National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- Ambulatory Care and Surgery (2)
- Asthma (1)
- Brain Injury (1)
- Children's Health Insurance Program (CHIP) (1)
- (-) Children/Adolescents (20)
- Chronic Conditions (4)
- Clinical Decision Support (CDS) (4)
- COVID-19 (1)
- Diabetes (1)
- Diagnostic Safety and Quality (1)
- Disabilities (1)
- Domestic Violence (1)
- Electronic Health Records (EHRs) (10)
- Evidence-Based Practice (1)
- Healthcare Costs (1)
- Healthcare Delivery (1)
- (-) Health Information Technology (HIT) (20)
- Health Insurance (1)
- Intensive Care Unit (ICU) (1)
- Lifestyle Changes (1)
- Medication (3)
- Nutrition (1)
- Obesity (2)
- Obesity: Weight Management (1)
- Prevention (1)
- Primary Care (4)
- Provider: Physician (1)
- Quality Improvement (1)
- Quality Measures (1)
- Quality of Care (2)
- Respiratory Conditions (1)
- Rural/Inner-City Residents (1)
- Rural Health (2)
- Shared Decision Making (2)
- Sickle Cell Disease (1)
- Teams (2)
- Telehealth (4)
- Transitions of Care (1)
- Trauma (1)
- Vulnerable Populations (1)
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 20 of 20 Research Studies DisplayedReeves SL, Patel PN, Madden B
Telehealth use before and during the COVID-19 pandemic among children with sickle cell anemia.
This study’s goal was to determine telehealth use before and during the COVID pandemic for children ages 1-17 years old with sickle cell anemia (SCA). The authors identified children with SCA continuously enrolled in Michigan Medicaid from January 2019 to December 2020. The study population consisted of 493 children with SCA with a mean age of 8.7 years at study entry. Pre-pandemic there were 4,367 outpatient visits, with all but 19 in-person. Telehealth visits peaked in April 2020 and then began declining. The majority of telehealth visits were with hematologists, followed up adult subspecialists (27%) and pediatrics/family medicine.
AHRQ-funded; HS027632.
Citation: Reeves SL, Patel PN, Madden B .
Telehealth use before and during the COVID-19 pandemic among children with sickle cell anemia.
Telemed J E Health 2022 Aug;28(8):1166-71. doi: 10.1089/tmj.2021.0132..
Keywords: Children/Adolescents, COVID-19, Telehealth, Health Information Technology (HIT), Sickle Cell Disease, Chronic Conditions, Access to Care
Randell KA, Ragavan MI, Query LA
Intimate partner violence and the pediatric electronic health record: a qualitative study.
The authors sought to explore expert perspectives on risks associated with the pediatric electronic health record (EHR) for intimate partner violence (IPV) survivors and their children and to identify strategies that may mitigate these risks. They conducted semistructured interviews with multidisciplinary pediatric IPV experts, and their findings suggested that the pediatric EHR may confer both risks and benefits for IPV survivors and their children. They recommended further work to develop best practices to address IPV risks related to the pediatric EHR, to ensure consistent use of these practices, and to include these practices as standard functionalities of the pediatric EHR.
AHRQ-funded; HS022242.
Citation: Randell KA, Ragavan MI, Query LA .
Intimate partner violence and the pediatric electronic health record: a qualitative study.
Acad Pediatr 2022 Jul;22(5):824-32. doi: 10.1016/j.acap.2021.08.013..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Domestic Violence
Huo T, Li Q, Cardel MI
AHRQ Author: Mistry K
Enhancing quality measurement with clinical information: a use case of body mass index change among children taking second generation antipsychotics.
The authors sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). They concluded that meeting the 2030 CMS goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked electronic health records and claims data allows identifying children at higher risk for SGAP-induced weight gain.
AHRQ-authored; AHRQ-funded; HS025298.
Citation: Huo T, Li Q, Cardel MI .
Enhancing quality measurement with clinical information: a use case of body mass index change among children taking second generation antipsychotics.
Acad Pediatr 2022 Apr;22(3S):S140-S49. doi: 10.1016/j.acap.2021.11.012..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Obesity, Obesity: Weight Management, Quality Measures, Quality of Care
Cifra CL, Tigges CR, Miller SL
Reporting outcomes of pediatric intensive care unit patients to referring physicians via an electronic health record-based feedback system.
