National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (2)
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- Quality Measures (3)
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- Respiratory Conditions (1)
- Risk (3)
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- Shared Decision Making (1)
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- Stroke (3)
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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 79 Research Studies DisplayedZachrison KS, Boggs KM, Hayden EM
A national survey of telemedicine use by US emergency departments.
Telemedicine has the potential to improve the delivery of emergency medical care: however, the extent of its adoption in United States (US) emergency departments is not known. The objectives of this study were to characterise the prevalence of telemedicine use among all US emergency departments, describe clinical applications for which it is most commonly used, and identify emergency department characteristics associated with its use.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Boggs KM, Hayden EM .
A national survey of telemedicine use by US emergency departments.
J Telemed Telecare 2020 Jun;26(5):278-84. doi: 10.1177/1357633x18816112..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, Healthcare Delivery, Hospitals
Furukawa MF, Eldridge N, Wang Y
AHRQ Author: Furukawa MF, Eldridge N
Electronic health record adoption and rates of in-hospital adverse events.
Researchers examined the association of hospitals' electronic health record (EHR) adoption and occurrence rates of adverse events among exposed patients. The study included patients hospitalized for acute cardiovascular disease, pneumonia, or conditions requiring surgery. The researchers found that patients exposed to a fully electronic EHR were less likely to experience in-hospital adverse events.
AHRQ-authored.
Citation: Furukawa MF, Eldridge N, Wang Y .
Electronic health record adoption and rates of in-hospital adverse events.
J Patient Saf 2020 Jun;16(2):137-42. doi: 10.1097/pts.0000000000000257..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Events, Inpatient Care, Hospitals, Patient Safety
Sun Y, Guo F, Kaffashi F
INSMA: an integrated system for multimodal data acquisition and analysis in the intensive care unit.
In this paper, the investigators proposed a multimodal data acquisition and analysis system called INSMA, with the ability to acquire, store, process, and visualize multiple types of data from the Philips IntelliVue patient monitor. They also discussed how the acquired data could be used for patient state tracking. INSMA is being tested in the ICU at University Hospitals Cleveland Medical Center.
AHRQ-funded; HS022860.
Citation: Sun Y, Guo F, Kaffashi F .
INSMA: an integrated system for multimodal data acquisition and analysis in the intensive care unit.
J Biomed Inform 2020 Jun;106:103434. doi: 10.1016/j.jbi.2020.103434..
Keywords: Intensive Care Unit (ICU), Health Information Technology (HIT), Hospitals
Latulipe C, Mazumder SF, Wilson RKW
Security and privacy risks associated with adult patient portal accounts in US hospitals.
The authors sought to identify the proportions of hospitals that provide proxy accounts to caregivers of adult patients, endorse password sharing with caregivers, and enable patients to restrict the types of information seen by their caregivers. They found that almost half of surveyed hospital personnel recommended password sharing and that few hospitals enabled patients to limit the types of information seen by those with proxy access. They concluded that hospitals and electronic health record vendors need to improve the availability and setup process of proxy accounts in a way that allows caregivers to care for patients without violating their privacy.
AHRQ-funded; HS021679.
Citation: Latulipe C, Mazumder SF, Wilson RKW .
Security and privacy risks associated with adult patient portal accounts in US hospitals.
JAMA Intern Med 2020 Jun;180(6):845-9. doi: 10.1001/jamainternmed.2020.0515..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Caregiving, Hospitals
Martinez DA, Cai J, Oke JB
Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management.
This study sought to characterize unit-to-unit intravenous infusion pump sharing and its impact on shortages, as well as to evaluate a system-control tool that balances inventory across all care areas, enabling increased availability of pumps. The network analysis supported design and deployment of a hospital-wide inventory balancing system, which resulted in a 44% increase in the number of care areas above safe inventory levels. Network phenomena are essential inputs to hospital equipment fleet management; therefore, benefits of improved inventory management in strategic units are capable of spreading safer inventory levels throughout the hospital.
AHRQ-funded.
Citation: Martinez DA, Cai J, Oke JB .
Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management.
J Am Med Inform Assoc 2020 Jun;27(6):884-92. doi: 10.1093/jamia/ocaa033..
Keywords: Health Information Technology (HIT), Hospitals
Classen DC, Holmgren AJ, Co Z
National trends in the safety performance of electronic health record systems from 2009 to 2018.
