National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 49 Research Studies DisplayedChen SI, Wang Y, Dreyer R
Insurance and prehospital delay in patients </=55 years with acute myocardial infarction.
The authors assessed whether gender differences in health insurance help explain gender differences in delay in seeking care for patients with acute myocardial infarction (AMI) in the US and in Spain. They concluded that in the US, women were more likely than men to delay, although it was not explained by differences in insurance status. Further, the lack of gender differences in prehospital delays in Spain suggests that these differences may vary by health care system and culture.
AHRQ-funded; HS023000.
Citation: Chen SI, Wang Y, Dreyer R .
Insurance and prehospital delay in patients </=55 years with acute myocardial infarction.
Am J Cardiol 2015 Dec 15;116(12):1827-32. doi: 10.1016/j.amjcard.2015.09.018.
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Keywords: Healthcare Delivery, Emergency Medical Services (EMS), Health Insurance, Heart Disease and Health, Sex Factors
McGeorge N, Hedge S, Berg RL
Assessment of innovative emergency department information displays in a clinical simulation center.
The authors assessed the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. They found that participants using the new displays showed improved situation awareness, demonstrating that cognitive systems engineering methods can be used to create innovative displays that better support emergency medicine tasks, without increasing workload, compared to more standard displays.
AHRQ-funded; HS020433.
Citation: McGeorge N, Hedge S, Berg RL .
Assessment of innovative emergency department information displays in a clinical simulation center.
J Cogn Eng Decis Mak 2015 Dec;9(4):329-46. doi: 10.1177/1555343415613723.
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Keywords: Healthcare Delivery, Emergency Department, Emergency Medical Services (EMS), Health Information Technology (HIT)
Nembhard IM, Morrow CT, Bradley EH
Implementing role-changing versus time-changing innovations in health care: differences in helpfulness of staff improvement teams, management, and network for learning.
This paper examined the hypothesis that the degree to which access to groups that can alter organizational learning depends on innovation type. Team representativeness and network membership were positively associated with implementing role-changing practices; while senior management engagement was positively associated with implementing time-changing practices. The authors concluded that these findings advance implementation science by explaining mixed results across past studies, that the nature of change for workers alters potential facilitators' effects on implementation.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Morrow CT, Bradley EH .
Implementing role-changing versus time-changing innovations in health care: differences in helpfulness of staff improvement teams, management, and network for learning.
Med Care Res Rev 2015 Dec;72(6):707-35. doi: 10.1177/1077558715592315.
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Keywords: Healthcare Delivery, Quality Improvement, Organizational Change, Teams, Quality of Care, Learning Health Systems, Implementation
Chao MT, Handley MA, Quan J
Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes.
The authors identified sociodemographic and communication factors associated with disclosure of complementary health approaches to providers by low-income patients with diabetes. Disclosure was associated with language concordance, physicians' interpersonal communication scores, shared decision making, and explanatory-type communication.
AHRQ-funded; HS020684; HS017261; HS022561.
Citation: Chao MT, Handley MA, Quan J .
Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes.
Patient Educ Couns 2015 Nov;98(11):1360-6. doi: 10.1016/j.pec.2015.06.011.
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Keywords: Low-Income, Diabetes, Complementary and Alternative Medicine, Racial and Ethnic Minorities, Healthcare Delivery
Blecker S, Goldfeld K, Park H
Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study.
The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends. The intervention was associated with a reduction in length of stay and an increase in weekend discharges.
AHRQ-funded; HS023683.
Citation: Blecker S, Goldfeld K, Park H .
Impact of an intervention to improve weekend hospital care at an academic medical center: an observational study.
J Gen Intern Med 2015 Nov;30(11):1657-64. doi: 10.1007/s11606-015-3330-6.
