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
1 to 25 of 201 Research Studies DisplayedWebb J, Sorensen A, Sommerness S
AHRQ Author: Mistry K
Advancing perinatal patient safety through application of safety science principles using health IT.
Researchers used semi-structured interviews with Labor and Delivery (L&D) units participating in AHRQ's Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation. Seventy percent of the units reported the use of health IT as an enabling strategy for their local implementation. Health IT was used to improve standardization of processes, use of independent checks, and to facilitate learning from defects.
AHRQ-authored; AHRQ-funded; 2902010000241.
Citation: Webb J, Sorensen A, Sommerness S .
Advancing perinatal patient safety through application of safety science principles using health IT.
BMC Med Inform Decis Mak 2017 Dec 19;17(1):176. doi: 10.1186/s12911-017-0572-8.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Pregnancy, Maternal Care
Huerta TR, McAlearney AS, Rizer MK
Introducing a patient portal and electronic tablets to inpatient care.
The researchers implemented a pilot inpatient portal (MyChart Bedside [Epic Systems]) using Android tablets to provide patients and their families and caregivers with an expected care plan each day, a roster of the care team, the ability to exchange secure messages with the care team, a way to write and save notes, and access to health information. They conducted the 90-day pilot program in 15 rooms on 1 patient unit in each of 2 hospitals and gave tablets to 179 patients. They found that patients wanted immediate access to laboratory results, that patients admitted for 1-2 days found the tablets less important, that those readmitted insisted on having a tablet, and that those with their own electronic devices were less likely to accept the tablet.
AHRQ-funded; HS024091.
Citation: Huerta TR, McAlearney AS, Rizer MK .
Introducing a patient portal and electronic tablets to inpatient care.
Ann Intern Med 2017 Dec 5;167(11):816-17. doi: 10.7326/m17-1766.
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Keywords: Health Information Technology (HIT), Hospitalization, Inpatient Care, Web-Based, Electronic Health Records (EHRs)
Beck A, Davidson AJ, Xu S
A multilevel analysis of individual, health system, and neighborhood factors associated with depression within a large metropolitan area.
This study geocoded depression diagnosis and demographic data from electronic health records to obtain both individual and neighborhood factors related to depression. The researchers found higher depression rates associated with greater age, female gender, white race, medical comorbidities, and with lower rates of home owner occupancy, residential stability, and higher educational attainment, but not with economic disadvantage. Among the cohort, higher depression rates were associated with higher crime rates and a lower percent of foreign born residents and single mother households.
AHRQ-funded; HS022143.
Citation: Beck A, Davidson AJ, Xu S .
A multilevel analysis of individual, health system, and neighborhood factors associated with depression within a large metropolitan area.
J Urban Health 2017 Dec;94(6):780-90. doi: 10.1007/s11524-017-0190-x..
Keywords: Depression, Electronic Health Records (EHRs), Social Determinants of Health, Urban Health
Larson EL, Cohen B, Liu J
Assessing intensity of nursing care needs using electronically available data.
The aim of this project was to develop and test a Nursing Intensity of Care Index using electronically available data from 152,072 patient discharges from three hospitals. In preliminary testing, data for the Nursing Intensity of Care Index, which accurately reflect nursing care intensity, can be obtained electronically in real time. The next steps will be a discrete-event simulation model and large-scale field trials.
AHRQ-funded; HS024915.
Citation: Larson EL, Cohen B, Liu J .
Assessing intensity of nursing care needs using electronically available data.
Comput Inform Nurs 2017 Dec;35(12):617-23. doi: 10.1097/cin.0000000000000375.
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Keywords: Electronic Health Records (EHRs), Nursing, Workforce
Benda N, Hettinger A, Bisantz A
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
This study described the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. It found that physician participants experienced significantly more communication events than nurse participants, while nurses initiated significantly more communication events than physicians. Most of the communication events occurred at the physician workstation followed by patient treatment areas.
AHRQ-funded; HS022542.
Citation: Benda N, Hettinger A, Bisantz A .
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
Journal of Healthcare Informatics Research 2017 Dec;1(2):218-30.
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Keywords: Communication, Electronic Health Records (EHRs), Provider: Health Personnel, Emergency Department, Nursing
Fan Y, Adam TJ, McEwan R
Detecting signals of interactions between warfarin and dietary supplements in electronic health records.
This study detected signals of interactions between warfarin and seven dietary supplements, viz., alfalfa, garlic, ginger, ginkgo, ginseng, St. John's Wort, and Vitamin E by analyzing structured clinical data and unstructured clinical notes from the University of Minnesota Clinical Data Repository. There was a statistically significant association of warfarin concurrently used with supplements which can potentially increase the risk of adverse events, such as gastrointestinal bleeding.
