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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 286 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
Semere W, Karter AJ, Lyles CR
Care partner engagement in secure messaging between patients with diabetes and their clinicians: cohort study.
This study based on a previous cohort study investigated secure messaging (SM) use among older diabetes patients, exploring the impact of care partners. Analyzing data from a large healthcare system's patient portal, proxy users, mainly older and with lower education, showed higher SM engagement. They initiated SM sooner, had more exchanges, yet didn't bridge existing disparities. Proxy involvement may enhance patient-clinician communication in diabetes care, warranting further research on its impact on clinical outcomes.
AHRQ-funded; HS027844.
Citation: Semere W, Karter AJ, Lyles CR .
Care partner engagement in secure messaging between patients with diabetes and their clinicians: cohort study.
JMIR Diabetes 2024 Feb 9; 9:e49491. doi: 10.2196/49491.
Keywords: Diabetes, Patient and Family Engagement, 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
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
Sprackling CM, Kieren MQ, Nacht CL
Adolescent access to clinicians' notes: adolescent, parent, and clinician perspectives.
This study’s goal was to identify adolescent, parent, and clinician perspectives on the anticipated benefits and concerns of giving adolescents access to clinicians’ notes and strategies in response to a 2021 federal mandate. The authors conducted six focus groups with adolescents, parents, and clinicians at a children's hospital from May to October 2021. A semistructured facilitator guide captured patient perspectives of the benefits, concerns, and strategies. A total of 38 stakeholders (17 adolescents, 10 parents, and 11 clinicians) described four benefits, three concerns, and four implementation strategies regarding adolescent note-sharing. Potential benefits captured in the focus groups included adolescents using notes to remember and reinforce the visit, gaining knowledge about their health, strengthening the adolescent-clinician relationship, and increasing agency in health care decisions. Concerns the guide captured included notes leading to a breach in confidentiality, causing negative emotions, and becoming less useful for clinicians. Strategies to address these concerns included making note-sharing more secure, optimizing note layout and content, setting clear expectations, and having a portion of the note for clinician use only.
AHRQ-funded; HS027214; HS027894.
Citation: Sprackling CM, Kieren MQ, Nacht CL .
Adolescent access to clinicians' notes: adolescent, parent, and clinician perspectives.
J Adolesc Health 2024 Jan; 74(1):155-60. doi: 10.1016/j.jadohealth.2023.08.008..
Keywords: Children/Adolescents, Clinician-Patient Communication, Patient and Family Engagement
Buchanan CL, Morris MA, Matlock D
Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction.
The objective of this study was to understand what families perceive as necessary information to guide decisionmaking in the treatment of children with ureteropelvic junction obstruction (UPJO). The authors conducted semi-structured interviews with parents of children with UPJO. Their findings were organized into three major themes: barriers to meaningful participation in decisionmaking, logistical aspects, and psychosocial aspects. They concluded that these results highlighted the importance of caregivers needing clear and accurate information to engage in meaningful discussions related to surgical decisionmaking regarding UPJO treatment. They recommended patient education and enhanced psychosocial support for more meaningful parental engagement in the surgical decisionmaking process.
AHRQ-funded; HS024597.
Citation: Buchanan CL, Morris MA, Matlock D .
Parental experience and understanding of parent-provider discussions of treatment for infants with ureteropelvic junction obstruction.
PEC Innov 2023 Dec; 2:100142. doi: 10.1016/j.pecinn.2023.100142..
Keywords: Newborns/Infants, Patient Experience, Shared Decision Making, Patient and Family Engagement, Clinician-Patient Communication
DiMeo A, Karlage A, Schoenherr K
Cultural brokering in pregnancy care: a critical review.
This study is a literature review of cultural brokering during pregnancy. The authors identified 33 articles in their literature search. They found that cultural brokering is not clearly defined in the current literature. Only a few articles provided information about language concordance between cultural brokers and patients or clinicians, with no articles describing the impact of cultural brokering on health outcomes. Cultural broker facilitating was described as providing information about language concordance between cultural brokers and patients or clinicians. Barriers included misunderstanding the responsibilities, difficulty maintaining personal boundaries, and limited availability and accessibility of cultural brokers. They propose cultural brokering as interactions that cover four key aims: (1) language support; (2) bridging cultural differences; (3) social support and advocacy; and (4) navigation of the healthcare system.
AHRQ-funded; HS026370.
Citation: DiMeo A, Karlage A, Schoenherr K .
Cultural brokering in pregnancy care: a critical review.
Int J Gynaecol Obstet 2023 Nov; 163(2):357-66. doi: 10.1002/ijgo.15063..
