National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (3)
- Ambulatory Care and Surgery (1)
- Arthritis (1)
- Back Health and Pain (1)
- Care Coordination (1)
- Caregiving (1)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (2)
- Decision Making (2)
- Diabetes (1)
- Diagnostic Safety and Quality (1)
- Elderly (1)
- (-) Electronic Health Records (EHRs) (22)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Guidelines (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (14)
- Hepatitis (1)
- Hospitals (2)
- Intensive Care Unit (ICU) (1)
- Maternal Care (1)
- Medical Errors (3)
- Medication (5)
- Medication: Safety (2)
- Organizational Change (1)
- Patient and Family Engagement (1)
- (-) Patient Safety (22)
- Policy (1)
- Pregnancy (1)
- Prevention (1)
- Provider (1)
- Provider: Health Personnel (1)
- Provider: Nurse (1)
- Provider: Physician (1)
- Quality Improvement (1)
- Quality of Care (3)
- Racial and Ethnic Minorities (1)
- Risk (1)
- Sex Factors (1)
- Training (1)
- Urban Health (1)
- Vulnerable Populations (2)
- 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 22 of 22 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
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
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
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
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
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
Bhise V, Meyer AND, Singh H
Errors in diagnosis of spinal epidural abscesses in the era of electronic health records.
With this study, the investigators set out to identify missed opportunities in diagnosis of spinal epidural abscesses to outline areas for process improvement. The investigators found that despite wide availability of clinical data, errors in diagnosis of spinal epidural abscesses were common and involved inadequate history, physical examination, and test ordering. They suggested that solutions should include renewed attention to basic clinical skills.
AHRQ-funded; HS022087.
Citation: Bhise V, Meyer AND, Singh H .
Errors in diagnosis of spinal epidural abscesses in the era of electronic health records.
Am J Med 2017 Aug;130(8):975-81. doi: 10.1016/j.amjmed.2017.03.009..
Keywords: Adverse Events, Back Health and Pain, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Patient Safety
Savage EL, Fairbanks RJ, Ratwani RM
Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison.
This study sought to compare government policies on usability and safety, and methods of examining compliance to those policies, across 3 federal agencies: the Office of the National Coordinator (ONC) and EHRs, the Federal Aviation Administration (FAA) and avionics, and the Food and Drug Administration (FDA) and medical devices. The goal was to identify whether differences in policies exist and, if they do exist, how policies and enforcement mechanisms from other industries might be applied to optimize EHR usability.
AHRQ-funded; HS023701.
Citation: Savage EL, Fairbanks RJ, Ratwani RM .
Are informed policies in place to promote safe and usable EHRs? A cross-industry comparison.
J Am Med Inform Assoc 2017 Jul 1;24(4):769-75. doi: 10.1093/jamia/ocw185.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Policy
Furukawa MF, Spector WD, Rhona Limcangco M
AHRQ Author: Furukawa MF, Spector WD, Encinosa WE
Meaningful use of health information technology and declines in in-hospital adverse drug events.
Hospital adoption of electronic health records with Meaningful Use (MU) capabilities expected to improve medication safety has grown rapidly. This study has found that MU capabilities and interoperability were associated with lower occurrence of adverse drug events (ADEs), but the effects did not vary by experience with MU. About one-fifth of the decline in ADEs from 2010 to 2013 was attributable to MU capabilities.
AHRQ-authored.
Citation: Furukawa MF, Spector WD, Rhona Limcangco M .
Meaningful use of health information technology and declines in in-hospital adverse drug events.
J Am Med Inform Assoc 2017 Jul 1;24(4):729-36. doi: 10.1093/jamia/ocw183.
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Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Adverse Drug Events (ADE), Patient Safety, Hospitals
Ancker JS, Edwards A, Nosal S
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
In this study, the investigators tested hypotheses arising from two possible alert fatigue mechanisms: (A) cognitive overload associated with amount of work, complexity of work, and effort distinguishing informative from uninformative alerts, and (B) desensitization from repeated exposure to the same alert over time. The investigators found that clinicians became less likely to accept alerts as they received more of them, particularly more repeated alerts. There was no evidence of an effect of workload per se, or of desensitization over time for a newly deployed alert.
