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
1 to 25 of 61 Research Studies DisplayedWust KL, Carayon P, Werner NE
Older adult patients and care partners as knowledge brokers in fragmented health care.
This study explores the knowledge broker roles of older adult patients and their care partners during emergency department (ED) visits. The research concludes that patients and care partners serve as information liaisons between fragmented care systems, providing details on diagnostic testing, medications, health history, and care accommodations. They engage in proactive and reactive knowledge brokering within and across ED work systems, aiding in communication and care coordination to mitigate healthcare fragmentation.
AHRQ-funded; HS026624.
Citation: Wust KL, Carayon P, Werner NE .
Older adult patients and care partners as knowledge brokers in fragmented health care.
Hum Factors 2024 Mar; 66(3):701-13. doi: 10.1177/00187208221092847.
Keywords: Elderly, Emergency Department, Caregiving, Clinician-Patient Communication, Communication
Barwise AK, Curtis S, Diedrich DA
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
The objectives of this planned qualitative study were to use machine learning predictive analytics to identify patients with language barriers and complex medical needs in order to prioritize them for in-person interpreters. The authors conducted semi-structured interviews with clinicians, interpreters, and staff involved in caring for patients or organizing interpreters to understand perceived risks and benefits of artificial intelligence (AI) in this domain. Perceived risks included concerns about transparency, accuracy, redundancy, privacy, stigmatization among patients, alert fatigue, and supply-demand issues; perceived benefits included increased awareness of in-person interpreters, improved standard of care, and prioritization for interpreter utilization. They concluded that the use of AI to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
AHRQ-funded; HS028475.
Citation: Barwise AK, Curtis S, Diedrich DA .
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
J Am Med Inform Assoc 2024 Feb 16; 31(3):611-21. doi: 10.1093/jamia/ocad224.
Keywords: Health Information Technology (HIT), Disparities, Communication, Clinician-Patient Communication
Sleath B, Beznos B, Carpenter DM
African American patient-provider communication about glaucoma vision quality-of-life.
A study was conducted to examine African American patient-provider communication about glaucoma-related quality-of-life. Patients completed a vision quality-of-life assessment to examine patient-provider characteristics, patient demographics, and socio-demographics. The study determined that patients with worse literacy, more severe glaucoma, or depression are likely to have a lower vision quality-of-life.
AHRQ-funded; HS025370.
Citation: Sleath B, Beznos B, Carpenter DM .
African American patient-provider communication about glaucoma vision quality-of-life.
Eye 2024 Feb; 38(2):343-48. doi: 10.1038/s41433-023-02693-8..
Keywords: Eye Disease and Health, Racial and Ethnic Minorities, Clinician-Patient Communication, Communication, Quality of Life
Beznos B, Sayner R, Carpenter DM
Do African American patients with glaucoma ask their eye providers the questions they have?
The objective of this randomized controlled trial was to test the effectiveness of a pre-visit video/glaucoma question prompt-list to increase question-asking during medical visits. Participants were adult African American patients with glaucoma and a history of non-adherence to glaucoma medications, The questions that patients checked on the question prompt list were described, and how often the same checked questions were asked during medical visits noted. The findings indicated that although patients with glaucoma had questions about glaucoma and their medications, few asked all their questions during visits. The researchers concluded that future research should focus on ways to improve question asking using a question prompt list.
AHRQ-funded; HS025370.
Citation: Beznos B, Sayner R, Carpenter DM .
Do African American patients with glaucoma ask their eye providers the questions they have?
Eye 2024 Feb; 38(2):279-83. doi: 10.1038/s41433-023-02674-x..
Keywords: Racial and Ethnic Minorities, Eye Disease and Health, Clinician-Patient Communication, Communication
Liu SK, Bourgeois F, Dong J
What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.
