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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 44 Research Studies DisplayedMcCullagh LJ, Sofianou A, Kannry J
User centered clinical decision support tools: adoption across clinician training level.
This study examined the differences in adoption of CDS tools across providers’ training level. It found that the completion rates of the CDS calculator and medication order sets were higher among first year residents compared to all other training levels. Attending physicians were the less likely to accept the initial step of the CDS tool (29.3 percent) or complete the medication order sets (22.4 percent) that guided their prescription decisions.
AHRQ-funded; HS018491.
Citation: McCullagh LJ, Sofianou A, Kannry J .
User centered clinical decision support tools: adoption across clinician training level.
Appl Clin Inform 2014 Dec 17;5(4):1015-25. doi: 10.4338/aci-2014-05-ra-0048.
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Keywords: Clinical Decision Support (CDS), Decision Making, Practice Patterns
Concannon TW, Fuster M, Saunders T
A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research.
This study reviewed 70 articles on methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. The authors found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with other stakeholders.The roles and activities of stakeholders were highly variable across research and program reports.
AHRQ-funded; HS017726
Citation: Concannon TW, Fuster M, Saunders T .
A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research.
J Gen Intern Med. 2014 Dec;29(12):1692-701. doi: 10.1007/s11606-014-2878-x..
Keywords: Comparative Effectiveness, Clinician-Patient Communication, Decision Making
Kuntz JL, Safford MM, Singh JA
Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings.
This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains. Out of 60 studies, the authors found the following types of intervention: patient education, augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. They were unable to determine whether these interventions were more effective than traditional medication adherence interventions.
AHRQ-funded; HS021107.
Citation: Kuntz JL, Safford MM, Singh JA .
Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings.
Patient Educ Couns 2014 Dec;97(3):310-26. doi: 10.1016/j.pec.2014.08.021.
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Keywords: Education: Patient and Caregiver, Decision Making, Medication, Patient Adherence/Compliance, Patient-Centered Healthcare
Heisler M, Choi H, Palmisano G
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
This study compared outcomes between community health worker (CHW) use of a tailored, interactive, Web-based, tablet computer-delivered tool specifically developed for the study and use of printed educational materials. In a population of low-income Latino and African American adults with diabetes and relatively low levels of formal education, participants in both CHW-led interventions reported mostly similar improvements in outcomes over 3 months.
AHRQ-funded; HS019256
Citation: Heisler M, Choi H, Palmisano G .
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
Ann Intern Med. 2014 Nov 18;161(10 Suppl):S13-22. doi: 10.7326/m13-3012..
Keywords: Health Information Technology (HIT), Diabetes, Decision Making, Outcomes, Social Determinants of Health
Einbinder J, Hebel E, Wright A
The number needed to remind: a measure for assessing CDS effectiveness.
The purpose of this paper is to provide a better understanding of population based clinical decision support (CDS) performance measurement, to identify best practices for designing and implementing CDS, and to introduce two new quality measures, titled Reminder Performance (RP) and the Number Needed to Remind (NNR) for evaluating the effectiveness of clinical reminders in the context of the CDS Dashboards.
AHRQ-funded; 290200810010.
Citation: Einbinder J, Hebel E, Wright A .
The number needed to remind: a measure for assessing CDS effectiveness.
AMIA Annu Symp Proc 2014 Nov 14;2014:506-15..
Keywords: Decision Making, Clinical Decision Support (CDS), Quality Measures, Quality of Care
Kruger JF, Chen AH, Rybkin A
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
The authors examined outpatient clinician attitudes towards considering radiation exposure when ordering CT scans and clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry. They found that displaying clinically relevant radiation exposure information at order entry may improve clinician knowledge and inform patient-clinician discussions regarding risks and benefits of imaging.
AHRQ-funded; HS018090.
Citation: Kruger JF, Chen AH, Rybkin A .
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
BMJ Qual Saf 2014 Nov;23(11):893-901. doi: 10.1136/bmjqs-2013-002773.
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Keywords: Decision Making, Provider: Health Personnel, Imaging, Patient Safety, Practice Patterns
Ghomrawi HM, Alexiades M, Pavlov H
Evaluation of two appropriateness criteria for total knee replacement.
The researchers evaluated the performance of 2 sets of non-U.S. appropriateness criteria (one from Spain and the other from Canada) for total knee replacement (TKR) in a group of 508 TKR patients. Although only 4.7 percent were classified as inappropriate by both sets of criteria, there was little agreement between the two.
AHRQ-funded; HS016075
Citation: Ghomrawi HM, Alexiades M, Pavlov H .
Evaluation of two appropriateness criteria for total knee replacement.
