National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Ambulatory Care and Surgery (2)
- Antibiotics (1)
- Behavioral Health (4)
- Cancer (1)
- Cardiovascular Conditions (1)
- Care Management (2)
- Case Study (2)
- Children/Adolescents (3)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- Community-Based Practice (3)
- Decision Making (3)
- Depression (1)
- Electronic Health Records (EHRs) (1)
- Emergency Department (1)
- Evidence-Based Practice (1)
- Healthcare Delivery (6)
- Health Information Technology (HIT) (3)
- Health Systems (2)
- Heart Disease and Health (1)
- Implementation (3)
- Learning Health Systems (1)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (1)
- Organizational Change (4)
- Patient-Centered Healthcare (12)
- Patient and Family Engagement (1)
- Patient Experience (2)
- Patient Safety (2)
- Policy (1)
- Practice-Based Research Network (PBRN) (1)
- Practice Improvement (2)
- Practice Patterns (1)
- Primary Care (15)
- (-) Primary Care: Models of Care (23)
- Provider (1)
- Provider: Clinician (1)
- Provider: Nurse (1)
- Provider: Pharmacist (1)
- Provider: Physician (1)
- Quality Improvement (1)
- Quality of Care (3)
- Screening (1)
- Substance Abuse (1)
- System Design (1)
- Teams (2)
- Training (1)
- Women (1)
- Workflow (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 23 of 23 Research Studies DisplayedDodd JH, Hall TA, Guilliams K
Optimizing neurocritical care follow-up through the integration of neuropsychology.
The authors proposed that integration of neuropsychology into neurocritical care follow-up provides incremental benefit to the identification and treatment of persisting complications and reduction in co-morbidities. Studying sixteen patients over six months, they found that integration of neuropsychology into follow-up care resulted in recommendations being made for services or concerns not already addressed. Parents reported high satisfaction, indicating that neuropsychological consultation improved their understanding and communication with their child, aiding them in knowing what to expect from their child during post-acute recovery. The authors conclude that these results indicate that integration of neuropsychology into neurocritical care follow-up programs contributes not only to parent satisfaction, but may provide incremental benefits to patient care.
AHRQ-funded; HS022981.
Citation: Dodd JH, Hall TA, Guilliams K .
Optimizing neurocritical care follow-up through the integration of neuropsychology.
Pediatr Neurol 2018 Dec;89:58-62. doi: 10.1016/j.pediatrneurol.2018.09.007..
Keywords: Children/Adolescents, Chronic Conditions, Patient-Centered Healthcare, Primary Care: Models of Care
Misra-Hebert AD, Perzynski A, Rothberg MB
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
This mixed-methods comparative case study examined the implementation of team-based primary care models in a large integrated health system. Field observations of 9 practices were conducted along with 75 interviews and provider and staff surveys. The 9 practices were categorized into 3 groups: high, partial, and low update of the new models. Ability of the practices to implement the new team-based model depended on their ability to adapt to change and to adapt team roles in workflow.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Perzynski A, Rothberg MB .
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
J Gen Intern Med 2018 Nov;33(11):1928-36. doi: 10.1007/s11606-018-4611-7..
Keywords: Case Study, Health Systems, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Harrison MI, Grantham S
AHRQ Author: Harrison MI
Learning from implementation setbacks: identifying and responding to contextual challenges.
The authors addressed organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. They found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics; however, team redesign was leading to improvements in chronic care and prevention and eased provider burden. Redesign and system leaders engaged in more thorough organizational learning. Their responses to challenges helped to strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health.
AHRQ-authored; AHRQ-funded; 2902010000341.
Citation: Harrison MI, Grantham S .
Learning from implementation setbacks: identifying and responding to contextual challenges.
Learn Health Syst 2018 Oct;2(4):e10068. doi: 10.1002/lrh2.10068..
Keywords: Organizational Change, Learning Health Systems, Health Systems, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Implementation
Fraze TK, Fisher ES, Tomaino MR
Comparison of populations served in hospital service areas with and without comprehensive primary care plus medical homes.
