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
101 to 125 of 185 Research Studies DisplayedJuckett DA, Davis FN, Gostine M
Patient-reported outcomes in a large community-based pain medicine practice: evaluation for use in phenotype modeling.
The researchers aimed to build a phenotype-to-outcome model targeting chronic pain to be used to drive clinical decision support for pain medicine in the community setting. Exploratory factor analysis of the intake Pain Health Assessment revealed 15 orthogonal factors representing pain levels; physical, social, and emotional functions; the effects of pain on these functions; vitality and health; and measures of outcomes and satisfaction.
AHRQ-funded; HS022335.
Citation: Juckett DA, Davis FN, Gostine M .
Patient-reported outcomes in a large community-based pain medicine practice: evaluation for use in phenotype modeling.
BMC Med Inform Decis Mak 2015 May 28;15:41. doi: 10.1186/s12911-015-0164-4..
Keywords: Care Management, Chronic Conditions, Community-Based Practice, Electronic Health Records (EHRs), Health Information Technology (HIT), Outcomes, Pain
Amarasingham R, Velasco F, Xie B
Electronic medical record-based multicondition models to predict the risk of 30 day readmission or death among adult medicine patients: validation and comparison to existing models.
The purpose of this study was to evaluate the degree to which electronic medical record-based risk models for 30-day readmission or mortality accurately identify high risk patients and to compare these models with published claims-based models. The researchers found that a new electronic multicondition model based on information derived from the electronic medical record predicted mortality and readmission at 30 days, and was superior to previously published claims-based models
AHRQ-funded; HS022418.
Citation: Amarasingham R, Velasco F, Xie B .
Electronic medical record-based multicondition models to predict the risk of 30 day readmission or death among adult medicine patients: validation and comparison to existing models.
BMC Med Inform Decis Mak 2015 May 20;15:39. doi: 10.1186/s12911-015-0162-6.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Mortality, Hospital Readmissions, Risk
Rajamani S, Chen ES, Akre ME
Assessing the adequacy of the HL7/LOINC Document Ontology Role axis.
This study assessed the adequacy of the Role axis for representing the type of author documenting care. Experts used a master list of 220 values created from seven resources and established mapping guidelines. Baseline certification, licensure, and didactic training were identified as key parameters that define roles and hence often need to be pre-coordinated. Document Ontology (DO) was inadequate in representing 82 percent of roles, and this gap was primarily due to lack of granularity in DO.
AHRQ-funded; HS022085.
Citation: Rajamani S, Chen ES, Akre ME .
Assessing the adequacy of the HL7/LOINC Document Ontology Role axis.
J Am Med Inform Assoc 2015 May;22(3):615-20. doi: 10.1136/amiajnl-2014-003100..
Keywords: Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT)
Roch AM, Mehrabi S, Krishnan A
Automated pancreatic cyst screening using natural language processing: a new tool in the early detection of pancreatic cancer.
The purpose of this study was to implement an automated Natural Language Processing (NLP)-based pancreatic cyst identification system. It found that NLP is an effective tool to automatically identify patients with pancreatic cysts based on electronic medical records (EMR). This highly accurate system can help capture patients ‘at-risk’ of pancreatic cancer in a registry.
AHRQ-funded; HS019818.
Citation: Roch AM, Mehrabi S, Krishnan A .
Automated pancreatic cyst screening using natural language processing: a new tool in the early detection of pancreatic cancer.
HPB 2015 May;17(5):447-53. doi: 10.1111/hpb.12375..
Keywords: Cancer, Electronic Health Records (EHRs), Registries, Health Information Technology (HIT)
Baker DW, Liss DT, Alperovitz-Bichell K
Colorectal cancer screening rates at community health centers that use electronic health records: a cross sectional study.
This study sought to validate use of electronic health record (EHR) data for measuring colorectal cancer (CRC) screening rates at community health centers (CHCs). It found that at participating CHCs, CRC screening rates ranged from 9.7 percent to 67.2 percent and adherence to annual fecal occult blood tests ranged from 3.3 percent to 59.0 percent. Most screening was done by colonoscopy.
