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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 19 of 19 Research Studies DisplayedYu J, Huckfeldt PJ, Mink PJ
Evaluating the association between expanded coverage of direct-to-consumer telemedicine and downstream utilization and quality of care for urinary tract infections and sinusitis.
The purpose of this study was to compare rates of testing, follow-up health care use, and quality for urinary tract infections (UTIs) and sinusitis between direct-to-consumer (DTC) telemedicine and in-person visits. Primary outcomes included number of laboratory tests, antibiotics filled, office and outpatient visits, emergency department (ED) visits, and standardized spending, based on standardized health service prices. The UTI and sinusitis samples included 215,134 and 624,630 episodes of care, respectively. Following the introduction of coverage for DTC telemedicine, 15.7% of UTI episodes and 8.9% of sinusitis episodes were initiated with DTC telemedicine. When compared to episodes without coverage for DTC telemedicine, UTI episodes with coverage had 0.25 fewer lab tests, lower standardized spending for the first UTI visit, and no change in office and outpatient visits, ED visits, antibiotics filled, or standardized medical spending. Sinusitis episodes with coverage for DTC telemedicine had fewer antibiotics filled and a minor increase in ED visits but no difference in lab tests, office and outpatient visits, or standardized medical spending.
AHRQ-funded; HS026088.
Citation: Yu J, Huckfeldt PJ, Mink PJ .
Evaluating the association between expanded coverage of direct-to-consumer telemedicine and downstream utilization and quality of care for urinary tract infections and sinusitis.
Health Serv Res 2023 Oct; 58(5):976-87. doi: 10.1111/1475-6773.14129..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Utilization, Quality of Care
Shah W, Villaflores CW, Chuong LH
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
This study investigated whether the rates of emergency department (ED) return visits and hospitalization differ between patients who obtain in-person versus telehealth encounters for post-ED follow-up care. This retrospective cohort study included adult patients who came to either of 2 in-system EDs of a single urban integrated academic system from April 2020 to September 2021, were discharged home, and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit. Overall, the study recorded 12,848 patients with 16,987 ED encounters (mean age 53 years; 57% women, 12% Black or African American; 22% Hispanic or Latinx; and 58% White) included. Overall, 17% of initial ED encounters led to returns to the ED, and 4% subsequent hospitalizations. Telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 more ED returns per 1000 encounters) and hospitalizations (10.6 more hospitalizations per 1000 encounters).
AHRQ-funded; HS026372.
Citation: Shah W, Villaflores CW, Chuong LH .
Association between in-person vs telehealth follow-up and rates of repeated hospital visits among patients seen in the emergency department.
JAMA Netw Open 2022 Oct;5(10):e2237783. doi: 10.1001/jamanetworkopen.2022.37783..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Hospitals
Dixit RA, Ratwani RM, Bishop JA
The impact of expanded telehealth availability on primary care utilization.
This study examined the impact of telehealth availability due to the COVID-19 pandemic and whether it may result in an unnecessary increase in utilization. The authors analyzed 4,114,651 primary care encounters from three healthcare systems between 2019 and 2021 and found little change in telehealth utilization as it became widely available.
AHRQ-funded; HS028255.
Citation: Dixit RA, Ratwani RM, Bishop JA .
The impact of expanded telehealth availability on primary care utilization.
NPJ Digit Med 2022 Sep 9;5(1):141. doi: 10.1038/s41746-022-00685-8..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care, Healthcare Utilization
Liu X, Goldenthal S, Li M
Comparison of telemedicine versus in-person visits on impact of downstream utilization of care.
This study’s objective was to evaluate the impact of telemedicine on downstream utilization of care compared to in-person visits. The authors evaluated insurance claims of a large commercial payer – Blue Cross Blue Shield of Michigan (BCBSM) – to assess the frequency of follow-up visits following encounters initiated via telemedicine versus in-person. Claim level data was used for the period 2011-2017 from encounters in the following places of service: hospital outpatient, doctor’s office, patient’s home, or psychiatric daycare facility. The intervention group consisted of episodes initiated via telemedicine, and the control group was episodes initiated in-person. Primary outcome analyzed was the percentage of 30-day episodes with a related visit across diagnostic categories. Secondary outcome was the mean related visit rate. Mean related visit rate was 16%, but telemedicine visits had a higher frequency of related visits across all diagnostic categories. Further research is needed to explore if increased utilization is a result of excessive care or expanded access to care.