This study examined trends in the safety performance of electronic health records (EHRs) in hospitals from 2009 to 2018. The Leapfrog Health IT Safety Measure test was administered by the Leapfrog Group from July 2018 to December 1, 2019. Overall mean performance scores increased from 53.9% in 2009 to 65.6% in 2018. Mean hospital scores for categories representing basic clinical decision support increased from 69.8% in 2009 to 85.6% in 2018. Advanced decision clinical support also increased from 29.5% in 2009 to 46.1%. These results showed great improvement, but there is still substantial safety risk in current hospital EHR systems.
AHRQ-funded; HS023696.
Citation: Classen DC, Holmgren AJ, Co Z .
National trends in the safety performance of electronic health record systems from 2009 to 2018.
JAMA Netw Open 2020 May;3(5):e205547. doi: 10.1001/jamanetworkopen.2020.5547..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Patient Safety, Quality Measures, Clinical Decision Support (CDS), Quality Indicators (QIs)
Fuller TE, Pong DD, Piniella N
Interactive digital health tools to engage patients and caregivers in discharge preparation: implementation study.
This clinical trial studied implementation of a suite of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization. Patients who were enrolled agreed to watch a discharge video, complete a checklist assessing discharge readiness, and request postdischarge text messaging with a physician 24 to 48 hours before their expected discharge date. Out of 752 patient admissions, from December 2017 to July 2018, 510 participated, 416 watched the video and completed the checklist, and 94 completed only the checklist. Most patients endorsed the tools, but felt that the video and checklist would be more useful closer to the actual discharge date. Clinicians participating in focus groups perceived the value for patients but felt that there were a number of limitations including low awareness and variable workflow regarding the intervention. A number of strategies were offered by the authors to address implementation barriers and promote adoption of these tools.
AHRQ-funded; HS024751.
Citation: Fuller TE, Pong DD, Piniella N .
Interactive digital health tools to engage patients and caregivers in discharge preparation: implementation study.
J Med Internet Res 2020 Apr 28;22(4):e15573. doi: 10.2196/15573..
Keywords: Health Information Technology (HIT), Patient and Family Engagement, Caregiving, Hospital Discharge, Transitions of Care, Hospitals
Everson J, Butler E
Hospital adoption of multiple health information exchange approaches and information accessibility.
The aim of this study was to determine the change in adoption of 3 types of electronic health information exchange (HIE) in hospitals for 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and to assess if growth in each approach corresponded to an increased ability to access and integrate patient information from outside providers. A sample of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016 was used for the analysis. Adoption of each approach increased by 9-15 percentage points over that time. The average number of HIE approaches increased from 1.0 to 1.4. The likelihood of having outside information increased by 10.3 percentage points with adoption of 1 approach, and by 9.5 percentage points with adoption of a second approach.
AHRQ-funded; HS026395.
Citation: Everson J, Butler E .
Hospital adoption of multiple health information exchange approaches and information accessibility.
J Am Med Inform Assoc 2020 Apr 1;27(4):577-83. doi: 10.1093/jamia/ocaa003..
Keywords: Health Information Technology (HIT), Health Information Exchange (HIE), Hospitals
Sharma R, Zachrison KS, Viswanathan A
Trends in telestroke care delivery: a 15-year experience of an academic hub and its network of spokes.
Telestroke provides access to vascular neurology expertise for hospitals lacking stroke coverage, and its use has risen rapidly in the past decade. In this study the investigators aimed to characterize consultations, spoke behavior, and the relationship between spoke telestroke utilization (number of telestroke consults per year) and spoke alteplase treatment metrics in an academic telestroke network.
AHRQ-funded; HS024561.
Citation: Sharma R, Zachrison KS, Viswanathan A .
Trends in telestroke care delivery: a 15-year experience of an academic hub and its network of spokes.
Circ Cardiovasc Qual Outcomes 2020 Mar;13(3):e005903. doi: 10.1161/circoutcomes.119.005903..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Healthcare Delivery, Care Management, Hospitals
Scott HF, Colborn KL, Sevick CJ
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
The purpose of this observational cohort study was to derive and validate a model of risk of septic shock among children with suspected sepsis, using data known in the electronic health record at hospital arrival. The investigators concluded that their model estimated the risk of septic shock in children at hospital arrival earlier than existing models. They indicate it leveraged the predictive value of routine electronic health record data through a modern predictive algorithm and suggest it has the potential to enhance clinical risk stratification in the critical moments before deterioration.
