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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 16 of 16 Research Studies DisplayedBierman 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
Johnson JK
Learning health systems are well suited to define and deliver the physical therapy value proposition.
This article discussed the physical therapist value strategies defined by Jewell, Moore, and Goldstein for identifying and adopting best practices, measuring provider performance, and evaluating cost-effectiveness. These strategies are aligned with the operational processes within learning health systems (LHSs), and the author proposed that the ideal structure for defining and delivering the physical therapist value proposition can be found within the framework of LHS cycles. The author concluded that, as more health systems committed to the adoption of this framework, the pace at which value-based care in physical therapy is defined and delivered will accelerate.
AHRQ-funded; HS028529.
Citation: Johnson JK .
Learning health systems are well suited to define and deliver the physical therapy value proposition.
Phys Ther 2023 Oct; 103(10). doi: 10.1093/ptj/pzad072..
Keywords: Learning Health Systems
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
Flynn A, Taksler G, Caverly T
CBK model composition using paired web services and executable functions: A demonstration for individualizing preventive services.
The integration of Computable Biomedical Knowledge (CBK) models presents a difficult task for evolving health systems. The purpose of the study was to show that by utilizing the technical abilities of the World Wide Web (WWW), along with digital entities named Knowledge Objects, and introducing a fresh method of CBK model activation, the assembly of CBK models can be achieved in a more standardized, manageable, and beneficial manner. Using previously indicated compound digital objects known as Knowledge Objects, CBK models are packaged with metadata, API descriptions, and runtime requirements. Using open-source runtimes and a tool the researchers developed (the KGrid Activator) CBK models can be instantiated inside runtimes and made accessible via RESTful APIs by the KGrid Activator. The KGrid Activator then serves as a gateway and provides a method for interconnecting CBK model outputs and inputs, thus establishing a CBK model composition method. As a means of validating their method, the researchers created an intricate composite CBK model made up of 42 CBK submodels. The resulting model (CM-IPP), calculates life-gain estimates for individuals based on their unique characteristics. The outcome is a highly modularized CM-IPP execution that can be distributed and made operational in any usual server environment. The study found that construction of CBK models using compound digital entities and distributed computing technologies is achievable.
AHRQ-funded; HS026257.
Citation: Flynn A, Taksler G, Caverly T .
CBK model composition using paired web services and executable functions: A demonstration for individualizing preventive services.
Learn Health Syst 2023 Apr; 7(2):e10325. doi: 10.1002/lrh2.10325..
Keywords: Learning Health Systems, Health Information Technology (HIT)
Bierman AS, Burke BT, Comfort LN
AHRQ Author: Bierman AS, Burke BT, Comfort LN, Gerstein M, Mueller NM, Umscheid CA
From precision medicine to precision care: choosing and using precision medicine in the context of multimorbidity.
Swift progress in personalized medicine offers significant potential to decrease disease and death rates for numerous health issues. To maximize the advantages of personalized medicine and minimize negative outcomes, addressing real-world obstacles in applying this research to clinical practice is crucial. A primary challenge involves selecting and employing personalized medicine approaches in everyday practice, considering the care of a substantial portion of individuals with multiple coexisting conditions. Personalized medicine should be incorporated into a broader framework of individualized care, which takes into account factors that impact the efficacy of specific treatments. Individualized care combines a patient-focused approach with personalized medicine to guide decision-making and care plans, considering multiple health conditions, functional ability, personal values, goals, preferences, and social and societal contexts. Creating dissemination and implementation strategies for personalized medicine centered around individualized care can enhance patient-centric quality and health outcomes, direct interventions toward those who will benefit most, improve access to novel treatments, reduce the likelihood of treatment withdrawal due to unforeseen side effects, and promote health equity by customizing interventions and care for diverse individuals and communities. Delivering personalized medicine within the scope of individualized care supports respectful treatment that aligns with patient preferences, values, and objectives, fostering trust and offering necessary information for informed decision-making. Accelerating its adoption demands focus on the entire translational research continuum: devising innovative methods, proving their value, disseminating and implementing findings, and involving patients throughout the process. This includes basic science, preclinical and clinical research, and integration into practice, all aimed at enhancing health. This paper scrutinizes the challenges in adopting personalized medicine in the presence of multiple health conditions. The authors conclude that while the promise of personalized medicine is immense, proactive measures are essential to prevent unintended repercussions and ensure its equitable and efficient implementation.
