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
- Access to Care (2)
- Adverse Drug Events (ADE) (1)
- Ambulatory Care and Surgery (5)
- Burnout (2)
- Cancer (3)
- Care Coordination (1)
- Care Management (1)
- Case Study (2)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (2)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (2)
- Data (2)
- Depression (1)
- Diabetes (2)
- Diagnostic Safety and Quality (2)
- Digestive Disease and Health (1)
- Disparities (6)
- Education: Curriculum (1)
- Elderly (1)
- Electronic Health Records (EHRs) (10)
- Evidence-Based Practice (11)
- Eye Disease and Health (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (7)
- Healthcare Delivery (37)
- Healthcare Utilization (1)
- Health Information Exchange (HIE) (3)
- Health Information Technology (HIT) (14)
- Health Insurance (2)
- Health Literacy (1)
- Health Services Research (HSR) (8)
- (-) Health Systems (105)
- Hospital Discharge (1)
- Hospital Readmissions (1)
- Hospitals (19)
- Implementation (11)
- Inpatient Care (1)
- Learning Health Systems (28)
- Medicaid (2)
- Medicare (8)
- Medication (3)
- Obesity (1)
- Organizational Change (6)
- Orthopedics (1)
- Outcomes (2)
- Patient-Centered Healthcare (7)
- Patient-Centered Outcomes Research (4)
- Patient and Family Engagement (3)
- Patient Experience (2)
- Patient Safety (2)
- Payment (7)
- Policy (2)
- Practice Improvement (2)
- Practice Patterns (1)
- Primary Care (11)
- Primary Care: Models of Care (3)
- Provider (3)
- Provider: Health Personnel (2)
- Provider: Physician (4)
- Provider Performance (7)
- Public Health (3)
- Quality Improvement (9)
- Quality Indicators (QIs) (2)
- Quality Measures (3)
- Quality of Care (16)
- Racial and Ethnic Minorities (2)
- Registries (1)
- Research Methodologies (2)
- Risk (4)
- Rural/Inner-City Residents (1)
- Rural Health (3)
- Screening (2)
- Shared Decision Making (4)
- Social Determinants of Health (2)
- Substance Abuse (1)
- Surgery (6)
- System Design (2)
- Teams (2)
- Tobacco Use (1)
- Tobacco Use: Smoking Cessation (1)
- Training (3)
- Vaccination (1)
- Web-Based (1)
- Workforce (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 25 of 105 Research Studies DisplayedAmu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Friedman CP, Lomotan EA, Richardson JE
AHRQ Author: Lomotan EA
Socio-technical infrastructure for a learning health system.
This partially AHRQ-authored article discusses the third characteristic that contributes to the uniqueness of learning health systems (LHSs) as an approach to health improvement, specifically infrastructure. It examines the role of infrastructure in the overall architecture of an LHS and describes the three linked elements: 1) Improvement cycles directed at critical health problems; 2) Socio-technical infrastructure providing key services supporting co-occurring improvement cycles; and 3) Governance of the system. It then discusses the scope and meaning of socio-technical infrastructure and provides a diagram and brief description of the 10 interconnected socio-technical services.
AHRQ-authored.
Citation: Friedman CP, Lomotan EA, Richardson JE .
Socio-technical infrastructure for a learning health system.
Learn Health Syst 2024 Jan 16; 8(1):e10405. doi: 10.1002/lrh2.10405..
Keywords: Learning Health Systems, Health Systems
Franklin PD, Drane D
Assessment of learning health system science competency in the equity and justice domain.
This paper assessed learning health system (LHS) competency in the newly added knowledge domain of Equity and Justice. This eighth domain was adopted by AHRQ in mid-2022. The authors developed a proficiency assessment for the new equity and justice domain. The assessment criteria were iteratively defined, reviewed, and edited by content experts and trainees. The new items were developed by trainees and experts at one LHS training center with experience conducting research focused on healthcare inequities among marginalized populations. The same proficiency assessment criteria as for the other domains was applied with four levels of mastery: "no exposure," "foundational awareness," "emerging," and "proficient".
AHRQ-funded; HS026385.
Citation: Franklin PD, Drane D .
Assessment of learning health system science competency in the equity and justice domain.