AHRQ-funded; HS025696.
Citation: Scott HF, Colborn KL, Sevick CJ .
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
J Pediatr 2020 Feb;217:145-51.e6. doi: 10.1016/j.jpeds.2019.09.079..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Hospitals, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Haldar S, Mishra SR, Pollack AH
Informatics opportunities to involve patients in hospital safety: a conceptual model.
This study investigated how hospital inpatients experience undesirable events (UEs) and to see if those present opportunities for new informatics solutions. The authors surveyed 242 patients and caregivers during their hospital stay and asked them open-ended questions about their experiences with UEs. They then developed a 4-stage conceptual model which illustrates inpatient experiences: from when they first encounter UEs, and opportunities to promote inpatients’ participation and engagement in the quality and safety of their care, help healthcare systems learn from inpatient experience, and reduce those harmful events.
AHRQ-funded; HS022894.
Citation: Haldar S, Mishra SR, Pollack AH .
Informatics opportunities to involve patients in hospital safety: a conceptual model.
J Am Med Inform Assoc 2020 Feb;27(2):202-11. doi: 10.1093/jamia/ocz167.
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Keywords: Patient Safety, Hospitals, Health Information Technology (HIT), Patient and Family Engagement, Patient Experience, Quality of Care
Everson J, Adler-Milstein J
Sharing information electronically with other hospitals is associated with increased sharing of patients.
This study examined whether patient sharing between hospitals increased when they participated in a health information organization (HIO). The researchers used national data on hospital participation in HIOs from the American Hospital Association Information Technology Supplement and data on the volume of Medicare patients shared between pairs of hospitals from 2010 to 2016. They found that there an increase in patient sharing in competitive markets and with larger hospitals. Participation by only one hospital had no impact on patient sharing.
AHRQ-funded; HS026395.
Citation: Everson J, Adler-Milstein J .
Sharing information electronically with other hospitals is associated with increased sharing of patients.
Health Serv Res 2020 Feb;55(1):128-35. doi: 10.1111/1475-6773.13240..
Keywords: Health Information Technology (HIT), Health Information Exchange (HIE), Hospitals
Haldar S, Mishra SR, Kim Y
Use and impact of an online community for hospital patients.
This study examined the impact of a technology resembling an online health community for hospitalized patients to exchange advice and provide each other support during their hospitalization. It was deployed at 1 pediatric and 1 adult hospital. Thirty participants were recruited and were interviewed bedside and were observed how they used the technology, along with follow-up phone interviews. It was found to be helpful to patients and that most (64%) of the shared advice was positive in nature. They also reported positive impacts to their quality, safety, and hospital experience due to the inpatient peer support community.
AHRQ-funded; HS022894.
Citation: Haldar S, Mishra SR, Kim Y .
Use and impact of an online community for hospital patients.
J Am Med Inform Assoc 2020 Apr;27(4):549-57. doi: 10.1093/jamia/ocz212..
Keywords: Health Information Technology (HIT), Hospitals, Patient and Family Engagement, Patient Experience
Smith AB, Mueller D, Garren B
Using qualitative research to reduce readmissions and optimize perioperative cystectomy care.
This study examined the need for qualitative research on meaningful patient-reported outcomes (PROs) to prevent complications and readmissions after cystectomy. The investigators looked at the potential use of mobile communication devices (mHealth) to capture patients’ experiences and to improve outcomes. Interviews were conducted with 15 readmitted patients and 10 of their partners over 45 semi-structured in-depth interviews. The most common perspectives were that patients and their caregivers were overloaded with cystectomy education; they need to know what are normal post-operative symptoms; and that using mHealth would help with patient and caregiver education.
AHRQ-funded; HS024134.
Citation: Smith AB, Mueller D, Garren B .
Using qualitative research to reduce readmissions and optimize perioperative cystectomy care.
Cancer 2019 Oct 15;125(20):3545-53. doi: 10.1002/cncr.32362..
Keywords: Hospital Readmissions, Surgery, Health Information Technology (HIT), Quality Improvement, Quality of Care, Hospitals, Patient-Centered Healthcare
Ji W, McKenna C, Ochoa A
Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia.
