learned would be useful in their anesthesia role, and 91% indicated the training prepared them to work in the ICU with minimal guidance. The researchers concluded that CI fellows are uniquely prepared to deliver EHR training for clinician deployment in operational crisis response.
AHRQ-funded; HS02373.
Citation: Jin DP, Samuel S, Bowden K .
Just-in-time electronic health record retraining to support clinician redeployment during the COVID-19 surge.
Appl Clin Inform 2022 Aug 29;13(5):949-55. doi: 10.1055/a-1933-1798..
Keywords: COVID-19, Electronic Health Records (EHRs), Health Information Technology (HIT), Public Health, Training, Workforce
Reeves SL, Patel PN, Madden B
Telehealth use before and during the COVID-19 pandemic among children with sickle cell anemia.
This study’s goal was to determine telehealth use before and during the COVID pandemic for children ages 1-17 years old with sickle cell anemia (SCA). The authors identified children with SCA continuously enrolled in Michigan Medicaid from January 2019 to December 2020. The study population consisted of 493 children with SCA with a mean age of 8.7 years at study entry. Pre-pandemic there were 4,367 outpatient visits, with all but 19 in-person. Telehealth visits peaked in April 2020 and then began declining. The majority of telehealth visits were with hematologists, followed up adult subspecialists (27%) and pediatrics/family medicine.
AHRQ-funded; HS027632.
Citation: Reeves SL, Patel PN, Madden B .
Telehealth use before and during the COVID-19 pandemic among children with sickle cell anemia.
Telemed J E Health 2022 Aug;28(8):1166-71. doi: 10.1089/tmj.2021.0132..
Keywords: Children/Adolescents, COVID-19, Telehealth, Health Information Technology (HIT), Sickle Cell Disease, Chronic Conditions, Access to Care
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Shared Decision Making
Shao CC, McLeod MC, Gleason LT
Inequity in telemedicine use among patients with cancer in the Deep South during the COVID-19 pandemic.
The authors’ goal was to characterize telemedicine use among a large oncology population in the Deep South during the COVID-19 pandemic. They found that telemedicine use, specifically with video, was significantly lower among historically vulnerable populations. They concluded that understanding barriers to telemedicine use and preferred modalities of communication among different populations will help inform insurance reimbursement and interventions at different socioecological levels to ensure that the continued evolution of telemedicine will be equitable.
AHRQ-funded; HS013852.
Citation: Shao CC, McLeod MC, Gleason LT .
Inequity in telemedicine use among patients with cancer in the Deep South during the COVID-19 pandemic.
https://www.pubmed.ncbi.nlm.nih.gov/35348793
Oncologist 2022 Jul 5;27(7):555-64. doi: 10.1093/oncolo/oyac046..
Oncologist 2022 Jul 5;27(7):555-64. doi: 10.1093/oncolo/oyac046..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Cancer, Disparities
Ward MJ, Shuster JL, Mohr NM
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
The purpose of this AHRQ-funded, mixed-methods study was to evaluate an emergency telehealth intervention in emergency department (ED) and urgent care clinic (UCC) settings within the Veterans Health Administration (VHA) in March 2020. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was utilized to compare the 3 months preimplementation of the telehealth intervention (December 1, 2019 through February 29, 2020) with the 3 months postimplementation of the telehealth intervention (April 1, 2020 through June 30, 2020), and then assess sustainability through January 31, 2021. Qualitative data from surveys and semistructured interviews were conducted and analyze. The telemental health intervention was used in 83% (319) of unscheduled mental health consultations in the postimplementation phase, with no adverse trends in length of stay, 7-day revisits, or 30-day mortality. In the sustainability phase, use of the intervention was high with 82% (n = 1,010) of all unscheduled mental health consultations performed by telemental health. The study concluded that the use of unscheduled telemental health intervention was highly acceptable and sustainable in ED and UCC settings and did not impact the safety and efficacy of mental health consultations.
AHRQ-funded; HS025753.
Citation: Ward MJ, Shuster JL, Mohr NM .
Implementation of telehealth for psychiatric care in VA emergency departments and urgent care clinics.