Keywords: Maternal Care, Women, Clinician-Patient Communication, Cultural Competence
Steitz BD, Padi-Adjirackor NA, Griffith KN
Impact of notification policy on patient-before-clinician review of immediately released test results.
The 21st Century Cures Act requires that test results be made available immediately upon request. Not all organizations send notifications when those results become available. The purpose of this study was to measure the effect of notification policies on rates of patient-before-clinician result review and patient-initiated messaging. The researchers implemented 2 policies, immediate notifications for all results, and notifications only to patients who opted in to the system. In the group with immediate notification of test results, the ratio of patient-before-clinician review rose 4-fold and the ratio of patients who sent messages increased 3%. After transition to opt-in notifications, patient-before-clinician review decreased 2.4% and patient-initiated messaging decreased 0.4%.
AHRQ-funded; HS026395.
Citation: Steitz BD, Padi-Adjirackor NA, Griffith KN .
Impact of notification policy on patient-before-clinician review of immediately released test results.
J Am Med Inform Assoc 2023 Sep 25; 30(10):1707-10. doi: 10.1093/jamia/ocad126..
Keywords: Policy, Clinician-Patient Communication
Hays RD, Walling AM, Sudore RL
Support for use of Consumer Assessment of Healthcare Providers and Systems communication items among seriously ill patients.
High-quality doctor-patient communication is essential for patients with serious illnesses. The purpose of this study was to assess the reliability and validity of Consumer Assessment of Healthcare Providers and Systems (CAHPS(®)) communication items among patients with serious illnesses. The study found that Eigenvalues and internal consistency reliability supported a 5-item communication scale. Item characteristic curves revealed a monotonic relationship of response options with the communication score. Item thresholds indicated that most patients reported positive patient experiences, and item slopes confirmed that all items were strongly related to the communication score. Reliability of the communication scale was higher for assessing patients with negative experiences of care than for the positive end of the spectrum. Communication was positively correlated with confidence in other's knowledge of ACP medical wishes, ACP engagement, and confidence in filling out ACP-related medical forms.
AHRQ-funded; HS029321.
Citation: Hays RD, Walling AM, Sudore RL .
Support for use of Consumer Assessment of Healthcare Providers and Systems communication items among seriously ill patients.
J Palliat Med 2023 Sep; 26(9):1234-39. doi: 10.1089/jpm.2022.0572..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Clinician-Patient Communication, Communication, Provider: Health Personnel
Rankine J, Kidd KM, Sequeira GM
Adolescent perspectives on the use of telemedicine for confidential health care: an exploratory mixed-methods study.
Gender-diverse youth (GDY) may benefit from telemedicine access but may have unique confidentiality issues; this article examined adolescents' perceived acceptability, preferences, and self-efficacy related to the use of telemedicine for confidential care. Participants included GDY and cisgender females aged 12 to 17 who were surveyed following a telemedicine visit with an adolescent medicine subspecialist. Results indicated that adolescents were interested in using telemedicine for confidential care but recognized threats to confidentiality. The authors concluded that clinicians and health systems should consider youth's preferences and unique confidentiality needs to ensure equitable access, uptake, and outcomes.
AHRQ-funded; HS026393.
Citation: Rankine J, Kidd KM, Sequeira GM .
Adolescent perspectives on the use of telemedicine for confidential health care: an exploratory mixed-methods study.
J Adolesc Health 2023 Aug; 73(2):360-66. doi: 10.1016/j.jadohealth.2023.04.005..
Keywords: Clinician-Patient Communication, Communication
Cho Y, Yang R, Gong Y
Use of electronic communication with clinicians among cancer survivors: Health Information National Trend Survey in 2019 and 2020.
This study’s objective was to describe cancer survivors' use of electronic communication (e-communication) with clinicians and identify factors associated with their use, including the COVID-19 pandemic. The authors conducted a secondary analysis of cancer survivors (N = 1,482) from the combined Health Information National Trends Survey HINTS 5 Cycle 3 and Cycle 4. Survivors' use of e-communication was defined by at least one of four e-communication use behaviors in the previous 12 months. Cancer survivors had a 64% prevalence of e-communication use, with older adults (≥65 years old) were less likely to use e-communication. Survivors who were white, living in a metro area, diagnosed with breast cancer, seeking cancer-related information previously, or having a regular health care provider were more likely to use e-communication. The start of the COVID-19 pandemic was marginally associated with the increased e-communication use when other variables were controlled.
AHRQ-funded; HS027846.
