National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (4)
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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
76 to 98 of 98 Research Studies DisplayedWu SS, Chan KS, Bae J
Electronic clinical reminder and quality of primary diabetes care.
The goal of this retrospective cohort study was to examine the association of EMR's clinical reminder use with a comprehensive set of diabetes quality metrics in office-based physicians and within solo- versus multi-physician practices. Data on visits made by adults with diabetes were identified from the National Ambulatory Medical Care Survey and a multiple logistic regression was used to test for associations between clinical reminder use and recommended services by the American Diabetes Association. The researchers found no statistically significant relationship that suggests clinical reminder use improves diabetes process guidelines for solo practices, and they conclude that other resource efforts are needed to reduce gaps in primary diabetes care.
AHRQ-funded; HS000029.
Citation: Wu SS, Chan KS, Bae J .
Electronic clinical reminder and quality of primary diabetes care.
Prim Care Diabetes 2019 Apr;13(2):150-57. doi: 10.1016/j.pcd.2018.08.007..
Keywords: Care Management, Chronic Conditions, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Quality of Care
Colborn KL, Bronsert M, Hammermeister K
Identification of urinary tract infections using electronic health record data.
Using the American College of Surgeons National Surgical Quality Improvement Program UTI status of patients who underwent an operation at the University of Colorado Hospital, the investigators sought to develop an algorithm for identifying UTIs using data from the electronic health record. The investigators concluded that a model with 14 predictors from the electronic health record identifies UTIs well, and it could be used to scale up UTI surveillance or to estimate the impact of large-scale interventions on UTI rates.
AHRQ-funded; HS026019.
Citation: Colborn KL, Bronsert M, Hammermeister K .
Identification of urinary tract infections using electronic health record data.
Am J Infect Control 2019 Apr;47(4):371-75. doi: 10.1016/j.ajic.2018.10.009..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care, Quality Improvement, Surgery, Urinary Tract Infection (UTI)
Sadasivaiah S, Lyles CR, Kyoi S
Disparities in patient-reported interest in web-based patient portals: survey at an urban academic safety-net hospital.
Offering hospitalized patients' enrollment into a health system's patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system's portal among hospitalized patients and reasons for no interest.
AHRQ-funded; HS022408; HS022561; HS023558.
Citation: Sadasivaiah S, Lyles CR, Kyoi S .
Disparities in patient-reported interest in web-based patient portals: survey at an urban academic safety-net hospital.
J Med Internet Res 2019 Mar 26;21(3):e11421. doi: 10.2196/11421..
Keywords: Disparities, Patient-Centered Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Hospitals, Patient and Family Engagement, Urban Health
Lyles CR, Gupta R, Tieu L
After-visit summaries in primary care: mixed methods results from a literature review and stakeholder interviews.
This literature review examined the perception of the value of after visit summaries (AVS) in primary care practices to both patients and providers. Seventeen studies were identified, and overall patients reported a higher perceived value of AVS than providers. Even so, key informants found that AVS included incorrect information and that they weren’t being used to their potential to help educate patients.
AHRQ-funded; HS022408.
Citation: Lyles CR, Gupta R, Tieu L .
After-visit summaries in primary care: mixed methods results from a literature review and stakeholder interviews.
Fam Pract 2019 Mar 20;36(2):206-13. doi: 10.1093/fampra/cmy045..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care
Simon KC, Yucus C, Castle J
Building of EMR tools to support quality and research in a memory disorders clinic.
This article describes the development of a customized EMR toolkit that standardizes patient data collection with hundreds of discrete fields, supports Best Practices for treating patients with memory disorders, and also supports practice-based research. The toolkit was successfully implemented to support Best Practices in the care of patients with memory disorders. Applications are also discussed. Data collection is ongoing, but the authors anticipate that the toolkit will generate data that allows for descriptive and hypothesis-driven research as well as quality improvement among patients seen in memory clinics.
AHRQ-funded; HS024057.
Citation: Simon KC, Yucus C, Castle J .