AHRQ-funded; HS022085.
Citation: Fan Y, Adam TJ, McEwan R .
Detecting signals of interactions between warfarin and dietary supplements in electronic health records.
Stud Health Technol Inform 2017;245:370-74.
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Keywords: Adverse Drug Events (ADE), Blood Thinners, Electronic Health Records (EHRs), Medication, Health Information Technology (HIT)
Asan O, Carayon P
Human factors of health information technology—challenges and opportunities.
This paper introduces a special issue presenting state-of -the-art research on human factors of health IT with eight articles that identify and address various human factor aspects of health IT. These eight articles examine multiple technologies and user groups and describe how health IT can support care that is highly distributed over time, space, and boundaries.
AHRQ-funded; HS023626.
Citation: Asan O, Carayon P .
Human factors of health information technology—challenges and opportunities.
Int J Hum Comput Interact 2017;33(4):255–57.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Senathirajah Y, Wang J, Borycki E
Mapping the electronic health record: a method to study display fragmentation.
Electronic health records have often been criticized for poor interaction design. The authors describe a method for evaluating and depicting the extent of display fragmentation and discuss its potential uses in comparing systems, identifying navigation pathways and information juxtaposition, and improving EHR interaction design.
AHRQ-funded; HS023708.
Citation: Senathirajah Y, Wang J, Borycki E .
Mapping the electronic health record: a method to study display fragmentation.
Stud Health Technol Inform 2017;245:1138-42.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Acker WW, Plasek JM, Blumenthal KG
Prevalence of food allergies and intolerances documented in electronic health records.
The researchers sought to determine the prevalence of food allergy and intolerance documented in the EHR allergy module. Among 2.7 million patients, they identified 97,482 patients (3.6 percent) with 1 or more food allergies or intolerances. The prevalence of food allergy and intolerance was higher in females (4.2 percent vs 2.9 percent) and Asians (4.3 percent vs 3.6 percent).
AHRQ-funded; HS022728.
Citation: Acker WW, Plasek JM, Blumenthal KG .
Prevalence of food allergies and intolerances documented in electronic health records.
J Allergy Clin Immunol 2017 Dec;140(6):1587-91.e1. doi: 10.1016/j.jaci.2017.04.006.
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Keywords: Electronic Health Records (EHRs), Patient Safety, Racial and Ethnic Minorities, Sex Factors
Ratanawongsa N, Chan LL, Fouts MM
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
This review highlights how the EHR electronic prescribing transformation has affected diabetes care for vulnerable patients and offers recommendations for improving patient safety through EHR electronic prescribing design, implementation, policy, and research. Specifically, it presents evidence for the adoption of RxNorm and standardized naming and picklist options for high alert medications such as insulin.
AHRQ-funded; HS022561; HS023558.
Citation: Ratanawongsa N, Chan LL, Fouts MM .
The challenges of electronic health records and diabetes electronic prescribing: implications for safety net care for diverse populations.
J Diabetes Res 2017;2017:8983237. doi: 10.1155/2017/8983237.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations, Diabetes, Patient Safety, Chronic Conditions
Rizvi RF, Marquard JL, Seywerd MA
Usability evaluation of an EHR's clinical notes interface from the perspective of attending and resident physicians: an exploratory study.
Usability of a commercial, inpatient Electronic Health Record (EHR) clinical notes documentation interface was analyzed from standpoints of two provider groups employing two standardized patient cases. The study results suggested that: (1) EHR usability and desirability is influenced by user characteristics, (2) repeated task performance improves user efficiency, and (3) user performance is correlated to their subjective system assessments.
AHRQ-funded; HS022085.
Citation: Rizvi RF, Marquard JL, Seywerd MA .
Usability evaluation of an EHR's clinical notes interface from the perspective of attending and resident physicians: an exploratory study.
Stud Health Technol Inform 2017;245:1128-32.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Health Personnel
Pantalone KM, Hobbs TM, Chagin KM
Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system.
The purpose of the study was to determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity. This cross-sectional summary from a large US integrated health system found that three out of every four patients had overweight or obesity based on BMI. Less than half of patients who were identified as having obesity according to BMI received a formal diagnosis via ICD-9 documentation.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Hobbs TM, Chagin KM .
Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system.
BMJ Open 2017 Nov 16;7(11):e017583. doi: 10.1136/bmjopen-2017-017583..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Systems, Obesity, Patient-Centered Outcomes Research
Lowry C, Orr K, Embry B
Primary care scribes: writing a new story for safety net clinics.
The researchers conducted an evaluation of trained volunteer scribes for primary care clinics serving a diverse, low-income population in a US safety net system, which implemented a new EHR between 2011 and 2014. In a safety net primary care system, trained volunteer scribes were associated with improved clinician efficiency and experience and no difference in patient satisfaction.