Arthritis Care Res. 2014 Nov;66(11):1749-53. doi: 10.1002/acr.22390..
Keywords: Surgery, Arthritis, Decision Making
Lacson R, Prevedello LM, Andriole KP
Four-year impact of an alert notification system on closed-loop communication of critical test results.
The authors evaluated the impact of an alert notification system on policy adherence for communicating critical imaging test results to referring providers and assessed system adoption over the first 4 years after implementation. They concluded that an automated alert notification system for communicating critical imaging results was successfully adopted and was associated with increased adherence to institutional policy for communicating critical test results and with reduced workflow interruptions.
AHRQ-funded; HS019635.
Citation: Lacson R, Prevedello LM, Andriole KP .
Four-year impact of an alert notification system on closed-loop communication of critical test results.
AJR Am J Roentgenol 2014 Nov;203(5):933-8. doi: 10.2214/ajr.14.13064.
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Keywords: Communication, Decision Making, Guidelines, Health Information Technology (HIT), Imaging
Schlesinger M, Kanouse DE, Martino SC
Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior.
The authors identified four pathways through which complexity may impair consumer choice. They examined these pathways using data from an experiment in which consumers hypothetically selected a primary care physician. They found that some of the loss of decision quality accompanying more complex choice sets can be explained by consumers' skills and decision-making style, but even after accounting for these factors, complexity undermines the quality of decision making in ways that cannot be fully explained. They concluded by discussing implications for report designers, sponsors, and policy makers aspiring to promote consumer empowerment and health care quality.
AHRQ-funded; HS016978; HS016980.
Citation: Schlesinger M, Kanouse DE, Martino SC .
Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior.
Med Care Res Rev 2014 Oct;71(5 Suppl):38s-64s. doi: 10.1177/1077558713496321.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Decision Making, Quality of Care, Primary Care, Public Reporting
Damberg CL, McNamara P
Postscript: research agenda to guide the next generation of public reports for consumers.
The authors identified five areas for additional public reporting tools research that, if addressed, could foster better design and delivery of quality and cost information to consumers.
AHRQ-authored.
Citation: Damberg CL, McNamara P .
Postscript: research agenda to guide the next generation of public reports for consumers.
Med Care Res Rev 2014 Oct;71(5 Suppl):97s-107s. doi: 10.1177/1077558714535982.
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Keywords: Education: Patient and Caregiver, Decision Making, Quality of Care, Health Services Research (HSR), Public Reporting
Welch BM, Eilbeck K, Del Fiol G
Technical desiderata for the integration of genomic data with clinical decision support.
The objective of this study is to develop and validate a guiding set of technical desiderata for supporting the clinical use of the whole genome sequence (WGS) through clinical decision support (CDS). A panel of domain experts in genomics and CDS developed a proposed set of seven additional requirements. These additional desiderata provide important guiding principles for the technical development of CDS capabilities for the clinical use of WGS information.
AHRQ-funded; HS018352.
Citation: Welch BM, Eilbeck K, Del Fiol G .
Technical desiderata for the integration of genomic data with clinical decision support.
J Biomed Inform 2014 Oct;51:3-7. doi: 10.1016/j.jbi.2014.05.014..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Genetics, Electronic Health Records (EHRs), Decision Making
Eden KB, Perrin NA, Vesco KK
A randomized comparative trial of two decision tools for pregnant women with prior cesareans.
The authors evaluated tools to help pregnant women with prior cesareans make informed decisions about having trials of labor. They found that women in both groups felt more informed, were more clear about their birth priorities, felt more supported, and overall reported less conflict after receiving either intervention.
AHRQ-funded; HS011338; HS013959.
Citation: Eden KB, Perrin NA, Vesco KK .
A randomized comparative trial of two decision tools for pregnant women with prior cesareans.
J Obstet Gynecol Neonatal Nurs 2014 Sep-Oct;43(5):568-79. doi: 10.1111/1552-6909.12485.
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Keywords: Education: Patient and Caregiver, Decision Making, Labor and Delivery, Patient-Centered Outcomes Research
Simianu VV, Bastawrous AL, Farrokhi ET
Addressing the appropriateness of elective colon resection for diverticulitis: a report from the SCOAP CERTAIN collaborative.
The aim of this study was to assess the clinician-reported indications for elective colectomy and describe trends in the number of prior episodes of diverticulitis. It found an increase in the proportion of cases that met expert-established guidelines for appropriate surgery, but nearly 1 in 3 still do not meet established criteria.
AHRQ-funded; HS020025
Citation: Simianu VV, Bastawrous AL, Farrokhi ET .