The purpose of this comparative cross sectional study was to describe practices that joined the Comprehensive Primary Care Plus (CPC+) model and compare hospital service areas with and without CPC+ practices. The authors concluded that according to this study, although a diverse set of practices joined the CPC+ program, practices in areas characterized by patient populations with greater advantage were more likely to join, which may affect access to advanced primary care medical home models such as CPC+, by vulnerable populations.
AHRQ-funded; HS024075.
Citation: Fraze TK, Fisher ES, Tomaino MR .
Comparison of populations served in hospital service areas with and without comprehensive primary care plus medical homes.
JAMA Netw Open 2018 Sep 7;1(5):e182169. doi: 10.1001/jamanetworkopen.2018.2169..
Keywords: Primary Care, Patient-Centered Healthcare, Primary Care: Models of Care, Healthcare Delivery, Access to Care
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Yonek JC, Jordan N, Dunlop D
Patient-centered medical home care for adolescents in need of mental health treatment.
The patient-centered medical home (PCMH) has emerged as an optimal primary care model for all youth; however, little is known about the extent to which adolescents in need of mental health (MH) treatment receive care consistent with the PCMH. This study assessed (1) 10-year trends in PCMH care among U.S. adolescents according to MH need and (2) variations in PCMH care and its subcomponents among adolescents with MH need, by individual and family characteristics.
AHRQ-funded; HS024183.
Citation: Yonek JC, Jordan N, Dunlop D .
Patient-centered medical home care for adolescents in need of mental health treatment.
J Adolesc Health 2018 Aug;63(2):172-80. doi: 10.1016/j.jadohealth.2018.02.006..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Behavioral Health, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care
Reed JE, Kaplan HC, Ismail SA
A new typology for understanding context: qualitative exploration of the model for understanding success in quality (MUSIQ).
The objective of this study was to advance understanding of the complex and dynamic interaction between context, intervention, and implementation strategies. Using the Model for Understanding Success in Quality (MUSIQ), the authors aimed to better understand the roles of, and inter-relationships between, contextual factors within quality improvement and implementation initiatives.
AHRQ-funded; HS021114.
Citation: Reed JE, Kaplan HC, Ismail SA .
A new typology for understanding context: qualitative exploration of the model for understanding success in quality (MUSIQ).
BMC Health Serv Res 2018 Jul 25;18(1):584. doi: 10.1186/s12913-018-3348-7..
Keywords: Quality of Care, Quality Improvement, Primary Care: Models of Care
Aysola J, Schapira MM, Huo H
Organizational processes and patient experiences in the patient-centered medical home.
The objective of this study was to examine associations between organizational processes that practices adopt to become patient-centered medical home (PCMH) and patient experiences with care. The researchers concluded that although some organizational processes related to patients' experiences with care irrespective of the background of the patient, further efforts are needed to align practice efforts with patient experience.
AHRQ-funded; HS021706.
Citation: Aysola J, Schapira MM, Huo H .
Organizational processes and patient experiences in the patient-centered medical home.
Med Care 2018 Jun;56(6):497-504. doi: 10.1097/mlr.0000000000000910.
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Keywords: Patient-Centered Healthcare, Patient Experience, Primary Care: Models of Care, Primary Care
Keller SC, Tamma PD, Cosgrove SE
AHRQ Author: Miller MA
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
The authors conducted a systematic review to identify controlled interventions and qualitative studies of ambulatory antibiotic stewardship (AS) interventions and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. They concluded that studies have not focused on clinic-wide approaches to AS.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Tamma PD, Cosgrove SE .
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
J Am Board Fam Med 2018 May-Jun;31(3):417-30. doi: 10.3122/jabfm.2018.03.170225.
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Keywords: Antibiotics, Clinical Decision Support (CDS), Primary Care: Models of Care, Ambulatory Care and Surgery, Patient Safety
Vankipuram A, Traub S, Patel VL
A method for the analysis and visualization of clinical workflow in dynamic environments.
The authors present a cohesive framework that combines a set of analytic techniques that can potentially complement traditional human observations to derive a deeper understanding of clinical workflow. Their framework is divided into three modules: (i) transformation, (ii) analysis, and (iii) visualization. They describe the methods used in each of these modules, and provide a series of visualizations developed using location-tracking data collected at the Mayo Clinic ED.
AHRQ-funded; HS022670.