Learn Health Syst 2024 Jan; 8(1):e10381. doi: 10.1002/lrh2.10381..
Keywords: Learning Health Systems, Health Systems
Yilmaz S, LeClaire M, Begnaud A
Developing LHS scholars' competency around reducing burnout and moral injury.
The study addresses the lack of a wellness competency focusing on burnout and moral injury prevention within Learning Health Systems (LHS). Experts collaborated to develop pathways for implementing such programs, emphasizing distinctions between moral injury and burnout, proposing interventions, and integrating expert input. The study found that a competency aimed at equipping scholars with skills for measuring, intervening, and embedding burnout and moral injury prevention into LHS structures, would potentially improve work lives and patient outcomes within LHS.
AHRQ-funded; HS026379.
Citation: Yilmaz S, LeClaire M, Begnaud A .
Developing LHS scholars' competency around reducing burnout and moral injury.
Learn Health Syst 2024 Jan; 8(1):e10378. doi: 10.1002/lrh2.10378..
Keywords: Learning Health Systems, Health Systems, Burnout, Provider: Health Personnel
Chisolm DJ, Dugan JA, Figueroa JF
Improving health equity through health care systems research.
This study’s objective was to describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes. This project was conducted as a component of the AHRQ stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. The stakeholders included experts from academia, health care organizations, industry, and government. Five priority themes were derived iteratively through experts from academia, health care organizations, industry, and government. They identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. They also suggested cross-cutting themes regarding research workforce and research timelines.
AHRQ-funded.
Citation: Chisolm DJ, Dugan JA, Figueroa JF .
Improving health equity through health care systems research.
Health Serv Res 2023 Dec; 58(suppl 3):289-99. doi: 10.1111/1475-6773.14192..
Keywords: Health Systems, Disparities, Social Determinants of Health, Healthcare Delivery
Bierman AS, Mistry KB
AHRQ Author: Bierman AS, Mistry KB
Commentary: Achieving health equity - the role of learning health systems.
The article discussed learning health systems and their role in achieving health equity. Issues considered were prioritization of health equity, development and implementation of models of care, partnerships with patients and communities, research on the effectiveness of interventions across diverse populations, integration strategies, and multisector collaborations to address social needs. The authors concluded that by considering these issues, learning health systems can play a pivotal role in eliminating health inequities.
AHRQ-authored.
Citation: Bierman AS, Mistry KB .
Commentary: Achieving health equity - the role of learning health systems.
Healthc Policy 2023 Nov; 19(2):21-27. doi: 10.12927/hcpol.2023.27236..
Keywords: Learning Health Systems, Health Systems, Disparities
Ganguli I, Mackwood MB, Yang CW
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
The objective of this retrospective cohort study was to characterize racial differences in receipt of low-value care among older Medicare beneficiaries overall and within U.S. health systems. Medicare fee-for-service administrative data was used for Black and White Medicare patients who were at least 65 as of 2016. Findings showed that, of the 40 low value services examined, Black patients had a higher adjusted receipt of 9 services and lower receipt of 20 services than White patients. Differences were generally small and largely due to differential care within health systems, but the authors concluded that their findings suggested potential factors that researchers, policymakers, and health system leaders might investigate to improve health care quality and equity.
AHRQ-funded; HS024930.
Citation: Ganguli I, Mackwood MB, Yang CW .
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
BMJ 2023 Oct 25; 383:e074908. doi: 10.1136/bmj-2023-074908..
Keywords: Elderly, Racial and Ethnic Minorities, Medicare, Health Systems
Kim B, Cruden G, Crable EL
A structured approach to applying systems analysis methods for examining implementation mechanisms.
This article delineated a structured approach to applying systems analysis methods to examining implementation mechanisms. This approach included steps for selecting, tailoring, and evaluating an implementation strategy. The authors illustrated the approach by using an example case, then discussed the strengths and limitations of this approach, when each step might be appropriate. They suggested work that might extend systems analysis methods to the implementation mechanisms research.
AHRQ-funded; HS025632.
Citation: Kim B, Cruden G, Crable EL .
A structured approach to applying systems analysis methods for examining implementation mechanisms.
Implement Sci Commun 2023 Oct 19; 4(1):127. doi: 10.1186/s43058-023-00504-5..