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Keywords: Quality Improvement, Quality of Care, Hospitals, Hospital Discharge, Hospital Readmissions, Healthcare Delivery, Outcomes, Patient-Centered Outcomes Research
Tataris KL, Mercer MP, Govindarajan P
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
The researchers sought to determine (1) the proportion of patients with suspected cardiac ischaemia who received aspirin and (2) patient and prehospital characteristics that independently predicted administration of aspirin. Patients living in the Southern region of the USA and patients with governmental (federally administered such as Veteran's Health Care, but not Medicare or Medicaid) insurance had the lowest odds of receiving aspirin.
AHRQ-funded; HS017965.
Citation: Tataris KL, Mercer MP, Govindarajan P .
Prehospital aspirin administration for acute coronary syndrome (ACS) in the USA: an EMS quality assessment using the NEMSIS 2011 database.
Emerg Med J 2015 Nov;32(11):876-81. doi: 10.1136/emermed-2014-204299.
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Keywords: Cardiovascular Conditions, Care Management, Emergency Medical Services (EMS), Heart Disease and Health, Healthcare Delivery, Medication
McConnochie KM
Pursuit of value in connected healthcare.
The authors highlighted differences in care models to mitigate controversy and to distinguish capacities of these different models. They concluded that the pursuit of value in connected care is fundamentally the same as with in-person care.
AHRQ-funded; HS016871; HS015165; HS018912.
Citation: McConnochie KM .
Pursuit of value in connected healthcare.
Telemed J E Health 2015 Nov;21(11):863-9. doi: 10.1089/tmj.2015.0111.
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Keywords: Healthcare Delivery, Quality of Care, Health Services Research (HSR), Telehealth
Heslin KC, Gable A, Dobalian A
AHRQ Author: Heslin KC
Special services for women in substance use disorders treatment: how does the Department of Veterans Affairs compare with other providers?
The researchers examined the prevalence of programs and key services for women in VA facilities in a survey of 14,311 substance use disorder treatment facilities. Approximately 31 percent of facilities had special programs exclusively for women. Although the VA had the lowest prevalence of programs for women, at 19.1 percent, it offered a significantly higher average number of key services for women.
AHRQ-authored.
Citation: Heslin KC, Gable A, Dobalian A .
Special services for women in substance use disorders treatment: how does the Department of Veterans Affairs compare with other providers?
Womens Health Issues 2015 Nov-Dec;25(6):666-72. doi: 10.1016/j.whi.2015.07.005.
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Keywords: Substance Abuse, Women, Healthcare Delivery
Kamal AH, Kavalieratos D, Bull J
Usability and acceptability of the QDACT-PC, an electronic point-of-care system for standardized quality monitoring in palliative care.
The researchers performed usability testing of the Quality Data Collection Tool for Palliative Care (QDACT-PC), a novel, point-of-care quality monitoring tool for palliative care. They found that testing the QDACT-PC reveals equivalence with paper for data collection time, but with less burden overall for electronic methods across other domains of usability.
AHRQ-funded; HS022989.
Citation: Kamal AH, Kavalieratos D, Bull J .
Usability and acceptability of the QDACT-PC, an electronic point-of-care system for standardized quality monitoring in palliative care.
J Pain Symptom Manage 2015 Nov;50(5):615-21. doi: 10.1016/j.jpainsymman.2015.05.013.
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Keywords: Healthcare Delivery, Quality of Care, Palliative Care, Patient-Centered Healthcare, Quality Measures
Aparicio HJ, Carr BG, Kasner SE
Racial disparities in intravenous recombinant tissue plasminogen activator use persist at primary stroke centers.
The researechers found that racial disparities in intravenous recombinant tissue plasminogen activator (rt-PA) use were not reduced by presentation to primary stroke centers (PSCs). Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model.
AHRQ-funded; HS018362; HS017960; HS013852.
Citation: Aparicio HJ, Carr BG, Kasner SE .
Racial disparities in intravenous recombinant tissue plasminogen activator use persist at primary stroke centers.
J Am Heart Assoc 2015 Oct 14;4(10):e001877. doi: 10.1161/jaha.115.001877.
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Keywords: Healthcare Delivery, Disparities, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Stroke
Aysola J, Werner RM, Keddem S
Asking the patient about patient-centered medical homes: a qualitative analysis.