The authors sought to propose and assess potentially objective, efficient, and reproducible surveillance definitions for non-ventilator hospital-acquired pneumonia (NV-HAP) using routine clinical data stored in electronic health record systems. They found that objective surveillance for NV-HAP using electronically computable definitions that incorporate common clinical criteria is feasible and generates incidence, mortality, and adjusted odds ratios for hospital mortality similar to estimates from manual surveillance. They concluded that these definitions have the potential to facilitate widespread, automated surveillance for NV-HAP and thus inform the development and evaluation of prevention programs.
AHRQ-funded; HS025008.
Citation: Ji W, McKenna C, Ochoa A .
Development and assessment of objective surveillance definitions for nonventilator hospital-acquired pneumonia.
JAMA Netw Open 2019 Oct 2;2(10):e1913674. doi: 10.1001/jamanetworkopen.2019.13674..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Respiratory Conditions, Public Health, Electronic Health Records (EHRs), Health Information Technology (HIT)
Vest JR, Unruh MA, Freedman S
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. The investigators concluded that reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggested that HIE technologies can better support the aim of higher quality care.
AHRQ-funded; HS024717.
Citation: Vest JR, Unruh MA, Freedman S .
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
J Am Med Inform Assoc 2019 Oct;26(10):989-98. doi: 10.1093/jamia/ocz116..
Keywords: Health Systems, Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT), Hospital Readmissions, Hospitals
Bush RA, Vemulakonda VM, Richardson AC
Providing access: differences in pediatric portal activation begin at patient check-in.
This study investigated patient portal use and activation patterns among pediatric urology patients at two geographically diverse tertiary pediatric hospitals. A retrospective cohort analysis was conducted of electronic portal audit records from 2011 to 2016. Out of 44,608 individuals offered a code for patient portal activation, only 19.3% activated portal access. Those patients were most likely to be female, Asian or white, non-Hispanic, and reporting English as the preferred language. This analysis showed that there are barriers to access by many patients and caregivers.
AHRQ-funded; HS024597; HS022404.
Citation: Bush RA, Vemulakonda VM, Richardson AC .
Providing access: differences in pediatric portal activation begin at patient check-in.
Appl Clin Inform 2019 Aug;10(4):670-78. doi: 10.1055/s-0039-1695792..
Keywords: Children/Adolescents, Hospitals, Electronic Health Records (EHRs), Health Information Technology (HIT)
Gadhia R, Schwamm LH, Viswanathan A
Evaluation of the experience of spoke hospitals in an academic telestroke network.
Implementation of telestroke has been associated with improved thrombolysis rates and clinical outcomes in remote or neurologically underserved spoke hospitals. Yet, the experience of spoke hospitals using telestroke has not been well described. In this study, the investigators sought to characterize spoke hospitals' perceptions of telestroke to understand perceived advantages, challenges, and barriers to use.
AHRQ-funded; HS024561.
Citation: Gadhia R, Schwamm LH, Viswanathan A .
Evaluation of the experience of spoke hospitals in an academic telestroke network.
Telemed J E Health 2019 Jul;25(7):584-90. doi: 10.1089/tmj.2018.0133..
Keywords: Telehealth, Health Information Technology (HIT), Hospitals, Stroke, Cardiovascular Conditions
Chai PR, Zhang H, Jambaulikar GD
An Internet of things buttons to measure and respond to restroom cleanliness in a hospital setting: descriptive study.
AHRQ-funded; HS024538; HS024713.
Citation: Chai PR, Zhang H, Jambaulikar GD .
An Internet of things buttons to measure and respond to restroom cleanliness in a hospital setting: descriptive study.
J Med Internet Res 2019 Jun 19;21(6):e13588. doi: 10.2196/13588..
Keywords: Hospitals, Health Information Technology (HIT), Patient Safety, Healthcare-Associated Infections (HAIs)
Dalal AK, Fuller T, Garabedian P
Systems engineering and human factors support of a system of novel EHR-integrated tools to prevent harm in the hospital.
