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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 20 of 20 Research Studies Displayed
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.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Safety Net, Diabetes, Patient Safety, Vulnerable Populations
Hong S, Burnett-Zeigler I
The frequency of PTSD and subthreshold PTSD among African-American women with depressive symptoms in a disadvantaged urban neighborhood: pilot study.
This report examined the frequency of a post-traumatic stress disorder (PTSD) diagnosis and subthreshold PTSD among 72 female participants with depressive symptoms in a mindfulness-based intervention for depression at an urban federally qualified health center. The authors reported the high frequency of PTSD diagnosis and subthreshold PTSD among underserved women with depressive symptoms.
Citation: Hong S, Burnett-Zeigler I . The frequency of PTSD and subthreshold PTSD among African-American women with depressive symptoms in a disadvantaged urban neighborhood: pilot study. J Racial Ethn Health Disparities 2017 Dec;4(6):1069-73. doi: 10.1007/s40615-016-0311-3.
Keywords: Depression, Behavioral Health, Racial / Ethnic Minorities, Urban Health, Vulnerable Populations
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.
Keywords: Electronic Health Records (EHRs), Medication, Patient Safety, Urban Health, Vulnerable Populations
Clarity C, Sarkar U, Lee J
Clinician perspectives on the management of abnormal subcritical tests in an urban academic safety-net health care system.
Missed or delayed follow-up of abnormal subcritical tests (tests that do not require immediate medical attention) can lead to poor patient outcomes. Safety-net health systems with limited resources and socially complex patients are vulnerable to safety gaps resulting from delayed management. In this study, clinician perspectives to identify system challenges, vulnerable situations, and potential solutions, were sought in focus groups.
Citation: Clarity C, Sarkar U, Lee J . Clinician perspectives on the management of abnormal subcritical tests in an urban academic safety-net health care system. Jt Comm J Qual Patient Saf 2017 Oct;43(10):517-23. doi: 10.1016/j.jcjq.2017.05.007..
Keywords: Urban Health, Safety Net, Diagnostic Safety and Quality, Patient Safety, Vulnerable Populations, Ambulatory Care and Surgery, Clinician-Patient Communication, Communication, Provider: Clinician, Provider
Louisias M, Phipatanakul W
Managing asthma in low-income, underrepresented minority, and other disadvantaged pediatric populations: closing the gap.
The authors review current understanding of the epidemiology and etiology of disparities in asthma. They also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors.
Citation: Louisias M, Phipatanakul W . Managing asthma in low-income, underrepresented minority, and other disadvantaged pediatric populations: closing the gap. Curr Allergy Asthma Rep 2017 Sep 15;17(10):68. doi: 10.1007/s11882-017-0734-x.
Keywords: Asthma, Children/Adolescents, Low-Income, Racial / Ethnic Minorities, Vulnerable Populations
Goto T, Faridi MK, Gibo K
Trends in 30-day readmission rates after COPD hospitalization, 2006-2012.
This study investigated trends in 30-day readmission rates after chronic obstructive pulmonary disease (COPD)-related hospitalization. Overall, the 30-day readmission rate for COPD-related hospitalization decreased modestly from 20.0 percent in 2006 to 19.2 percent in 2012. Similar to the overall population, the readmission rate over the 7-year period remained persistently high in most of AHRQ-defined priority populations.
Citation: Goto T, Faridi MK, Gibo K . Trends in 30-day readmission rates after COPD hospitalization, 2006-2012. Respir Med 2017 Sep;130:92-97. doi: 10.1016/j.rmed.2017.07.058.
Keywords: Respiratory Conditions, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Social Determinants of Health, Vulnerable Populations
Grande SW, Castaldo MG, Carpenter-Song E
A digital advocate? Reactions of rural people who experience homelessness to the idea of recording clinical encounters.
This study examines the reactions of homeless people to the idea of using a smartphone to record their own clinical encounter, either covertly or with permission from their physician. The researchers conducted semi-structured interviews with individuals at a temporary housing shelter in Northern New England. The study found that while many rural, disadvantaged individuals felt marginalized by the wide social distance between themselves and their clinicians, recording technology may serve as an advocate by holding both patients and doctors accountable and by permitting the burden of clinical proof to be shared.
Citation: Grande SW, Castaldo MG, Carpenter-Song E . A digital advocate? Reactions of rural people who experience homelessness to the idea of recording clinical encounters. Health Expect 2017 Aug;20(4):618-25. doi: 10.1111/hex.12492..