This paper evaluated positive patient/family feedback to generate broader perspectives on what constitutes a "good" diagnostic process (DxP). Eligible participants included patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) who were then invited to complete a survey between December 2020 and March 2020. The authors adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words. A total of 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Positive feedback was provided by 1,578 participants, ranging from 1-79 words. Categories of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). In the Relationships category patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). For Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %).
AHRQ-funded; HS027367.
Citation: Liu SK, Bourgeois F, Dong J .
What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.
Diagnosis 2024 Feb 1; 11(1):63-72. doi: 10.1515/dx-2023-0075.
Keywords: Diagnostic Safety and Quality, Clinician-Patient Communication, Communication, Patient and Family Engagement
Nacht CL, Jacobson N, Shiyanbola O
Perception of physicians' notes among parents of different health literacy levels.
The study explored how parents of varying health literacy levels perceive accessing physicians' notes during pediatric hospitalization. Thematic analysis of interviews with 28 parents revealed benefits like information recall and autonomy, with challenges including receiving bad news before face-to-face communication. The study found that parents with limited literacy found notes especially helpful for understanding the care of the child while reducing worry. Simplifying medical terms could enhance note accessibility for all parents, ensuring equitable access to healthcare information.
AHRQ-funded; HS027214.
Citation: Nacht CL, Jacobson N, Shiyanbola O .
Perception of physicians' notes among parents of different health literacy levels.
Hosp Pediatr 2024 Feb; 14(2):108-15. doi: 10.1542/hpeds.2023-007240.
Keywords: Children/Adolescents, Health Literacy, Caregiving, Clinician-Patient Communication, Communication
Mangal S, Berger L, Bruzzese JM
Seeing things the same way: perspectives and lessons learned from research-design collaborations.
This paper summarizes the experiences of health researchers in their collaborations with creative professionals such as graphic designers, illustrators, or user interface/user experience designers in creating information visualizations. The authors offer suggestions for determining design needs, communicating with design professionals, and carrying out the design process. They assert that successful collaborations are predicated on careful and intentional planning at the outset of a project, a thorough understanding of each party's scope expertise, clear communication, and ample time for the design process to unfold.
AHRQ-funded; HS022961.
Citation: Mangal S, Berger L, Bruzzese JM .
Seeing things the same way: perspectives and lessons learned from research-design collaborations.
J Am Med Inform Assoc 2024 Jan 18; 31(2):542-47. doi: 10.1093/jamia/ocad124..
Keywords: Communication
Carroll AR, Johnson JA, Stassun JC
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
This study’s objective was to test a health literacy-informed communication intervention to decrease liquid medication dosing errors compared with standard counseling in hospitalized children. This parallel, randomized clinical trial was conducted from June 22, 2021, to August 20, 2022, at a tertiary care, US children's hospital. English- and Spanish-speaking caregivers of hospitalized children 6 years or younger prescribed a new, scheduled liquid medication at discharge were included in the analysis. Observed dosing errors were the main outcome measured, and secondary outcomes included caregiver-reported medication knowledge. Among 198 randomized caregivers (mean age 31.4 years; 186 women [93.9%]; 36 [18.2%] Hispanic or Latino and 158 [79.8%] White), the primary outcome was available for 151 (76.3%). The observed mean (SD) percentage dosing error was 1.0% (2.2 percentage points) among the intervention group and 3.3% (5.1 percentage points) among the standard counseling group (absolute difference, 2.3 percentage points). Twenty-four of 79 caregivers in the intervention group (30.4%) measured an incorrect dose compared with 39 of 72 (54.2%) in the standard counseling group. The intervention enhanced caregiver-reported medication knowledge compared with the standard counseling group for medication dose (71 of 76 [93.4%] vs 55 of 69 [79.7%]), duration of administration (65 of 76 [85.5%] vs 49 of 69 [71.0%], and correct reporting of 2 or more medication adverse effects (60 of 76 [78.9%] vs 13 of 69 [18.8%]).
AHRQ-funded; HS026122.
