National Healthcare Quality and Disparities Report
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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
26 to 50 of 91 Research Studies DisplayedMisra-Hebert AD, Ji X, Nowacki AS
Impact of the COVID-19 pandemic on healthcare workers' risk of infection and outcomes in a large, integrated health system.
Researchers assessed healthcare workers (HCW) risk for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission. Participants were individuals who had tested for SARS-CoV-2 infection in a large academic healthcare system. The study found that, in a large healthcare system, HCW had similar odds for testing positive, but lower odds of hospitalization, compared to non-HCW. Patient-facing HCW had higher odds of a positive test.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Ji X, Nowacki AS .
Impact of the COVID-19 pandemic on healthcare workers' risk of infection and outcomes in a large, integrated health system.
J Gen Intern Med 2020 Nov;35(11):3293-301. doi: 10.1007/s11606-020-06171-9..
Keywords: COVID-19, Risk, Provider: Health Personnel, Public Health, Healthcare Delivery, Infectious Diseases
Berridge C, Lima J, Schwartz M
Leadership, staff empowerment, and the retention of nursing assistants: findings from a survey of U.S. nursing homes.
In this cross-sectional study, the investigators examined the relationship between nursing assistant (NA) retention and a measure capturing nursing home leadership and staff empowerment. The investigators found that modifiable leadership and staff empowerment practices are associated with NA retention. Associations were most significant when examining the highest practice scores and retention categories. The investigators suggested that nursing homes seeking to improve NA retention might look to leadership and staff empowerment practice changes common to culture change.
AHRQ-funded; HS000011.
Citation: Berridge C, Lima J, Schwartz M .
Leadership, staff empowerment, and the retention of nursing assistants: findings from a survey of U.S. nursing homes.
J Am Med Dir Assoc 2020 Sep;21(9):1254-59.e2. doi: 10.1016/j.jamda.2020.01.109..
Keywords: Nursing Homes, Provider: Health Personnel
Shechter A, Diaz F, Moise N
Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.
The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. In this study the authors, using a cross-sectional web survey, characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic. They concluded that NYC HCWs, especially nurses and advanced practice providers, were experiencing COVID-19-related psychological distress.
AHRQ-funded; HS024262.
Citation: Shechter A, Diaz F, Moise N .
Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.
Gen Hosp Psychiatry 2020 Sep-Oct;66:1-8. doi: 10.1016/j.genhosppsych.2020.06.007..
Keywords: COVID-19, Stress, Provider: Clinician, Provider: Physician, Provider: Nurse, Provider: Health Personnel, Behavioral Health
Cho HJ, Feldman LS, Keller S
Choosing Wisely in the COVID-19 era: preventing harm to healthcare workers.
This paper highlights the 5 top recommendations developed for hospitals in the COVID-19 era as part of the Choosing Wisely® campaign. This top 5 list of overuse practices in hospital medicine can lead to harm of both patients and healthcare workers. The recommendations include: 1) Do not obtain nonurgent labs in separate blood draws if they can be batched together; 2) Do not use bronchodilators unless there is active obstructive airway disease; 3) Do not use posteroanterior and lateral chest X-ray (CXR) as initial imaging, use a portable CXR instead; 4) Avoid in-person evaluations in favor of virtual communication unless necessary; and 5) Do not delay goals of care conversations for hospitalized patients who are unlikely to benefit from life-sustaining treatments.
AHRQ-funded; HS025782.
Citation: Cho HJ, Feldman LS, Keller S .
Choosing Wisely in the COVID-19 era: preventing harm to healthcare workers.
J Hosp Med 2020 Jun;15(6):360-62. doi: 10.12788/jhm.3457..
Keywords: COVID-19, Infectious Diseases, Hospitals, Prevention, Public Health, Provider: Health Personnel
Baloh J, Thom KA, Perencevich E
Hand hygiene before donning nonsterile gloves: healthcareworkers' beliefs and practices.