AHRQ-authored: All.
Citation: Bierman AS, Burke BT, Comfort LN .
From precision medicine to precision care: choosing and using precision medicine in the context of multimorbidity.
Cambridge Prisms: Precision Medicine 2023 Feb 21;1:e19. doi:10.1017/pcm.2023.8.
Keywords: Learning Health Systems, Patient-Centered Healthcare, Evidence-Based Practice, Patient-Centered Outcomes Research
Strayer TE, Spalluto LB, Burns A
Using the framework for reporting adaptations and modifications-expanded (frame) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study.
The purpose of this study was to apply the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to study adaptations in lung cancer screening delivery processes in a Veterans Health Administration (VHA) Initiative. Between 2019 and 2021 the researchers prospectively administered semi-structured interviews with lung cancer screening program navigators at 10 Veterans Affairs Medical Centers (VAMCs). Baseline process maps were developed for each program, and each program navigator reviewed process maps in subsequent years 1 and 2. Researchers then identified, documented, and mapped adaptations in screening processes to the FRAME categories. 16 interviews were conducted across 10 VHA lung cancer screening programs, with 6 of these being operational, and of those 3 reported adaptations to their screening processes that were planned or in response to COVID-19. In year 2 all 10 programs were operational and eligible. Programs reported 14 adaptations in year 2. The adaptations identified were both planned and unplanned and often prompted by increased workload; 57% of year 2 adaptations were associated with the identification and eligibility of Veterans and 43% were associated with follow-up with Veterans for screening results. During the 2 years, adaptations associated with data management and patient tracking took place in 60% of programs to improve the data collection and tracking of Veterans in the screening process. The study concluded that adaptations took place predominantly in the categories of patient identification and communication of results due to increased workload.
AHRQ-funded; HS026122; HS026395.
Citation: Strayer TE, Spalluto LB, Burns A .
Using the framework for reporting adaptations and modifications-expanded (frame) to study adaptations in lung cancer screening delivery in the Veterans Health Administration: a cohort study.
Implement Sci Commun 2023 Jan 12; 4(1):5. doi: 10.1186/s43058-022-00388-x..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Evidence-Based Practice, Learning Health Systems
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
Henriksen K, Rodrick D, Grace EN
AHRQ Author: Henriksen K, Rodrick D, Grace EN, Shofer M, Brady, JP
Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment.
This article describes a grant initiative undertaken by AHRQ that brings design, systems engineering, and health care delivery research together to test new ideas that could make health care safer. Based on feedback received from project teams, lessons learned are emerging that find considerable variation among project teams in deploying the methodology and a longer-than-anticipated amount of time in bringing team members from different disciplines together where they learn to communicate and function as a team. Three narratives are generated in terms of what success might look like.
AHRQ-authored.
Citation: Henriksen K, Rodrick D, Grace EN .
Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment.
J Patient Saf 2021 Dec 1;17(8):e1685-e90. doi: 10.1097/pts.0000000000000577..
Keywords: Patient Safety, Healthcare Delivery, Learning Health Systems, Health Systems
Austin EJ, LeRouge C, Lee JR
A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization.
The authors reported on their effort to develop generalizable learnings that can support the integration of electronic patient-reported outcome measures into clinical practice within a learning health system (LHS) framework. They concluded that the guidelines produced from this work highlighted the complex, multidisciplinary nature of implementing change within LHS contexts, as well as the value of action research approaches to enable rapid, iterative learning that leverages the knowledge and experience of communities of practice.
AHRQ-funded; HS023785.
Citation: Austin EJ, LeRouge C, Lee JR .
A learning health systems approach to integrating electronic patient-reported outcomes across the health care organization.
Learn Health Syst 2021 Oct;5(4):e10263. doi: 10.1002/lrh2.10263..
Keywords: Learning Health Systems, Health Information Technology (HIT), Patient-Centered Outcomes Research, Outcomes, Evidence-Based Practice
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
Subash M, Liu LH, DeQuattro K
The Development of the Rheumatology Informatics System for Effectiveness Learning Collaborative for improving patient-reported outcome collection and patient-centered communication in adult rheumatology.