AHRQ-funded; HS027632.
Citation: Liu X, Goldenthal S, Li M .
Comparison of telemedicine versus in-person visits on impact of downstream utilization of care.
Telemed J E Health 2021 Oct;27(10):1099-104. doi: 10.1089/tmj.2020.0286.
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Keywords: Telehealth, Health Information Technology (HIT), Healthcare Utilization
Freeman RE, Boggs KM, Zachrison KS
National study of telepsychiatry use in U.S. emergency departments.
This study examined the use of telepsychiatry in US emergency departments (EDs). A survey was conducted of all 5,375 US EDs in 2016. The survey found that about 20% reported receiving telepsychiatry. EDs that utilized telepsychiatry the most tended to have higher annual total visit volumes, rural location, and Critical Access Hospital designation. Autonomous freestanding EDs tended to have a lower likelihood of telepsychiatry use. The majority (59%) reported telepsychiatry as their only form of emergency psychiatric services and 25% received services at least once a day. The most common uses were admission or discharge decisions (80%) and transfer coordination (76%).
AHRQ-funded; HS024561.
Citation: Freeman RE, Boggs KM, Zachrison KS .
National study of telepsychiatry use in U.S. emergency departments.
Psychiatr Serv 2020 Jun;71(6):540-46. doi: 10.1176/appi.ps.201900237..
Keywords: Emergency Department, Telehealth, Health Information Technology (HIT), Behavioral Health, Healthcare Utilization
Feldman AG, Atkinson K, Wilson K
Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions.
This paper describes ways that digital health technologies may help solid organ transplant recipients stay free from vaccine-preventable infections so they are not underimmunized at the time of transplant and thereafter. Due to vaccine hesitancy and refusal in the general population, recipients can no longer rely on herd immunity to protect them. Digital health technologies can provide accurate information about vaccine safety, efficacy and timing in the pre- and post-transplant periods; make complete immunization records universally available and easily accessible; enable communication between patients and multiple providers; and provide automated vaccine reminders to both patients and providers.
AHRQ-funded; HS026510.
Citation: Feldman AG, Atkinson K, Wilson K .
Underimmunization of the solid organ transplant population: An urgent problem with potential digital health solutions.
Am J Transplant 2020 Jan;20(1):34-39. doi: 10.1111/ajt.15605..
Keywords: Transplantation, Surgery, Healthcare Utilization, Infectious Diseases, Telehealth, Health Information Technology (HIT), Vaccination
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Shared Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Wissel BD, Greiner HM, Glauser TA
Investigation of bias in an epilepsy machine learning algorithm trained on physician notes.
Racial disparities in the utilization of epilepsy surgery are well documented, but it is unknown whether a natural language processing (NLP) algorithm trained on physician notes would produce biased recommendations for epilepsy presurgical evaluations. To assess this, an NLP algorithm was trained to identify potential surgical candidates using 1097 notes from 175 epilepsy patients with a history of resective epilepsy surgery and 268 patients who achieved seizure freedom without surgery (total N = 443 patients).
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner HM, Glauser TA .
Investigation of bias in an epilepsy machine learning algorithm trained on physician notes.
Epilepsia 2019 Sep;60(9):e93-e98. doi: 10.1111/epi.16320..
Keywords: Neurological Disorders, Surgery, Clinical Decision Support (CDS), Healthcare Utilization, Health Information Technology (HIT), Shared Decision Making
Gillespie SM, Wasserman EB, Wood NE
High-intensity telemedicine reduces emergency department use by older adults with dementia in senior living communities.
Individuals with dementia have high rates of emergency department (ED) use for acute illnesses. In this study, the investigators evaluated the effect of a high-intensity telemedicine program that delivered care for acute illnesses on ED use rates for individuals with dementia residing in senior living communities (SLCs; independent and assisted living).
AHRQ-funded; HS018047.
Citation: Gillespie SM, Wasserman EB, Wood NE .