Telemed J E Health 2022 Jul;28(7):985-93. doi: 10.1089/tmj.2021.0263..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Behavioral Health, Emergency Department
Sun J, Peng L, Li T
Performance of a chest radiograph AI diagnostic tool for COVID-19: a prospective observational study.
The purpose of this observational study was to evaluate the real-time performance of an interpretable artificial intelligence (AI) model to detect COVID-19 on chest radiographs. The researchers utilized 95,363 chest radiographs for model training, external validation, and real-time validation. There were 5,335 real-time predictions and a COVID-19 prevalence of 4.8%. The study found that participants positive for COVID-19 had higher COVID-19 diagnostic scores than participants negative for COVID-19. Real-time model performance remained the same during the 19 weeks of implementation. Model sensitivity was higher in men than in women, but model specificity was higher in women. Sensitivity was higher for Asian and Black participants compared with White participants. The COVID-19 AI diagnostic system had worse accuracy compared with radiologist predictions. The researchers concluded that AI tools underperform when compared with radiologist results.
AHRQ-funded; HS026379.
Citation: Sun J, Peng L, Li T .
Performance of a chest radiograph AI diagnostic tool for COVID-19: a prospective observational study.
Radiol Artif Intell 2022 Jul;4(4):e210217. doi: 10.1148/ryai.210217..
Keywords: COVID-19, Imaging, Diagnostic Safety and Quality, Health Information Technology (HIT)
Andino JJ, Zhu Z, Surapaneni M
Interstate telehealth use by Medicare beneficiaries before and after COVID-19 licensure waivers, 2017-20.
This study analyzed trends in interstate telehealth use by Medicaid beneficiaries during 2017-2020, which covers the period both directly before and during the first year of the pandemic. Although the volume of interstate telehealth use increased in 2020, out-of-state telehealth only made up 0.8% of all outpatient visits, and 5% of all telehealth visits overall. For individual states, out-of-state telehealth made up between 0.2-9.3% of all outpatient visits. Most out-of-state telehealth visits were used for established patient care, and a higher percentage of out-of-state telehealth users lived in rural areas compared with beneficiaries who stayed with in-state care (28% versus 23%).
AHRQ-funded; HS027632.
Citation: Andino JJ, Zhu Z, Surapaneni M .
Interstate telehealth use by Medicare beneficiaries before and after COVID-19 licensure waivers, 2017-20.
Health Aff 2022 Jun;41(6):838-45. doi: 10.1377/hlthaff.2021.01825.
AHRQ-funded; HS027632..
AHRQ-funded; HS027632..
Keywords: Telehealth, COVID-19, Health Information Technology (HIT), Medicare, Healthcare Delivery
Fraze TK, Beidler LB, De Marchis EH
"Beyond just a supplement": administrators' visions for the future of virtual primary care services.
The purpose of this study was to examine what health care organization administrators think about the future of virtual primary care services post-pandemic. In March-April 2021, the administrators of 17 health care organizations participated in semistructured qualitative phone interviews. The researchers explored how the administrators thought their organizations would offer virtual services after the pandemic. The study found that all the participants anticipated that their organization’s virtual primary care services would exist after the pandemic, with the main goals of 1) optimizing medical services; 2) enhancing the patient experience; and 3) increasing loyalty among patients, and the primary motivation being to remain competitive and financial solvency. The researchers concluded that administrators of health care organizations are examining how virtual services can continue after the pandemic, and what roles they will play in the delivery of services.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, De Marchis EH .
"Beyond just a supplement": administrators' visions for the future of virtual primary care services.
J Am Board Fam Med 2022 May-Jun;35(3):527-36. doi: 10.3122/jabfm.2022.03.210479..
Keywords: Primary Care, Telehealth, Health Information Technology (HIT), Healthcare Delivery, COVID-19
Chen J, Li KY, Andino J
Predictors of audio-only versus video telehealth visits during the COVID-19 pandemic.