Building of EMR tools to support quality and research in a memory disorders clinic.
Front Neurol 2019 Mar 7;10:161. doi: 10.3389/fneur.2019.00161..
Keywords: Dementia, Electronic Health Records (EHRs), Health Information Technology (HIT), Neurological Disorders, Quality of Care, Quality Improvement, Tools & Toolkits
Bucher BT, Shi J, Pettit RJ
Determination of marital status of patients from structured and unstructured electronic healthcare data.
This paper describes a robust method to determine the marital status of patients, which is included as a Social Determinant of Health and considered a key driver of health care utilization. A robust method to determine marital status using structured and unstructured electronic healthcare data was developed using data from a single US academic institution. A natural language processing (NLP) pipeline was developed and validated. Performance was compared against two baseline methods: a machine learning n-gram model and structured data from the electronic health record. Overall the NLP engine had excellent to superior performance compared with the other models.
AHRQ-funded; HS025776.
Citation: Bucher BT, Shi J, Pettit RJ .
Determination of marital status of patients from structured and unstructured electronic healthcare data.
AMIA Annu Symp Proc 2020 Mar 4;2019:267-74..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Social Determinants of Health, Healthcare Utilization
Ancker JS, Mauer E, Kalish RB
Early adopters of patient-generated health data upload in an electronic patient portal.
Patient-generated health data (PGHD) may help providers monitor patient status between clinical visits. The objective of this study was to describe a medical center's early experience with an electronic flowsheet allowing patients to upload self-monitored blood glucose to their provider's electronic health record (EHR). The authors concluded that despite the potential value of PGHD in health care, the rate of adoption of a tool allowing patients to upload PGHD to their provider's EHR had been slow.
AHRQ-funded; HS021531.
Citation: Ancker JS, Mauer E, Kalish RB .
Early adopters of patient-generated health data upload in an electronic patient portal.
Early adopters of patient-generated health data upload in an electronic patient portal..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Chronic Conditions
Liu LH, Choden S, Yazdany J
Quality improvement initiatives in rheumatology: an integrative review of the last 5 years.
Researchers reviewed recent quality improvement initiatives in the field of rheumatology to identify common strategies and themes leading to measurable change. Their review demonstrated common solutions, particularly involving leveraging health IT and workflow redesign. Electronic health record (EHR)-based interventions were most successful when reinforced with provider education, reminders, and performance feedback. Structured models such as the learning collaborative may help disseminate successful initiatives across practices.
AHRQ-funded; HS025638.
Citation: Liu LH, Choden S, Yazdany J .
Quality improvement initiatives in rheumatology: an integrative review of the last 5 years.
Curr Opin Rheumatol 2019 Mar;31(2):98-108. doi: 10.1097/bor.0000000000000586..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care, Quality Improvement
Norgeot B, Glicksberg BS, Trupin L
Assessment of a deep learning model based on electronic health record data to forecast clinical outcomes in patients with rheumatoid arthritis.
This study researched the use of artificial intelligence learning models to predict clinical outcomes in patients with rheumatoid arthritis (RA). Patients from a university hospital (UH) and a public safety-net hospital (SNH). The populations were quite different from each other. A total of 578 UH patients and 242 SNH patients were included in the study. Patients at the UH were seen more frequently than the SNH patients and were often prescribed high-class medications (63% vs. 28.9%). The model that was used showed a statistically random performance based on each patients’ most recent disease activity score.
AHRQ-funded; HS024412.
Citation: Norgeot B, Glicksberg BS, Trupin L .
Assessment of a deep learning model based on electronic health record data to forecast clinical outcomes in patients with rheumatoid arthritis.
JAMA Netw Open 2019 Mar;2(3):e190606. doi: 10.1001/jamanetworkopen.2019.0606..
Keywords: Arthritis, Electronic Health Records (EHRs), Health Information Technology (HIT), Outcomes
Garabedian PM, Wright A, Newbury I
Comparison of a prototype for indications-based prescribing with 2 commercial prescribing systems.