Patient-reported outcomes (PROs) are an integral part of treat-to-target approaches in managing rheumatoid arthritis (RA). In clinical practice, however, routine collection, documentation, and discussion of PROs with patients are highly variable. In this paper, the investigators discussed the Development of the Rheumatology Informatics System for Effectiveness Learning Collaborative for improving patient-reported outcome collection and patient-centered communication in adult rheumatology.
AHRQ-funded; HS025638.
Citation: Subash M, Liu LH, DeQuattro K .
The Development of the Rheumatology Informatics System for Effectiveness Learning Collaborative for improving patient-reported outcome collection and patient-centered communication in adult rheumatology.
ACR Open Rheumatol 2021 Oct;3(10):690-98. doi: 10.1002/acr2.11310..
Keywords: Arthritis, Patient-Centered Outcomes Research, Learning Health Systems, Health Information Technology (HIT)
Siddique SM, Tipton K, Leas B
Interventions to reduce hospital length of stay in high-risk populations: a systematic review.
Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. The objective of this study was to identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS.
AHRQ-funded; 75Q80120D00002.
Citation: Siddique SM, Tipton K, Leas B .
Interventions to reduce hospital length of stay in high-risk populations: a systematic review.
JAMA Netw Open 2021 Sep;4(9):e2125846. doi: 10.1001/jamanetworkopen.2021.25846..
Keywords: Learning Health Systems, Health Systems, Evidence-Based Practice, Hospital Discharge, Risk, Inpatient Care, Care Management
Bishop JR, Huang RS, Brown JT
Pharmacogenomics education, research and clinical implementation in the state of Minnesota.
This article looks at the development and implementation of formal pharmacogenomic (PGx) clinical programs at several healthcare organizations across Minnesota. These programs increase drug safety and effectiveness. The article reviews the state of PGx activities in the state of Minnesota including educational programs, research, national consortia involvement, technology, clinical implementation and utilization and reimbursement, and outlines the challenges and opportunities in equitable implementation of these activities.
AHRQ-funded; HS026379.
Citation: Bishop JR, Huang RS, Brown JT .
Pharmacogenomics education, research and clinical implementation in the state of Minnesota.
Pharmacogenomics 2021 Jul;22(11):681-91. doi: 10.2217/pgs-2021-0058..
Keywords: Medication, Implementation, Learning Health Systems, Evidence-Based Practice, Patient-Centered Outcomes Research
Yano EM, Resnick A, Gluck M
AHRQ Author: Kwon H, Mistry KB
Accelerating learning healthcare system development through embedded research: career trajectories, training needs, and strategies for managing and supporting embedded researchers.
Health systems and organizations seeking to achieve learning healthcare system principles are increasingly relying on embedded research teams to optimize delivery of evidence-based, high-quality care that improves patient and staff experience alike. In February 2018, 115 attendees from multiple agencies, institutions and professional societies participated in a conference to accelerate development of learning healthcare systems through embedded research. This paper describes the process.
AHRQ-authored.
Citation: Yano EM, Resnick A, Gluck M .
Accelerating learning healthcare system development through embedded research: career trajectories, training needs, and strategies for managing and supporting embedded researchers.
Healthc 2021 Jun;8(Suppl 1):100479. doi: 10.1016/j.hjdsi.2020.100479..
Keywords: Learning Health Systems, Health Systems, Health Services Research (HSR)
Harrison MI, Shortell SM
AHRQ Author: Harrison MI
Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation.
The authors have developed a comprehensive, multilevel framework to inform learning health systems (LHSs) research and practice in order to enhance both research on LHSs and practical steps toward their development. Drawing on the Consolidated Framework for Implementation Research, the social-ecological framework, and the organizational change framework, their new framework can help investigators and practitioners broadly scan and then investigate forces influencing improvement and learning and may point to otherwise unnoticed interactions among influential factors.
AHRQ-authored.
Citation: Harrison MI, Shortell SM .
Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation.
Learn Health Syst 2021 Apr;5(2):e10226. doi: 10.1002/lrh2.10226..
Keywords: Learning Health Systems, Health Systems, Implementation, Organizational Change