During the Covid-19 pandemic, most health insurance companies reimbursed telehealth visits; both video and audio-only (i.e., phone). Post-pandemic many of these organizations may discontinue coverage for phone visits, yet the impact of doing so on different patient subgroups is not clear. The purpose of this study was to identify the patient subgroups that are more likely to use phone vs video to access telehealth services. The researchers conducted a retrospective study on a cohort of all patients at a United States medical center who had a telehealth-eligible outpatient visit from April 2020 through June 2020. The primary measure was the effect of patient geographic, demographic, and socioeconomic characteristics on the probability of phone visits vs video visits. The study found that of the 104,204 total patients with at least one telehealth visit, 45.4% received their care through phone visits only. Patient age, being African American, needing an interpreter, having Medicaid as their primary insurance, and living in a zip code with low broadband access were all characteristics associated with a lower likelihood of using video visits. In addition, the majority of patients had more than one characteristic which further reduced their likelihood of using video visits. The study concluded that patients with the characteristics identified are less likely to use video visits when compared to phone visits. The researchers state that for patients with one or more of those characteristics, elimination of insurance coverage for telehealth phone visits may decrease telehealth access.
AHRQ-funded; HS027632.
Citation: Chen J, Li KY, Andino J .
Predictors of audio-only versus video telehealth visits during the COVID-19 pandemic.
J Gen Intern Med 2022 Apr;37(5):1138-44. doi: 10.1007/s11606-021-07172-y..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT)
Huang J, Graetz I, Millman A
Primary care telemedicine during the COVID-19 pandemic: patient's choice of video versus telephone visit.
The goal of this study was to examine the association between patient characteristics and primary care telemedicine choice among integrated delivery system patients self-scheduling visits during the COVID-19 pandemic. Findings showed that patients of Black or Hispanic race/ethnicity, or living in low socioeconomic status or low internet access neighborhoods were less likely to schedule video visits. Also, patients 65 years or older, with prior video visit experience or mobile portal access, or visiting their own personal provider were more likely to schedule video visits. While video adoption was substantial in all patient groups examined, differences in telemedicine choice suggested the persistence of a digital divide.
AHRQ-funded; HS025189.
Citation: Huang J, Graetz I, Millman A .
Primary care telemedicine during the COVID-19 pandemic: patient's choice of video versus telephone visit.
JAMIA Open 2022 Apr;5(1):ooac002. doi: 10.1093/jamiaopen/ooac002..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Access to Care
Hays RD, Skootsky SA
Patient experience with in-person and telehealth visits before and during the COVID-19 pandemic at a large integrated health system in the United States.
Researchers sought to compare patient experience by visit type and before and during the pandemic. Using CAHPS® data, they found that patient experience with telehealth visits was as positive as or more positive than that with traditional office-based visits. Doctor communication on telehealth visits was viewed as slightly more positive than that of in-office or telephone visits. Telehealth visits were also slightly more positive than in-office visits for care coordination, overall rating of the doctor, and willingness to recommend to family and friends. Office staff were viewed less positively on the telephone than telehealth or in-office visits. Further, patient experience was similar before and during the COVID-19 pandemic.
AHRQ-funded; HS025920.
Citation: Hays RD, Skootsky SA .
Patient experience with in-person and telehealth visits before and during the COVID-19 pandemic at a large integrated health system in the United States.
J Gen Intern Med 2022 Mar;37(4):847-52. doi: 10.1007/s11606-021-07196-4..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Patient Experience, Healthcare Delivery
Kamran F, Tang S, Otles E
Early identification of patients admitted to hospital for covid-19 at risk of clinical deterioration: model development and multisite external validation study.
The authors sought to create and validate a simple and transferable machine learning model from electronic health record data to accurately predict clinical deterioration in patients with COVID-19 across institutions, through use of a novel paradigm for model development and code sharing. They determined that a model to predict clinical deterioration was developed rapidly in response to the COVID-19 pandemic at a single hospital, was applied externally without the sharing of data, and performed well across multiple medical centers, patient subgroups, and time periods, showing its potential as a tool for use in optimizing healthcare resources.
AHRQ-funded; HS028038.
Citation: Kamran F, Tang S, Otles E .
Early identification of patients admitted to hospital for covid-19 at risk of clinical deterioration: model development and multisite external validation study.
BMJ 2022 Feb 17;376:e068576. doi: 10.1136/bmj-2021-068576..
Keywords: COVID-19, Hospitalization, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)