Before critically ill children are sent to a pediatric intensive care unit (PICU), many receive their initial evaluations from front-line emergency care clinicians with variable levels of pediatric training. The authors state that reporting pediatric patient outcomes back to the front-line clinicians who provided the emergency care may offer valuable lessons. The purpose of the study was to evaluate a semiautomated electronic health record (EHR)-supported feedback system, developed at a single institution, to determine its usability and clinical relevance in providing timely and relevant PICU feedback to the front-line referring emergency department (ED) clinicians. Applying the Health Information Technology Safety Framework as a guiding model, the researchers conducted qualitative research with stakeholders, and then translated stakeholder, organizational, and usability objectives to design, develop, implement, and assess a semi-automated HER-supported feedback system. The study applied three cycles of an iterative process of implementation and evaluation over 6 months and determined that an EHR-supported feedback process is feasible, and can provide timely, usable, and clinically relevant feedback. In usability testing, physicians reported the process added minimal workload, was well integrated into their existing clinical workflows, and both the act of delivering and receiving feedback was relevant to their clinical practice. The study concluded that a semiautomated EHR-supported clinical feedback system to provide referring ED clinicians with patient outcome feedback was feasible, usable, and relevant to providers. The authors recommend future research to explore applicability to other, similar clinical settings and situations.
AHRQ-funded; HS027363; HS026965.
Citation: Cifra CL, Tigges CR, Miller SL .
Reporting outcomes of pediatric intensive care unit patients to referring physicians via an electronic health record-based feedback system.
Appl Clin Inform 2022 Mar;13(2):495-503. doi: 10.1055/s-0042-1748147..
Keywords: Children/Adolescents, Intensive Care Unit (ICU), Electronic Health Records (EHRs), Health Information Technology (HIT)
Greenberg JK, Otun A, Kyaw PT
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
The Kids Intracranial Injury Decision Support tool for Traumatic Brain Injury (KIIDS-TBI) is a validated risk prediction model designed to manage children with mild traumatic brain injuries (mTBI) and intracranial injuries. Implementing electronic clinical decision support (CDS) may help integrate this evidence-based guidance into clinical practice. The purpose of this study was to assess the acceptability and usability of an electronic CDS tool for managing children with mTBI and intracranial injuries. Emergency medicine and neurosurgery physicians (10 each) from 10 hospitals in the United States participated in usability testing of a novel CDS prototype within a simulated electronic health record environment. The testing involved a think-aloud protocol, an acceptability and usability survey, and a semi-structured interview. The prototype underwent two updates during testing based on user feedback. Usability issues identified in the videos were categorized using content analysis, while interview transcripts were analyzed using thematic analysis. The study found that of the 20 participants, the majority worked at teaching hospitals (80%), freestanding children's hospitals (95%), and level-1 trauma centers (75%). During the two prototype updates, issues with clarity of terminology and navigation within the CDS interface were identified and resolved. As a result, the number of usability problems decreased from 35 in phase 1 to 8 in phase 3, and the number of errors made dropped from 18 in phase 1 to 2 in phase 3. According to the survey, 90% of participants found the tool easy to use, 95% found the tool useful in determining a patient's level of care, 90% found it likely to improve resource utilization, and 79% found it likely to improve patient safety. Interview themes focused on the CDS's capability to support evidence-based decision-making and enhance clinical workflow, as well as suggested implementation strategies and potential challenges.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Otun A, Kyaw PT .
Usability and acceptability of clinical decision support based on the KIIDS-TBI tool for children with mild traumatic brain injuries and intracranial injuries.
Appl Clin Inform 2022 Mar; 13(2):456-67. doi: 10.1055/s-0042-1745829..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Brain Injury, Health Information Technology (HIT)
Ray KN, Bohnhoff JC, Schweiberger K
Use of telemedicine for initial outpatient subspecialist consultative visit: a national survey of general pediatricians and pediatric subspecialists.
The authors performed a survey of general pediatricians and pediatric subspecialists about the use of telemedicine for patients newly referred for pediatric subspecialty care. They found that 76% of respondents thought telemedicine should be offered for some and 11% thought telemedicine should be offered for all initial subspecialist visits. Factors perceived to reduce the appropriateness of telemedicine for subspecialty consultation included the need for interpreter services and a prior history of frequent no-shows. They further found that responses from generalists and subspecialists rarely differed significantly.
