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
26 to 50 of 125 Research Studies DisplayedLapham GT, Rubinsky AD, Shortreed SM
Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients.
This study sought to determine if differences in how brief intervention (BI) was implemented across health systems could lead to differences in the proportion of documented BI recalled and reported by patients across health systems. It found that the association between documented BI and patient-reported BI did not vary across VA networks in adjusted logistic regression models.
AHRQ-funded; HS022800.
Citation: Lapham GT, Rubinsky AD, Shortreed SM .
Comparison of provider-documented and patient-reported brief intervention for unhealthy alcohol use in VA outpatients.
Drug Alcohol Depend 2015 Aug 1;153:159-66. doi: 10.1016/j.drugalcdep.2015.05.027..
Keywords: Alcohol Use, Electronic Health Records (EHRs), Health Information Technology (HIT), Substance Abuse
Baer HJ, Wee CC, DeVito K
Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.
The researchers described the design of a trial to examine the effectiveness of electronic health record-based tools for the assessment and management of overweight and obesity among adult primary care patients, as well as the challenges encountered. New features included reminders to measure height and weight, and an alert asking providers to add overweight or obesity to the problem list.
AHRQ-funded; HS019789.
Citation: Baer HJ, Wee CC, DeVito K .
Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.
Clin Trials 2015 Aug;12(4):374-83. doi: 10.1177/1740774515578132..
Keywords: Health Information Technology (HIT), Primary Care, Obesity, Electronic Health Records (EHRs), Clinician-Patient Communication
Carayon P, Wetterneck TB, Alyousef B
Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit.
This study assessed the impact of EHR technology on the work and workflow of ICU physicians and compared time spent by ICU resident and attending physicians on various tasks before and after EHR implementation. It found that after EHR implementation, both residents and attending physicians spent more of their time on clinical review and documentation (40 percent and 55 percent increases, respectively).
AHRQ-funded; HS000083; HS015274.
Citation: Carayon P, Wetterneck TB, Alyousef B .
Impact of electronic health record technology on the work and workflow of physicians in the intensive care unit.
Int J Med Inform 2015 Aug;84(8):578-94. doi: 10.1016/j.ijmedinf.2015.04.002..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU)
Grundmeier RW, Song L, Ramos MJ
Imputing missing race/ethnicity in pediatric electronic health records: Reducing bias with use of U.S. census location and surname data.
The researchers assessed the utility of imputing race/ethnicity using U.S. Census race/ethnicity, residential address, and surname information compared to standard missing data methods in a pediatric cohort. In a simulation experiment, they constructed dichotomous and continuous outcomes with pre-specified associations with known race/ethnicity. They found that imputation using U.S. Census information reduced bias for both continuous and dichotomous outcomes.
AHRQ-funded; HS021645.
Citation: Grundmeier RW, Song L, Ramos MJ .
Imputing missing race/ethnicity in pediatric electronic health records: Reducing bias with use of U.S. census location and surname data.
Health Serv Res 2015 Aug;50(4):946-60. doi: 10.1111/1475-6773.12295..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Children/Adolescents, Racial and Ethnic Minorities
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
Ancker JS, Brenner S, Richardson JE
Trends in public perceptions of electronic health records during early years of meaningful use.
To track consumer perceptions of EHRs during this period, the researchers conducted a national telephone survey annually for 3 consecutive years, from 2011 to 2013, corresponding with the early years of Meaningful Use. They concluded that during the early years of the MU program, exposure to EHRs increased while confidence in the benefits of EHRs and concerns about privacy risks became less marked.
AHRQ-funded; HS021531.
Citation: Ancker JS, Brenner S, Richardson JE .
Trends in public perceptions of electronic health records during early years of meaningful use.
Am J Manag Care 2015 Aug;21(8):e487-93..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Education: Patient and Caregiver
Lyles C, Schillinger D, Sarkar U
Connecting the dots: health information technology expansion and health disparities.
The authors argue that early evidence links EHR and portal use to better healthcare processes and health outcomes. Promoting patient engagement with health technology such as portals is challenging, and rapid expansion of portals could exacerbate existing healthcare disparities if only well-resourced individuals use these websites.
AHRQ-funded; HS023558; HS022408; HS022047.
Citation: Lyles C, Schillinger D, Sarkar U .
Connecting the dots: health information technology expansion and health disparities.
PLoS Med 2015 Jul 14;12(7):e1001852. doi: 10.1371/journal.pmed.1001852..
Keywords: Disparities, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient and Family Engagement, Web-Based
Abbott AA, Fuji KT, Galt KA
A qualitative case study exploring nurse engagement with electronic health records and e-prescribing.
The purpose of this qualitative case study was to describe how nurses adapt to using an electronic health record with electronic prescribing (e-Rx) system in a rural ambulatory care practice. Findings showed that nurses adjust their routine in response to providers' preferential behavior yet retained focus on the patient and care coordination. e-Rx adoption increased workload and introduced safety risks.
AHRQ-funded; HS018625.
Citation: Abbott AA, Fuji KT, Galt KA .
A qualitative case study exploring nurse engagement with electronic health records and e-prescribing.
West J Nurs Res 2015 Jul;37(7):935-51. doi: 10.1177/0193945914567359.
