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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Ambulatory Care and Surgery (1)
- Behavioral Health (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Community-Based Practice (1)
- Cultural Competence (1)
- Dialysis (1)
- Elderly (1)
- Electronic Health Records (EHRs) (2)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (1)
- Healthcare Delivery (4)
- Health Information Technology (HIT) (2)
- Health Insurance (1)
- Health Systems (1)
- Hospitals (4)
- Implementation (6)
- Kidney Disease and Health (1)
- Long-Term Care (1)
- Medication (2)
- Nursing (1)
- Nursing Homes (2)
- (-) Organizational Change (25)
- Patient-Centered Healthcare (10)
- Patient Experience (1)
- Patient Safety (4)
- Policy (1)
- Practice Improvement (7)
- Pressure Ulcers (1)
- Prevention (1)
- Primary Care (12)
- Primary Care: Models of Care (3)
- Provider (5)
- Provider: Clinician (1)
- Provider: Nurse (1)
- Provider: Physician (1)
- Quality Improvement (6)
- Quality of Care (8)
- Risk (1)
- Surveys on Patient Safety Culture (1)
- Teams (3)
- Urban Health (1)
- Vulnerable Populations (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 25 of 25 Research Studies DisplayedSittig DF, Singh H
Toward more proactive approaches to safety in the electronic health record era.
This article discusses a proactive approach to safety in the electronic health record era. It discusses an updated health IT Sentinel Event Alert, released in March 2015 by the Joint Commission which took a broad, sociotechnical approach in exploring the factors involved in the safe use of health IT.
AHRQ-funded; HS023602; HS022087.
Citation: Sittig DF, Singh H .
Toward more proactive approaches to safety in the electronic health record era.
Jt Comm J Qual Patient Saf 2017 Oct;43(10):540-47. doi: 10.1016/j.jcjq.2017.06.005..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Guidelines, Organizational Change, Risk
Soban LM, Kim L, Yuan AH
Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.
The researchers describe the presence and operationalisation of organisational strategies to support implementation of pressure ulcer prevention programmes across acute care hospitals in a large, integrated health-care system. Organisational strategies that support implementation of a pressure ulcer prevention programme (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high level.
AHRQ-funded; HS000046.
Citation: Soban LM, Kim L, Yuan AH .
Organisational strategies to implement hospital pressure ulcer prevention programmes: findings from a national survey.
J Nurs Manag 2017 Sep;25(6):457-67. doi: 10.1111/jonm.12416.
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Keywords: Pressure Ulcers, Prevention, Hospitals, Patient Safety, Implementation, Organizational Change
Hoff T, Scott S
The strategic nature of individual change behavior: how physicians and their staff implement medical home care.
The purpose of this study was to gain insight into patient-centered medical home (PCMH) implementation at the workplace level by understanding better how primary care physicians and staff perceive, experience, and use certain types of PCMH work for adapting to new demands. The investigators indicated that the findings showed that particular forms of PCMH work not only advanced patient care in favorable ways but also enhanced individual and organizational capacity for adapting to this innovative model and its demands.
AHRQ-funded; HS020931.
Citation: Hoff T, Scott S .
The strategic nature of individual change behavior: how physicians and their staff implement medical home care.
Health Care Manage Rev 2017 Jul/Sep;42(3):226-36. doi: 10.1097/hmr.0000000000000109..
Keywords: Patient-Centered Healthcare, Primary Care, Organizational Change, Practice Improvement, Implementation
Kerrissey M, Satterstrom P, Leydon N
Integrating: a managerial practice that enables implementation in fragmented health care environments.
This inductive qualitative study examines primary care clinics implementing improvement efforts in order to identify mechanisms that enable implementation despite common barriers, such as lack of time and fragmentation across stakeholder groups. It found that successfully implementing clinics exhibited the managerial practice of integrating, which was defined as achieving unity of effort among stakeholder groups in the pursuit of a shared and mutually developed goal.
AHRQ-funded; HS019508.
Citation: Kerrissey M, Satterstrom P, Leydon N .
Integrating: a managerial practice that enables implementation in fragmented health care environments.
Health Care Manage Rev 2017 Jul/Sep;42(3):213-25. doi: 10.1097/hmr.0000000000000114.
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Keywords: Primary Care, Quality Improvement, Organizational Change, Implementation, Quality of Care
Applequist J, Miller-Day M, Cronholm PF
“In principle we have agreement, but in practice it is a bit more difficult”: obtaining organizational buy-in to patient-centered medical home transformation.