The researchers characterized patients' experiences with care after PCMH adoption and their understanding and perceptions of the PCMH model and its key components, and to compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. They found that patients uniformly lacked awareness of the PCMH concept, and the vast majority perceived no PCMH-related structural changes, regardless of the degree of practice-reported PCMH adoption or the patient's race/ethnicity.
AHRQ-funded; HS021706.
Citation: Aysola J, Werner RM, Keddem S .
Asking the patient about patient-centered medical homes: a qualitative analysis.
J Gen Intern Med 2015 Oct;30(10):1461-7. doi: 10.1007/s11606-015-3312-8.
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Keywords: Healthcare Delivery, Quality of Care, Patient Experience, Patient Experience, Patient-Centered Healthcare
Kamal AH, Harrison KL, Bakitas M
Improving the quality of palliative care through national and regional collaboration efforts.
The purpose of this paper was to review examples of quality-improvement collaborations in palliative care to understand the similarities, differences, and future directions of quality measurement and improvement strategies. These three examples showed areas of robust and growing quality-improvement collaboration in the field of palliative care: the Global Palliative Care Quality Alliance; Palliative Care Quality Network; and Project Educate, Nurture, Advise, Before Life Ends.
AHRQ-funded; HS023681.
Citation: Kamal AH, Harrison KL, Bakitas M .
Improving the quality of palliative care through national and regional collaboration efforts.
Cancer Control 2015 Oct;22(4):396-402. doi: 10.1177/107327481502200405.
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Keywords: Healthcare Delivery, Palliative Care, Quality of Care, Quality Improvement
Jung HY, Trivedi AN, Grabowski DC
Integrated Medicare and Medicaid managed care and rehospitalization of dual eligibles.
The objective of this study was to conduct an early evaluation of an innovative program that coordinates benefits for elderly dual eligibles. The authors found no statistically significant effect of senior care options on rehospitalization. They concluded that coordinating the financing and delivery of services through an integrated managed program may not sufficiently address the problems of inefficiency and fragmentation in care for hospitalized dual eligible enrollees.
AHRQ-funded; HS020756.
Citation: Jung HY, Trivedi AN, Grabowski DC .
Integrated Medicare and Medicaid managed care and rehospitalization of dual eligibles.
Am J Manag Care 2015 Oct;21(10):711-7.
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Keywords: Healthcare Delivery, Care Management, Medicaid, Medicare, Hospital Readmissions
Polisena J, Garritty C, Umscheid CA
Rapid Review Summit: an overview and initiation of a research agenda.
This discussion paper highlights the important discussions that occurred during the Rapid Review Summit: Then, Now and in the Future, focusing on the initial development of a research agenda that resulted from the presentations and discussions. The research topics centered on three key areas of interest: (1) how to conduct a rapid review; (2) investigating the validity and utility of rapid reviews; and (3) how to improve access to rapid reviews.
AHRQ-funded; HS018987.
Citation: Polisena J, Garritty C, Umscheid CA .
Rapid Review Summit: an overview and initiation of a research agenda.
Syst Rev 2015 Sep 26;4:111. doi: 10.1186/s13643-015-0111-6.
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Keywords: Evidence-Based Practice, Healthcare Delivery, Policy, Research Methodologies
Lee BY, Bartsch SM, Mvundura M
An economic model assessing the value of microneedle patch delivery of the seasonal influenza vaccine.
The researchers utilized a susceptible-exposed-infectious-recovered transmission model linked to an economic influenza outcomes model to assess the economic value of introducing the microneedle patch (MNP) into the U.S. influenza vaccine market from the third-party payer and societal perspectives. They concluded that if healthcare providers administered the MNP, its introduction would be less costly and more effective in the majority of scenarios assessed.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Mvundura M .
An economic model assessing the value of microneedle patch delivery of the seasonal influenza vaccine.
Vaccine 2015 Sep 08;33(37):4727-36. doi: 10.1016/j.vaccine.2015.02.076.