Keywords: Implementation, Evidence-Based Practice, Health Systems
Simpson SA, Loh R, Elliott L
A mortality surveillance collaboration between a health system and public health department.
The authors described a collaboration between a health system and public health department to create a mortality surveillance system that enabled the health system to identify more than six times the number of deaths identified through local system medical records. They concluded that this epidemiological process that combined nuanced data captured through clinical care in health systems with subsequent data on mortality can be of particular benefit to underserved communities.
AHRQ-funded; HS027389.
Citation: Simpson SA, Loh R, Elliott L .
A mortality surveillance collaboration between a health system and public health department.
Am J Public Health 2023 Sep; 113(9):943-46. doi: 10.2105/ajph.2023.307335..
Keywords: Public Health, Health Systems
Johnson PT, Conway SJ, Berkowitz SA
Transforming health care from volume to value: a health system implementation road map.
The mission of the High Value Practice Academic Alliance is to 1) rapidly disseminate effective value-based performance improvement processes to safely decrease the cost of care for patients, and 2) train the next generation of physicians in principles of high value practice. The organization convened 100 academic medical center partners, and after 5 years of practice, opened membership to any medical center and became the High Value Practice Alliance. In 2021 and 2022, directors of the alliance devoted educational programs of the annual conference to developing a care delivery roadmap identifying the strategies and programs required to maximize resource use, clinical effectiveness, and care coordination. The group is now publishing the “playbook” as a series of focused articles, a comprehensive framework to improve the health care value in a delivery system. This playbook includes 3 performance improvement approaches: 1) resource focused, 2) infrastructure focused, and 3) condition focused. The Transforming Healthcare from Volume to Value: a Health System Implementation RoadMap manuscript series will address each of the strategies and relevant programs.
AHRQ-funded; HS029151; HS026350.
Citation: Johnson PT, Conway SJ, Berkowitz SA .
Transforming health care from volume to value: a health system implementation road map.
Am J Med 2023 Aug; 136(8):763-67. doi: 10.1016/j.amjmed.2023.04.030..
Keywords: Health Systems, Implementation, Healthcare Delivery
Ong T, Albon D, Amin RS
Establishing a Cystic Fibrosis Learning Network: interventions to promote collaboration and data-driven improvement at scale.
This paper describes the Cystic Fibrosis Learning Network (CFLN), which was designed to improve medical outcomes and quality of life through an intentional focus on achieving reliable evidence-based chronic care delivery and creating a system for data-driven collaborative learning. The authors described the development and growth of the CFLN considering six domains of a Network Maturity Grid: system leadership; governance and policy management; quality improvement (QI); engagement and community building; data and analytics; and research. The CFLN represents 36 accredited care centers in the CF Foundation Care Center Network caring for over 6300 patients, with 77% of 6779 patient clinical care visits/quarter entering into the Registry within 30 days. Almost all CFLN teams (94%) have a patient/family partner (PFP), and 74% of PFPs indicate they are actively participating, taking ownership of, or leading QI initiatives with the interdisciplinary care team. In 2022, most (97%) centers reported completing 1-13 improvement cycles per month, and 82% contributed to monthly QI progress reports to share learning.
AHRQ-funded; HS02639.
Citation: Ong T, Albon D, Amin RS .
Establishing a Cystic Fibrosis Learning Network: interventions to promote collaboration and data-driven improvement at scale.
Learn Health Syst 2023 Jul; 7(3):e10354. doi: 10.1002/lrh2.10354..
Keywords: Learning Health Systems, Health Systems
Harrison MI, Borsky AE
AHRQ Author: Harrison MI
How alignment between health systems and their embedded research units contributes to system learning.
This AHRQ-authored paper examined the organization of learning health system (LHS) research units and conditions affecting their contributions to system improvement and learning. The authors conducted 12 key-informant and 44 semi-structured interviews in six delivery systems engaged in LHS research. Using rapid qualitative analysis, they identified themes and compared successful versus challenging projects; LHS units and other research units in the same system; and LHS units in different systems. They found that LHS units operate both independently and as subunits within larger research centers. Key alignment factors identified were availability of internal (system) funding directing researchers' work toward system priorities; researchers' skills and experiences that fit a system's operational needs; LHS unit subculture supporting system improvement and collaboration with clinicians and other internal stakeholders; applications of external funding to system priorities; and executive leadership for system-wide learning. Direct consultation between LHS unit leaders and system executives and engagement of researchers in clinical and operational activities fostered mutual understanding and collaboration between researchers, clinicians, and leaders.