High-intensity telemedicine reduces emergency department use by older adults with dementia in senior living communities.
J Am Med Dir Assoc 2019 Aug;20(8):942-46. doi: 10.1016/j.jamda.2019.03.024..
Keywords: Elderly, Telehealth, Health Information Technology (HIT), Dementia, Neurological Disorders, Healthcare Delivery, Chronic Conditions, Emergency Department, Healthcare Utilization
Durojaiye AB, Levin S, Toerper M
Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data.
This study electronic health record (EHR) data to compare usage patterns from pediatric trauma patients with minor injuries at a Level I pediatric trauma center. The data was used to compare demographics, clinical and network characteristics, and emergency department (ED) length of stay (LOS). Three distinct groups were compared: fully connected, partially connected, and disconnected. The fully connected group had a decreased ED LOS compared with the partially connected group.
AHRQ-funded; HS023837.
Citation: Durojaiye AB, Levin S, Toerper M .
Evaluation of multidisciplinary collaboration in pediatric trauma care using EHR data.
J Am Med Inform Assoc 2019 Jun;26(6):506-15. doi: 10.1093/jamia/ocy184..
Keywords: Children/Adolescents, Trauma, Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Healthcare Utilization
Bucher BT, Shi J, Pettit RJ
Determination of marital status of patients from structured and unstructured electronic healthcare data.
This paper describes a robust method to determine the marital status of patients, which is included as a Social Determinant of Health and considered a key driver of health care utilization. A robust method to determine marital status using structured and unstructured electronic healthcare data was developed using data from a single US academic institution. A natural language processing (NLP) pipeline was developed and validated. Performance was compared against two baseline methods: a machine learning n-gram model and structured data from the electronic health record. Overall the NLP engine had excellent to superior performance compared with the other models.
AHRQ-funded; HS025776.
Citation: Bucher BT, Shi J, Pettit RJ .
Determination of marital status of patients from structured and unstructured electronic healthcare data.
AMIA Annu Symp Proc 2020 Mar 4;2019:267-74..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Social Determinants of Health, Healthcare Utilization
Auger KA, Shah SS, Tubbs-Cooley HL
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
The purpose of this study was to determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. The investigators concluded that although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, the method showed promise to bolster postdischarge education.
AHRQ-funded; HS024735.
Citation: Auger KA, Shah SS, Tubbs-Cooley HL .
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
JAMA Pediatr 2018 Sep;172(9):e181482. doi: 10.1001/jamapediatrics.2018.1482..
Keywords: Care Coordination, Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Healthcare Delivery, Healthcare Utilization, Hospital Discharge, Outcomes, Provider, Provider: Nurse, Telehealth, Transitions of Care
Kan HJ, Kharrazi H, Leff B
Defining and assessing geriatric risk factors and associated health care utilization among older adults using claims and electronic health records.
This study used electronic health records (EHRs) to identify patients with factors associated with geriatric risk for hospitalization among older adults. Prevalence was estimated using claims, structured EHRs, and unstructured EHRs. Odds were calculated on the occurrence of hospitalizations for patients with 1 or 2 and greater risk factors.
AHRQ-funded; HS000029.
Citation: Kan HJ, Kharrazi H, Leff B .
Defining and assessing geriatric risk factors and associated health care utilization among older adults using claims and electronic health records.
Med Care 2018 Mar;56(3):233-39. doi: 10.1097/mlr.0000000000000865..
Keywords: Elderly, Hospitalization, Healthcare Utilization, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kessler R, Stowell JR, Vogel JA
Effect of interventional program on the utilization of PACS in point-of-care ultrasound.
The study’s objective was to determine if a simple interventional program would influence the utilization of Picture Archiving and Communication Systems (PACS) in point-of-care ultrasound. It concluded that a simple interventional program for emergency physicians can significantly increase and sustain the utilization of PACS for point-of-care ultrasound.
AHRQ-funded; HS023901.
Citation: Kessler R, Stowell JR, Vogel JA .
Effect of interventional program on the utilization of PACS in point-of-care ultrasound.
J Digit Imaging 2016 Dec;29(6):701-05. doi: 10.1007/s10278-016-9893-x.