AHRQ-funded; HS022561; HS023558.
Citation: Lowry C, Orr K, Embry B .
Primary care scribes: writing a new story for safety net clinics.
BMJ Open Qual 2017 Oct 25;6(2):e000124. doi: 10.1136/bmjoq-2017-000124.
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Keywords: Electronic Health Records (EHRs), Patient Experience, Primary Care, Health Information Technology (HIT), Workflow
Sadasivaiah S, Smith DE, Goldman S
Improving best possible medication history with vulnerable patients at an urban safety net academic hospital using pharmacy technicians.
A multidisciplinary team designed an EHR-facilitated medication reconciliation program by which pharmacy technicians engaged newly admitted patients and their caregivers at the bedside to develop and electronically document the best possible medication history (BPMH). They found that, by optimizing not only the health information technology platform but also the operational processes, the program achieved a nearly 80 percent generation of BPMH completed by a highly trained pharmacy technician.
AHRQ-funded; HS022561; HS023558.
Citation: Sadasivaiah S, Smith DE, Goldman S .
Improving best possible medication history with vulnerable patients at an urban safety net academic hospital using pharmacy technicians.
BMJ Open Qual 2017 Oct 21;6(2):e000102. doi: 10.1136/bmjoq-2017-000102.
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Keywords: Electronic Health Records (EHRs), Medication, Patient Safety, Urban Health, Vulnerable Populations
Sakaguchi-Tang DK, Bosold AL, Choi YK
Patient portal use and experience among older adults: systematic review.
The aim of this review was to assess the existing research landscape related to patient portal and electronic personal health records (ePHRs) use and experience among older adults and to understand the benefits and barriers to older adults' use and adoption of patient portals and ePHRs. Overall, it found 2 main barriers to use: (1) privacy and security and (2) access to and ability to use technology and the Internet.
AHRQ-funded; HS022106.
Citation: Sakaguchi-Tang DK, Bosold AL, Choi YK .
Patient portal use and experience among older adults: systematic review.
JMIR Med Inform 2017 Oct 16;5(4):e38. doi: 10.2196/medinform.8092.
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Keywords: Elderly, Electronic Health Records (EHRs), Patient Experience, Web-Based
Rhee C, Dantes R, Epstein L
Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014.
The researchers estimated the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. In clinical data from 409 hospitals, sepsis was present in 6 percent of adult hospitalizations, and in contrast to claims-based analyses, neither the incidence of sepsis nor the combined outcome of death or discharge to hospice changed significantly between 2009-2014.
AHRQ-funded; HS025008.
Citation: Rhee C, Dantes R, Epstein L .
Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014.
JAMA 2017 Oct 3;318(13):1241-49. doi: 10.1001/jama.2017.13836.
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Keywords: Data, Electronic Health Records (EHRs), Hospitals, Mortality, Sepsis
Elysee G, Herrin J, Horwitz LI
An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
Stagnation in hospitals' adoption of data integration functionalities coupled with reduction in the number of operational health information exchanges could become a significant impediment to hospitals' adoption of 3 critical capabilities: electronic health information exchange, interoperability, and medication reconciliation, in which electronic systems are used to assist with resolving medication discrepancies and improving patient safety. This observational study examines the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
AHRQ-funded; HS022882.
Citation: Elysee G, Herrin J, Horwitz LI .
An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
Medicine 2017 Oct;96(41):e8274. doi: 10.1097/MD.0000000000008274..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals, Medication
Chung S, Panattoni L, Chi J
Can secure patient-provider messaging improve diabetes care?
The authors examined whether messaging with physicians for medical advice is associated with fewer face-to-face visits and better diabetes management. Patients with diabetes using an online portal were studied; 72% used messaging, and those who made frequent visits were also more likely to message. No messaging at all was negatively associated with the likelihood of meeting an HbA1c target. Among message users, additional messages were associated with better outcome, with a stronger relationship for noninsulin users. Physician-initiated messages had effects similar to those for patient-initiated messages.
AHRQ-funded; HS019815.
Citation: Chung S, Panattoni L, Chi J .
Can secure patient-provider messaging improve diabetes care?
Diabetes Care 2017 Oct;40(10):1342-48. doi: 10.2337/dc17-0140.
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Keywords: Communication, Diabetes, Clinician-Patient Communication, Electronic Health Records (EHRs)
Ancker JS, Send A, Hafeez B
Health IT usability focus section: adapting EHR-based medication instructions to comply with plain language guidance-a randomized experiment.