AHRQ-funded; HS021531.
Citation: Ancker JS, Edwards A, Nosal S .
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
BMC Med Inform Decis Mak 2017 Apr 10;17(1):1-9. doi: 10.1186/s12911-017-0430-8..
Keywords: Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Provider, Provider: Nurse, Provider: Physician
Duckworth M, Leung E, Fuller T
Nurse, patient, and care partner perceptions of a personalized safety plan screensaver.
A patient safety plan dashboard was developed that captures disparate data from the electronic health record that is then displayed as a personalized bedside screensaver. End user perceptions of the content and interface of the personalized safety plan screensavers were identified and strategies to overcome the barriers to use for future iterations were defined. Differences emerged stemming from each group of end users' role on the care team.
AHRQ-funded; HS023535.
Citation: Duckworth M, Leung E, Fuller T .
Nurse, patient, and care partner perceptions of a personalized safety plan screensaver.
J Gerontol Nurs 2017 Apr;43(4):15-22. doi: 10.3928/00989134-20170313-05.
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Keywords: Elderly, Electronic Health Records (EHRs), Health Information Technology (HIT), Caregiving, Patient Safety, Patient and Family Engagement, Care Coordination
Hanauer DA, Branford GL, Greenberg G
Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. The primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction.
AHRQ-funded; HS023613.
Citation: Hanauer DA, Branford GL, Greenberg G .
Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
J Am Med Inform Assoc 2017 Apr 1;24(e1):e157-e65. doi: 10.1093/jamia/ocw077.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Ambulatory Care and Surgery, Patient Safety, Workflow
Roman LC, Ancker JS, Johnson SB
Navigation in the electronic health record: a review of the safety and usability literature.
The purpose of this literature review was to improve access to navigation-related research in usability. Specifically, the investigators aimed to (1) assess the prevalence of navigation-related topics within the EHR usability and safety research literature, (2) categorize types of navigation actions within the EHR, (3) capture relationships between these navigation actions and usability principles, and (4) collect terms and concepts related to EHR navigation.
AHRQ-funded; HS023708.
Citation: Roman LC, Ancker JS, Johnson SB .
Navigation in the electronic health record: a review of the safety and usability literature.
J Biomed Inform 2017 Mar;67:69-79. doi: 10.1016/j.jbi.2017.01.005..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Menon S, Singh H, Giardina TD
Safety huddles to proactively identify and address electronic health record safety.
This study explored the use of safety huddles for identifying and learning about EHR-related safety concerns. Data were obtained from daily safety huddle briefing notes recorded at a single midsized tertiary-care hospital in the United States over 1 year. The study concluded that safety huddles promoted discussion of several technology-related issues at the organization level and can serve as a promising technique to identify and address EHR-related safety concerns.
AHRQ-funded; HS022087; HS023609.
Citation: Menon S, Singh H, Giardina TD .
Safety huddles to proactively identify and address electronic health record safety.
J Am Med Inform Assoc 2017 Mar;24(2):261-67. doi: 10.1093/jamia/ocw153.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Hospitals
Schmajuk G, Tonner C, Trupin L
Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.
Hepatitis B virus (HBV) reactivation in the setting of rituximab use is a potentially fatal but preventable safety event. The rate of HBV screening and proportion of patients at risk who receive antiviral prophylaxis in patients initiating rituximab is unknown. This study found wide variations in hepatitis B screening practices among patients receiving rituximab, resulting in unnecessary risks to patients.
AHRQ-funded; HS023558; HS024412.
Citation: Schmajuk G, Tonner C, Trupin L .
Using health-system-wide data to understand hepatitis B virus prophylaxis and reactivation outcomes in patients receiving rituximab.
Medicine 2017 Mar;96(13):e6528. doi: 10.1097/md.0000000000006528.