The purpose of this study was to examine the practices and beliefs of health care workers related to the use of nonsterile gloves and associated hand hygiene (HH) before gloving. Gloving and HH practices of health care workers at three large academic hospitals were observed as they entered patient rooms, and interviews were conducted with providers, nurses, and nursing assistants to elicit their beliefs and perceptions of these hygiene practices. While interviewed health care workers reported 100% HH compliance before gloving, observed HH compliance was only 42% and observed gloving before entering contact precaution rooms was 78%. Most health care workers described glove use more often than was necessary, and generally used gloves for their own safety, and sanitized their hands before gloving for patient safety. The authors conclude that HH and glove use are intertwined in clinical practice and should be considered jointly to improve infection prevention improvement efforts.
AHRQ-funded; HS024108.
Citation: Baloh J, Thom KA, Perencevich E .
Hand hygiene before donning nonsterile gloves: healthcareworkers' beliefs and practices.
Am J Infect Control 2019 May;47(5):492-97. doi: 10.1016/j.ajic.2018.11.015..
Keywords: Provider: Clinician, Provider, Provider: Health Personnel, Patient Safety, Prevention
Sterling MR, Silva AF, Leung PBK
"It's like they forget that the word 'health' is in 'home health aide'": Understanding the perspectives of home care workers who care for adults with heart failure.
Home care workers (HCWs) were interviewed about their role and perspectives in caring for community-dwelling adults with heart failure (HF) posthospitalization. Researchers conducted a total of 8 focus groups in partnership with the Home Care Industry Education Fund. A total of 46 English- and Spanish-speaking HCWs employed by 21 unique home care agencies participated. Generally they felt overworked and unappreciated but care about their clients and families and still love their job. The majority of HCWs have not received HF training, so do not feel supported when their clients’ symptoms worsened.
AHRQ-funded; HS024569.
Citation: Sterling MR, Silva AF, Leung PBK .
"It's like they forget that the word 'health' is in 'home health aide'": Understanding the perspectives of home care workers who care for adults with heart failure.
J Am Heart Assoc 2018 Dec 4;7(23):e010134. doi: 10.1161/jaha.118.010134..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Home Healthcare, Provider: Health Personnel
Blanco N, Johnson JK, Sorkin JD
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities.
The purpose of this study was to estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission. The investigators found that RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission.
AHRQ-funded; HS019979.
Citation: Blanco N, Johnson JK, Sorkin JD .
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities.
Infect Control Hosp Epidemiol 2018 Dec;39(12):1425-30. doi: 10.1017/ice.2018.247.
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Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Prevention, Provider, Provider: Health Personnel
Blechter B, Jiang N, Cleland C
Correlates of burnout in small independent primary care practices in an urban setting.
Little is known about the prevalence and correlates of burnout among providers who work in small independent primary care practices (< 5 providers). The authors conducted a cross-sectional analysis by using data collected from 235 providers practicing in 174 small independent primary care practices in New York City. The burnout rate was relatively low among their sample of providers compared with previous surveys that focused primarily on larger practices.
AHRQ-funded; HS023922.
Citation: Blechter B, Jiang N, Cleland C .
Correlates of burnout in small independent primary care practices in an urban setting.
J Am Board Fam Med 2018 Jul-Aug;31(4):529-36. doi: 10.3122/jabfm.2018.04.170360..
Keywords: Burnout, Provider: Health Personnel, Primary Care
McCurdy RK, Encinosa WE
AHRQ Author: Encinosa, WE
Are medical offices ready for value-based reimbursement? Staff perceptions of a workplace climate for value and efficiency.
The goal of the study was to assess medical office staff member perceptions of a workplace climate for value. The study’s findings highlight the need for management strategies that emphasize staff training and engagement and the use of performance data and that stress value principles across all organizational activities, including workforce development, performance management, and recruitment.
AHRQ-authored; AHRQ-funded
Citation: McCurdy RK, Encinosa WE .
Are medical offices ready for value-based reimbursement? Staff perceptions of a workplace climate for value and efficiency.
Am J Accountable Care 2018 Jun;6(2):11-19..