AHRQ-funded; HS026393.
Citation: Ray KN, Bohnhoff JC, Schweiberger K .
Use of telemedicine for initial outpatient subspecialist consultative visit: a national survey of general pediatricians and pediatric subspecialists.
Healthc 2022 Mar;10(1):100600. doi: 10.1016/j.hjdsi.2021.100600..
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Provider: Physician, Ambulatory Care and Surgery
Durojaiye A, Fackler J, McGeorge N
Examining diurnal differences in multidisciplinary care teams at a pediatric trauma center using electronic health record data: social network analysis.
The purpose of this study was to apply social network analysis to electronic health record (EHR) data to explore diurnal differences in the multidisciplinary teams caring for pediatric trauma patients. The researchers created an event log comprised of clinical activity metadata obtained from the EHR. The resulting event log was separated into 6 unique event logs, with content based on clinical activity shift (day shift or night shift) and location of the activities (divided by emergency department (ED), pediatric intensive care unit (PICU), and floor). For each event log, social networks were constructed and community overlap identified. The researchers utilized a comparison with qualitative care team data to compare and validate daytime and nighttime network structures for each care location. Validation was assessed via member-checking interviews with clinicians and qualitatively derived care team data, obtained through semi-structured interviews. The study found that of the 413 clinical encounters taking place within the 1-year study period, 65.9% began during the day shift and 34.1% began during the night shift. Multiple communities were identified in the ED and on the floor during the night shift, while a single community was identified in the ED and on the floor during the day shift, and in the PICU during the night shift. Qualitative data results indicated that the networks were accurate representations of the composition and interactions of the care teams. The researchers concluded that social network analysis was an effective method for utilization on EHR data at a pediatric trauma center to explore, identify, and describe diurnal differences in multidisciplinary care teams.
AHRQ-funded; HS023837.
Citation: Durojaiye A, Fackler J, McGeorge N .
Examining diurnal differences in multidisciplinary care teams at a pediatric trauma center using electronic health record data: social network analysis.
J Med Internet Res 2022 Feb 4;24(2):e30351. doi: 10.2196/30351..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Teams, Healthcare Delivery
Kan K, Shaunfield S, Kanaley M
Health provider perspectives of electronic medication monitoring in outpatient asthma care: a qualitative investigation using the consolidated framework for implementation research.
This study’s objective was to quantitatively explore the experience of health providers using electronic medication monitoring (EMM) in pediatric outpatient asthma care. The authors conducted interviews with 10 health providers using the Consolidated Framework of Implementation Research (CFIR) on their EMM experience with asthma patients from 5 primary care or specialty clinics. The EMM tracked albuterol and inhaled corticosteroid (ICS) use. Health providers called parents whenever ICS adherence waned, or albuterol use increased. The interviews were audio-recorded, transcribed, and deductively analyzed. Most providers felt the intervention improved care delivery, but implementation of the intervention model would require additional employees to handle the increased administrative and clinical workload.
AHRQ-funded; HS026385.
Citation: Kan K, Shaunfield S, Kanaley M .
Health provider perspectives of electronic medication monitoring in outpatient asthma care: a qualitative investigation using the consolidated framework for implementation research.
J Asthma 2022 Feb;59(2):342-51. doi: 10.1080/02770903.2020.1846745..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Ambulatory Care and Surgery
Davidson L, Haynes SC, Favila-Meza A
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
This study investigated patient and therapist experience and cost savings from the payer perspective associated with a novel tele-physiatry program for children living in rural and underserved communities. Study setting was four school-based clinics in Northern California with a total of 268 encounters (124 telemedicine and 144 in-person). Parent and therapists reported no difference in experience and perceived quality of care between telemedicine and in-person encounters. For parents whose children received a telemedicine encounter, 54.8% reported no preference for their child’s subsequent encounter, 28.8% preferred a physiatrist telemedicine visit, and 12 preferred a physiatrist in-person visit. There was also an average cost savings of $100 per clinic owing to physician milage for in-person visits.
AHRQ-funded; HS025714.
Citation: Davidson L, Haynes SC, Favila-Meza A .
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
Arch Phys Med Rehabil 2022 Jan;103(1):8-13. doi: 10.1016/j.apmr.2021.07.807..