Citation: Cho Y, Yang R, Gong Y .
Use of electronic communication with clinicians among cancer survivors: Health Information National Trend Survey in 2019 and 2020.
Telemed J E Health 2023 Jun; 29(6):866-74. doi: 10.1089/tmj.2022.0203..
Keywords: Clinician-Patient Communication, Communication, Cancer, Telehealth, Health Information Technology (HIT)
Alexandre W, Muhammad H, Agbalajobi O
Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis.
The purpose of this study was to investigate the relationships between medical dialogues concerning alcohol use disorder (AUD) treatment, AUD treatment engagement, and mortality rates. The retrospective cohort study encompassed all patients diagnosed with cirrhosis and AUD receiving hepatology care within a single healthcare system in 2015. Baseline data on demographics, medical history, liver disease, and AUD treatment were examined. Information on AUD treatment discussions, initiation, alcohol cessation, and the subsequent 5-year mortality rates was gathered. Out of 436 patients with alcohol-related cirrhosis, 15% received AUD treatment at baseline, with 11% undergoing behavioral therapy, 2% receiving pharmacotherapy, and 1% obtaining both. Within the first year after the initial hepatology visit, 37 patients had AUD treatment, 51 remained in treatment, and 14 discontinued. Hepatology-documented AUD treatment recommendations were provided to 30% of patients, while 26% received primary care-documented recommendations. The majority of hepatology (86%) and primary care (88%) recommendations focused on behavioral therapy. Among patients with persistent alcohol use at baseline, AUD treatment after one year was significantly and independently associated with hepatology or primary care treatment discussions, and negatively associated with Medicaid insurance. When treatment discussions occurred in both settings, high treatment rates followed. Over five years, 35% of patients died. Ongoing alcohol use, age, hepatic decompensation, and hepatocellular carcinoma significantly contributed to mortality in the final survival model. In patients with alcohol-related cirrhosis, AUD treatment discussions were documented in fewer than half of hepatology and primary care encounters; however, such discussions were significantly correlated with AUD treatment receipt.
AHRQ-funded; HS019461.
Citation: Alexandre W, Muhammad H, Agbalajobi O .
Alcohol treatment discussions and clinical outcomes among patients with alcohol-related cirrhosis.
BMC Gastroenterol 2023 Feb 2; 23(1):29. doi: 10.1186/s12876-023-02656-z..
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Clinician-Patient Communication, Communication
Hsueh L, Huang J, Millman AK
Cross-sectional association of patient language and patient-provider language concordance with video telemedicine use among patients with limited English proficiency.
The surge in telemedicine use during the COVID-19 pandemic underscores the need to address gaps in patient care, particularly for individuals with limited English proficiency. The purpose of this study was to investigate the relationship between patient language, patient-provider language alignment, and the type of telemedicine visit (video or phone consultation). The researchers conducted a cross-sectional analysis using automated data from primary care telemedicine appointments scheduled between March 16, 2020, and October 31, 2020 within a comprehensive healthcare delivery system in Northern California. A total of 22,427 completed primary care telemedicine visits booked by 13,764 patients with limited English proficiency through the patient portal. The study examined the cross-sectional link between electronic health record-documented patient language (with Spanish as the reference) and patient-provider language concordance, considering patient demographics, technology access, and technology familiarity. RESULTS: The study found that among all scheduled appointments, 34.5% (n=7747) were video consultations. The three most common patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). After adjusting for demographic and technology factors, video visit usage was higher for patients speaking Cantonese, Mandarin, or Vietnamese, compared to Spanish-speaking patients, but lower for those who spoke Punjabi. Language concordance was linked to decreased video visit utilization and influenced the relationship between speaking Spanish, Cantonese, and Korean with video visit usage. Furthermore, for all language groups, patients with prior video visit experience were more likely to use video visits again.
AHRQ-funded; HS025189
Citation: Hsueh L, Huang J, Millman AK .
Cross-sectional association of patient language and patient-provider language concordance with video telemedicine use among patients with limited English proficiency.
J Gen Intern Med 2023 Feb;38(3):633-40. doi: 10.1007/s11606-022-07887-6.
Keywords: Telehealth, Health Information Technology (HIT), Cultural Competence, Clinician-Patient Communication, Communication, Healthcare Delivery, COVID-19
Kim KM, Giannitrapani KF, Garcia A
Patient characteristics associated with occurrence of preoperative goals-of-care conversations.