Keywords: Payment, Provider: Health Personnel
White VanGompel E, Main EK, Tancredi D
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
The authors estimated the association between individual provider attitudes towards birth and their low-risk primary cesarean rate. Through surveys of California providers of intrapartum care in 2013, they found that provider attitudinal differences are associated with nulliparous, term, singleton, vertex cesarean rates. Those meeting the HP2020 goal hold attitudes more favorable towards vaginal birth, suggesting a modifiable target for quality improvement initiatives to decrease low risk primary cesareans.
AHRQ-funded; HS022236.
Citation: White VanGompel E, Main EK, Tancredi D .
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
BMC Pregnancy Childbirth 2018 May 29;18(1):184. doi: 10.1186/s12884-018-1756-7.
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Keywords: Provider: Health Personnel, Labor and Delivery, Pregnancy, Practice Patterns
Grout RW, Cheng ER, Carroll AE
A six-year repeated evaluation of computerized clinical decision support system user acceptability.
This study examined user acceptance patterns over six years of a continuous computerized clinical decision support system (CDSS) integration and updated a long-term, repeated follow-up of user acceptability of a CDSS. It found that favorable opinions of the CDSS were more likely in frequent users, physicians and advanced practitioners, and full-time workers.
AHRQ-funded; HS017939; HS018453; HS020640.
Citation: Grout RW, Cheng ER, Carroll AE .
A six-year repeated evaluation of computerized clinical decision support system user acceptability.
Int J Med Inform 2018 Apr;112:74-81. doi: 10.1016/j.ijmedinf.2018.01.011.
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Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Provider: Health Personnel, Health Information Technology (HIT), Quality Improvement
Berridge C, Tyler DA, Miller SC
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. It concluded that after adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44 percent greater likelihood of having higher CNA retention.
AHRQ-funded; HS000011.
Citation: Berridge C, Tyler DA, Miller SC .
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
J Appl Gerontol 2018 Apr;37(4):419-34. doi: 10.1177/0733464816665204.
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Keywords: Long-Term Care, Nursing Homes, Provider, Provider: Health Personnel, Workforce
Nowak-Wegrzyn A, Greenhawt M
The importance of food allergy to the practicing clinician.
This article introduces a theme issue on food allergy that brings an impressive lineup of state-of-the-art reviews, provocative commentaries, and innovative original research studies. It briefly summarizes the content of the various studies and commentaries included in the issue.
AHRQ-funded; HS024599.
Citation: Nowak-Wegrzyn A, Greenhawt M .
The importance of food allergy to the practicing clinician.
Ann Allergy Asthma Immunol 2018 Mar;120(3):227-28. doi: 10.1016/j.anai.2018.01.024.
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Keywords: Evidence-Based Practice, Provider: Health Personnel, Nutrition, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Benda N, Hettinger A, Bisantz A
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
This study described the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. It found that physician participants experienced significantly more communication events than nurse participants, while nurses initiated significantly more communication events than physicians. Most of the communication events occurred at the physician workstation followed by patient treatment areas.
AHRQ-funded; HS022542.
Citation: Benda N, Hettinger A, Bisantz A .
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
Journal of Healthcare Informatics Research 2017 Dec;1(2):218-30.
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Keywords: Communication, Electronic Health Records (EHRs), Provider: Health Personnel, Emergency Department, Nursing
Rizvi RF, Marquard JL, Seywerd MA
Usability evaluation of an EHR's clinical notes interface from the perspective of attending and resident physicians: an exploratory study.
Usability of a commercial, inpatient Electronic Health Record (EHR) clinical notes documentation interface was analyzed from standpoints of two provider groups employing two standardized patient cases. The study results suggested that: (1) EHR usability and desirability is influenced by user characteristics, (2) repeated task performance improves user efficiency, and (3) user performance is correlated to their subjective system assessments.
AHRQ-funded; HS022085.
Citation: Rizvi RF, Marquard JL, Seywerd MA .
Usability evaluation of an EHR's clinical notes interface from the perspective of attending and resident physicians: an exploratory study.
Stud Health Technol Inform 2017;245:1128-32.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Health Personnel
Mosaly PR, Mazur LM, Marks LB
Quantification of baseline pupillary response and task-evoked pupillary response during constant and incremental task load.