Keywords: Health Information Exchange (HIE), Clinician-Patient Communication, Rural Health, Vulnerable Populations
Horton M, McDonald R, Green TC
A mapping review of take-home naloxone for people released from correctional settings.
The objective of this review is to map research into take-home naloxone (THN) for people released from correctional settings in order to identify further research needs. It concluded that the feasibility of THN in the context of release from a correctional setting has been established, but there is a need for rigorous research into health outcomes and program implementation.
Citation: Horton M, McDonald R, Green TC . A mapping review of take-home naloxone for people released from correctional settings. Int J Drug Policy 2017 Aug;46:7-16. doi: 10.1016/j.drugpo.2017.05.015.
Keywords: Adverse Drug Events (ADE), Medication, Opioids, Substance Abuse, Vulnerable Populations
Kruse GR, Hays H, Orav EJ
Meaningful use of the Indian Health Service electronic health record.
This study sought to understand the use of electronic health record (EHR) functionalities by physicians practicing in an underserved setting. Physicians routinely used a median 7 of 10 EHR functionalities targeted by the Meaningful Use program, but only 5 percent used all 10. Most (63 percent) felt the EHR improved quality of care. Many (76 percent) reported increased documentation time and poorer quality patient-physician interactions (45 percent).
Citation: Kruse GR, Hays H, Orav EJ . Meaningful use of the Indian Health Service electronic health record. Health Serv Res 2017 Aug;52(4):1349-63. doi: 10.1111/1475-6773.12531.
Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Practice Patterns, Vulnerable Populations
Payan DD, Sloane DC, Illum J
Catalyzing implementation of evidence-based interventions in safety net settings: a clinical-community partnership in South Los Angeles.
This study was a process evaluation of a clinical-community partnership that implemented evidence-based interventions in clinical safety net settings. Key participants and health care providers, involved in the study, expressed a high level of satisfaction with the collaborative and the interventions, respectively. The authors provide key lessons learned for researchers and practitioners interested in partnering with Federally Qualified Health Centers to implement health promotion interventions.
Citation: Payan DD, Sloane DC, Illum J . Catalyzing implementation of evidence-based interventions in safety net settings: a clinical-community partnership in South Los Angeles. Health Promot Pract 2017 Jul;18(4):586-97. doi: 10.1177/1524839917705418..
Keywords: Community Partnerships, Safety Net, Health Promotion, Evidence-Based Practice, Vulnerable Populations, Implementation
ML Linder, JA Clark, CR
AHRQ Author: Barnett
Low-value medical services in the safety-net population.
The objective of this study was to measure rates of low-value care and high-value care received by patients without insurance or with Medicaid, compared with privately insured patients, and provided by safety-net physicians vs non-safety-net physicians. The study concluded that rates of low-value and high-value care were similar among physicians serving vulnerable patients and other physicians. Overuse of low-value care is a potentially important focus for state Medicaid programs and safety-net institutions to pursue cost savings and improved quality of health care delivery.
Citation: ML Linder, JA Clark, CR . Low-value medical services in the safety-net population. JAMA Intern Med 2017 Jun;177(6):829-37. doi: 10.1001/jamainternmed.2017.0401..
Keywords: Access to Care, Quality of Care, Safety Net, Value, Vulnerable Populations
Tieu L, Schillinger D, Sarkar U
Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?
The objective of this study was to examine specific usability barriers to patient portal engagement among a diverse group of patients and caregivers. In navigating the portal, participants experienced basic computer barriers (eg, difficulty using a mouse), routine computer barriers (eg, mistyping, navigation issues), reading/writing barriers, and medical content barriers.
AHRQ-funded; HS022408; HS022561.
Citation: Tieu L, Schillinger D, Sarkar U . Online patient websites for electronic health record access among vulnerable populations: portals to nowhere? J Am Med Inform Assoc 2017 Apr 1;24(e1):e47-e54. doi: 10.1093/jamia/ocw098.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Literacy, Vulnerable Populations, Web-Based
Abdelsattar ZM, Hendren S, Wong SL
The impact of health insurance on cancer care in disadvantaged communities.
The extent to which health insurance can mitigate the effects of the social determinants of health on cancer care is unknown. This study of cancer patients diagnosed with the 4 leading causes of cancer deaths between 2007 and 2011 found that patients from disadvantaged communities benefit most from health insurance, and there is a reduction in disparities in outcome.
AHRQ-funded; HS020937; HS000053.