AHRQ-authored.
Citation: Harrison MI, Borsky AE .
How alignment between health systems and their embedded research units contributes to system learning.
Healthc 2023 Jun; 11(2):100688. doi: 10.1016/j.hjdsi.2023.100688..
Keywords: Health Systems, Learning Health Systems
Beaulieu ND, Chernew ME, McWilliams JM
Organization and performance of US health systems.
The objectives of this evidence review were to identify and describe health systems in the US, to assess differences between physicians and hospitals in and outside of health systems, and to compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. A total of 580 health systems in a great variety of sizes were identified; prices for physician, hospital services, and total spending were assessed in 2018 commercial claims data. Health system physicians and hospitals were shown to deliver a large portion of medical services. Clinical quality performance and patient experience measures were slightly better in systems; however, spending and prices were significantly higher, especially in small practices. The authors concluded that slight quality differentials in combination with large price differentials suggested that health systems have not realized their potential for better care at equal or lower cost.
AHRQ-funded; HS024072.
Citation: Beaulieu ND, Chernew ME, McWilliams JM .
Organization and performance of US health systems.
JAMA 2023 Jan 24; 329(4):325-35. doi: 10.1001/jama.2022.24032..
Keywords: Health Systems, Healthcare Delivery, Provider Performance, Quality Measures, Quality of Care, Hospitals
Sirkin JT, Flanagan E, Tong ST
AHRQ Author: Tong ST, McNellis RJ, Bierman AS
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
The purpose of this paper was to review the Agency for Healthcare Research and Quality’s (AHRQ) learning community organized to engage and support primary care in responding to COVID-19 and provide an opportunity for participants to communicate learning and peer support, improve understanding of the stressors and challenges faced by practices, determine needs, and identify possible solutions to challenges of the pandemic. The researchers identified challenges, responses, and innovations that occurred through the engagement and information sharing of the learning community and categorized them across 5 domains, including: patient-centeredness, clinician and practice, systems and infrastructure, community and public health; and health equity which cut across each of the other domains. The authors concluded that the learning community provided valuable insights for future research and policy, primary care delivery improvement, and ensuring greater preparedness for future challenges.
AHRQ-authored.
Citation: Sirkin JT, Flanagan E, Tong ST .
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
Ann Fam Med 2023 Jan-Feb; 21(1):76-82. doi: 10.1370/afm.2904..
Keywords: COVID-19, Primary Care, Learning Health Systems, Health Systems, Evidence-Based Practice, Public Health
Lock LJ, Channa R, Brennan MB
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
The goal of this retrospective cohort study was to determine the role of level of disadvantage in diabetic eye screening to explain the effect of health systems on rural and urban disparities. Researchers used an all-payer, statewide claims database to include adult Wisconsin residents with diabetes who had claims billed throughout the baseline and measurement years. Results indicated that patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics; similar findings emerged for both Medicare and non-Medicare subgroups. The researchers concluded that health systems, especially those that serve urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions and supporting patients in overcoming barriers.
AHRQ-funded; HS026279.
Citation: Lock LJ, Channa R, Brennan MB .
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
BMJ Open Diabetes Res Care 2022 Dec;10(6):e003174. doi: 10.1136/bmjdrc-2022-003174..
Keywords: Rural Health, Access to Care, Screening, Diabetes, Eye Disease and Health, Disparities, Chronic Conditions, Health Systems
Rodriguez HP, Kyalwazi MJ, Lewis VA
Adoption of patient-reported outcomes by health systems and physician practices in the USA.