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Keywords: Healthcare Delivery, Healthcare Costs, Influenza, Vaccination
Phillips RL, Jr., Bazemore AW, DeVoe JE
A family medicine health technology strategy for achieving the triple aim for US health care.
To inform the Family Medicine for America's Health (FMAHealth) initiative, this paper explores strategies and tactics that family medicine could pursue to improve the utility of technology for primary care and to help primary care become a leader in rapid development, testing, and implementation of new technologies. These strategies were also designed with a broader stakeholder audience in mind, intending to reach beyond the work being done by FMAHealth.
AHRQ-funded; HS022583.
Citation: Phillips RL, Jr., Bazemore AW, DeVoe JE .
A family medicine health technology strategy for achieving the triple aim for US health care.
Fam Med 2015 Sep;47(8):628-35.
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Keywords: Electronic Health Records (EHRs), Healthcare Delivery, Primary Care, Health Information Technology (HIT)
Davis MM, Balasubramanian BA, Cifuentes M
Clinician staffing, scheduling, and engagement strategies among primary care practices delivering integrated care.
This study examined the interrelationship among behavioral health clinician staffing, scheduling, and a primary care practice's approach to delivering integrated care. It concluded that practices' approaches to staffing by primary care clinicians and behavioral health clinicians, scheduling, and delivery of integrated care mutually influenced each other and were shaped by the local context.
AHRQ-funded; HS022981.
Citation: Davis MM, Balasubramanian BA, Cifuentes M .
Clinician staffing, scheduling, and engagement strategies among primary care practices delivering integrated care.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S32-40. doi: 10.3122/jabfm.2015.S1.150087.
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Keywords: Behavioral Health, Patient-Centered Healthcare, Healthcare Delivery, Primary Care: Models of Care, Primary Care, Community-Based Practice
Gunn R, Davis MM, Hall J
Designing clinical space for the delivery of integrated behavioral health and primary care.
This study sought to describe features of the physical space in which practices integrating primary care and behavioral health care work and to identify the arrangements that enable integration of care. Two dominant spatial layouts emerged across practices: type-1 layouts were characterized by having primary care clinicians (PCCs) and behavioral health clinicians (BHCs) located in separate work areas, and type-2 layouts had BHCs and PCCs sharing work space.
AHRQ-funded; HS022981.
Citation: Gunn R, Davis MM, Hall J .
Designing clinical space for the delivery of integrated behavioral health and primary care.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S52-62. doi: 10.3122/jabfm.2015.S1.150053.
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Keywords: Behavioral Health, Healthcare Delivery, Patient-Centered Healthcare, Primary Care
Cohen DJ, Davis M, Balasubramanian BA
Integrating behavioral health and primary care: consulting, coordinating and collaborating among professionals.
This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions. It concluded that primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems.
AHRQ-funded; HS022981.
Citation: Cohen DJ, Davis M, Balasubramanian BA .
Integrating behavioral health and primary care: consulting, coordinating and collaborating among professionals.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S21-31. doi: 10.3122/jabfm.2015.S1.150042.
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Keywords: Healthcare Delivery, Community-Based Practice, Shared Decision Making, Behavioral Health, Primary Care
Hall J, Cohen DJ, Davis M
Preparing the workforce for behavioral health and primary care integration.
The researchers sought to identify how organizations prepare clinicians to work together to integrate behavioral health and primary care. They concluded that insufficient training capacity and practical experience opportunities continue to be major barriers to supplying the workforce needed for effective behavioral health and primary care integration. Until the training capacity grows to meet the demand, practices must put forth considerable effort and resources to train their own employees.
AHRQ-funded; HS022981.
Citation: Hall J, Cohen DJ, Davis M .
Preparing the workforce for behavioral health and primary care integration.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S41-51. doi: 10.3122/jabfm.2015.S1.150054.
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Keywords: Patient-Centered Healthcare, Healthcare Delivery, Primary Care: Models of Care, Primary Care, Behavioral Health, Training, Community-Based Practice
Balasubramanian BA, Fernald D, Dickinson LM
REACH of interventions integrating primary care and behavioral health.