Citation: Carroll AR, Johnson JA, Stassun JC .
Health literacy-informed communication to reduce discharge medication errors in hospitalized children: a randomized clinical trial.
JAMA Netw Open 2024 Jan 2; 7(1):e2350969. doi: 10.1001/jamanetworkopen.2023.50969..
Keywords: Children/Adolescents, Health Literacy, Communication, Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Clinician-Patient Communication, Hospital Discharge, Medication: Safety
Wooldridge AR, Carayon P, Hoonakker P
Team cognition in handoffs: relating system factors, team cognition functions and outcomes in two handoff processes.
This study investigated how team cognition occurs in care transitions from operating room (OR) to intensive care unit (ICU) and then sought to understand how the sociotechnical system and team cognition are related. The authors conducted the study in an academic, Level 1 trauma center in the Midwestern US. Semi-structured interviews were conducted with 28 healthcare workers that included physicians (surgery, anesthesia, pediatric critical care) and nurses (OR, ICU). Three cognition functions in hand-offs were described by participants: (1) information exchange, (2) assessment, and (3) planning and decision making; information exchange was mentioned most. Inter-professional handoffs facilitated information exchange but included large teams with diverse backgrounds communicating that can decrease efficiency. Intra-professional handoffs decreased team size and role diversity, which may simplify communication but can increase information loss. Participants in inter-professional handoffs reflected on outcomes significantly more in relation to system factors and team cognition, while participants in intra-professional handoffs discussed handoffs as a task.
AHRQ-funded; HS023837.
Citation: Wooldridge AR, Carayon P, Hoonakker P .
Team cognition in handoffs: relating system factors, team cognition functions and outcomes in two handoff processes.
Hum Factors 2024 Jan; 66(1):271-93. doi: 10.1177/00187208221086342..
Keywords: Teams, Transitions of Care, Communication
Meisel ZF, Metlay JP, Sinnenberg L
A randomized trial testing the effect of narrative vignettes versus guideline summaries on provider response to a professional organization clinical policy for safe opioid prescribing.
The authors compared whether narrative vignettes embedded in the American College of Emergency Physicians (ACEP) daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared with traditional summary text. They found that the vignettes outperformed traditional guideline text in promoting engagement with an evidence-based clinical guideline related to opioid prescriptions.
AHRQ-funded; HS021956.
Citation: Meisel ZF, Metlay JP, Sinnenberg L .
A randomized trial testing the effect of narrative vignettes versus guideline summaries on provider response to a professional organization clinical policy for safe opioid prescribing.
Ann Emerg Med 2016 Dec;68(6):719-28. doi: 10.1016/j.annemergmed.2016.03.007.
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Keywords: Communication, Evidence-Based Practice, Guidelines, Opioids, Medication, Medication: Safety, Policy, Provider
Mello MM, Greenberg Y, Senecal SK
Case outcomes in a communication-and-resolution program in New York hospitals.
The researchers sought to determine case outcomes in a communication-and-resolution program (CRP) implemented to respond to adverse events in general surgery. They concluded that the bulk of CRPs' work is in investigating and communicating about events not caused by substandard care. These CRPs were quite successful in handling such events, but less consistent in offering compensation in cases involving substandard care.
AHRQ-funded; R18 HS019505.
Citation: Mello MM, Greenberg Y, Senecal SK .
Case outcomes in a communication-and-resolution program in New York hospitals.
Health Serv Res 2016 Dec;51 Suppl 3:2583-99. doi: 10.1111/1475-6773.12594.
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Keywords: Adverse Events, Communication, Medical Errors, Medical Liability, Surgery
Mello MM, Armstrong SJ, Greenberg Y
Challenges of implementing a communication-and-resolution program where multiple organizations must cooperate.