This study examined the extent of patient-reported outcome (PRO) measure adoption among health systems and physician practices nationally and examines the organizational capabilities associated with more extensive PRO adoption. A total of 323 US health system and 2,190 physician practices responded to one of two nationally representative surveys. Survey results found that pain (50.6%) and depression (43.8%) PROs were more commonly adopted by all hospitals and medical groups within health systems compared to disability PROs (26.5%). Systems with more advanced health IT functions were more likely to use disability and depression PROs than systems with less advanced health IT. Practice-level advanced health IT was positively associated with use of depression PRO, but not disability or pain PRO use. The three PROs were more likely to be adopted in practices with more chronic care management processes, broader medical and social risk screening, and more processes to support patient responsiveness. Also, compared to independent physician practices, system-owned practices and community health centers were less likely to adopt PROs.
AHRQ-funded; HS024075.
Citation: Rodriguez HP, Kyalwazi MJ, Lewis VA .
Adoption of patient-reported outcomes by health systems and physician practices in the USA.
J Gen Intern Med 2022 Nov;37(15):3885-92. doi: 10.1007/s11606-022-07631-0..
Keywords: Health Systems, Provider: Physician, Patient-Centered Healthcare
Coley RY, Duan KI, Hoopes AJ
A call to integrate health equity into learning health system research training.
This paper is a call to integrate health equity into the competency domain for learning health systems (LHS) research training. In 2016, AHRQ recommended seven domains for training and mentoring researchers, but health equity was not included. Scholars in the Consortium for Applied Training to Advance the Learning health system with Scholars/Trainees (CATALyST) K12 program recommend that competency domains be extended to reflect growing demands for evidence on health inequities and interventions to alleviate them. The authors present real-life case studies in an LHS research training program that illustrate facilitators, challenges, and potential solutions at the program, funder, and research community-level to receiving training and mentorship in health equity-focused LHS science. They recommend actions in four areas for LHS research training programs: (a) integrate health equity throughout the current LHS domains; (b) develop training and mentoring in health equity; (c) establish program evaluation standards for consideration of health equity; and (d) bring forth relevant, extant expertise from the areas of health disparities research, community-based participatory research, and community-engaged health services research.
AHRQ-funded; HS026369.
Citation: Coley RY, Duan KI, Hoopes AJ .
A call to integrate health equity into learning health system research training.
Learn Health Syst 2022 Oct;6(4):e10330. doi: 10.1002/lrh2.10330..
Keywords: Learning Health Systems, Health Systems, Health Services Research (HSR), Training, Disparities
Franklin PD, Drane D, Wakschlag L
Development of a learning health system science competency assessment to guide training and proficiency assessment.
This paper describes the development of the learning health systems (LHS) Competency Assessment by the AHRQ-funded ACCELERAT K12 training program. Domain experts and trainees were recruited to define and operationalize items to include in an LHS Competency Assessment to support emerging and existing LHS scientists in prioritizing and monitoring proficiency development. The method used was to conduct sequential interviews with 18 experts who iteratively defined skills and tasks to illustrate stage in proficiency and its progression for each of 42 competencies in the seven LHS expertise domains: systems science; research questions and standards of scientific evidence; research methods; informatics; ethics of research and implementation in health systems; improvement and implementation science; and engagement, leadership, and research management. The LHS Competency Assessment was reviewed, and pilot tested by current trainees and further refinement was completed using their feedback. The LHS Competency Assessment was found to offer consistent, graded criteria across the seven LHS domains.
AHRQ-funded; HS026369.
Citation: Franklin PD, Drane D, Wakschlag L .
Development of a learning health system science competency assessment to guide training and proficiency assessment.
Learn Health Syst 2022 Oct;6(4):e10343. doi: 10.1002/lrh2.10343..
Keywords: Learning Health Systems, Health Systems, Health Services Research (HSR), Training, Education: Curriculum
Lozano PM, Lane-Fall M, Franklin PD
AHRQ Author: Chesley FD
Training the next generation of learning health system scientists.
The purpose of this paper was to describe the approaches developed by 11 Agency for Healthcare Research and Quality (AHRQ)- and Patient-Centered Outcomes Research Institute- funded Centers of Excellence (COEs) to grow the number of learning health systems (LHS) scientists. Program directors for each COE have provided descriptive program data since 2018. The authors found that since the program began, the 11 COEs have partnered with health systems to train 110 scholars. Nine programs partner with a Veterans Affairs health system and 9 partner with safety net providers. Clinically trained scholars include 70 physicians and 17 scholars in other clinical disciplines. Non-clinicians represent diverse fields, with most representing population health sciences. Challenges include guiding scholars through issues that can disrupt or delay projects during already-limited program time, such as delays in accessing data, organizational changes, pandemic impacts and others. The researchers concluded that the program documentation provides evidence of scholars' academic accomplishments and career-trajectory achievements.