The objective of this study was to evaluate, in comparison with the prescribing modules of 2 leading electronic health record prescribing systems, the efficiency, error rate, and satisfaction with a new computerized provider order entry prototype for the outpatient setting that allows clinicians to initiate prescribing using the indication. The investigators found that reengineering prescribing to start with the drug indication allowed indications to be captured in an easy and useful way, which may be associated with saved time and effort, reduced medication errors, and increased clinician satisfaction.
AHRQ-funded; HS023694.
Citation: Garabedian PM, Wright A, Newbury I .
Comparison of a prototype for indications-based prescribing with 2 commercial prescribing systems.
JAMA Netw Open 2019 Mar;2(3):e191514. doi: 10.1001/jamanetworkopen.2019.1514..
Keywords: Electronic Health Records (EHRs), Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Medication
Rhee C, Zhang Z, Kadri SS
Sepsis surveillance using adult sepsis events simplified eSOFA criteria versus sepsis-3 sequential organ failure assessment criteria.
This retrospective cohort study compared simplified organ dysfunction criteria optimized for electronic health records (eSOFA) with Sequential Organ Failure Assessment with regard to sepsis prevalence, overlap, and outcomes using 111 U.S. hospitals in the Cerner HealthFacts dataset. Clinical indicators of presumed infection, such as blood cultures and antibiotics, were identified concurrent with either: an increase in Sequential Organ Failure Assessment score by 2 or more points (Sepsis-3) or one or more eSOFA criteria. The authors conclude that the Adult Sepsis Event's eSOFA organ dysfunction criteria identify a smaller, more severely ill sepsis cohort when compared with the Sequential Organ Failure Assessment score, although there is overlap between the two and both show similar clinical characteristics.
AHRQ-funded; HS025008.
Citation: Rhee C, Zhang Z, Kadri SS .
Sepsis surveillance using adult sepsis events simplified eSOFA criteria versus sepsis-3 sequential organ failure assessment criteria.
Crit Care Med 2019 Mar;47(3):307-14. doi: 10.1097/ccm.0000000000003521..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Sepsis
Wolfson AR, Zhou L, Li Y
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome identified in the electronic health record allergy module.
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe hypersensitivity reaction that remains poorly characterized in the United States. The objective of this study was to identify and describe DRESS syndrome cases in an integrated health care system using electronic health record (EHR) allergy module free-text searches.
AHRQ-funded; HS022728; HS025375.
Citation: Wolfson AR, Zhou L, Li Y .
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome identified in the electronic health record allergy module.
J Allergy Clin Immunol Pract 2019 Feb;7(2):633-40. doi: 10.1016/j.jaip.2018.08.013..
Keywords: Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Masterson Creber RM, Grossman LV, Ryan B
Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal.
This study examined the effects of an inpatient portal intervention on patient activation, patient satisfaction, patient engagement with health information, and 30-day hospital admissions. A randomized trial was conducted from March 2014 to May 2017 with 426 English- or Spanish-speaking patients from 2 cardiac medical-surgical units at an urban academic medical center. Patients were randomized into 3 groups: 1) usual care, 2) tablet with general Internet access, and 3) tablet with an inpatient portal. There was a difference in patient activation between the 3 groups, but the inpatient portal group had lower 30-day hospital admissions. There was also a difference with patient engagement with health information between the inpatient portal and tablet-only groups.
AHRQ-funded; HS021816.
Citation: Masterson Creber RM, Grossman LV, Ryan B .
Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal.
J Am Med Inform Assoc 2019 Feb;26(2):115-23. doi: 10.1093/jamia/ocy146..
Keywords: Patient and Family Engagement, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Patient Experience, Inpatient Care
Cykert S, DeWalt DA, Weiner BJ
A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ's EvidenceNow initiative.