The researchers sought to implement a communication-and-resolution program (CRP) in a setting in which liability insurers and health care facilities must collaborate to resolve incidents involving a facility and separately insured clinicians. They found that sites experienced small victories in resolving particular cases and streamlining some working relationships, but they were unable to successfully implement a collaborative CRP.
AHRQ-funded; HS019531.
Citation: Mello MM, Armstrong SJ, Greenberg Y .
Challenges of implementing a communication-and-resolution program where multiple organizations must cooperate.
Health Serv Res 2016 Dec;51 Suppl 3:2550-68. doi: 10.1111/1475-6773.12580.
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Keywords: Communication, Medical Errors, Medical Liability, Patient Safety
Helmchen LA, Lambert BL, McDonald TB
Changes in physician practice patterns after implementation of a communication-and-resolution program.
The researchers tested if a 2006 communication-and-resolution program to address unexpected adverse outcomes was associated with changes in cost and use trajectories. They found that the intervention hospital recorded an increase in the number of patients with a principal diagnosis of chest pain. Among admitted patients, quarterly growth rates of clinical laboratory and radiology charges at the intervention hospital declined by 3.8 and 6.9 percentage points.
AHRQ-funded; HS019565.
Citation: Helmchen LA, Lambert BL, McDonald TB .
Changes in physician practice patterns after implementation of a communication-and-resolution program.
Health Serv Res 2016 Dec;51 Suppl 3:2516-36. doi: 10.1111/1475-6773.12610.
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Keywords: Adverse Events, Communication, Medical Errors, Medical Liability, Practice Patterns
Gallagher TH, Farrell ML, Karson H
Collaboration with regulators to support quality and accountability following medical errors: The Communication and Resolution Program Certification Pilot.
The Medical Quality Assurance Commission (MQAC, board of medicine) in Washington State has collaborated with the Foundation for Health Care Quality (FHCQ) on the CRP Certification pilot. A panel of physicians, risk managers, and patient advocates at FHCQ will review cases for use of the CRP key elements. After describing the process, the authors concluded that the CRP Certification program is a promising example of collaboration among institutions, insurers, and regulators to promote patient-centered accountability and learning following adverse events.
AHRQ-funded; HS019531.
Citation: Gallagher TH, Farrell ML, Karson H .
Collaboration with regulators to support quality and accountability following medical errors: The Communication and Resolution Program Certification Pilot.
Health Serv Res 2016 Dec;51 Suppl 3:2569-82. doi: 10.1111/1475-6773.12557.
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Keywords: Adverse Events, Communication, Medical Errors, Medical Liability, Patient Safety, Quality of Care
Naslund JA, Aschbrenner KA, Bartels SJ
How people with serious mental illness use smartphones, mobile apps, and social media.
The researchers surveyed individuals with serious mental illness to explore their use of mobile devices or whether they access social media. Among respondents (n = 70), 93 percent owned cellphones, 78 percent used text messaging, 50 percent owned smartphones, and 71 percent used social media such as Facebook. Most respondents reported daily use of text messaging, mobile apps, and social media.
AHRQ-funded; HS021695.
Citation: Naslund JA, Aschbrenner KA, Bartels SJ .
How people with serious mental illness use smartphones, mobile apps, and social media.
Psychiatr Rehabil J 2016 Dec;39(4):364-67. doi: 10.1037/prj0000207.
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Keywords: Communication, Community-Based Practice, Health Promotion, Behavioral Health, Social Media
Gordon HS, Street RL
How physicians, patients, and observers compare on the use of qualitative and quantitative measures of physician-patient communication.
The purpose of this study was to compare several different measures of physician-patient communication. Communication was measured with rating scales completed by patients and physicians and by two groups of external observers who used rating scales or coded the frequency of communication behaviors. The findings highlight the potential for using observers' ratings as an alternate measure of communication to more labor intensive frequency measures.
AHRQ-funded; HS010876.
Citation: Gordon HS, Street RL .
How physicians, patients, and observers compare on the use of qualitative and quantitative measures of physician-patient communication.