AHRQ-authored; AHRQ-funded; HS026369; HS026370; HS026372; HS026379; HS026383; HS026385; HS026390; HS026393; HS026395; HS026396; HS026407
Citation: Lozano PM, Lane-Fall M, Franklin PD .
Training the next generation of learning health system scientists.
Learn Health Syst 2022 Oct;6(4):e10342. doi: 10.1002/lrh2.10342..
Keywords: Learning Health Systems, Health Systems, Patient-Centered Outcomes Research, Evidence-Based Practice, Training, Workforce
Bradford A, Shofer M, Singh H
AHRQ Author: Shofer M, Singh H
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
This paper discusses Measure Dx, a new AHRQ resource that translates knowledge from diagnostic measurement research into actionable recommendations. This resource guides healthcare organizations to detect, analyze, and learn from diagnostic safety events as part of a continuous learning and feedback cycle. The goal of Measure Dx is to advance new frontiers in reducing preventable diagnostic harm to patients.
AHRQ-authored; AHRQ-funded; 233201500022I; HS027363.
Citation: Bradford A, Shofer M, Singh H .
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
Int J Qual Health Care 2022 Sep 10;34(3). doi: 10.1093/intqhc/mzac068..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality Improvement, Quality of Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Systems, Learning Health Systems
Sherry TB, Damberg CL, DeYoreo M
Is bigger better?: A closer look at small health systems in the United States.
The purpose of this study was to expand existing health systems research by comparing the features, cost, and quality of care in small U.S. health care systems with those of large U.S. health systems. In this retrospective study with a repeated cross-sectional analysis, the researchers evaluated between 468 and 479 large health systems and between 608 and 641 small health systems serving fee-for-service Medicare beneficiaries, yearly between the year of 2013 and 2017. The study found that small systems had a larger share of beneficiaries and practice sites in small towns or rural areas, performance quality was lower in small systems that in large systems, and there was no difference in total cost of care. The study concluded that the quality of care in small systems is lower than large systems, but small systems provide care for rural Medicare populations. The researchers recommended that future research should explore the reasons for why these differences exist in quality.
AHRQ-funded; HS024067.
Citation: Sherry TB, Damberg CL, DeYoreo M .
Is bigger better?: A closer look at small health systems in the United States.
Med Care 2022 Jul;60(7):504-11. doi: 10.1097/mlr.0000000000001727..
Keywords: Health Systems, Medicaid, Healthcare Delivery
Kerrissey M, Tietschert M, Novikov Z
Social features of integration in health systems and their relationship to provider experience, care quality and clinical integration.
The purpose of this study was to explore the social features of health system integration -elements of normative integration (alignment of norms) and interpersonal integration (collaboration among professionals and with patients). The researchers administered surveys to practice managers and 1,360 staff and physicians at 59 practice sites within 17 health systems, with a 61% response rate of 828. The study found that the variables of normative and interpersonal integration were both consistently related to better provider experience, perceived care quality, and clinical integration. Variance in social features of integration may help explain why some health systems are better at integrating care, highlighting normative and interpersonal integration as possible resources for improvement.
AHRQ-funded; HS024067.
Citation: Kerrissey M, Tietschert M, Novikov Z .
Social features of integration in health systems and their relationship to provider experience, care quality and clinical integration.
Med Care Res Rev 2022 Jun; 79(3):359-70. doi: 10.1177/10775587211024796..
Keywords: Burnout, Provider: Physician, Health Systems
Perlin J, Sands K, Meyers D
AHRQ Author: Meyers D
Harnessing COVID-19 data through collaboration-rhe Consortium of HCA Healthcare and Academia for Research Generation.