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Healthcare Costs, Rural Health, Vulnerable Populations, Disabilities, Rural/Inner-City Residents
Hoonakker PLT, Hose BZ, Carayon P
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
This study’s objective was to examine if the Teamwork Transition Technology (T(3)) supports teams and team cognition. Using a scenario-based mock-up methodology with 36 clinicians and staff from the different units and departments who are involved in pediatric trauma to examine T(3), results showed that most participants agreed that the technology helped to achieve the goals set out in the design phase. Respondents thought that T(3) organized and presented information in a different way that was helpful to them. The authors concluded that the results of their evaluation showed that participants agreed that T(3) does support them in their work and increases their situation awareness.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Hose BZ, Carayon P .
Scenario-based evaluation of team health information technology to support pediatric trauma care transitions.
Appl Clin Inform 2022 Jan;13(1):218-29. doi: 10.1055/s-0042-1742368.
AHRQ-funded; HS023837..
AHRQ-funded; HS023837..
Keywords: Children/Adolescents, Transitions of Care, Health Information Technology (HIT), Teams, Trauma
Shaikh U, Nettiksimmons J, Joseph JG
Collaborative practice improvement for childhood obesity in rural clinics: the Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP).
The authors assessed the impact of participation in a virtual quality improvement (QI) learning network on adherence to clinical guidelines for childhood obesity prevention in rural clinics. They found that children who received care from clinicians who led the implementation of the intervention at their clinic showed significant improvements in nutrition and physical activity. Virtual QI learning networks in geographically dispersed clinics can significantly increase clinicians' adherence to guidelines for childhood obesity and improve access to recommended care for rural and underserved children.
AHRQ-funded; HS018567.
Citation: Shaikh U, Nettiksimmons J, Joseph JG .
Collaborative practice improvement for childhood obesity in rural clinics: the Healthy Eating Active Living Telehealth Community of Practice (HEALTH COP).
Am J Med Qual 2014 Nov-Dec;29(6):467-75. doi: 10.1177/1062860613506252.
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Keywords: Children/Adolescents, Evidence-Based Practice, Health Information Technology (HIT), Lifestyle Changes, Nutrition, Obesity, Prevention, Quality Improvement, Rural Health, Telehealth
Adams WG, Phillips BD, Bacic JD
Automated conversation system before pediatric primary care visits: a randomized trial.
The purpose of this study was to determine whether use of an interactive voice response system, the Personal Health Partner (PHP), before routine health care maintenance visits could improve the quality of primary care visits and be well accepted by parents and clinicians. It found that the PHP was able to identify and counsel in multiple areas. All clinicians reported that PHP improved the quality of their care.
AHRQ-funded; HS017248
Citation: Adams WG, Phillips BD, Bacic JD .
Automated conversation system before pediatric primary care visits: a randomized trial.
Pediatrics. 2014 Sep;134(3):e691-9. doi: 10.1542/peds.2013-3759..
Keywords: Primary Care, Quality of Care, Children/Adolescents, Health Information Technology (HIT)
Carroll AE, Bauer NS, Dugan TM
Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.
A study to determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices found that use of such a system significantly increased the number of children screened at 9, 18, and 30 months of age. It also increased the number of children who ultimately were diagnosed as having a developmental delay.
AHRQ-funded; HS017939
Citation: Carroll AE, Bauer NS, Dugan TM .
Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.
JAMA Pediatr. 2014 Sep;168(9):815-21. doi: 10.1001/jamapediatrics.2014.464..
Keywords: Health Information Technology (HIT), Clinical Decision Support (CDS), Primary Care, Children/Adolescents
Forrest CB, Margolis PA, Bailey LC
PEDSnet: a National Pediatric Learning Health System.
The authors describe a National Pediatric Learning Health System (NPLHS) that is being implemented by PEDSnet, a clinical data research network. The NPLHS will consist of a flexible dual data architecture that incorporates two widely used data models and national terminology standards to support multi-institutional data integration, cohort discovery, and advanced analytics that enable rapid learning.
AHRQ-funded; HS022974; HS019912
Citation: Forrest CB, Margolis PA, Bailey LC .
PEDSnet: a National Pediatric Learning Health System.
J Am Med Inform Assoc. 2014 Jul-Aug;21(4):602-6. doi: 10.1136/amiajnl-2014-002743..
Keywords: Children/Adolescents, Health Information Technology (HIT), Chronic Conditions
Forrest CB, Margolis P, Seid M
PEDSnet: how a prototype pediatric learning health system is being expanded into a national network.