Eval Health Prof 2016 Dec;39(4):496-511. doi: 10.1177/0163278715625737.
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Keywords: Communication, Shared Decision Making, Patient and Family Engagement, Clinician-Patient Communication
Sulzer SH, Muenchow E, Potvin A
Improving patient-centered communication of the borderline personality disorder diagnosis.
This study aimed to understand how clinicians communicate the diagnosis of borderline personality disorder (BPD) with patients, and compare these practices with patient communication preferences. It found that the majority of clinicians sampled did not actively share the BPD diagnosis with their patients, while the majority of patients wanted to be told that they had the disorder, as well as have their providers discuss the stigma they would face.
AHRQ-funded; HS000032.
Citation: Sulzer SH, Muenchow E, Potvin A .
Improving patient-centered communication of the borderline personality disorder diagnosis.
J Ment Health 2016;25(1):5-9. doi: 10.3109/09638237.2015.1022253.
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Keywords: Communication, Diagnostic Safety and Quality, Behavioral Health, Clinician-Patient Communication, Social Stigma
Traino HM, Siminoff LA
Keep it going: maintaining health conversations using relational and instrumental approaches.
The researchers examined how elements of relational and instrumental communication occurring within the first five minutes of the request impacted the length of the discussion. Sixteen U.S. tissue banking organizations and their staff making telephone requests for donation to families of tissue-donation eligible patients agreed to participate in the research. The researchers concluded that aspects of both relational and instrumental communication were associated with discussion length.
AHRQ-funded; HS013152.
Citation: Traino HM, Siminoff LA .
Keep it going: maintaining health conversations using relational and instrumental approaches.
Health Commun 2016;31(3):308-19. doi: 10.1080/10410236.2014.950020.
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Keywords: Communication, Patient and Family Engagement, Clinician-Patient Communication
Sentell T, Chang A, Ahn HJ
Maternal language and adverse birth outcomes in a statewide analysis.
The study goal was to consider the relationship of maternal language to birth outcomes using Hawaii’s hospitalization data. It found that non-English speakers had approximately two times higher risk of having an obstetric trauma during a vaginal birth when other factors, including race/ethnicity, were controlled. Non-English speakers also had higher rates of potentially high-risk deliveries.
AHRQ-funded; HS019990; HS021903.
Citation: Sentell T, Chang A, Ahn HJ .
Maternal language and adverse birth outcomes in a statewide analysis.
Women Health 2016;56(3):257-80. doi: 10.1080/03630242.2015.1088114.
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Keywords: Adverse Events, Communication, Labor and Delivery, Outcomes
Lambert BL, Centomani NM, Smith KM
The "Seven Pillars" response to patient safety incidents: effects on medical liability processes and outcomes.
This study's objective was to determine whether a communication and resolution approach to patient harm is associated with changes in medical liability processes and outcomes. It found that the intervention nearly doubled the number of incident reports, halved the number of claims, and reduced legal fees and costs as well as total costs per claim, settlement amounts, and self-insurance costs. The study found that a communication and optimal resolution (CANDOR) approach to adverse events was associated with long-lasting, clinically and financially significant changes in a large set of core medical liability process and outcome measures.
AHRQ-funded; HS019565.
Citation: Lambert BL, Centomani NM, Smith KM .
The "Seven Pillars" response to patient safety incidents: effects on medical liability processes and outcomes.
Health Serv Res 2016 Dec;51 Suppl 3:2491-515. doi: 10.1111/1475-6773.12548.
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Keywords: Adverse Events, Medical Liability, Medical Errors, Communication, Patient Safety
Harrod M, Montoya A, Mody L
Challenges for nurses caring for individuals with peripherally inserted central catheters in skilled nursing facilities.
The researchers sought to understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs. They noted differences between resident self-reported PICC concerns (quality of life) and those described by frontline nurses.