This article describes the rapid initiation of a COVID-19 research consortium known as CHARGE (Consortium of HCA Healthcare and Academia for Research Generation), a multi-institution research partnership in conjunction AHRQ, and its resulting application of the learning health system model. HCA Healthcare developed a curated registry of data during the care of
121, 000 inpatients with COVID-19 in 2020, and AHRQ, along with other partners, helped guide the development of CHARGE to facilitate external researchers using registry data to expand evidence regarding the best management of COVID-19. While HCA Healthcare retained full control of its registry data sets and their use, consortium members were provided academic freedom to conduct approved studies. Through the process, 10 research projects were approved through March 2022. Topics included therapeutic efficacy, health equity, risk stratification, operation efficiency, and predictive models for COVID-19 outcomes. Operational support for all workgroups, including database management, subject matter expertise, legal and privacy consultation, and other support, was provided by HCA Healthcare. The researchers concluded that the development of CHARGE facilitated the development of research partnerships and data solutions to utilize immense amounts of health care data collected during the care of a large influx of critically ill patients.
121, 000 inpatients with COVID-19 in 2020, and AHRQ, along with other partners, helped guide the development of CHARGE to facilitate external researchers using registry data to expand evidence regarding the best management of COVID-19. While HCA Healthcare retained full control of its registry data sets and their use, consortium members were provided academic freedom to conduct approved studies. Through the process, 10 research projects were approved through March 2022. Topics included therapeutic efficacy, health equity, risk stratification, operation efficiency, and predictive models for COVID-19 outcomes. Operational support for all workgroups, including database management, subject matter expertise, legal and privacy consultation, and other support, was provided by HCA Healthcare. The researchers concluded that the development of CHARGE facilitated the development of research partnerships and data solutions to utilize immense amounts of health care data collected during the care of a large influx of critically ill patients.
AHRQ-authored.
Citation: Perlin J, Sands K, Meyers D .
Harnessing COVID-19 data through collaboration-rhe Consortium of HCA Healthcare and Academia for Research Generation.
JAMA Health Forum 2022 May 6;3(5):e220874. doi: 10.1001/jamahealthforum.2022.0874..
Keywords: COVID-19, Learning Health Systems, Health Systems, Registries
Sutherland BL, Pecanac K, LaBorde TM
Good working relationships: how healthcare system proximity influences trust between healthcare workers.
The authors interviewed healthcare workers who worked with proximal and distributed colleagues to care for patients with diabetic foot ulcers and analyzed transcripts using content analysis. They found that proximal, compared to distributed, dyads had more options available for interactions which, in turn, facilitated communication and working together to build trust. Further, few effective tools existed at the level of interprofessional collaborations, teams, or broader healthcare systems to support trust between distributed healthcare workers.
AHRQ-funded; HS026279.
Citation: Sutherland BL, Pecanac K, LaBorde TM .
Good working relationships: how healthcare system proximity influences trust between healthcare workers.
J Interprof Care 2022 May-Jun;36(3):331-39. doi: 10.1080/13561820.2021.1920897..
Keywords: Health Systems, Provider, Provider: Health Personnel
Jiang S, Mathias PC, Hendrix N
Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis.
This paper describes a cost-effectiveness model that was constructed to assess the clinical and economic value of a clinical decision support (CDS) alert program that provides pharmacogenomic (PGx) testing results compared to no alert program in acute coronary syndrome (ACS) and atrial fibrillation (AF) from a health system perspective. The authors projected that 20% of 500,000 health-system members between the ages of 55 and 65 received PGx testing for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) annually. Clinical events, costs, and quality-adjusted life years (QALYs) were calculated for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) testing outcomes annually. Clinical events, costs, and quality-adjusted life years (QALYs) over 20 years were calculated with an annual discount rate of 3%. A total of 3169 alerts would be fired. The CDS alert program was predicted to help avoid 16 major clinical events and 6 deaths for ACS; and 2 clinical events and 0.9 deaths for AF. The incremental cost-effectiveness ratio was measured as $39,477/QALY, which would make the alert program cost-effective.
AHRQ-funded; HS026544.
Citation: Jiang S, Mathias PC, Hendrix N .
Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis.
Pharmacogenomics J 2022 May;22(3):188-97. doi: 10.1038/s41397-022-00275-7..
Keywords: Clinical Decision Support (CDS), Healthcare Costs, Health Systems, Health Information Technology (HIT)