AHRQ-funded; HS021141.
Citation: Baker DW, Liss DT, Alperovitz-Bichell K .
Colorectal cancer screening rates at community health centers that use electronic health records: a cross sectional study.
J Health Care Poor Underserved 2015 May;26(2):377-90. doi: 10.1353/hpu.2015.0030..
Keywords: Screening, Electronic Health Records (EHRs), Community-Based Practice, Health Information Technology (HIT)
LaFleur J, Steenhoek CL, Horne J
Comparing fracture absolute risk assessment (FARA) tools: an osteoporosis clinical informatics tool to improve identification and care of men at high risk of first fracture.
The researchers compared 2 fracture absolute risk assessment (FARA) tools for use with electronic health records (EHRs) to determine which would more accurately identify patients known to be high risk for fracture. They found that absolute fracture risk estimation with the VA-FARA is more predictive of a first fracture than the WHO’s eFRAX in male veterans when used in an EHR-based population screening tool.
AHRQ-funded; HS018582.
Citation: LaFleur J, Steenhoek CL, Horne J .
Comparing fracture absolute risk assessment (FARA) tools: an osteoporosis clinical informatics tool to improve identification and care of men at high risk of first fracture.
Ann Pharmacother 2015 May;49(5):506-14. doi: 10.1177/1060028015572819..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Injuries and Wounds, Osteoporosis, Risk
Morton S, Shih SC, Winther CH
Health IT-enabled care coordination: A national survey of patient-centered medical home clinicians.
This study assessed the feasibility and acceptability of 6 proposed care coordination objectives for stage 3 of the Centers for Medicare and Medicaid Services electronic health record incentive program (Meaningful Use) related to referrals, notification of care from other facilities, patient clinical summaries, and patient dashboards. It found that the activity most frequently supported by health IT was providing clinical summaries to patients.
AHRQ-funded; HS022693.
Citation: Morton S, Shih SC, Winther CH .
Health IT-enabled care coordination: A national survey of patient-centered medical home clinicians.
Ann Fam Med 2015 May-Jun;13(3):250-6. doi: 10.1370/afm.1797..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Primary Care, Patient-Centered Healthcare
Ornstein SM, Nemeth LS, Nietert PJ
Learning from primary care meaningful use exemplars.
This report presents the results of a multimethod study combining an EHR-based clinical quality measurements (CQM) performance assessment, a provider survey, and focus groups among high CQM performers. It concluded that purposeful use of EHR functionality coupled with staff education in a milieu where Quality Improvement is valued and supported is associated with higher performance on CQM.
AHRQ-funded; HS022701; HS018984.
Citation: Ornstein SM, Nemeth LS, Nietert PJ .
Learning from primary care meaningful use exemplars.
J Am Board Fam Med 2015 May-Jun;28(3):360-70. doi: 10.3122/jabfm.2015.03.140219..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Quality Indicators (QIs), Quality of Care
Kuhn L, Reeves K, Taylor Y
Planning for action: the impact of an asthma action plan decision support tool integrated into an electronic health record (EHR) at a large health care system.
This project aimed to embed an electronic asthma action plan decision support tool (eAAP) into the medical record to streamline evidence-based guidelines for providers at the point of care, create individualized patient handouts, and evaluate effects on disease outcomes. Its findings supports existing evidence that patient self-management plays an important role in reducing asthma exacerbations.
AHRQ-funded; HS019946.
Citation: Kuhn L, Reeves K, Taylor Y .
Planning for action: the impact of an asthma action plan decision support tool integrated into an electronic health record (EHR) at a large health care system.
J Am Board Fam Med 2015 May-Jun;28(3):382-93. doi: 10.3122/jabfm.2015.03.140248..
Keywords: Electronic Health Records (EHRs), Clinical Decision Support (CDS), Asthma, Patient Self-Management, Evidence-Based Practice
Ash JS, Sittig DF, McMullen CK
Multiple perspectives on clinical decision support: a qualitative study of fifteen clinical and vendor organizations.
