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 182 Research Studies DisplayedRead JM, Weiler DT, Satterly T
Provider preference in exam room layout design and computing.
This study examined the impact of electronic health records (EHRs) on exam room design which would make it easier for providers to promote flexibility, mobility, and body orientation directed towards the patient. Semistructured interviews with 28 providers was conducted and the interviews were audio recorded and transcribed for analysis. Flexibility in sharing the computer screen with patients was an important theme as well as exam room layout, exam room computing and provider workflow.
AHRQ-funded; HS024488.
Citation: Read JM, Weiler DT, Satterly T .
Provider preference in exam room layout design and computing.
Appl Clin Inform 2019 Oct;10(5):972-80. doi: 10.1055/s-0039-3401813..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow, Primary Care, Provider
Wang SV, Rogers JR, Jin Y
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
Clinical guidelines recommend anticoagulation for patients with atrial fibrillation (AF) at high risk of stroke; however, studies report 40% of this population is not anticoagulated. The purpose of this study was to evaluate a population health intervention to increase anticoagulation use in high-risk patients with AF. The investigators concluded that algorithms to identify underuse of anticoagulation among patients with AF in healthcare databases may not capture clinical subtleties or patient preferences and may overestimate the extent of undertreatment.
AHRQ-funded; HS022193.
Citation: Wang SV, Rogers JR, Jin Y .
Stepped-wedge randomised trial to evaluate population health intervention designed to increase appropriate anticoagulation in patients with atrial fibrillation.
BMJ Qual Saf 2019 Oct;28(10):835-42. doi: 10.1136/bmjqs-2019-009367..
Keywords: Blood Thinners, Heart Disease and Health, Cardiovascular Conditions, Medication, Health Information Technology (HIT), Shared Decision Making, Electronic Health Records (EHRs), Practice Patterns, Healthcare Utilization
Nahm ES, Zhu S, Bellantoni M
The effects of a theory-based patient portal e-learning program for older adults with chronic illnesses.
The main aim of this study was to assess the impact of an older adult friendly Theory-based Patient portal e-Learning Program (T-PeP) on patient portal (PP) knowledge, selected health outcomes (health decision-making self-efficacy [SE] and health communication), PP SE and use, and e-health literacy in older adults. The investigators found that the T-PeP was effective in improving selected health and PP usage outcomes.
AHRQ-funded; HS024739.
Citation: Nahm ES, Zhu S, Bellantoni M .
The effects of a theory-based patient portal e-learning program for older adults with chronic illnesses.
Telemed J E Health 2019 Oct;25(10):940-51. doi: 10.1089/tmj.2018.0184..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Elderly, Chronic Conditions, Education: Patient and Caregiver
Cochran AL, Rathouz PJ, Kocher KE
A latent variable approach to potential outcomes for emergency department admission decisions.
The authors sought to provide a general framework to evaluate admission decisions from electronic healthcare records. They estimated that while admitting a patient with higher latent needs reduced the 30-day risk of revisiting the emergency department or later being admitted through the emergency department by over 79%, admitting a patient with lower latent needs actually increased these 30-day risks by 3.0% and 7.6%, respectively.
AHRQ-funded; HS024160.
Citation: Cochran AL, Rathouz PJ, Kocher KE .
A latent variable approach to potential outcomes for emergency department admission decisions.
Stat Med 2019 Sep 10;38(20):3911-35. doi: 10.1002/sim.8210..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Clinical Decision Support (CDS), Shared Decision Making, Hospitalization
Rangachari P, Dellsperger KC, Rethemeyer RK
A health system's pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
Similar to issues faced in health systems across USA, AU Health, based in Augusta, Georgia, faced a scenario of low physician engagement in, and limited-use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which translated to high rates of medication discrepancies and low accuracy of the patient's active medication list, during transitions of care. This paper describes AU Health’s pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P, Dellsperger KC, Rethemeyer RK .
A health system's pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
J Hosp Manag Health Policy 2019 Sep;3(22). doi: 10.21037/jhmhp.2019.08.01..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Health Systems
Bacon E, Budney G, Bondy J
Developing a regional distributed data network for surveillance of chronic health conditions: the Colorado Health Observation Regional Data Service.