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Keywords: Hepatitis, Electronic Health Records (EHRs), Medication, Prevention, Patient Safety
Adams KT, Howe JL, Fong A
An analysis of patient safety incident reports associated with electronic health record interoperability.
The study’s objectives were to (1) identify patient safety incident reports that reflect EHR interoperability challenges with other health IT, and (2) perform a detailed analysis of these reports. It found that the majority of EHR interoperability patient safety event (PSE) reports involved interfacing with pharmacy systems (i.e. medication related), followed by laboratory, and radiology. Most of the interoperability challenges in these clinical areas were associated with the EHR receiving information from other health IT systems.
AHRQ-funded; HS023701.
Citation: Adams KT, Howe JL, Fong A .
An analysis of patient safety incident reports associated with electronic health record interoperability.
Appl Clin Inform 2017 Feb;8(2):593-602. doi: 10.4338/ACI-2017-01-RA-0014.
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Keywords: Healthcare Delivery, Electronic Health Records (EHRs), Electronic Prescribing (E-Prescribing), Medication: Safety, Patient Safety
Horsky J, Aarts J, Verheul L
Clinical reasoning in the context of active decision support during medication prescribing.
The purpose of this study was to describe and analyze reasoning patterns of clinicians responding to drug-drug interaction alerts in order to understand the role of patient-specific information in the decision-making process about the risks and benefits of medication therapy. The investigators found that declining an alert suggestion was preceded by sometimes brief but often complex reasoning, prioritizing different aspects of care quality and safety, especially when the perceived risk was higher.
AHRQ-funded; HS021094.
Citation: Horsky J, Aarts J, Verheul L .
Clinical reasoning in the context of active decision support during medication prescribing.
Int J Med Inform 2017 Jan;97:1-11. doi: 10.1016/j.ijmedinf.2016.09.004..
Keywords: Adverse Drug Events (ADE), Adverse Events, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Patient Safety
Collinsworth AW, Masica AL, Priest EL
Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium.
This case study describes how an integrated health care delivery system modified its inpatient electronic health record to accelerate the implementation and evaluation of ABCDE bundle deployment as a safety and quality initiative for the prevention of delirium in intensive care unit patients.
AHRQ-funded; HS021459
Citation: Collinsworth AW, Masica AL, Priest EL .
Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium.
eGEMS. 2014;2(1):1121. doi: 10.13063/2327-9214.1121..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Patient Safety, Quality of Care
Peterson SM, Gurses AP, Regan L
Resident to resident handoffs in the emergency department: an observational study.
This study aimed to identify hazards to patient safety and barriers to efficiency related to resident handoffs in the ED. It found that residents were interrupted, on average, every 8.5 min. The most common deficit in relaying the plan of care strategy was failing to relay medications administered (32 percent). In addition, there were ambiguities related to medication administration.
AHRQ-funded; HS018762.
Citation: Peterson SM, Gurses AP, Regan L .
Resident to resident handoffs in the emergency department: an observational study.
J Emerg Med 2014 Nov;47(5):573-9. doi: 10.1016/j.jemermed.2014.06.027..
Keywords: Emergency Department, Emergency Medical Services (EMS), Patient Safety, Electronic Health Records (EHRs), Medication
Pohl JM, Tanner C, Hamilton A
Medication safety after implementation of a commercial electronic health record system in five safety-net practices: a mixed methods approach.
This study, conducted in five safety-net practices, examined the impact of implementing a commercial electronic health records system on medication safety. The authors found 130 "true" drug-drug interaction (DDI) pairs, representing 149,087 visits and 62 providers, with the largest DDI categories being related to antihypertensive medications, which are often prescribed together. They found no significant differences between physicians and nurse practitioners on the rate of DDI pairs.
AHRQ-funded; HS017191.
Citation: Pohl JM, Tanner C, Hamilton A .
Medication safety after implementation of a commercial electronic health record system in five safety-net practices: a mixed methods approach.
J Am Assoc Nurse Pract 2014 Aug;26(8):438-44. doi: 10.1002/2327-6924.12089.
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Keywords: Medication: Safety, Medication, Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Medical Errors, Patient Safety