Investigators estimated cholesterol scores for patients between the ages of 40 and 79 in large practice electronic health networks who did not have that in their electronic health record (EHR). This data was used to calculate 10-year Assessment of Cardiovascular Disease Risk (ASCVD) risk scores for patients in 219 practices. They estimated the scores using both “good value’ estimation methodology and formal imputation. The “good value” estimation methodology resulted in less patients with risk scores than imputation but it had higher specificity and a lower false positive rate.
AHRQ-funded; HS023912.
Citation: Cykert S, DeWalt DA, Weiner BJ .
A population approach using cholesterol imputation to identify adults with high cardiovascular risk: a report from AHRQ's EvidenceNow initiative.
J Am Med Inform Assoc 2019 Feb;26(2):155-58. doi: 10.1093/jamia/ocy151..
Keywords: Cardiovascular Conditions, Electronic Health Records (EHRs), Heart Disease and Health, Evidence-Based Practice, Health Information Technology (HIT), Patient-Centered Outcomes Research, Quality Improvement
Murphy DR, Meyer AN, Sittig DF
Application of electronic trigger tools to identify targets for improving diagnostic safety.
This article discusses the use of electronic trigger tools to reduce diagnostic errors and improve patient safety. The authors present a framework called Safer Dx Trigger Tools Framework that will enable health systems to develop and implement e-trigger tools. It identifies and measures diagnostic errors using comprehensive electronic health record (EHR) data. The application of the algorithms used will require a diverse team of specialists to implement. Future research is also outlined.
AHRQ-funded; HS022901; HS022087; HS017820.
Citation: Murphy DR, Meyer AN, Sittig DF .
Application of electronic trigger tools to identify targets for improving diagnostic safety.
BMJ Qual Saf 2019 Feb;28(2):151-59. doi: 10.1136/bmjqs-2018-008086..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Belden JL, Wegier P, Patel J
Designing a medication timeline for patients and physicians.
Researchers designed a prototype medication timeline visualization for physicians which can be used in the care of chronic disease. It was designed using open source software. A small pilot evaluation of the design was used with physicians. It was designed to improve physician performance by reducing temporal and cognitive load.
AHRQ-funded; HS023328.
Citation: Belden JL, Wegier P, Patel J .
Designing a medication timeline for patients and physicians.
J Am Med Inform Assoc 2019 Feb;26(2):95-105. doi: 10.1093/jamia/ocy143..
Keywords: Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication
Powers EM, Shiffman RN, Melnick ER
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
Clinical decision support (CDS) hard-stop alerts-those in which the user is either prevented from taking an action altogether or allowed to proceed only with the external override of a third party-are increasingly common but can be problematic. To understand their appropriate application, the investigators explored 3 key questions: (1) To what extent are hard-stop alerts effective in improving patient health and healthcare delivery outcomes? (2) What are the adverse events and unintended consequences of hard-stop alerts? (3) How do hard-stop alerts compare to soft-stop alerts?
AHRQ-funded; HS024332.
Citation: Powers EM, Shiffman RN, Melnick ER .
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
J Am Med Inform Assoc 2018 Nov;25(11):1556-66. doi: 10.1093/jamia/ocy112..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Patient Safety
Murray SG, Avati A, Schmajuk G
Automated and flexible identification of complex disease: building a model for systemic lupus erythematosus using noisy labeling.
The authors adapted methods that allow for automated ‘noisy labeling’ of positive and negative controls to create a "silver standard" for machine learning to automate identification of systemic lupus erythematosus (SLE). Their final model outperformed all existing algorithms for SLE. They demonstrated how the probabilistic outputs of their model can be adapted to various clinical needs. Deploying a similar methodology to other complex diseases has the potential to dramatically simplify the landscape of population identification in the electronic health record.
AHRQ-funded; HS024412.
Citation: Murray SG, Avati A, Schmajuk G .
Automated and flexible identification of complex disease: building a model for systemic lupus erythematosus using noisy labeling.