The patient-centered medical home (PCMH) is a model of care that emphasizes the coordination of patient treatment among health care providers. Practice transformation to this model, however, presents a number of challenges. One of these challenges is getting the buy-in of all personnel to commit to making organizational changes in the journey to becoming a nationally recognized medical home. This study, grounded in stakeholder theory, investigated internal messages of buy-in as communicated by practices transitioning to this type of care.
AHRQ-funded; HS019150.
Citation: Applequist J, Miller-Day M, Cronholm PF .
“In principle we have agreement, but in practice it is a bit more difficult”: obtaining organizational buy-in to patient-centered medical home transformation.
Qual Health Res 2017 May;27(6):909-22. doi: 10.1177/1049732316680601..
Keywords: Patient-Centered Healthcare, Organizational Change, Primary Care: Models of Care, Primary Care
Clark KD, Miller BF, Green LA
Implementation of behavioral health interventions in real world scenarios: managing complex change.
This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. It offers an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care.
AHRQ-funded; HS022981.
Citation: Clark KD, Miller BF, Green LA .
Implementation of behavioral health interventions in real world scenarios: managing complex change.
Fam Syst Health 2017 Mar;35(1):36-45. doi: 10.1037/fsh0000239.
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Keywords: Behavioral Health, Patient-Centered Healthcare, Primary Care, Implementation, Organizational Change, Healthcare Delivery
Alexander G, Madsen R, Newton M
Analyzing change in nursing home information technology sophistication: a 2-year survey.
Currently, a national sample of nursing homes (NHs) is being surveyed for 3 consecutive years to determine trends in NH information technology (IT) sophistication (e.g., measures of IT capabilities, extent of IT use, IT integration with internal and external stakeholders). IT sophistication is measured in resident care, clinical support, and administrative activities. The current article provides details of the differences in NH IT sophistication reported by administrators completing Year 1 and Year 2 surveys.
AHRQ-funded; HS022497.
Citation: Alexander G, Madsen R, Newton M .
Analyzing change in nursing home information technology sophistication: a 2-year survey.
Analyzing change in nursing home information technology sophistication: a 2-year survey..
Keywords: Health Information Technology (HIT), Nursing Homes, Organizational Change
Quigley DD, Predmore ZS, Chen AY
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Researchers conducted interviews at 14 primary care practices undergoing patient-centered medical home (PCMH) transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. They concluded that full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy.
AHRQ-funded; HS000029.
Citation: Quigley DD, Predmore ZS, Chen AY .
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Qual Manag Health Care 2017 Jan/Mar;26(1):7-14. doi: 10.1097/qmh.0000000000000118.
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Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams
Nembhard IM, Tucker AL
Applying organizational learning research to Accountable Care Organizations.
In this article, the authors discuss seven lessons from the organizational learning literature that can help Accountable Care Organizations (ACOs) overcome the inherent challenges of learning how to work together in radically new ways. The article concludes by outlining opportunities for future research on organizational learning in ACOs.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Tucker AL .
Applying organizational learning research to Accountable Care Organizations.
Med Care Res Rev 2016 Dec;73(6):673-84. doi: 10.1177/1077558716640415..
Keywords: Quality of Care, Organizational Change, Health Insurance
Rodriguez HP, Chen X, Martinez AE
Availability of primary care team members can improve teamwork and readiness for change.
Researchers conducted a survey of adult primary care providers and staff in California safety net practices to assess primary care team structure (team size, team member availability, and access to interdisciplinary expertise), teamwork, and readiness for change. Greater team member availability was associated with greater readiness for change, but the relationship was stronger for staff than for primary care providers.
AHRQ-funded; HS020120.
Citation: Rodriguez HP, Chen X, Martinez AE .
Availability of primary care team members can improve teamwork and readiness for change.
Health Care Manage Rev 2016 Oct-Dec;41(4):286-95. doi: 10.1097/hmr.0000000000000082.
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Keywords: Primary Care, Teams, Patient-Centered Healthcare, Organizational Change, Practice Improvement
Friedberg MW, Rodriguez HP, Martsolf GR
Measuring workplace climate in community clinics and health centers.
The authors assessed the psychometric properties of a survey instrument combining items from several existing surveys of workplace climate and generated a shorter instrument for future use. They concluded that survey instruments designed to measure workplace climate have substantial overlap, and the set they identified might help target and tailor clinics' quality improvement efforts.
AHRQ-funded; HS020120.
Citation: Friedberg MW, Rodriguez HP, Martsolf GR .
Measuring workplace climate in community clinics and health centers.
Med Care 2016 Oct;54(10):944-9. doi: 10.1097/mlr.0000000000000585.