The objective of this study was to assess variability in baseline pupil size and task-evoked pupillary response (TEPR) during two basic working memory tasks: constant load of 3-letters memorization-recall (10 trials), and incremental load memorization-recall. It concluded that quantification of TEPR can be affected by shifts in baseline pupil size that are most likely affected by non-cognitive factors when other external factors are kept constant.
AHRQ-funded; HS023458; HS024062.
Citation: Mosaly PR, Mazur LM, Marks LB .
Quantification of baseline pupillary response and task-evoked pupillary response during constant and incremental task load.
Ergonomics 2017 Oct;60(10):1369-75. doi: 10.1080/00140139.2017.1288930.
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Keywords: Health Information Technology (HIT), Provider: Health Personnel, Patient Safety
Kruse GR, Hays H, Orav EJ
Meaningful use of the Indian Health Service electronic health record.
This study sought to understand the use of electronic health record (EHR) functionalities by physicians practicing in an underserved setting. Physicians routinely used a median 7 of 10 EHR functionalities targeted by the Meaningful Use program, but only 5 percent used all 10. Most (63 percent) felt the EHR improved quality of care. Many (76 percent) reported increased documentation time and poorer quality patient-physician interactions (45 percent).
AHRQ-funded; 290200900023I.
Citation: Kruse GR, Hays H, Orav EJ .
Meaningful use of the Indian Health Service electronic health record.
Health Serv Res 2017 Aug;52(4):1349-63. doi: 10.1111/1475-6773.12531.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Practice Patterns, Vulnerable Populations
Davis MM, Howk S, Spurlock M
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
Researchers conducted this study to explore what clinic and community-based users want in intervention toolkits and to identify the factors that support application in practice. They found that participants wanted toolkits targeted at the right audience and demonstrated to be effective. Well organized toolkits, often with a quick start guide, with tools that were easy to tailor and apply were desired.
AHRQ-funded; HS022981.
Citation: Davis MM, Howk S, Spurlock M .
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
BMC Health Serv Res 2017 Jul 18;17(1):497. doi: 10.1186/s12913-017-2413-y.
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Keywords: Provider: Health Personnel, Ambulatory Care and Surgery, Primary Care, Tools & Toolkits, Implementation
Dyrbye LN, Shanafelt TD, Sinsky CA
AHRQ Author: Meyers D
https://nam.edu/burnout-among-health-care-professionals-a-call-to-explore-and-address-this-underrecognized-threat-to-safe-high-quality-care
Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care.
The high prevalence of burnout among health care professionals is cause for concern because it appears to be affecting quality, safety, and health care system performance. Efforts are needed to address this growing problem. Progress will require methodologically sound studies, adequate funding, and collaborative efforts. The authors hope that research sponsors, institutions, clinician organizations, researchers, clinicians, and patients join in supporting enhanced research efforts focused on these topics.
AHRQ-authored.
Citation: Dyrbye LN, Shanafelt TD, Sinsky CA .
Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care.
NAM Perspectives 2017 Jul 5.
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Keywords: Quality of Care, Provider: Health Personnel, Patient Safety, Workforce
Bush RA, Connelly CD, Perez A
Physician perception of the role of the patient portal in pediatric health.
Little information regarding physician opinion of the patient portal is available, with almost no information gathered in the pediatric environment. Using a mixed-methods approach, physicians in a large pediatric medical facility and integrated delivery network were surveyed by online quantitative questionnaire and structured interviews. Physicians reported the portal's role in more communication efficiency for patients, parents, and providers.
AHRQ-funded; HS022404.
Citation: Bush RA, Connelly CD, Perez A .
Physician perception of the role of the patient portal in pediatric health.
J Ambul Care Manage 2017 Jul/Sep;40(3):238-45. doi: 10.1097/jac.0000000000000175.
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Keywords: Children/Adolescents, Electronic Health Records (EHRs), Provider: Health Personnel, Clinician-Patient Communication, Web-Based
Loresto FL, Jr., Jupiter D, Kuo YF
Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.
There is a perception that nurse practitioners (NPs), as compared with primary care medical doctors (PCMDs), tend to provide care to healthier patients. In this study, patients utilizing NP-only or PCMD-only models for primary care were characterized and compared in terms of functional, cognitive, and psychological factors. The results were contrary to the initial perception. In terms of health status, NP-only patients were similar to PCMD-only patients.