This article describes attributes of regional distributed data networks using electronic health records (EHR) data and the history and design of Colorado Health Observation Regional Data Service as an emerging public health surveillance tool for chronic health conditions. The authors indicate that while benefits from EHR-based surveillance are described, a number of technology, partnership, and value proposition challenges remain.
AHRQ-funded; HS0122143.
Citation: Bacon E, Budney G, Bondy J .
Developing a regional distributed data network for surveillance of chronic health conditions: the Colorado Health Observation Regional Data Service.
J Public Health Manag Pract 2019 Sep/Oct;25(5):498-507. doi: 10.1097/phh.0000000000000810..
Keywords: Chronic Conditions, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Public Health
Liu L, Ni Y, Zhang N
Mining patient-specific and contextual data with machine learning technologies to predict cancellation of children's surgery.
The objectives of this study were: 1) to develop predictive models of last-minute surgery cancellation, utilizing machine learning technologies, from patient-specific and contextual data from two distinct pediatric surgical sites of a single institution; and 2) to identify specific key predictors that impact children's risk of day-of-surgery cancellation. The study demonstrated the capacity of machine learning models for predicting pediatric patients at risk of last-minute surgery cancellation and providing useful insight into root causes of cancellation. The author’s approach offers the promise of targeted interventions to significantly decrease both healthcare costs and families' negative experiences.
AHRQ-funded; HS024983.
Citation: Liu L, Ni Y, Zhang N .
Mining patient-specific and contextual data with machine learning technologies to predict cancellation of children's surgery.
Int J Med Inform 2019 Sep;129:234-41. doi: 10.1016/j.ijmedinf.2019.06.007..
Keywords: Children/Adolescents, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery
Quinn M, Forman J, Harrod M
Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process.
Diagnosis requires that clinicians communicate and share patient information in an efficient manner. Advances in electronic health records (EHRs) and health information technologies have created challenges and opportunities for such communication. In this multi-method, focused ethnographic study of physicians on general medicine inpatient units in two teaching hospitals, the investigators found that existing communication technologies and EHR-based data sharing processes were perceived as barriers to diagnosis. In particular, reliance on paging systems and lack of face-to-face communication among clinicians created obstacles to sustained thinking and discussion of diagnostic decision-making.
AHRQ-funded; HS022835; HS024385.
Citation: Quinn M, Forman J, Harrod M .
Electronic health records, communication, and data sharing: challenges and opportunities for improving the diagnostic process.
Diagnosis 2019 Aug 27;6(3):241-48. doi: 10.1515/dx-2018-0036.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Communication
Sockolow PS, Bass EJ, Ynag Y
Availability and quality of information used by nurses while admitting patients to a rural home health care agency.
This study investigated the availability and quality of information used by nurses in a rural home health care agency during patient admission. Twelve in-home admissions were observed and the nurses were interviewed before and after the admissions process. Content and quality of documents available to the nurses was analyzed and needed documents were not uniformly present. They rarely received visit pattern or medication management information. These results show the need for a high quality electronic health record system.
AHRQ-funded; HS024537.
Citation: Sockolow PS, Bass EJ, Ynag Y .
Availability and quality of information used by nurses while admitting patients to a rural home health care agency.
Stud Health Technol Inform 2019 Aug 21;264:798-802. doi: 10.3233/shti190333..
Keywords: Rural Health, Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Provider
Hultman GM, Marquard JL, Kandaswamy S
Electronic progress note reading patterns: an eye tracking analysis.
This study used eye-tracking to understand how the order of note sections influences the way physicians read electronic progress notes. Results showed no relationship between time spent reading a section and section origin of verbal summaries.
AHRQ-funded; HS022085.
Citation: Hultman GM, Marquard JL, Kandaswamy S .
Electronic progress note reading patterns: an eye tracking analysis.
Stud Health Technol Inform 2019 Aug 21;264:1684-85. doi: 10.3233/shti190596..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider, Provider: Physician
Turner AM, Osterhage K, Hartzler A
Personal health information management practices of older adults: one size does not fit all.
