National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Ambulatory Care and Surgery (1)
- Cancer (1)
- Cancer: Lung Cancer (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Community-Based Practice (1)
- Cultural Competence (1)
- Dialysis (1)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (1)
- Healthcare Delivery (3)
- Health Insurance (1)
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- Hospitals (4)
- Implementation (5)
- Kidney Disease and Health (1)
- Learning Health Systems (1)
- Long-Term Care (1)
- Medication (2)
- Nursing (1)
- Nursing Homes (1)
- (-) Organizational Change (21)
- Patient-Centered Healthcare (6)
- Patient Experience (1)
- Patient Safety (3)
- Policy (1)
- Practice Improvement (5)
- Primary Care (7)
- Primary Care: Models of Care (2)
- Provider (5)
- Provider: Clinician (1)
- Provider: Nurse (1)
- Provider: Physician (1)
- Quality Improvement (5)
- Quality of Care (7)
- Rural Health (1)
- Screening (1)
- Surveys on Patient Safety Culture (1)
- Teams (3)
- TeamSTEPPS (1)
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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 21 of 21 Research Studies DisplayedSpalluto LB, Lewis JA, Stolldorf D
Organizational readiness for lung cancer screening: a cross-sectional evaluation at a Veterans Affairs medical center.
Lung cancer has the highest cancer-related mortality in the United States and among Veterans. Screening of high-risk individuals with low-dose CT (LDCT) can improve survival through detection of early-stage lung cancer. Organizational factors that aid or impede implementation of this evidence-based practice in diverse populations are not well described. In this study, the investigators evaluated organizational readiness for change and change valence (belief that change is beneficial and valuable) for implementation of LDCT screening.
AHRQ-funded; HS026395.
Citation: Spalluto LB, Lewis JA, Stolldorf D .
Organizational readiness for lung cancer screening: a cross-sectional evaluation at a Veterans Affairs medical center.
J Am Coll Radiol 2021 Jun;18(6):809-19. doi: 10.1016/j.jacr.2020.12.010..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Implementation, Organizational Change
Harrison MI, Shortell SM
AHRQ Author: Harrison MI
Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation.
The authors have developed a comprehensive, multilevel framework to inform learning health systems (LHSs) research and practice in order to enhance both research on LHSs and practical steps toward their development. Drawing on the Consolidated Framework for Implementation Research, the social-ecological framework, and the organizational change framework, their new framework can help investigators and practitioners broadly scan and then investigate forces influencing improvement and learning and may point to otherwise unnoticed interactions among influential factors.
AHRQ-authored.
Citation: Harrison MI, Shortell SM .
Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation.
Learn Health Syst 2021 Apr;5(2):e10226. doi: 10.1002/lrh2.10226..
Keywords: Learning Health Systems, Health Systems, Implementation, Organizational Change
Baloh J, Zhu X, Ward MM
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
This study looked at the influences on sustainment of internal facilitation activities. For two years the authors followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program. Factors the authors examined were the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME), and team continuity (CONTINUITY). Five hospitals sustained facilitation activities and they found that the combination of SMS, MMS, and CONTINUITY was a sufficient condition for sustainment. The five other hospitals that did not sustain facilitation activities either lacked MMS or lacked both TIME and CONTINUITY. They also discussed the implications for research and practice.
AHRQ-funded; HS024112; HS018396.
Citation: Baloh J, Zhu X, Ward MM .
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
Med Care Res Rev 2021 Apr;78(2):146-56. doi: 10.1177/1077558719848267..
Keywords: TeamSTEPPS, Teams, Implementation, Hospitals, Patient Safety, Rural Health, Organizational Change
Lee YSH, Cleary PD, Nembhard IM
Effects of leader tactics on the creativity, implementation, and evolution of ideas to improve healthcare delivery.
Researchers examined the association between leader tactics and the creativity, implementation outcome, and evolution of quality improvement ideas from clinicians and staff. They found that two identified tactics, brainstorming and reflection, were helpful depending on goals. They suggested that brainstorming may aide leaders seeking disruptive change via more creative, rapidly implemented ideas, while reflection on team process may aide leaders seeking high-engagement ideas that may be implemented slowly. They concluded that both tactics may help leaders cultivate dynamics that increase implementation of ideas that improve healthcare.
AHRQ-funded; HS016978.
Citation: Lee YSH, Cleary PD, Nembhard IM .
Effects of leader tactics on the creativity, implementation, and evolution of ideas to improve healthcare delivery.
J Gen Intern Med 2021 Feb;36(2):341-48. doi: 10.1007/s11606-020-06139-9..
Keywords: Organizational Change, Healthcare Delivery, Quality Improvement, Quality of Care, Implementation
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