AHRQ-funded; HS019979; HS022835.
Citation: Harrod M, Montoya A, Mody L .
Challenges for nurses caring for individuals with peripherally inserted central catheters in skilled nursing facilities.
J Am Geriatr Soc 2016 Oct;64(10):2059-64. doi: 10.1111/jgs.14341.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Communication, Nursing, Quality of Life, Transitions of Care
Krouss M, Croft L, Morgan DJ
Physician understanding and ability to communicate harms and benefits of common medical treatments.
The researchers evaluated physician understanding of harms and benefits of common tests and therapies. They found that most clinicians overestimate harms and benefits for most treatments. Likewise, most of the clinicians in our study reported rarely or never using statistical terms to explain treatment options to patients. However, they were interested in resources to improve understanding of treatment effect size.
AHRQ-funded; HS018111.
Citation: Krouss M, Croft L, Morgan DJ .
Physician understanding and ability to communicate harms and benefits of common medical treatments.
JAMA Intern Med 2016 Oct;176(10):1565-67. doi: 10.1001/jamainternmed.2016.5027.
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Keywords: Adverse Events, Communication, Education: Patient and Caregiver, Patient Safety, Clinician-Patient Communication
Curtis LM, Mullen RJ, Russell A
An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: the role of written and spoken communication.
The researchers tested the feasibility and efficacy of an electronic health record (EHR) strategy that automated the delivery of print medication information at the time of prescribing. They found that written information and physician counseling were independently associated with patient understanding of risk information and that receiving both was most beneficial. They concluded that although an EHR can be a reliable means to deliver tangible, print medication education to patients, it cannot replace physician-patient communication, and that offering both written and spoken information resulted in a synergistic effect for informing patients.
AHRQ-funded; HS017220.
Citation: Curtis LM, Mullen RJ, Russell A .
An efficacy trial of an electronic health record-based strategy to inform patients on safe medication use: the role of written and spoken communication.
Patient Educ Couns 2016 Sep;99(9):1489-95. doi: 10.1016/j.pec.2016.07.004.
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Keywords: Electronic Health Records (EHRs), Communication, Education: Patient and Caregiver, Medication: Safety, Medication
Shay LA, Street RL, Jr., Baldwin AS
Characterizing safety-net providers' HPV vaccine recommendations to undecided parents: a pilot study.
The researchers developed a tool to describe strength and content of provider HPV vaccination recommendations. The tool showed how providers undercut their recommendations through qualifications or support them with a rationale. The authors recommended that providers would benefit from communication skills training on how to make explicit recommendations with an evidence-based rationale.
AHRQ-funded; HS022418.
Citation: Shay LA, Street RL, Jr., Baldwin AS .
Characterizing safety-net providers' HPV vaccine recommendations to undecided parents: a pilot study.
Patient Educ Couns 2016 Sep;99(9):1452-60. doi: 10.1016/j.pec.2016.06.027.
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Keywords: Practice Patterns, Vaccination, Infectious Diseases, Sexual Health, Clinician-Patient Communication, Guidelines, Evidence-Based Practice, Communication
Mueller SK, Schnipper JL, Giannelli K
Impact of regionalized care on concordance of plan and preventable adverse events on general medicine services.
This study regionalized 3 inpatient general medical teams to nursing units and examined the association with communication and preventable adverse events (AEs). It found that regionalization of care teams improved recognition of care team members, discussion of daily care plan, and agreement on estimated discharge date, but did not significantly improve nurse and physician concordance of the care plan or reduce the odds of preventable AEs.
AHRQ-funded; HS023331.
Citation: Mueller SK, Schnipper JL, Giannelli K .
Impact of regionalized care on concordance of plan and preventable adverse events on general medicine services.
J Hosp Med 2016 Sep;11(9):620-7. doi: 10.1002/jhm.2566.
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Keywords: Adverse Events, Communication, Hospitals, Patient Safety, Teams