This study examined systems engineering and human factors support of a system of novel electronic health record (EHR)-integrated tools for patient safety in the hospital. The authors established a Patient Safety Learning Laboratory of 2 core and 3 individual project teams to introduce a suite of digital health tools integrated with their EHR to identify, assess, and mitigate threats to patient safety. They identified 7 themes regarding use of 12 systems engineering and human factors over the 4-year project.
AHRQ-funded; HS023535.
Citation: Dalal AK, Fuller T, Garabedian P .
Systems engineering and human factors support of a system of novel EHR-integrated tools to prevent harm in the hospital.
J Am Med Inform Assoc 2019 Jun;26(6):553-60. doi: 10.1093/jamia/ocz002..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Hospitals, Quality Improvement, Quality of Care
Asan O, Scanlan MC, Crotty B
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
The objective of this study was to explore the perceptions of parents of pediatric patients in a PICU regarding real-time open electronic health record data displayed in patient rooms. The investigators suggest that a new health information technology system providing continuous access to open electronic health record data may be an effective way to empower and engage parents in the PICU, but also note potential drawbacks.
AHRQ-funded; HS023626.
Citation: Asan O, Scanlan MC, Crotty B .
Parental perceptions of displayed patient data in a PICU: an example of unintentional empowerment.
Pediatr Crit Care Med 2019 May;20(5):435-41. doi: 10.1097/pcc.0000000000001895..
Keywords: Caregiving, Children/Adolescents, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Intensive Care Unit (ICU), Patient and Family Engagement
Larsen E, Hoffman D, Rivera C
Continuing patient care during electronic health record downtime.
This study examined the impact of electronic health record (EHR) downtime in hospitals on patient care. Two mid-Atlantic hospitals where the EHR system was either fully or partially unavailable were used to document the problems using historic performance data and semistructured interviews. A total of 17 hospital employees were interviewed. Laboratory test results were delayed an average of 62% during downtime events. Paper documentation created during the downtime period was often incomplete or incorrect. The authors provided recommendations to improve downtime contingency plans based on their findings.
AHRQ-funded; HS024350.
Citation: Larsen E, Hoffman D, Rivera C .
Continuing patient care during electronic health record downtime.
Appl Clin Inform 2019 May;10(3):495-504. doi: 10.1055/s-0039-1692678..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Hospitals, Quality of Care
Toomey SL, Elliott MN, Zaslavsky AM
Improving response rates and representation of hard-to-reach groups in family experience surveys.
This study examined the use of an audio-enabled tablet to survey parents of children discharged from 4 units of a children’s hospital. Normal mail survey response rates are very low, especially for black, Latino, and low-income respondents. This survey was done day of discharge at the hospital and there was a response rate of 71.1% via tablet versus 16.3% for mail only. The Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used. Tablet response rates were highest with fathers, those more likely to have a high school education or less, less likely to be white, and more likely to be publicly insured. The results are promising for future surveys using tablet administration.
AHRQ-funded; HS020513; HS025299.
Citation: Toomey SL, Elliott MN, Zaslavsky AM .
Improving response rates and representation of hard-to-reach groups in family experience surveys.
Acad Pediatr 2019 May - Jun;19(4):446-53. doi: 10.1016/j.acap.2018.07.007..
Keywords: Caregiving, Children/Adolescents, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Information Technology (HIT), Hospitals, Low-Income, Patient Experience, Quality of Care, Quality Improvement, Racial and Ethnic Minorities
Delahanty RJ, Alvarez J, Flynn LM
Development and evaluation of a machine learning model for the early identification of patients at risk for sepsis.
In this study, the investigators aimed to use machine learning to develop a new sepsis screening tool, the Risk of Sepsis (RoS) score, and compare it with a slate of benchmark sepsis-screening tools, including the Systemic Inflammatory Response Syndrome, Sequential Organ Failure Assessment (SOFA), qSOFA, Modified Early Warning Score, and National Early Warning Score. The investigators concluded that in this retrospective study, RoS was more timely and discriminant than benchmark screening tools, including those recommend by the Sepsis-3 Task Force.
AHRQ-funded; HS024750.
Citation: Delahanty RJ, Alvarez J, Flynn LM .
Development and evaluation of a machine learning model for the early identification of patients at risk for sepsis.
Ann Emerg Med 2019 Apr;73(4):334-44. doi: 10.1016/j.annemergmed.2018.11.036..
Keywords: Health Information Technology (HIT), Hospitals, Risk, Sepsis
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