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Keywords: Community-Based Practice, Provider, Organizational Change, Quality Improvement, Quality of Care, Practice Improvement
Shao H, Brown L, Diana ML
Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.
The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation. The estimated incremental cost for clinics that underwent transformation was $37.61 per visit per 6 months, and overall it cost $24.86 per visit per 6 months in grant funds to support a clinic's transformation.
AHRQ-funded; HS022624.
Citation: Shao H, Brown L, Diana ML .
Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.
Medicine 2016 Sep;95(39):e4990. doi: 10.1097/md.0000000000004990.
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Keywords: Patient-Centered Healthcare, Healthcare Costs, Access to Care, Organizational Change
Hickner J, Smith SA, Yount N
Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medical Office Survey on Patient Safety Culture.
This study examines differences in patient safety culture perceptions among providers, management and staff in a large national survey of safety culture in ambulatory practices in the USA. Its findings suggest that managers need to pay attention to the training needs of office staff, since this was an area with one of the greatest gaps in perceptions. In addition, both office managers and physicians need to encourage more open communication.
AHRQ-funded; 290200710024C.
Citation: Hickner J, Smith SA, Yount N .
Differing perceptions of safety culture across job roles in the ambulatory setting: analysis of the AHRQ Medical Office Survey on Patient Safety Culture.
BMJ Qual Saf 2016 Aug;25(8):588-94. doi: 10.1136/bmjqs-2014-003914.
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Keywords: Ambulatory Care and Surgery, Organizational Change, Patient Safety, Provider
Hung D, Chung S, Martinez M
Effect of organizational culture on patient access, care continuity, and experience of primary care.
The authors examined relationships between organizational culture and patient-centered outcomes in primary care. They found that, compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care.
AHRQ-funded; HS019815; HS019167.
Citation: Hung D, Chung S, Martinez M .
Effect of organizational culture on patient access, care continuity, and experience of primary care.
J Ambul Care Manage 2016 Jul-Sep;39(3):242-52. doi: 10.1097/jac.0000000000000116.
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Keywords: Access to Care, Organizational Change, Patient-Centered Healthcare, Patient Experience, Primary Care
Poghosyan L, Liu J
Nurse practitioner autonomy and relationships with leadership affect teamwork in primary care practices: a cross-sectional survey.
The authors investigated whether nurse practitioner (NP) autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians. They concluded that NP autonomy and favorable relationships with leadership improve teamwork, and they recommended that policy and organizational change focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes.
AHRQ-funded; HS020999.
Citation: Poghosyan L, Liu J .
Nurse practitioner autonomy and relationships with leadership affect teamwork in primary care practices: a cross-sectional survey.
J Gen Intern Med 2016 Jul;31(7):771-7. doi: 10.1007/s11606-016-3652-z.
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Keywords: Nursing, Organizational Change, Primary Care, Teams
Rangachari P
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
In this paper, Rangachari 1) conducted a narrative review of the literature on "technology use," to understand how technologies-in-practice may be transformed from limited use to meaningful use; 2) conducted a narrative review of the literature on "organizational change implementation," to understand how changes in technology use could be successfully implemented and sustained in a healthcare organizational context; and 3) applied lessons learned from the narrative literature reviews to identify strategies for the meaningful use and successful implementation of EHR Medication Reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
J Hosp Adm 2016 Jun;5(3):98-106. doi: 10.5430/jha.v5n3p98.
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Keywords: Health Systems, Medication, Hospitals, Organizational Change, Electronic Health Records (EHRs)
Gray CP, Harrison MI, Hung D
AHRQ Author: Harrison MI
Medical assistants as flow managers in primary care: challenges and recommendations.
Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, the authors found that using medical assistants (Mas) as flow managers required overcoming several challenges. These included entrenched social and occupational hierarchies between physicians and MAs, a lack of adequate training and mentorship, and difficulty attracting and retaining talented MAs.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Gray CP, Harrison MI, Hung D .
Medical assistants as flow managers in primary care: challenges and recommendations.
J Healthc Manag 2016 May-Jun;61(3):181-91.
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Keywords: Primary Care, Organizational Change, Practice Improvement, Quality Improvement, Quality of Care, Workflow, Provider
Harrison MI, Paez K, Carman KL
AHRQ Author: Harrison MI
Effects of organizational context on Lean implementation in five hospital systems.
In order to help reduce gaps in knowledge of effects of intraorganizational context, the authors researched Lean implementation initiatives in five organizations and examined 12 of their Lean rapid improvement projects. They identified intraorganizational characteristics including CEO commitment to Lean and active support for it, prior organizational capacity for quality improvement-based performance improvement, and alignment of the Lean initiative with the organizational mission.