This study’s goal was to evaluate the association between patient risk of hospitalization or death and goals-of-care conversations documented with a completed Life-Sustaining Treatment (LST) Decisions Initiative note among veterans undergoing surgery. This retrospective cross-sectional study included 190,040 veterans who underwent operations between January 2017 and February 2020. The main outcome looked at was preoperative LST note completion (30 days before or on the day of surgery) or no LST note completion within the 30-day preoperative period prior to or on the day of the index operation. Of 190,040 veterans (90.8% men), 3.8% completed an LST note before surgery, and 96.2% did not complete an LST note. In the groups with and without LST note completion before surgery, most were aged between 65 and 84 years, male, and Whites. Compared with patients who completed an LST, patients who did not tended to be female, married, Black, and in better health; to have a lower risk of hospitalization or death; or to undergo neurosurgical or urologic surgical procedures. Over the 3-year study interval, unadjusted rates of LST note completion before surgery increased from 0.1% to 9.6%. High-risk surgery was not associated with increased LST note completion before surgery. Veterans who underwent cardiothoracic surgery had the highest likelihood of LST note completion before surgery.
AHRQ-funded; F32 HS028747.
Citation: Kim KM, Giannitrapani KF, Garcia A .
Patient characteristics associated with occurrence of preoperative goals-of-care conversations.
JAMA Netw Open 2023 Feb;6(2):e2255407. doi: 10.1001/jamanetworkopen.2022.55407.
Keywords: Surgery, Clinician-Patient Communication, Communication
Zisman-Ilani Y, Thompson KD, Siegel LS
Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial.
The purpose of this multi-site cluster randomised controlled trial was to test the impact of standard Crohn's disease care and compare with the impact of shared decision making (SDM) on the provider’s choice of therapy, quality of decisions, and provider trust. A total of 158 adult patients with Crohn's disease within 15 years of their diagnosis, with no prior Crohn's disease complications, and who were candidates to receive immunomodulators or biologics, from 14 diverse gastroenterology practices in the US, participated in the study. 99 of those participants received the intervention and 59 received standard care. The study found that participants in the intervention group chose combination therapy more frequently, had a significantly lower decisional conflict, and had greater trust in their provider.
AHRQ-funded; HS021747.
Citation: Zisman-Ilani Y, Thompson KD, Siegel LS .
Crohn's disease shared decision making intervention leads to more patients choosing combination therapy: a cluster randomised controlled trial.
Aliment Pharmacol Ther 2023 Jan;57(2):205-14. doi: 10.1111/apt.17286..
Keywords: Digestive Disease and Health, Chronic Conditions, Shared Decision Making, Patient-Centered Healthcare, Clinician-Patient Communication
Quigley DD, Elliott MN, Slaughter ME
Follow-up shadow coaching improves primary care provider-patient interactions and maintains improvements when conducted regularly: a spline model analysis.
The purpose of this study was to explore whether a second shadow coaching session (re-coaching) improves the patient experience and maintains it over time. The researchers observed a statistically significant increase of 3.7 points among re-coached providers after re-coaching on overall provider rating (OPR) and 3.5 points on provider communication (PC) (differences of 1, 3, and 5 points or more are considered small, medium, and large, respectively). Improvements from the re-coaching endured for 12 months for OPR and 8 months for PC.
AHRQ-funded; HS025920.
Citation: Quigley DD, Elliott MN, Slaughter ME .
Follow-up shadow coaching improves primary care provider-patient interactions and maintains improvements when conducted regularly: a spline model analysis.
J Gen Intern Med 2023 Jan; 38(1):221-27. doi: 10.1007/s11606-022-07881-y..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Primary Care, Clinician-Patient Communication, Patient Experience, Provider Performance
Rao BR, Jung EH, Dickert NW
Getting cost discussions right: nudging patients to avoid cognitive pitfalls.
The purpose of this article was to discuss the challenges of high out-of-pocket medication costs and their negative impact on healthcare, patient behavior, and access to quality care. The authors report that integrating cost information into medical decisions can be a useful tool for improving patient outcomes, but there are several cognitive biases that can skew patients' decisions in different directions. The article emphasizes the need for using nudge strategies as a focused counterweight to address out-of-pocket costs and other complex medical decisions. The authors explain that nudges involving manipulations in framing and choice architecture can be harnessed to impact decisions in a predictable way without restricting options or changing economic incentives. The article suggests several nudge strategies that clinicians can employ to help patients make better decisions and avoid cognitive pitfalls in shared decision-making discussions related to out-of-pocket costs.
AHRQ-funded; HS028558.
Citation: Rao BR, Jung EH, Dickert NW .
Getting cost discussions right: nudging patients to avoid cognitive pitfalls.