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Keywords: Case Study, Electronic Health Records (EHRs), Electronic Prescribing (E-Prescribing), Nursing, Patient Safety
Kim KK, Joseph JG, Ohno-Machado L
Comparison of consumers' views on electronic data sharing for healthcare and research.
The researchers surveyed California consumers to learn their views of privacy, security, and consent in electronic data sharing for healthcare and research together. They found considerable concern that health information exchanges will worsen privacy (40.3 percent) and security (42.5 percent). Consumers are in favor of electronic data sharing but elements of transparency are important: individual control, who has access, and the purpose for use of data.
AHRQ-funded; HS019913.
Citation: Kim KK, Joseph JG, Ohno-Machado L .
Comparison of consumers' views on electronic data sharing for healthcare and research.
J Am Med Inform Assoc 2015 Jul;22(4):821-30. doi: 10.1093/jamia/ocv014..
Keywords: Communication, Data, Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Patient-Centered Healthcare
Carrington JM, Gephart SM, Verran JA
Development of an instrument to measure the unintended consequences of EHRs.
The authors examined the creation and design of an instrument measuring unintended consequences of electronic health records. They suggested that other researchers will find their methods article informative for similar undertakings.
AHRQ-funded; HS022908.
Citation: Carrington JM, Gephart SM, Verran JA .
Development of an instrument to measure the unintended consequences of EHRs.
West J Nurs Res 2015 Jul;37(7):842-58. doi: 10.1177/0193945915576083.
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Keywords: Communication, Decision Making, Electronic Health Records (EHRs), Nursing, Patient Safety
Sittig DF, Murphy DR, Smith MW
Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems.
In an attempt to understand how well current electronic health records (EHRs) facilitate accurate display and interpretation of clinical laboratory test results, the researchers evaluated the graphical displays of laboratory test results in 8 EHRs using objective criteria for optimal graphs. None of the EHRs met all 11 criteria.
AHRQ-funded; HS022087
Citation: Sittig DF, Murphy DR, Smith MW .
Graphical display of diagnostic test results in electronic health records: a comparison of 8 systems.
J Am Med Inform Assoc. 2015 Jul;22(4):900-4. doi: 10.1093/jamia/ocv013..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Comparative Effectiveness
Dalal AK, Pesterev BM, Eibensteiner K
Linking acknowledgement to action: closing the loop on non-urgent, clinically significant test results in the electronic health record.
This study measured use of an acknowledgment tool by 146 primary care physicians (PCPs) at 13 network-affiliated practices that use the same EHR. It then surveyed PCPs to assess use of, satisfaction with, and desired enhancements to the acknowledgment tool. Most (64 percent) were satisfied with the tool. Both satisfied and nonsatisfied PCPs reported that enhancements linking acknowledgment to routine actions would be useful.
AHRQ-funded; HS019603.
Citation: Dalal AK, Pesterev BM, Eibensteiner K .
Linking acknowledgement to action: closing the loop on non-urgent, clinically significant test results in the electronic health record.
J Am Med Inform Assoc 2015 Jul;22(4):905-8. doi: 10.1093/jamia/ocv007..
Keywords: Patient Safety, Electronic Health Records (EHRs), Primary Care, Health Information Technology (HIT)
Lai KH, Topaz M, Goss FR
Automated misspelling detection and correction in clinical free-text records.
This paper describes the development of a spelling correction system for medical text. The spell checker is based on Shannon’s noisy channel model, and uses an extensive dictionary compiled from many sources. It achieved detection performance of up to 94.4 percent and correction accuracy of up to 88.2 percent, showing that high-performance spelling correction is possible on a variety of clinical documents.
AHRQ-funded; HS022728.
Citation: Lai KH, Topaz M, Goss FR .
Automated misspelling detection and correction in clinical free-text records.
J Biomed Inform 2015 Jun;55:188-95. doi: 10.1016/j.jbi.2015.04.008..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Overby CL, Devine EB, Abernethy N
Making pharmacogenomic-based prescribing alerts more effective: a scenario-based pilot study with physicians.
This pilot study explored the communication effectiveness and clinical impact of using a prototype clinical decision support (CDS) system embedded in an electronic health record (EHR) to deliver pharmacogenomic (PGx) information to physicians. The proportion of physicians that saw a relative advantage to using PGx-CDS was 83 percent at the start and 94 percent at the conclusion of our study.
AHRQ-funded; HS014739.
Citation: Overby CL, Devine EB, Abernethy N .
Making pharmacogenomic-based prescribing alerts more effective: a scenario-based pilot study with physicians.
J Biomed Inform 2015 Jun;55:249-59. doi: 10.1016/j.jbi.2015.04.011..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Patient Safety
Giardina TD, Callen J, Georgiou A
Releasing test results directly to patients: a multisite survey of physician perspectives.
The researchers conducted a cross-sectional survey to explore physician perspectives about direct test result notification to patients in two countries, the U.S. and Australia. They found that physicians have substantial concerns about direct notification of test results. Most concerns are about abnormal test results and more specifically about sensitive tests although physicians are generally in favor of direct notification of normal test results to patients.
AHRQ-funded; HS022087; HS023602.
Citation: Giardina TD, Callen J, Georgiou A .
Releasing test results directly to patients: a multisite survey of physician perspectives.
Patient Educ Couns 2015 Jun;98(6):788-96. doi: 10.1016/j.pec.2015.02.011..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Juckett 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)