Addressing the appropriateness of elective colon resection for diverticulitis: a report from the SCOAP CERTAIN collaborative.
Ann Surg. 2014 Sep;260(3):533-8; discussion 38-9. doi: 10.1097/sla.0000000000000894..
Keywords: Decision Making, Surgery, Evidence-Based Practice, Guidelines
Tang DH, Warholak TL, Hines LE
Evaluation of Pharmacy and Therapeutic (P&T) Committee member knowledge, attitudes and ability regarding the use of comparative effectiveness research (CER) in health care decision-making.
This study was conducted to evaluate changes in CER knowledge, attitudes, and ability among Pharmacy and Therapeutics (P&T) Committee members and support staff after attending a tailored educational program. It found that the CER educational program was effective in increasing participants’ CER knowledge and self-perceived ability to evaluate relevant evidence.
AHRQ-funded; HS019220.
Citation: Tang DH, Warholak TL, Hines LE .
Evaluation of Pharmacy and Therapeutic (P&T) Committee member knowledge, attitudes and ability regarding the use of comparative effectiveness research (CER) in health care decision-making.
Res Social Adm Pharm 2014 Sep-Oct;10(5):768-80. doi: 10.1016/j.sapharm.2013.11.008..
Keywords: Comparative Effectiveness, Decision Making, Evidence-Based Practice
Islam R, Weir C, Del Fiol G
Heuristics in managing complex clinical decision tasks in experts' decision making.
The authors sought to understand how clinicians manage complexity while dealing with complex clinical decision tasks. They found that experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes, and focusing on only the most relevant information.
AHRQ-funded; HS023349.
Citation: Islam R, Weir C, Del Fiol G .
Heuristics in managing complex clinical decision tasks in experts' decision making.
IEEE Int Conf Healthc Inform 2014 Sep;2014:186-93. doi: 10.1109/ichi.2014.32.
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Keywords: Clinical Decision Support (CDS), Decision Making, Patient Safety
Boehme AK, Rawal PV, Lyerly MJ
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
The researchers compared several scoring systems among patients receiving systemic and endovascular treatments. They concluded that their study demonstrated that although highly predictive of outcome in the original study design treatment groups, prediction scores may not generalize to all patient samples, highlighting the importance of validating prediction scores in diverse samples.
AHRQ-funded; HS013852.
Citation: Boehme AK, Rawal PV, Lyerly MJ .
Investigating the utility of previously developed prediction scores in acute ischemic stroke patients in the stroke belt.
J Stroke Cerebrovasc Dis 2014 Sep;23(8):2001-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.02.003.
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Keywords: Decision Making, Diagnostic Safety and Quality, Risk, Stroke
Salihu HM, Salemi JL, Nash MC
Assessing the economic impact of paternal involvement: a comparison of the generalized linear model versus decision analysis trees.
The authors illustrated a methodological comparison of decision analysis modeling and generalized linear modeling (GLM) techniques using a case study that assesses the cost-effectiveness of potential father involvement interventions. They found that lack of paternal involvement was associated with higher rates of preterm birth, small-for-gestational age, and infant morbidity and mortality, concluding that healthcare costs could be significantly reduced through enhanced father involvement during pregnancy.
AHRQ-funded; HS019997.
Citation: Salihu HM, Salemi JL, Nash MC .
Assessing the economic impact of paternal involvement: a comparison of the generalized linear model versus decision analysis trees.
Matern Child Health J 2014 Aug;18(6):1380-90. doi: 10.1007/s10995-013-1372-0.
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Keywords: Family Health and History, Newborns/Infants, Outcomes, Pregnancy, Case Study, Decision Making
Dahlke AR, Merkow RP, Chung JW
Comparison of postoperative complication risk prediction approaches based on factors known preoperatively to surgeons versus patients.
The objective of this paper was to compare three estimation models: (1) the All Information Model; (2) the Surgeon Assessment Model; and (3) the Patient-Entered Model. The investigators observed a small decline in model performance that they suggest may not be clinically meaningful. They concluded that the Surgeon Assessment and Patient-Entered models with fewer predictors can be used with relative confidence to predict a patient's risk.
AHRQ-funded; HS021857.
Citation: Dahlke AR, Merkow RP, Chung JW .
Comparison of postoperative complication risk prediction approaches based on factors known preoperatively to surgeons versus patients.
Surgery 2014 Jul;156(1):39-45. doi: 10.1016/j.surg.2014.03.002.
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Keywords: Adverse Events, Decision Making, Risk, Surgery
Barton JL, Trupin L, Tonner C
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
The objective of this study was to examine patterns of perceived communication around decision making in 2 cohorts of adults with rheumatoid arthritis (RA). The investigators found that nearly one-third of subjects reported suboptimal shared decision making communication (SDM) with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts.