Citation: Abdelsattar ZM, Hendren S, Wong SL . The impact of health insurance on cancer care in disadvantaged communities. Cancer 2017 Apr 1;123(7):1219-27. doi: 10.1002/cncr.30431.
Keywords: Cancer, Health Insurance, Patient-Centered Outcomes Research, Vulnerable Populations
Schnall R, Cho H, Webel A
Predictors of willingness to use a smartphone for research in underserved persons living with HIV.
The purpose of this study was to assess factors associated with persons living with HIV (PLVH) for participation in research using smartphones. It concluded that future mHealth interventions targeting PLWH should take into account the inverse relationship between smartphone use and age, HIV stigma, and social isolation, and other predictor variables.
Citation: Schnall R, Cho H, Webel A . Predictors of willingness to use a smartphone for research in underserved persons living with HIV. Int J Med Inform 2017 Mar;99:53-59. doi: 10.1016/j.ijmedinf.2017.01.002.
Keywords: Human Immunodeficiency Virus (HIV), Patient Self-Management, Social Stigma, Telehealth, Vulnerable Populations
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.
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.
Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams
Gilmer TP, Stefancic A, Katz ML
Fidelity to the housing first model and effectiveness of permanent supported housing programs in California.
This paper examined the relationship between fidelity to the Housing First model and residential outcomes among clients of full service partnerships (FSPs) in California. They concluded that programs with greater fidelity to the Housing First model enrolled clients with longer histories of homelessness and placed most of them in apartments.
Citation: Gilmer TP, Stefancic A, Katz ML . Fidelity to the housing first model and effectiveness of permanent supported housing programs in California. Psychiatr Serv 2014 Nov;65(11):1311-7. doi: 10.1176/appi.ps.201300447.
Keywords: Value, Vulnerable Populations
Vanderwerker L, Akincigil A, Olfson M
Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.
The researchers investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths. They found that foster care youths had higher rates of externalizing disorders than the comparison group and greater antipsychotic use. Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates.
AHRQ-funded; HS017918; HS019937; HS021112.
Citation: Vanderwerker L, Akincigil A, Olfson M . Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths. Psychiatr Serv 2014 Oct;65(10):1281-4. doi: 10.1176/appi.ps.201300455.
Keywords: Children/Adolescents, Medication, Medicaid, Vulnerable Populations, Behavioral Health
Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q
Substance use, risk of dependence, counseling and treatment among adult health center patients.
The authors examined the prevalence of substance use and risk of dependence among health center patients, and identified factors associated with desire for counseling/treatment and discussions about substance use with a clinician. They found that 84% of patients who desired substance use counseling or treatment reported receiving it, and those patients most likely to desire substance use counseling or treatment were male, unmarried, insured, current smokers, and indicated mental health problems.
Citation: Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q . Substance use, risk of dependence, counseling and treatment among adult health center patients. J Health Care Poor Underserved 2014 Aug;25(3):1217-30. doi: 10.1353/hpu.2014.0130.
Keywords: Behavioral Health, Community-Based Practice, Substance Abuse, Vulnerable Populations
Allgood KL, Rauscher GH, Whitman S
Validating self-reported mammography use in vulnerable communities: findings and recommendations.
The researchers examined the potential extent of overreporting of mammography use in low-income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. They found that although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all ethnic groups studied.
Citation: Allgood KL, Rauscher GH, Whitman S . Validating self-reported mammography use in vulnerable communities: findings and recommendations. Cancer Epidemiol Biomarkers Prev 2014 Aug;23(8):1649-58. doi: 10.1158/1055-9965.epi-13-1253.
Keywords: Healthcare Utilization, Mammogram, Racial / Ethnic Minorities, Vulnerable Populations, Low-Income, Urban Health, Women
Moy E, Freeman W
AHRQ Author: Moy E, Freeman W
Federal investments to eliminate racial/ethnic health-care disparities.
The authors presented a model that describes the relationships among social disadvantage, health-care disparities, and health disparities. They proposed that increasing the diversity of the public health and health-care workforces is an efficient strategy for reducing disparities because it impacts both access to care and patient-provider communication.
Citation: Moy E, Freeman W . Federal investments to eliminate racial/ethnic health-care disparities. Public Health Rep 2014 Jan-Feb;129 Suppl 2:62-70. doi: 10.1177/00333549141291s212.
Keywords: Access to Care, Disparities, Racial / Ethnic Minorities, Social Determinants of Health, Vulnerable Populations