J Am Med Inform Assoc 2019 Jan;26(1):61-65. doi: 10.1093/jamia/ocy154..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Shah T, Patel-Teague S, Kroupa L
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
In this study, the investigators evaluated the impact of a national, multicomponent, quality improvement (QI) programme designed to reduce low-value EHR notifications. The investigators found that, based on prior estimates on time to process notifications, this national QI programme potentially saved 1.5 hours per week per PCP to enable higher value work. The investigators also found that the number of daily notifications remained high, suggesting the need for additional multifaceted interventions and protected clinical time to help manage them.
AHRQ-funded; HS022087.
Citation: Shah T, Patel-Teague S, Kroupa L .
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
BMJ Qual Saf 2019 Jan;28(1):10-14. doi: 10.1136/bmjqs-2017-007447..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Improvement, Quality of Care, Primary Care, Primary Care: Models of Care
Hose BZ, Hoonakker PLT, Wooldrige AR
Physician perceptions of the electronic problem list in pediatric trauma care.
Researchers described physician perceptions of the potential goals, characteristics, and content of the electronic problem list (PL) in pediatric trauma. They identified five goals of the PL, seven characteristics, and 22 patient-related information elements. They found that physicians involved in pediatric trauma care described the electronic PL as ideally more than a list of a patient's medical diagnoses and injuries. They recommend future work to evaluate the optimal design of the PL so that users with emergent cases have access to key information related to the patient's immediate problems.
AHRQ-funded; HS023837.
Citation: Hose BZ, Hoonakker PLT, Wooldrige AR .
Physician perceptions of the electronic problem list in pediatric trauma care.
Appl Clin Inform 2019 Jan;10(1):113-22. doi: 10.1055/s-0039-1677737..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Trauma, Provider: Physician, Provider
Kutney-Lee A, Sloane DM, Bowles KH
Electronic health record adoption and nurse reports of usability and quality of care: the role of work environment.
This study assessed the role of electronic health record (EHR) adoption and work environment for nurses. If the EHR system has positive usability ratings it impacts quality of care. Over 12,000 nurses in 353 hospitals were surveyed.
AHRQ-funded; HS023805.
Citation: Kutney-Lee A, Sloane DM, Bowles KH .
Electronic health record adoption and nurse reports of usability and quality of care: the role of work environment.
Appl Clin Inform 2019 Jan;10(1):129-39. doi: 10.1055/s-0039-1678551..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Nursing, Provider: Nurse, Quality of Care
Yang Y, Bass EJ, Bowles KH
Impact of home care admission nurses' goals on electronic health record documentation strategies at the point of care.
The article reports on a study designed to investigate documentation strategies used by home care nurses with respect to entering electronic data during admission as well as the effect of nursing goals on the process. This was done to characterize admission nurses' practices at the point of care and to establish a basis for design recommendations for electronic health records (EHRs). Five nurses in rural Pennsylvania home care agencies were observed during the admission process. The results of the study lead the authors to recommend that EHR design and training should support the manner in which home care nurses document patient encounters.
AHRQ-funded; HS024537.
Citation: Yang Y, Bass EJ, Bowles KH .
Impact of home care admission nurses' goals on electronic health record documentation strategies at the point of care.
Comput Inform Nurs 2019 Jan;37(1):39-46. doi: 10.1097/cin.0000000000000468..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Home Healthcare, Nursing
Son H, Nahm ES
Older adults' experience using patient portals in communities: challenges and opportunities.
The purpose of this study was to assess the perceived usability of patient portals currently used by older adults. 272 older adults were recruited from an online trial testing the effects of a 3-week Theory-Based Patient Portal eLearning Program. Self-efficacy and perceived usability of patient portals were both low; difficulties with using patient portals were primarily associated with login/access and specific portal functions. Favored features were review of medical information and eMessaging.
AHRQ-funded; HS024739.
Citation: Son H, Nahm ES .
Older adults' experience using patient portals in communities: challenges and opportunities.
Comput Inform Nurs 2019 Jan;37(1):4-10. doi: 10.1097/cin.0000000000000476..
Keywords: Clinician-Patient Communication, Communication, Elderly, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Web-Based