AHRQ-funded; HS019209.
Citation: Barton JL, Trupin L, Tonner C .
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
J Rheumatol 2014 Jul;41(7):1290-7. doi: 10.3899/jrheum.131350..
Keywords: Arthritis, Clinician-Patient Communication, Communication, Decision Making, Health Literacy, Patient and Family Engagement
Barton JL, Trupin L, Tonner C
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
The objective of this study was to examine patterns of perceived communication around decision making in 2 cohorts of adults with rheumatoid arthritis (RA). The investigators found that nearly one-third of subjects reported suboptimal shared decision making communication (SDM) with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts.
AHRQ-funded; HS019209.
Citation: Barton JL, Trupin L, Tonner C .
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
J Rheumatol 2014 Jul;41(7):1290-7. doi: 10.3899/jrheum.131350..
Keywords: Arthritis, Clinician-Patient Communication, Communication, Decision Making, Health Literacy, Patient and Family Engagement
Kaplan RM
Patient-centered outcome assessment may lead to different conclusions and different treatment decisions.
Over the last few decades, the Agency for Healthcare Research and Quality (AHRQ), clinicians, policy makers, and patient advocates have demonstrated a growing interest in measuring patient-reported outcomes. Most illnesses are now evaluated in terms of their effects on usual life activities. This article discusses Patient-Centered Outcomes Research and the measurement of outcomes from the patient perspective.
AHRQ-authored.
Citation: Kaplan RM .
Patient-centered outcome assessment may lead to different conclusions and different treatment decisions.
American Journal of Accountable Care 2014 Jun 20;2(2):14-15..
Keywords: Decision Making, Patient-Centered Outcomes Research
Moore JE, Low LK, Titler MG
Moving toward patient-centered care: women's decisions, perceptions, and experiences of the induction of labor process.
The researchers identified factors that influence inductions from the perspective of women. They found that lack of informed decision making was cited as a barrier to optimal care; additional themes emerged from the preinduction and postinduction interviews.
AHRQ-authored.
Citation: Moore JE, Low LK, Titler MG .
Moving toward patient-centered care: women's decisions, perceptions, and experiences of the induction of labor process.
Birth 2014 Jun;41(2):138-46. doi: 10.1111/birt.12080.
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Keywords: Decision Making, Labor and Delivery, Patient-Centered Healthcare, Patient Experience, Pregnancy
Admon AJ, Cooke CR
Will Choosing Wisely(R) improve quality and lower costs of care for patients with critical illness?
This article reports on a campaign by the American Board of Internal Medicine to improve care and lower costs by generating a “top five” list of expensive tests or treatments without known benefits. It offers several strategies for stakeholders to increase the impact of the critical care top-five list.
AHRQ-funded; HS020672
Citation: Admon AJ, Cooke CR .
Will Choosing Wisely(R) improve quality and lower costs of care for patients with critical illness?
Ann Am Thorac Soc. 2014 Jun;11(5):823-7. doi: 10.1513/AnnalsATS.201403-093OI..
Keywords: Decision Making, Critical Care, Quality of Care, Healthcare Costs
Longo DR, Woolf HS
Rethinking the information priorities of patients.
Efforts have intensified to provide consumers with online data tools and consumer reports that offer profiles and statistics for evaluating specialists, hospitals, and other clinical facilities. In this article, the authors examine two key questions: what should these resources look like and do patients really want them?
AHRQ-funded; HS021902
Citation: Longo DR, Woolf HS .
Rethinking the information priorities of patients.
JAMA. 2014 May 14;311(18):1857-8. doi: 10.1001/jama.2014.3038..
Keywords: Education: Patient and Caregiver, Decision Making, Quality of Care, Health Information Technology (HIT), Web-Based
Del Fiol G, Workman TE, Gorman PN
Clinical questions raised by clinicians at the point of care: a systematic review.
The researchers conducted a systematic review of studies examining the questions that clinicians raise in the context of patient care decisionmaking. They concluded that clinicians frequently raise questions about patient care in their practice. Although they are effective at finding answers to questions they pursue, roughly half of the questions are never pursued.
AHRQ-funded; HS018352.
Citation: Del Fiol G, Workman TE, Gorman PN .
Clinical questions raised by clinicians at the point of care: a systematic review.
JAMA Intern Med. 2014 May;174(5):710-8. doi: 10.1001/jamainternmed.2014.368..
Keywords: Education: Patient and Caregiver, Decision Making, Health Information Exchange (HIE), Health Information Technology (HIT), Practice Patterns