This study’s objective was to describe a process of identifying personal health information management (PHIM) activities and objectives of older adults aged 60 years and older from different resident settings. The purpose was to better align PHIM with their needs and practices.
AHRQ-funded; HS022106.
Citation: Turner AM, Osterhage K, Hartzler A .
Personal health information management practices of older adults: one size does not fit all.
Stud Health Technol Inform 2019 Aug 21;264:1995-96. doi: 10.3233/shti190752..
Keywords: Elderly, Electronic Health Records (EHRs), Health Information Technology (HIT), Chronic Conditions
Senathirajah Y, Borycki EM, Kushniruk A
Use of eye-tracking in studies of EHR usability - the current state: a scoping review.
This study examined the use of eye-tracking in studies of electronic health record (EHR) system usability. There were three main themes that emerged: studies of usual use of systems, development of new methods, and studies of new features.
AHRQ-funded; HS023708.
Citation: Senathirajah Y, Borycki EM, Kushniruk A .
Use of eye-tracking in studies of EHR usability - the current state: a scoping review.
Stud Health Technol Inform 2019 Aug 21;264:1976-77. doi: 10.3233/shti190742..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Kroth PJ, Morioka-Douglas N, Veres S
Association of electronic health record design and use factors with clinician stress and burnout.
The authors sought to determine which electronic health record (EHR) design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. Surveying ambulatory primary care and subspecialty clinicians from 3 institutions, they found that, although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.
AHRQ-funded; HS022065.
Citation: Kroth PJ, Morioka-Douglas N, Veres S .
Association of electronic health record design and use factors with clinician stress and burnout.
JAMA Netw Open 2019 Aug 2;2(8):e199609. doi: 10.1001/jamanetworkopen.2019.9609..
Keywords: Burnout, Stress, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider: Clinician, Provider: Physician, Provider: Nurse
Knierim KE, Hall TL, Dickinson LM
Primary care practices' ability to report electronic clinical quality measures in the EvidenceNOW Southwest Initiative to Improve Heart Health.
The objective of this study was to determine how quickly primary care practices can report electronic clinical quality measures (eCQMs) and to identify the practice characteristics associated with faster reporting. Examining the EvidenceNOW Southwest initiative, the researchers’ results showed that the time to report eCQMs varied by measure and practice type, with very few practices reporting quickly. Additional support for practices to succeed in new programs that require eCQM reporting was recommended.
AHRQ-funded; HS023904.
Citation: Knierim KE, Hall TL, Dickinson LM .
Primary care practices' ability to report electronic clinical quality measures in the EvidenceNOW Southwest Initiative to Improve Heart Health.
JAMA Netw Open 2019 Aug 2;2(8):e198569. doi: 10.1001/jamanetworkopen.2019.8569..
Keywords: Primary Care, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Heart Disease and Health, Cardiovascular Conditions, Patient-Centered Outcomes Research, Evidence-Based Practice, Electronic Health Records (EHRs), Health Information Technology (HIT)
Polubriaginof FCG, Ryan P, Salmasian H
Challenges with quality of race and ethnicity data in observational databases.
This study assessed the quality of race and ethnicity information in observational health databases as well as electronic health records (EHRs) and to propose patient self-recording as a way to improve accuracy. Data from the Healthcare Cost and Utilization Project (HCUP) and Optum Labs, and from a single New York City healthcare system’s EHR was compared. Among 160 million patients in the HCUP database, no race or ethnicity data was recorded for 25% of the records. Among the 2.4 million patients in the New York City HER, race or ethnicity was unknown for 57%. However, when patients were allowed to directly record their race and ethnicity, percentages rose to 86%.
AHRQ-funded; HS021816; HS023704; HS024713.
Citation: Polubriaginof FCG, Ryan P, Salmasian H .
Challenges with quality of race and ethnicity data in observational databases.
J Am Med Inform Assoc 2019 Aug;26(8-9):730-36. doi: 10.1093/jamia/ocz113..
Keywords: Healthcare Cost and Utilization Project (HCUP), Data, Racial and Ethnic Minorities, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Wang X, Kim TC, Hegde S
Design and evaluation of an integrated, patient-focused electronic health record display for emergency medicine.