The authors describe a National Pediatric Learning Health System (NPLHS) that is being implemented by PEDSnet, a clinical data research network. The NPLHS will consist of a flexible dual data architecture that incorporates two widely used data models and national terminology standards to support multi-institutional data integration, cohort discovery, and advanced analytics that enable rapid learning.
AHRQ-funded; HS020024
Citation: Forrest CB, Margolis P, Seid M .
PEDSnet: how a prototype pediatric learning health system is being expanded into a national network.
Health Aff. 2014 Jul;33(7):1171-7. doi: 10.1377/hlthaff.2014.0127..
Keywords: Children/Adolescents, Health Information Technology (HIT), Chronic Conditions
Kirkendall ES, Spires WL, Mottes TA
Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm.
The authors described an approach and provided a technical framework for the creation of risk-stratifying acute kidney injury (AKI) triggers and the development of an application to manage the AKI trigger data. Their report summarizes the construction of a trigger-based application, the performance of the triggers, and the challenges uncovered during the design, build, and implementation of the system.
AHRQ-funded; HS021114.
Citation: Kirkendall ES, Spires WL, Mottes TA .
Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm.
Appl Clin Inform 2014 Apr 2;5(2):313-33. doi: 10.4338/aci-2013-12-ra-0102.
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Keywords: Adverse Drug Events (ADE), Children/Adolescents, Medication, Health Information Technology (HIT), Electronic Health Records (EHRs)
Bauer NS, Carroll AE, Downs SM
Understanding the acceptability of a computer decision support system in pediatric primary care.
In this study, the investigators examine the attitudes and opinions of pediatric users' toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. The investigators found that pediatric users appreciated the system's automation and enhancements that allowed relevant and meaningful clinical data to be accessible at point of care.
AHRQ-funded; HS018453; HS017939.
Citation: Bauer NS, Carroll AE, Downs SM .
Understanding the acceptability of a computer decision support system in pediatric primary care.
J Am Med Inform Assoc 2014 Jan-Feb;21(1):146-53. doi: 10.1136/amiajnl-2013-001851..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care
Bauer NS, Carroll AE, Downs SM
Understanding the acceptability of a computer decision support system in pediatric primary care.
In this study, the investigators examine the attitudes and opinions of pediatric users' toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. The investigators found that pediatric users appreciated the system's automation and enhancements that allowed relevant and meaningful clinical data to be accessible at point of care.
AHRQ-funded; HS018453; HS017939.
Citation: Bauer NS, Carroll AE, Downs SM .
Understanding the acceptability of a computer decision support system in pediatric primary care.
J Am Med Inform Assoc 2014 Jan-Feb;21(1):146-53. doi: 10.1136/amiajnl-2013-001851..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care
Lawrence JM, Black MH, Zhang JL
Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.
The researchers explored the utility of different algorithms for diabetes case identification by using electronic health records. They found that case identification accuracy was highest in 75% of bootstrapped samples for those who had 1 or more outpatient diabetes diagnoses or 1 or more insulin prescriptions and in 25% of samples for those who had 2 or more outpatient diabetes diagnoses and 1 or more antidiabetic medications.
AHRQ-funded; HS019859.
Citation: Lawrence JM, Black MH, Zhang JL .
Validation of pediatric diabetes case identification approaches for diagnosed cases by using information in the electronic health records of a large integrated managed health care organization.
Am J Epidemiol 2014 Jan;179(1):27-38. doi: 10.1093/aje/kwt230..
Keywords: Children/Adolescents, Diabetes, Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality
Hatch B, Angier H, Marino M
Using electronic health records to conduct children's health insurance surveillance.
The purpose of this study is to demonstrate secondary usage of electronic health records (EHRs) as an emerging data source for health insurance surveillance by community health centers and other primary care providers to track patients’ insurance coverage status and to identify patients most likely to benefit from outreach and support to obtain and maintain coverage.
AHRQ-funded; HS018569.
Citation: Hatch B, Angier H, Marino M .
Using electronic health records to conduct children's health insurance surveillance.
Pediatrics 2013 Dec;132(6):e1584-91. doi: 10.1542/peds.2013-1470..
Keywords: Electronic Health Records (EHRs), Children/Adolescents, Health Insurance, Children's Health Insurance Program (CHIP), Health Information Technology (HIT)