Using examples of clinician-written medication instructions from an electronic health record, the investigators conducted an experiment to determine whether parental misinterpretations would be reduced by instructions that followed best practices for plain language. The researchers found that a relatively simple intervention of revising text was associated with a modest reduction in frequency of misinterpretations of medication instructions.
AHRQ-funded; HS021531.
Citation: Ancker JS, Send A, Hafeez B .
Health IT usability focus section: adapting EHR-based medication instructions to comply with plain language guidance-a randomized experiment.
Appl Clin Inform 2017 Oct;8(4):1127-43. doi: 10.4338/aci-2017-06-ra-0111..
Keywords: Communication, Education: Patient and Caregiver, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication
Lyles CR, Fruchterman J, Youdelman M
Legal, practical, and ethical considerations for making online patient portals accessible for all.
The authors argue that there are potential legal mandates for improving portal accessibility (e.g., the Civil Rights and the Rehabilitation Acts), as well as ethical considerations to prevent the exacerbation of existing health and health care disparities. To address these legal, practical, and ethical considerations, they present standards and broad recommendations that could greatly improve the reach and impact of portal Web sites.
AHRQ-funded; HS022408.
Citation: Lyles CR, Fruchterman J, Youdelman M .
Legal, practical, and ethical considerations for making online patient portals accessible for all.
Am J Public Health 2017 Oct;107(10):1608-11. doi: 10.2105/ajph.2017.303933.
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Keywords: Health Information Technology (HIT), Web-Based, Education: Patient and Caregiver, Electronic Health Records (EHRs)
Schmajuk G, Yazdany J
Leveraging the electronic health record to improve quality and safety in rheumatology.
In the coming years, developing and leveraging tools within the electronic health record (EHR) will be the key to making the next big strides in improving the health of patients with rheumatoid arthritis and other rheumatic diseases, including building EHR infrastructure to capture patient outcomes and developing automated methods to retrieve information from free text of clinical notes.
AHRQ-funded; HS024412.
Citation: Schmajuk G, Yazdany J .
Leveraging the electronic health record to improve quality and safety in rheumatology.
Rheumatol Int 2017 Oct;37(10):1603-10. doi: 10.1007/s00296-017-3804-4.
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Keywords: Electronic Health Records (EHRs), Quality of Care, Patient Safety, Quality Improvement, Arthritis
Sittig 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
Rizvi RF, Marquard JL
Usability evaluation of electronic health record system around clinical notes usage-an ethnographic study.
The purpose of this study was to evaluate usability strengths and weaknesses of two widely implemented electronic health record graphical user interfaces for critical clinical notes usage tasks. This study provides usability-specific insights to inform future, improved, electronic health record interface that is better aligned with user centered design approach.
AHRQ-funded; HS022085.
Citation: Rizvi RF, Marquard JL .
Usability evaluation of electronic health record system around clinical notes usage-an ethnographic study.
Appl Clin Inform 2017 Oct;8(4):1095-105. doi: 10.4338/aci-2017-04-ra-0067.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), System Design
Pranaat R, Mohan V, O'Reilly M
Use of simulation based on an electronic health records environment to evaluate the structure and accuracy of notes generated by medical scribes: Proof-of-concept study.
The objective of the researchers was to develop a virtual video-based simulation to demonstrate and quantify the variability and accuracy of scribes' transcribed notes in the EHR. Their high-fidelity, video-based EHR simulation was able to assess multiple performance indicators in medical scribes and demonstrate significant variability both in terms of structure and accuracy in clinical documentation.
AHRQ-funded; HS025141.
Citation: Pranaat R, Mohan V, O'Reilly M .
Use of simulation based on an electronic health records environment to evaluate the structure and accuracy of notes generated by medical scribes: Proof-of-concept study.
JMIR Med Inform 2017 Sep 20;5(3):e30. doi: 10.2196/medinform.7883.
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Keywords: Electronic Health Records (EHRs), Quality of Care, Patient Safety, Training
Ong TC, Kahn MG, Kwan BM
Dynamic-ETL: a hybrid approach for health data extraction, transformation and loading.
The researchers designed and implemented a health data transformation and loading approach, which we refer to as Dynamic ETL (Extraction, Transformation and Loading) (D-ETL), that automates part of the process through use of scalable, reusable and customizable code. Their results showed that ETL rule composition methods and the D-ETL engine offer a scalable solution for health data transformation via automatic query generation to harmonize source datasets.
AHRQ-funded; HS019908; HS022956.
Citation: Ong TC, Kahn MG, Kwan BM .
Dynamic-ETL: a hybrid approach for health data extraction, transformation and loading.
BMC Med Inform Decis Mak 2017 Sep 13;17(1):134. doi: 10.1186/s12911-017-0532-3.
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Keywords: Comparative Effectiveness, Data, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Outcomes Research