This study used work-centered usability methods to evaluate an integrated patient-focused status display designed to support ED clinicians' communication and situation awareness regarding a patient's health status and progress through their ED plan of care. The display design was informed by previous studies we conducted examining the information and cognitive support requirements of ED providers and nurses. The investigators concluded that participants' subjective ratings of usability, usefulness, and support for cognitive objectives were encouraging.
AHRQ-funded; HS022542.
Citation: Wang X, Kim TC, Hegde S .
Design and evaluation of an integrated, patient-focused electronic health record display for emergency medicine.
Appl Clin Inform 2019 Aug;10(4):693-706. doi: 10.1055/s-0039-1695800..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department
Grossman LV, Masterson Creber RM, Benda NC
Interventions to increase patient portal use in vulnerable populations: a systematic review.
The authors sought to systematically review the impact of interventions designed to increase portal use or predictors of use in vulnerable patient populations or to reduce disparities in use. They found that individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements have not been sufficiently studied to draw conclusions. They recommend that research move beyond identifying disparities to systematically addressing them at multiple levels.
AHRQ-funded; HS021816.
Citation: Grossman LV, Masterson Creber RM, Benda NC .
Interventions to increase patient portal use in vulnerable populations: a systematic review.
J Am Med Inform Assoc 2019 Aug;26(8-9):855-70. doi: 10.1093/jamia/ocz023..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations, Disparities
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)
Deng F, Li MD, Wong A
Quality of documentation of contrast agent allergies in electronic health records.
The purpose of this study was to describe and appraise contrast agent allergy documentation in the electronic health record (EHR). The investigators concluded that contrast allergy records in EHRs were diverse and commonly low quality. They suggest that continued EHR enhancements and training are needed to support contrast allergy documentation to facilitate improved patient care and medical research.
AHRQ-funded; HS025375.
Citation: Deng F, Li MD, Wong A .
Quality of documentation of contrast agent allergies in electronic health records.
J Am Coll Radiol 2019 Aug;16(8):1027-35. doi: 10.1016/j.jacr.2019.01.027..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging
Patterson BW, Pulia MS, Ravi S
Scope and influence of electronic health record-integrated clinical decision support in the emergency department: a systematic review.
This systematic review examined the scope and influence of electronic health record-integrated clinical decision support (CDS) technologies implemented in hospital emergency departments. A literature search was conducted using 4 databases from the inception of these CDS systems through January 2018. Out of 2,558 potential studies identified, 42 met inclusion criteria. Common uses for CDS technologies included medication and radiology ordering practices, and more comprehensive systems supporting diagnosis and treatment for specific diseases. The majority of studies (83%) reported positive effects on outcomes, with most studies using a pre-post experimental design (76%). The authors concluded that although most studies show positive effects of CDS technologies, many of the studies were small and poorly controlled.
AHRQ-funded; HS024342; HS024558; HS022086.
Citation: Patterson BW, Pulia MS, Ravi S .
Scope and influence of electronic health record-integrated clinical decision support in the emergency department: a systematic review.
Ann Emerg Med 2019 Aug;74(2):285-96. doi: 10.1016/j.annemergmed.2018.10.034..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department
Schnock KO, Snyder JE, Fuller TE
Acute care patient portal intervention: portal use and patient activation.
The aim of this study was to describe the use of an acute care patient portal and investigate its association with patient and care partner activation in the hospital setting. The investigators concluded that portal users most often accessed the portal to view their clinical information, though portal usage was limited to only the first few days of enrollment. They found an association between the use of the portal and HIT tools with improved levels of patient activation.
AHRQ-funded; HS023535.
Citation: Schnock KO, Snyder JE, Fuller TE .
Acute care patient portal intervention: portal use and patient activation.
J Med Internet Res 2019 Jul 18;21(7):e13336. doi: 10.2196/13336..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient and Family Engagement, Patient-Centered Healthcare, Inpatient Care
Yanez B, Bouchard LC, Cella D
Patient-centered engagement and symptom/toxicity monitoring in the new era of tumor next-generation sequencing and immunotherapy: the OncoTool and OncoPRO platforms.