Citation: Vankipuram A, Traub S, Patel VL .
A method for the analysis and visualization of clinical workflow in dynamic environments.
J Biomed Inform 2018 Mar;79:20-31. doi: 10.1016/j.jbi.2018.01.007.
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Keywords: Emergency Department, Health Information Technology (HIT), Health Information Technology (HIT), Primary Care: Models of Care, Workflow
Aalsma MC, Zerr AM, Etter DJ
Physician intervention to positive depression screens among adolescents in primary care.
The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. The investigators found that when a computer-based decision support system algorithm focused on adolescent depression and was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.
AHRQ-funded; HS022681.
Citation: Aalsma MC, Zerr AM, Etter DJ .
Physician intervention to positive depression screens among adolescents in primary care.
J Adolesc Health 2018 Feb;62(2):212-18. doi: 10.1016/j.jadohealth.2017.08.023..
Keywords: Care Management, Children/Adolescents, Decision Making, Depression, Health Information Technology (HIT), Behavioral Health, Primary Care, Primary Care: Models of Care, Screening
Ashok M, Hung D, Rojas-Smith L
AHRQ Author: Harrison M
Framework for research on implementation of process redesigns.
Complex system interventions benefit from close attention to factors affecting implementation and resultant outcomes. This article describes a framework for examining these factors in process redesign (PR) and for assessing PR outcomes. The authors concluded that their PR framework helped guide the qualitative study and aided researchers in informing their leadership about critical issues affecting PR implementation.
AHRQ-authored; AHRQ-funded; 290200710056I; 2902010000221.
Citation: Ashok M, Hung D, Rojas-Smith L .
Framework for research on implementation of process redesigns.
Qual Manag Health Care 2018 Jan/Mar;27(1):17-23. doi: 10.1097/qmh.0000000000000158.
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Keywords: Implementation, Primary Care: Models of Care, Primary Care, System Design
Kuo YF, Adhikari D, Eke CG
Processes and outcomes of congestive heart failure care by different types of primary care models.
This study compared treatment of congestive heart failure (CHF) with primary care physicians (PCPs), nurse practitioners (NPs), or shared with PCPs and NPs. The rate of emergency room (ER) visits and hospitalizations along with Medicare spending was tracked although most patients (73%) were treated by PCPs. Patients under the shared care model had a higher rate of ER visits and hospitalizations than the PCP model.
AHRQ-funded; HS020642; HS022134.
Citation: Kuo YF, Adhikari D, Eke CG .
Processes and outcomes of congestive heart failure care by different types of primary care models.
J Card Fail 2018 Jan;24(1):9-18. doi: 10.1016/j.cardfail.2017.08.459..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Primary Care, Primary Care: Models of Care
Campbell-Voytal K, Daly JM, Nagykaldi ZJ
Team science approach to developing consensus on research good practices for practice-based research networks: A case study.
Using peer learning strategies, seven experienced practice-based research networks (PBRNs) working in collaborative teams articulated procedures for PBRN Research Good Practices (PRGPs). The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. This paper describes the team science processes which culminated in the PRGPs.
AHRQ-funded; HS016713; HS019601.
Citation: Campbell-Voytal K, Daly JM, Nagykaldi ZJ .
Team science approach to developing consensus on research good practices for practice-based research networks: A case study.
Clin Transl Sci 2015 Dec;8(6):632-7. doi: 10.1111/cts.12363.
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Keywords: Primary Care: Models of Care, Practice-Based Research Network (PBRN), Primary Care, Teams, Implementation
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
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
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, Decision Making, Evidence-Based Practice, Primary Care: Models of Care, Practice Patterns
Senathirajah Y
Safer design - composable EHRs and mechanisms for safety.
In this paper, the author discussed how the different drag/drop interaction paradigm has implications for health IT safety via several mechanisms. These mechanisms included display fragmentation and the need to changeably prioritize information elements, interruptions, fit to tasks and contexts, and rapid changeability allowing low-cost readjustments when lack of fit is found.
AHRQ-funded; HS023708.
Citation: Senathirajah Y .
Safer design - composable EHRs and mechanisms for safety.