Circ Cardiovasc Qual Outcomes 2023 Jan; 16(1):e009447. doi: 10.1161/circoutcomes.122.009447..
Keywords: Healthcare Costs, Shared Decision Making, Clinician-Patient Communication, Communication
Kelly MM, Hoonakker PLT, Nacht CL
Parent perspectives on sharing pediatric hospitalization clinical notes.
This qualitative study sought to identify parent perceptions of the benefits and challenges of real-time note access during their child's hospitalization and strategies to optimize note-sharing at the bedside. The study conducted 60-minute interviews with 28 parents who were given access to their child's admission and daily progress notes on a bedside tablet (iPad) and interviewed upon discharge. The parents described 6 benefits of having note access, which: provided a recap and improved their knowledge about their child's care plan, enhanced communication, facilitated empowerment, increased autonomy, and incited positive emotions. Potential challenges described included: causing confusion, hindering communication with the health care team, highlighting problems with note content, and inciting negative emotions. The parents recommended 4 strategies to support sharing: provide preemptive communication about expectations, optimize the note release process, consider parent-friendly note template modifications, and offer informational resources for parents.
AHRQ-funded; HS027214.
Citation: Kelly MM, Hoonakker PLT, Nacht CL .
Parent perspectives on sharing pediatric hospitalization clinical notes.
Pediatrics 2023 Jan; 151(1). doi: 10.1542/peds.2022-057756..
Keywords: Children/Adolescents, Hospitals, Clinician-Patient Communication, Communication, Hospitalization
Jensen JL, Sweeney A, Gill C
Evaluation of patient access to Spanish-language-concordant care on a postpartum unit.
This study evaluated patient access to Spanish-language-concordant care on a postpartum unit and to identify facilitators and barriers to the use of interpretation services. This mixed-methods study included a chart review of 50 randomly selected birthing parent-newborn couplets and interviews with 14 inpatient health care team members, and semistructured interviews at a tertiary academic medical center in the southeastern United States. The chart review included examination of patient characteristics, health care team composition including Spanish language proficiency, length of stay, number of interpreter requests, and time between clinician interpreter requests and interpreter arrival on the unit. Access to an interpreter or clinician certified in medical Spanish was offered to 12 of 50 (24%) couplets upon admission to the unit and to 7 of 50 (14%) of couplets for daily maternal and newborn medical rounds. Clinicians reported on long and unpredictable wait times to access interpreters. Temporary solutions included relying on hand gestures, broken Spanish, and smartphone apps to "get by" when communicating with patients without certified interpretation services. These deviations from national standards may put postpartum families at risk for harm.
AHRQ-funded; HS027260.
Citation: Jensen JL, Sweeney A, Gill C .
Evaluation of patient access to Spanish-language-concordant care on a postpartum unit.
Nurs Womens Health 2022 Dec;26(6):429-38. doi: 10.1016/j.nwh.2022.09.002.
Keywords: Maternal Care, Cultural Competence, Clinician-Patient Communication, Communication
Schuttner L, Hockett Sherlock S, Simons CE
My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity.
This study’s goal was to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. The authors conducted semi-structured telephone interviews from April to July 2020 with 23 physicians across 20 clinical sites, with most being female (61%). Facilitators included: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care.
AHRQ-funded; HS026369.
Citation: Schuttner L, Hockett Sherlock S, Simons CE .
My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity.
J Gen Intern Med 2022 Dec;37(16):4189-96. doi: 10.1007/s11606-022-07533-1..
Keywords: Patient-Centered Healthcare, Healthcare Delivery, Chronic Conditions, Clinician-Patient Communication, Communication, Patient and Family Engagement
Quigley DD, Qureshi N, Palimaru A
Content and actionability of recommendations to providers after shadow coaching.
This paper examined the content of the recommendations given to shadow-coached providers aimed at improving provider-patient interactions, to characterize these recommendations, and to examine their actionability. Using CAHPS data, the study’s findings showed that patient experience surveys were effective at identifying where improvement is needed but are not always informative enough to instruct providers on how to modify and improve their interactions with patients. Analyzing the feedback given to coached providers as part of an effective shadow-coaching program provides details about implementation on shadow-coaching feedback.
AHRQ-funded; HS025920.
Citation: Quigley DD, Qureshi N, Palimaru A .
Content and actionability of recommendations to providers after shadow coaching.
Qual Manag Health Care 2022 Oct-Dec;31(4):199-209. doi: 10.1097/qmh.0000000000000354..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Quality Improvement, Quality of Care, Practice Improvement, Clinician-Patient Communication, Communication