AHRQ-funded; HS020642.
Citation: Loresto FL, Jr., Jupiter D, Kuo YF .
Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.
J Am Assoc Nurse Pract 2017 Jun;29(6):340-47. doi: 10.1002/2327-6924.12465.
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Keywords: Provider: Health Personnel, Medicare, Primary Care, Workforce
Kavalieratos D, Siconolfi DE, Steinhauser KE
"It is like heart failure. It is chronic ... and it will kill you": a qualitative analysis of burnout among hospice and palliative care clinicians.
This study explored burnout among palliative care clinicians, specifically their experiences with burnout, their perceived sources of burnout, and potential individual, interpersonal, organizational, and policy-level solutions to address burnout. Common sources of burnout included increasing workload, tensions between nonspecialists and palliative care specialists, and regulatory issues. Participants proposed antiburnout solutions, including promoting the provision of generalist palliative care, frequent rotations on-and-off service, and organizational support for self-care.
AHRQ-funded; HS023681; HS022989.
Citation: Kavalieratos D, Siconolfi DE, Steinhauser KE .
"It is like heart failure. It is chronic ... and it will kill you": a qualitative analysis of burnout among hospice and palliative care clinicians.
J Pain Symptom Manage 2017 May;53(5):901-10.e1. doi: 10.1016/j.jpainsymman.2016.12.337.
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Keywords: Provider: Health Personnel, Palliative Care, Workforce
Scerbo MW, Britt RC, Montano M
Effects of a retention interval and refresher session on intracorporeal suturing and knot tying skill and mental workload.
The effects of refraining from practice for different intervals on laparoscopic suturing and mental workload were assessed with a secondary task developed by the authors. When participants who reached proficiency in suturing and knot tying were reassessed after either 1 or 5 months without practice, their performance times increased by 35 percent and secondary task scores decreased by 30 percent. These deficits, however, were nearly reversed after a single refresher session.
AHRQ-funded; HS020386.
Citation: Scerbo MW, Britt RC, Montano M .
Effects of a retention interval and refresher session on intracorporeal suturing and knot tying skill and mental workload.
Surgery 2017 May;161(5):1209-14. doi: 10.1016/j.surg.2016.11.011.
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Keywords: Surgery, Education: Continuing Medical Education, Training, Provider: Health Personnel
Kruser JM, Taylor LJ, Campbell TC
"Best case/worst case": training surgeons to use a novel communication tool for high-risk acute surgical problems.
"Best Case/Worst Case" (BC/WC) is a communication tool designed to promote goal-concordant care during discussions about high-risk surgery. The objective of this study was to evaluate a structured training program designed to teach surgeons how to use BC/WC. It concluded that : surgeons can learn to use BC/WC with older patients considering acute high-risk surgical interventions..
AHRQ-funded; HS000078.
Citation: Kruser JM, Taylor LJ, Campbell TC .
"Best case/worst case": training surgeons to use a novel communication tool for high-risk acute surgical problems.
J Pain Symptom Manage 2017 Apr;53(4):711-19.e5. doi: 10.1016/j.jpainsymman.2016.11.014.
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Keywords: Communication, Shared Decision Making, Provider: Health Personnel, Surgery, Training
Rocque GB, Dionne-Odom JN, Sylvia Huang CH
Implementation and impact of patient lay navigator-led advance care planning conversations.
Advance care planning (ACP) improves alignment between patient preferences for life-sustaining treatment and care received at end of life (EOL). This study evaluated implementation of lay navigator-led ACP and concluded that a navigator-led ACP program was feasible and may be associated with lower rates of resource utilization near EOL.
AHRQ-funded; HS023009.
Citation: Rocque GB, Dionne-Odom JN, Sylvia Huang CH .
Implementation and impact of patient lay navigator-led advance care planning conversations.
J Pain Symptom Manage 2017 Apr;53(4):682-92. doi: 10.1016/j.jpainsymman.2016.11.012.
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Keywords: Communication, Elderly, Palliative Care, Patient-Centered Healthcare, Provider: Health Personnel