The purpose of this study was to discover how the views of clinical stakeholders, clinical decision support (CDS) content vendors, and EHR vendors are alike or different with respect to challenges in the development, management, and use of CDS. The groups share views on the importance of appropriate manpower, careful knowledge management, CDS that fits user workflow, and the need for communication among the groups.
AHRQ-funded; 290200810010.
Citation: Ash JS, Sittig DF, McMullen CK .
Multiple perspectives on clinical decision support: a qualitative study of fifteen clinical and vendor organizations.
BMC Med Inform Decis Mak 2015 Apr 24;15:35. doi: 10.1186/s12911-015-0156-4..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT)
Yuan CT, Bradley EH, Nembhard IM
A mixed methods study of how clinician 'super users' influence others during the implementation of electronic health records.
The researchers present the results of a comparative case study in which they sought to identify the mechanisms of super users’ influence on implementation success and examine the impact of a core contextual factor: how super users are selected. They found that super users on both medical units in a large hospital were more proactive, provided more comprehensive explanations for their actions, used positive framing, and shared information.
AHRQ-funded; HS018987; HS022201; HS017589.
Citation: Yuan CT, Bradley EH, Nembhard IM .
A mixed methods study of how clinician 'super users' influence others during the implementation of electronic health records.
BMC Med Inform Decis Mak 2015 Apr 10;15:26. doi: 10.1186/s12911-015-0154-6..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals
Fuji KT, Abbott AA, Galt KA
A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record.
The authors explored how patients with type 2 diabetes used a personal health record (PHR) to manage their diabetes-related health information for self-care. They found that, despite some potential positive benefits resulting from PHR use, several barriers inhibited sustained and effective use over time. They concluded that provider and patient education about the benefits of PHR use and about the potential for filling in information gaps in the provider-based record is key to engage patients and stimulate PHR adoption and use.
AHRQ-funded; HS018625.
Citation: Fuji KT, Abbott AA, Galt KA .
A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record.
Telemed J E Health 2015 Apr;21(4):296-300. doi: 10.1089/tmj.2014.0084.
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Keywords: Diabetes, Electronic Health Records (EHRs), Patient Self-Management, Telehealth
Fiks AG, Zhang P, Localio AR
Adoption of electronic medical record-based decision support for otitis media in children.
The authors characterized adoption of an otitis media clinical decision support (CDS) system, the impact of performance feedback on adoption, and the effects of adoption on guideline adherence. The performance feedback increased CDS adoption, but additional strategies are needed to integrate CDS into primary care workflows.
AHRQ-funded; HS017042
Citation: Fiks AG, Zhang P, Localio AR .
Adoption of electronic medical record-based decision support for otitis media in children.
Health Serv Res. 2015 Apr;50(2):489-513. doi: 10.1111/1475-6773.12240..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Ear Infections, Electronic Health Records (EHRs), Health Information Technology (HIT)
Mehrabi S, Krishnan A, Sohn S
DEEPEN: A negation detection system for clinical text incorporating dependency relation into NegEx.
The researchers developed a negation algorithm called DEEPEN to decrease NegEx’s false positives by taking into account the dependency relationship between negation words and concepts within a sentence using Stanford dependency parser. The evaluation results demonstrate DEEPEN, which incorporates dependency parsing into NegEx, can reduce the number of incorrect negation assignment for patients with positive findings.
AHRQ-funded; HS019818.
Citation: Mehrabi S, Krishnan A, Sohn S .
DEEPEN: A negation detection system for clinical text incorporating dependency relation into NegEx.
J Biomed Inform 2015 Apr;54:213-9. doi: 10.1016/j.jbi.2015.02.010..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Education: Patient and Caregiver
Fiks AG, Mayne SL, Karavite DJ
Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT.
This study evaluated the feasibility, acceptability, and impact of MyAsthma, an EHR-linked patient portal supporting shared decision-making for pediatric asthma. It found that parents of children with moderate to severe persistent asthma used the portal more than others; 92 percent were satisfied with MyAsthma. Parents reported that use improved their communication with the office, ability to manage asthma, and awareness of the importance of ongoing attention to treatment.