This study reports REACH (the extent to which an intervention or program was delivered to the identified target population) of interventions integrating primary care and behavioral health implemented by real-world practices. Practices that implemented systematic protocols to identify patients needing integrated care had a significantly higher screening REACH compared with practices that used clinicians' discretion.
AHRQ-funded; HS022981.
Citation: Balasubramanian BA, Fernald D, Dickinson LM .
REACH of interventions integrating primary care and behavioral health.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S73-85. doi: 10.3122/jabfm.2015.S1.150055.
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Keywords: Behavioral Health, Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Community-Based Practice, Implementation, Community-Based Practice, Implementation
Cohen DJ, Balasubramanian BA, Davis M
Understanding care integration from the ground up: five organizing constructs that shape integrated practices.
The authors identified 5 key organizing constructs influencing integration of primary care and behavioral health. They concluded that the interaction among 5 organizing constructs and practice context produces diverse expressions of integrated care. These constructs provide a framework for understanding how primary care and behavioral health services can be integrated in routine practice.
AHRQ-funded; HS022981.
Citation: Cohen DJ, Balasubramanian BA, Davis M .
Understanding care integration from the ground up: five organizing constructs that shape integrated practices.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S7-20. doi: 10.3122/jabfm.2015.S1.150050.
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Keywords: Behavioral Health, Healthcare Delivery, Community-Based Practice, Primary Care
Reschovsky JD, Rich EC, Lake TK
Factors contributing to variations in physicians' use of evidence at the point of care: a conceptual model.
The purpose of this article is to help identify modifiable factors that can influence clinical decisions at the point of care. It presents a conceptual model and literature review of physician decisionmaking. The authors describe the multitude of factors—drawn from different disciplines—that have been shown to influence physician point-of-care decisions. They also present a conceptual framework for organizing these factors.
AHRQ-funded; 23320095642; 23337033T.
Citation: Reschovsky JD, Rich EC, Lake TK .
Factors contributing to variations in physicians' use of evidence at the point of care: a conceptual model.
J Gen Intern Med 2015 Aug;30 Suppl 3:S555-61. doi: 10.1007/s11606-015-3366-7..
Keywords: Healthcare Delivery, Shared Decision Making, Evidence-Based Practice, Primary Care: Models of Care, Practice Patterns
Fleming C, Rich E, DesRoches C
Measuring changes in the economics of medical practice.
This paper explores current issues relevant to defining and measuring the inputs and outputs of physician practice. It reviews practice inputs and outputs as typically described in the literature on the economics of medical practice, and identifies the conceptual challenges for defining these inputs and outputs in a complex and evolving health care system.
AHRQ-funded; 23320095642WC; 23337033T.
Citation: Fleming C, Rich E, DesRoches C .
Measuring changes in the economics of medical practice.
J Gen Intern Med 2015 Aug;30 Suppl 3:S562-7. doi: 10.1007/s11606-015-3368-5..
Keywords: Healthcare Delivery, Health Systems, Practice Patterns, Data
Fontaine P, Whitebird R, Solberg LI
Minnesota's early experience with medical home implementation: viewpoints from the front lines.
This study aimed to identify the facilitators and barriers encountered by nine diverse primary care practices selected from the first 80 to achieve patient-centered medical home (PCMH) certification in Minnesota. It found that facilitators to achieve PCMH certification included a requirement for patient involvement, which pushed practices to create patient-centered innovations, and new reimbursement models based on quality indicators for a population.
AHRQ-funded; HS019161.
Citation: Fontaine P, Whitebird R, Solberg LI .
Minnesota's early experience with medical home implementation: viewpoints from the front lines.
J Gen Intern Med 2015 Jul;30(7):899-906. doi: 10.1007/s11606-014-3136-y..
Keywords: Patient-Centered Healthcare, Primary Care, Implementation, Organizational Change, Healthcare Delivery, Practice Improvement, Health Services Research (HSR)