Stud Health Technol Inform 2015;218:40602.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Primary Care: Models of Care, Patient Safety
Moore JE, Titler MG, Kane Low L
AHRQ Author: Moore JE
Transforming patient-centered care: development of the evidence informed decision making through engagement model.
The purpose of this article is to set forth a new patient-centered implementation model informed by a qualitative study that explored women’s decisions, perceptions, and experiences of elective induction of labor. Through a process of theory evaluation and development, the authors explore patient-centered concepts (patient activation and shared decision making) within an implementation model by mapping qualitative data from an elective induction of labor study to assess the model’s ability to capture these key concepts.
AHRQ-authored.
Citation: Moore JE, Titler MG, Kane Low L .
Transforming patient-centered care: development of the evidence informed decision making through engagement model.
Womens Health Issues 2015 May-Jun;25(3):276-82. doi: 10.1016/j.whi.2015.02.002..
Keywords: Decision Making, Patient and Family Engagement, Patient-Centered Healthcare, Primary Care: Models of Care, Women
Snyder ME, Earl TR, Gilchrist S
Collaborative drug therapy management: case studies of three community-based models of care.
The objectives of this study were to understand how collaborative drug therapy management (CDTM) practices were implemented in 3 community settings and to identify common and unique facilitators and barriers to implementing CDTM. The authors believe that the models described in this study could be used to strengthen clinical–community linkages through team-based care, particularly for chronic disease prevention and management.
AHRQ-funded; HS022119.
Citation: Snyder ME, Earl TR, Gilchrist S .
Collaborative drug therapy management: case studies of three community-based models of care.
Prev Chronic Dis 2015 Mar 26;12:E39. doi: 10.5888/pcd12.140504..
Keywords: Care Management, Case Study, Community-Based Practice, Medication, Primary Care: Models of Care, Provider: Pharmacist
Solberg LI, Crain AL, Tillema JO
Challenges of medical home transformation reported by 118 patient-centered medical home (PCMH) leaders.
The authors surveyed newly-certified medical homes in Minnesota to determine the most important organizational factors and strategies for transforming primary clinics into patient-centered medical homes (PCMHs). They found that many items in the survey about transformation seem to have face validity for leaders of certified PCMHs and to be associated with the extent to which their clinics have made systems changes.
AHRQ-funded; HS019161.
Citation: Solberg LI, Crain AL, Tillema JO .
Challenges of medical home transformation reported by 118 patient-centered medical home (PCMH) leaders.
J Am Board Fam Med 2014 Jul-Aug;27(4):449-57. doi: 10.3122/jabfm.2014.04.130303.
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Keywords: Patient-Centered Healthcare, Practice Improvement, Primary Care: Models of Care, Primary Care, Organizational Change, Quality of Care
Wexler RK
Invited letter: the evolving model of health care in the United States: system change is not enough.
In this letter, the author argues that the spread of new health care delivery models such as the Patient-Centered Medical Home and Accountable Care Organizations are necessary to improve population health but do not fully address the need for a fundamental change in how patients think about and access care. He calls for raising patient awareness of how the health care delivery system works and draws attention to practitioners’ concerns about patient satisfaction as a definitive marker of quality.
AHRQ-funded; HS020693
Citation: Wexler RK .
Invited letter: the evolving model of health care in the United States: system change is not enough.
Adv Health Care Manag. 2014;16:173-6..
Keywords: Access to Care, Healthcare Delivery, Patient-Centered Healthcare, Patient Experience, Primary Care, Primary Care: Models of Care
Bleser WK, Miller-Day M, Naughton D
Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home.
In this paper the authors describe strategies for obtaining organizational buy-in to and whole-staff engagement of patient-centered medical home (PCMH) transformation and practice improvement. The investigators suggest that their study provides a list of strategies useful for facilitating PCMH transformation in primary care. They assert that these strategies could be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers.
AHRQ-funded; HS019150.
Citation: Bleser WK, Miller-Day M, Naughton D .
Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home.
Ann Fam Med 2014 Jan-Feb;12(1):37-45. doi: 10.1370/afm.1564..
Keywords: Patient-Centered Healthcare, Organizational Change, Primary Care: Models of Care, Primary Care, Practice Improvement, Provider: Nurse, Provider: Physician, Provider: Clinician, Provider