AHRQ-authored.
Citation: Harrison MI, Paez K, Carman KL .
Effects of organizational context on Lean implementation in five hospital systems.
Health Care Manage Rev 2016 Apr-Jun;41(2):127-44. doi: 10.1097/hmr.0000000000000049..
Keywords: Organizational Change, Hospitals, Quality Improvement, Quality of Care, Healthcare Delivery, Implementation
Howard J, Etz RS, Crocker JB
Maximizing the patient-centered medical home (PCMH) by choosing words wisely.
The authors described new terminology that some innovative primary care practices are using to support the transformational culture of the PCMH. Using data from the AHRQ-funded Working Conference for PCMH Innovation 2013, they found that language innovations were used by 5 of the 10 convened practices and that participants felt that the language used was important for reinforcing substantive changes. They concluded that new terminology must represent values to which practices genuinely aspire.
AHRQ-funded; HS021287.
Citation: Howard J, Etz RS, Crocker JB .
Maximizing the patient-centered medical home (PCMH) by choosing words wisely.
J Am Board Fam Med 2016 Mar-Apr;29(2):248-53. doi: 10.3122/jabfm.2016.02.150199.
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Keywords: Cultural Competence, Patient-Centered Healthcare, Primary Care, Organizational Change
Davis KK, Harris KG, Mahishi V
Perceptions of culture of safety in hemodialysis centers.
Staff members, physicians, nurse practitioners, and physician assistants from a sample of hemodialysis facilities completed a 10-item assessment with modified questions from the Hospital Survey on Patient Safety Culture, with an emphasis on safety culture related to vascular access infections. Overall, scores were high, indicating a positive patient safety culture.
AHRQ-funded; 2902010000251.
Citation: Davis KK, Harris KG, Mahishi V .
Perceptions of culture of safety in hemodialysis centers.
Nephrol Nurs J 2016 Mar-Apr;43(2):119-26, 82; quiz 27.
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Keywords: Surveys on Patient Safety Culture, Patient Safety, Dialysis, Kidney Disease and Health, Organizational Change, Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Provider
Urick BY, Kaskie BP, Carnahan RM
Improving antipsychotic prescribing practices in nursing facilities: the role of surveyor methods and surveying agencies in upholding the Nursing Home Reform Act.
The objectives of this study were to explore surveyor observations of skilled nursing facilities/nursing facilities care practices subsequent to participation the Partnership guidance program and to use a social ecological framework to estimate how these observations were influenced by individual, organizational, and contextual factors. It found substantial variation in surveyor observations of changes to clinical care in response to the Partnership guidance initiative.
AHRQ-funded; HS019355.
Citation: Urick BY, Kaskie BP, Carnahan RM .
Improving antipsychotic prescribing practices in nursing facilities: the role of surveyor methods and surveying agencies in upholding the Nursing Home Reform Act.
Res Social Adm Pharm 2016 Jan-Feb;12(1):91-103. doi: 10.1016/j.sapharm.2015.04.006.
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Keywords: Elderly, Nursing Homes, Long-Term Care, Policy, Medication, Organizational Change
Lyles CR, Aulakh V, Jameson W
Innovation and transformation in California's safety net health care settings: an inside perspective.
The authors investigated how safety net settings will innovate in order to achieve transformation of care delivery. Through informant interviews, they found that safety net systems have already begun implementing innovative practices supporting their key priority areas, but that more support is needed, specifically to accelerate the change needed to succeed under health reform.
AHRQ-funded; HS017594.
Citation: Lyles CR, Aulakh V, Jameson W .
Innovation and transformation in California's safety net health care settings: an inside perspective.
Am J Med Qual 2014 Nov-Dec;29(6):538-45. doi: 10.1177/1062860613507474.
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Keywords: Healthcare Delivery, Organizational Change
Nembhard IM, Cherian P, Bradley EH
Deliberate learning in health care: the effect of importing best practices and creative problem solving on hospital performance improvement.
The authors examined the effect on quality improvement of two common but distinct approaches to organizational learning, importing best practices and creative problem solving, in hospitals focused on improving treatment time for patients with heart attacks. They found that importing best practices helps hospitals achieve initial phase improvement, after which significant further improvement requires creative problem solving as well.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Cherian P, Bradley EH .
Deliberate learning in health care: the effect of importing best practices and creative problem solving on hospital performance improvement.
Med Care Res Rev 2014 Oct;71(5):450-71. doi: 10.1177/1077558714536619.
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Keywords: Quality Improvement, Quality of Care, Hospitals, Organizational Change
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
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