AHRQ-funded; HS021645.
Citation: Fiks AG, Mayne SL, Karavite DJ .
Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT.
Pediatrics 2015 Apr;135(4):e965-73. doi: 10.1542/peds.2014-3167..
Keywords: Asthma, Children/Adolescents, Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT)
Brennan PF, Valdez R, Alexander G
Patient-centered care, collaboration, communication, and coordination: a report from AMIA's 2013 Policy Meeting.
AMIA’s 2013 Health Policy Invitational was focused on examining existing challenges surrounding full engagement of the patient and crafting a research agenda and policy framework encouraging the use of informatics solutions to achieve this goal. This paper summarizes the meeting as well as the research agenda and policy recommendations prioritized among the invited experts and stakeholders.
AHRQ-funded; HS021825.
Citation: Brennan PF, Valdez R, Alexander G .
Patient-centered care, collaboration, communication, and coordination: a report from AMIA's 2013 Policy Meeting.
J Am Med Inform Assoc 2015 Apr;22(e1):e2-6. doi: 10.1136/amiajnl-2014-003176..
Keywords: Care Coordination, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Healthcare, Policy
Callen J, Giardina TD, Singh H
Emergency physicians' views of direct notification of laboratory and radiology results to patients using the Internet: a multisite survey.
The authors explored emergency physicians' current practices of test result notification and attitudes to direct patient notification of clinically significant abnormal and normal test results. They found that more than half of the emergency physicians were uncomfortable with patients receiving direct notification of normal or abnormal test results. Main concerns were that patients could be anxious, confused, and lacking in the necessary expertise to interpret their results.
AHRQ-funded; HS022087.
Citation: Callen J, Giardina TD, Singh H .
Emergency physicians' views of direct notification of laboratory and radiology results to patients using the Internet: a multisite survey.
J Med Internet Res 2015 Mar 4;17(3):e60. doi: 10.2196/jmir.3721.
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Keywords: Communication, Electronic Health Records (EHRs), Emergency Medical Services (EMS), Provider: Health Personnel, Web-Based
Bishop TF, Ryan MS, McCullough CM
Do provider attitudes about electronic health records predict future electronic health record use?
The authors studied whether comfort with technology and more positive attitudes about EHRs affect use of EHR functions once they are adopted. They found that comfort with computers and attitudes about EHRs did not predict future use of the EHR functions, suggesting that meaningful use of the EHR may not be affected by providers' prior attitudes about EHRs.
AHRQ-funded; HS018546.
Citation: Bishop TF, Ryan MS, McCullough CM .
Do provider attitudes about electronic health records predict future electronic health record use?
Healthc (Amst) 2015 Mar;3(1):5-11. doi: 10.1016/j.hjdsi.2014.04.002.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Primary Care
Kern LM, Edwards AM, Pichardo M
Electronic health records and health care quality over time in a federally qualified health center.
The researchers sought to determine the association between EHRs and quality of care in a large Federally Qualified Health Center (FQHC), during the 3 years following EHR implementation. They found that the magnitude of absolute improvement ranged from 5 percent to 20 percent per measure. EHRs were associated with continuing improvement in health care quality for at least 3 years post-implementation in the safety-net setting of a FQHC.
AHRQ-funded; HS017067.
Citation: Kern LM, Edwards AM, Pichardo M .
Electronic health records and health care quality over time in a federally qualified health center.
J Am Med Inform Assoc 2015 Mar;22(2):453-8. doi: 10.1093/jamia/ocu049..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care
Tannenbaum D, Doctor JN, Persell SD
Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.
The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. It found that provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise.
AHRQ-funded; RC4 AG039115 (NIA/AHRQ).
Citation: Tannenbaum D, Doctor JN, Persell SD .
Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.
J Gen Intern Med 2015 Mar;30(3):298-304. doi: 10.1007/s11606-014-3051-2..