This paper describes the development of the OncoTool and OncoPRO platforms to help patients with late-stage cancer (stages III-IV) and their providers in providing patient-centered education and remote and routine monitoring of symptoms and toxicities after tumor next-generation sequencing testing and treatment. The OncoTool is a web-based educational resource tailored for people with advanced cancer. It aims to provide patients with easy-to-understand treatment options and associated toxicities as well as evidence-based strategies for managing symptoms and improving stress management. It is fully integrated with OncoPRO which provides feedback on patient-reported outcomes (PROs) to clinicians. The data from the platform can be integrated with the patient’s electronic health record (HER) and can provide an alert message. These systems are currently being tested with 4 trials – 1 for OncoTool and the other 3 for OncoPRO.
AHRQ-funded; HS023011.
Citation: Yanez B, Bouchard LC, Cella D .
Patient-centered engagement and symptom/toxicity monitoring in the new era of tumor next-generation sequencing and immunotherapy: the OncoTool and OncoPRO platforms.
Cancer 2019 Jul 15;125(14):2338-44. doi: 10.1002/cncr.32030..
Keywords: Cancer, Education: Patient and Caregiver, Electronic Health Records (EHRs), Evidence-Based Practice, Health Information Technology (HIT), Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient and Family Engagement
Grout RW, Cheng ER, Aalsma MC
Let them speak for themselves: improving adolescent self-report rate on pre-visit screening.
This study examined the effect of an automated alert during electronic pre-visit electronic tablet screening on the adolescent self-report rate at pediatric ambulatory clinics. The goal was to increase self-reporting as opposed to parents or caregivers filling out the screening information.bAn interventional study was conducted over a 16 month period. Preintervention rates were low for adolescents, with parents or caregivers completing the pre-visit reports at a high rate. After intervention, self-reporting by younger adolescents nearly doubled and among older adolescents the stable baseline rate of 53.6% increased by 9.2 absolute percentage points.
AHRQ-funded; HS017939; HS018453; HS020640; HS022681.
Citation: Grout RW, Cheng ER, Aalsma MC .
Let them speak for themselves: improving adolescent self-report rate on pre-visit screening.
Acad Pediatr 2019 Jul;19(5):581-88. doi: 10.1016/j.acap.2019.04.010..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Communication, Clinician-Patient Communication
Kimmel HJ, Brice YN, Trikalinos TA
Real-time emergency department electronic notifications regarding high-risk patients: a systematic review.
In this study, the authors systematically reviewed evidence on the feasibility and efficacy of real-time electronic notifications about patients at high risk of emergency department (ED) recidivism. They concluded that real-time electronic notifications of ED providers regarding patients at high risk of ED recidivism are feasible and may help reduce resource utilization and costs. The authors indicate that large knowledge gaps remain regarding patient- and provider-centered outcomes.
AHRQ-funded; HS022998.
Citation: Kimmel HJ, Brice YN, Trikalinos TA .
Real-time emergency department electronic notifications regarding high-risk patients: a systematic review.
Telemed J E Health 2019 Jul;25(7):604-18. doi: 10.1089/tmj.2018.0117..
Keywords: Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospital Readmissions
Murphy DR, Satterly T, Rogith D
Barriers and facilitators impacting reliability of the electronic health record-facilitated total testing process.
This exploratory study identified factors that impact the total testing process (TTP) for electronic health record (EHR)-enabled care. Experts were interviewed at three large HER-enabled health care organizations and all TTP steps performed were identified. Findings from the three sites were combined to develop a detailed process map. Then 39 experts were interviewed to identify the barriers and twenty-five unique barriers were identified. The barriers were related to technology and usability issues, time and resource constraints, suboptimal clinic workflows, patient-related factors, information access limitations, and insufficient clinician training. Twenty-four unique facilitators were identified that could be used to improve TTP reliability.
AHRQ-funded; HS022087; HS022901.
Citation: Murphy DR, Satterly T, Rogith D .
Barriers and facilitators impacting reliability of the electronic health record-facilitated total testing process.
Int J Med Inform 2019 Jul;127:102-08. doi: 10.1016/j.ijmedinf.2019.04.004..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)