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Keywords: Emergency Medical Services (EMS), Imaging, Healthcare Utilization, Health Information Technology (HIT)
Gillespie SM, Shah MN, Wasserman EB
Reducing emergency department utilization through engagement in telemedicine by senior living communities.
High-intensity telemedicine has been shown to reduce the need for emergency department (ED) care for older adult senior living community (SLC) residents with acute illnesses. In this study, the investigators evaluated the effect of SLC engagement in a telemedicine program on ED use rates. The investigators concluded that individuals residing in more engaged SLCs experienced a greater decrease in ED use compared with subjects residing in less engaged SLCs or those without access to high-intensity telemedicine for acute illnesses.
AHRQ-funded; HS018047.
Citation: Gillespie SM, Shah MN, Wasserman EB .
Reducing emergency department utilization through engagement in telemedicine by senior living communities.
Telemed J E Health 2016 Jun;22(6):489-96. doi: 10.1089/tmj.2015.0152..
Keywords: Elderly, Emergency Department, Health Information Technology (HIT), Healthcare Utilization, Patient and Family Engagement, Telehealth
Shah MN, Wasserman EB, Wang H
High-intensity telemedicine decreases emergency department use by senior living community residents.
The authors evaluated the effect on emergency departrment use of a high-intensity telemedicine program that provides acute illness care for senior living community (SLC) residents. They found that high-intensity telemedicine significantly reduced emergency department use among SLC residents without increasing other utilization or mortality.
AHRQ-funded; HS018047.
Citation: Shah MN, Wasserman EB, Wang H .
High-intensity telemedicine decreases emergency department use by senior living community residents.
Telemed J E Health 2016 Mar;22(3):251-8. doi: 10.1089/tmj.2015.0103.
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Keywords: Elderly, Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Long-Term Care
Shah MN, Wasserman EB, Gillespie SM
High-intensity telemedicine decreases emergency department use for ambulatory care sensitive conditions by older adult senior living community residents.
The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs). It found that providing acute illness care by high-intensity telemedicine to older adults residing in SLCs significantly decreases the rate of ED use for ACSCs over 1 year.
AHRQ-funded; HS018047.
Citation: Shah MN, Wasserman EB, Gillespie SM .
High-intensity telemedicine decreases emergency department use for ambulatory care sensitive conditions by older adult senior living community residents.
J Am Med Dir Assoc 2015 Dec;16(12):1077-81. doi: 10.1016/j.jamda.2015.07.009..
Keywords: Elderly, Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Utilization, Long-Term Care
Wexler R, Hefner JL, Sieck C
Connecting emergency department patients to primary care.
The researchers developed and evaluated a system change innovation designed to remove system barriers to primary care access for Medicaid patients. The intervention did not decrease ED visits nor increase primary care use over the 12 months of the study period. The qualitative results provide insight into nonurgent ED utilization by patients with Medicaid, suggesting potential future interventions.
AHRQ-funded; HS020693.
Citation: Wexler R, Hefner JL, Sieck C .
Connecting emergency department patients to primary care.
J Am Board Fam Med 2015 Nov-Dec;28(6):722-32. doi: 10.3122/jabfm.2015.06.150044.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Primary Care, Health Information Technology (HIT), Healthcare Utilization
Shapiro JS, Johnson SA, Angiollilo J
Health information exchange improves identification of frequent emergency department users.
The goal of the project was to measure the incremental increase in the number of frequent ED users who were identified when data
from all EDs participating in an health information exchange were compared with site-specific data. When the researchers analyzed HIE-wide data instead of site-specific data, they identified 20.3 percent more frequent ED users and 16.0 percent more visits by them to the ED.
from all EDs participating in an health information exchange were compared with site-specific data. When the researchers analyzed HIE-wide data instead of site-specific data, they identified 20.3 percent more frequent ED users and 16.0 percent more visits by them to the ED.
AHRQ-funded; HS021261.
Citation: Shapiro JS, Johnson SA, Angiollilo J .
Health information exchange improves identification of frequent emergency department users.
Health Aff 2013 Dec;32(12):2193-8. doi: 10.1377/hlthaff.2013.0167..
Keywords: Data, Emergency Department, Healthcare Utilization, Health Information Exchange (HIE), Health Information Technology (HIT)