Keywords: Electronic Health Records (EHRs), Primary Care, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication
Neff JM, Clifton H, Popalisky J
Stratification of children by medical complexity.
The investigators stratified children using the software, Clinical Risk Groups (CRGs), in a tertiary children's hospital and a state's Medicaid claims data into 3 condition groups: complex chronic disease; noncomplex chronic disease, and nonchronic disease. They concluded that CRGs can be used to stratify children receiving care at a tertiary care hospital according to complexity in both hospital and Medicaid administrative data.
AHRQ-funded; HS020506.
Citation: Neff JM, Clifton H, Popalisky J .
Stratification of children by medical complexity.
Acad Pediatr 2015 Mar-Apr;15(2):191-6. doi: 10.1016/j.acap.2014.10.007.
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Keywords: Children/Adolescents, Chronic Conditions, Data, Electronic Health Records (EHRs), Children/Adolescents
Jones JB, Weiner JP, Shah NR
The wired patient: patterns of electronic patient portal use among patients with cardiac disease or diabetes.
The researchers described the types and patterns of portal users in an integrated delivery system. They found naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features.
AHRQ-funded; HS016228.
Citation: Jones JB, Weiner JP, Shah NR .
The wired patient: patterns of electronic patient portal use among patients with cardiac disease or diabetes.
J Med Internet Res 2015 Feb 20;17(2):e42. doi: 10.2196/jmir.3157..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Primary Care, Healthcare Delivery, Chronic Conditions
Hosomura N, Goldberg SI, Shubina M
Electronic documentation of lifestyle counseling and glycemic control in patients with diabetes.
The aim of this study was to establish quantitative characteristics of documentation of lifestyle counseling that are associated with improved glycemic control in patients with diabetes, using a previously validated natural language processing system that enables abstraction of lifestyle counseling documentation from narrative electronic provider notes. It identified novel quantitative characteristics of electronic documentation of lifestyle counseling that are associated with improved glycemic control in patients with diabetes.
AHRQ-funded; HS017030.
Citation: Hosomura N, Goldberg SI, Shubina M .
Electronic documentation of lifestyle counseling and glycemic control in patients with diabetes.
Diabetes Care 2015 Jul;38(7):1326-32. doi: 10.2337/dc14-2016..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Lifestyle Changes
Unni S, Yao Y, Milne N
An evaluation of clinical risk factors for estimating fracture risk in postmenopausal osteoporosis using an electronic medical record database.
The researchers sought to identify variables in an EMR database for calculating fracture risk Assessment (FRAX) score in a cohort of postmenopausal women, to estimate absolute fracture risk. They found that mean 10-year risk for any major fracture was 11.1 percent when bone mineral density (BMD) was used and 11.2 percent when BMI was used.
AHRQ-funded; HS0018582.
Citation: Unni S, Yao Y, Milne N .
An evaluation of clinical risk factors for estimating fracture risk in postmenopausal osteoporosis using an electronic medical record database.
Osteoporos Int 2015 Feb;26(2):581-7. doi: 10.1007/s00198-014-2899-7..
Keywords: Electronic Health Records (EHRs), Injuries and Wounds, Risk, Osteoporosis, Health Information Technology (HIT)
Dingfield L, Bender L, Harris P
Comparison of pediatric and adult hospice patients using electronic medical record data from nine hospices in the United States, 2008-2012.
The researchers aimed to assess differences between pediatric and adult hospice patients regarding patient characteristics and outcomes. They found that pediatric patients were less likely to have an admitting diagnosis of cancer and less likely to use oxygen at enrollment but were more likely to have an enteral feeding tube. Also, pediatric patients were half as likely as adults to have a do-not-resuscitate order upon hospice enrollment.
AHRQ-funded; HS018425; HS021780.
Citation: Dingfield L, Bender L, Harris P .
Comparison of pediatric and adult hospice patients using electronic medical record data from nine hospices in the United States, 2008-2012.
J Palliat Med 2015 Feb;18(2):120-6. doi: 10.1089/jpm.2014.0195..
Keywords: Cancer, Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT)