National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (10)
- Adverse Events (7)
- Anxiety (1)
- Behavioral Health (1)
- Blood Pressure (1)
- Care Management (1)
- Children/Adolescents (2)
- Clinical Decision Support (CDS) (1)
- Data (1)
- Depression (1)
- Diabetes (3)
- Diagnostic Safety and Quality (1)
- (-) Electronic Health Records (EHRs) (19)
- Emergency Department (1)
- Emergency Medical Services (EMS) (1)
- Health Information Technology (HIT) (15)
- Hospitalization (1)
- Hospitals (1)
- Medical Errors (4)
- (-) Medication (19)
- Medication: Safety (8)
- Outcomes (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (1)
- Patient Safety (13)
- Prevention (2)
- Primary Care (1)
- Quality of Care (2)
- Risk (2)
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 19 of 19 Research Studies DisplayedWright A, Aaron S, Seger DL
Reduced effectiveness of interruptive drug-drug interaction alerts after conversion to a commercial electronic health record.
This study examined the effects of conversion from a homegrown electronic health record (EHR) system to a commercial system on the effectiveness of drug-drug interaction (DDI) alert. The EHR system included 3277 clinicians in the before and after studies. There was a marked decrease in the acceptance rate (100 to 8.4% for severe alerts, 29.3 to 7.5% for medium severity) at first. The least severe alerts were then disabled, which lowered the alert burden by 50.5% which rose the acceptance of Tier 1 alerts to 12.7%. However, there was no clear explanation after that why the acceptance rate remained so much lower. The authors believe that workflow factors were probably the predominant reasons.
AHRQ-funded; HS016970.
Citation: Wright A, Aaron S, Seger DL .
Reduced effectiveness of interruptive drug-drug interaction alerts after conversion to a commercial electronic health record.
J Gen Intern Med 2018 Nov;33(11):1868-76. doi: 10.1007/s11606-018-4415-9..
Keywords: Adverse Drug Events (ADE), Medication, Adverse Events, Medical Errors, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Prey JE, Polubriaginof F, Grossman LV
Engaging hospital patients in the medication reconciliation process using tablet computers.
Researchers conducted a pilot study to determine whether patients’ use of an electronic home medication review tool on a table computer could improve medication safety before or after hospitalization. Patients were randomized to the tool and out of 76 patients approached, 65 participated. About three-quarters (74%) made changes to their home medication list. Out of that total, 74% of the changes identified had a significant or greater potential severity, and 49% had a greater than 50-50 chance of harm. This medication reconciliation tool showed great potential to improve medication safety during and after hospitalization.
AHRQ-funded; HS021816.
Citation: Prey JE, Polubriaginof F, Grossman LV .
Engaging hospital patients in the medication reconciliation process using tablet computers.
J Am Med Inform Assoc 2018 Nov;25(11):1460-69. doi: 10.1093/jamia/ocy115..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Hospitals, Medication, Medication: Safety, Patient and Family Engagement, Patient Safety, Prevention
Ratwani RM, Savage E, Will A
Identifying electronic health record usability and safety challenges in pediatric settings.
To understand specific usability issues and medication errors in the care of children, the investigators analyzed 9,000 patient safety reports, made in the period 2012-17, from three different health care institutions that were likely related to EHR use. They found: the general pattern of usability challenges and medication errors were the same across the three sites; the most common usability challenges were associated with system feedback and the visual display; and the most common medication error was improper dosing.
AHRQ-funded; HS023701.
Citation: Ratwani RM, Savage E, Will A .
Identifying electronic health record usability and safety challenges in pediatric settings.
Health Aff 2018 Nov;37(11):1752-59. doi: 10.1377/hlthaff.2018.0699..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Children/Adolescents
Bates DW, Singh H
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
This paper comments on the progress made in improving patient safety since the 1999 report from The Institute of Medicine titled “To Err is Human” was published. This landmark report highlighted problem areas, and since then there has been a number of effective interventions to prevent hospital-acquired infections and improve medication safety. Additional areas for improvement have also been identified in the past two decades, including outpatient care, diagnostic, errors and the use of health information technology. The authors believe that electronic data developments can help increase patient safety even further.
AHRQ-funded; HS022087; HS017820.
Citation: Bates DW, Singh H .
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
Health Aff 2018 Nov;37(11):1736-43. doi: 10.1377/hlthaff.2018.0738..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Prevention
Blumenthal KG, Li Y, Acker WW
Multiple drug intolerance syndrome and multiple drug allergy syndrome: epidemiology and associations with anxiety and depression.
In this study, the authors used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. The investigators concluded that: 1.) while 6% of patients had MDIS, only 1% had MDAS; 2.) MDIS was associated with both anxiety and depression; 3.) patients with both anxiety and depression had an almost twofold increased odds of MDIS; 4.) MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety.
AHRQ-funded; HS022728.
Citation: Blumenthal KG, Li Y, Acker WW .
Multiple drug intolerance syndrome and multiple drug allergy syndrome: epidemiology and associations with anxiety and depression.
Allergy 2018 Oct;73(10):2012-23. doi: 10.1111/all.13440..
Keywords: Adverse Drug Events (ADE), Adverse Events, Anxiety, Depression, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Behavioral Health, Patient Safety
Ramirez M, Maranon R, Fu J
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
The purpose of this study was to evaluate provider responses to a narrowly targeted Best Practice Advisory (BPA) alert regarding the intensification of blood pressure medications for persons with diabetes before and after implementation of a ‘chart closure’ hard stop. Researchers designed a BPA that sent alerts via an electronic health record system during outpatient encounters when patients with diabetes had elevated blood pressures and were not on angiotensin receptor blocking medications. These alerts were implemented in eight primary care practices within UCLA Health. Data on provider responses to the alerts was compared before and after implementing a ‘chart closure’ hard stop. Providers responded to alerts more often after the ‘chart closure’ hard stop was implemented. The researchers conclude that targeting specific omitted medication classes can produce specific alerts that may reduce alert fatigue, and that using a ‘chart closure’ hard stop may prompt providers to take action without major disruptions to their workflow.
AHRQ-funded; HS000046.
Citation: Ramirez M, Maranon R, Fu J .
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
J Am Med Inform Assoc 2018 Sep;25(9):1167-74. doi: 10.1093/jamia/ocy073..
Keywords: Blood Pressure, Diabetes, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Care Management
Wong A, Plasek JM, Montecalvo SP
Natural language processing and its implications for the future of medication safety: a narrative review of recent advances and challenges.
This review illustrates the fundamentals of natural language processing (NLP) and discusses the application the NLPs to medication safety in four data sources: electronic health records, Internet-based data, published literature, and reporting systems. The benefit of NLP is its time-saving features in association with the automation of medication safety tasks, as well as the potential for near real-time identification of adverse events, such as incidents posted on social media that might otherwise go unanalyzed. However, NLP is limited by a lack of data sharing between health care organizations, which inhibits wider adverse event monitoring across populations. The authors anticipate that future work on NLPs will focus on integrating of data sources from different domains to more quickly identify potential adverse events and to improve clinical decision support regarding patients’ estimated risks for specific adverse events.
AHRQ-funded; HS022728; HS024264; HS025375.
Citation: Wong A, Plasek JM, Montecalvo SP .
Natural language processing and its implications for the future of medication safety: a narrative review of recent advances and challenges.
Pharmacotherapy 2018 Aug;38(8):822-41. doi: 10.1002/phar.2151..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety, Patient Safety
Flory JH, Keating SJ, Siscovick D
Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record.
Non-persistence may be a significant barrier to the use of metformin. The objective of this study was to assess reasons for metformin non-persistence, and whether initial metformin dosing or use of extended release (ER) formulations affect persistence to metformin therapy. The investigators concluded that their data supported the routine prescribing of low starting doses of metformin as a tool to improve persistence.
AHRQ-funded; HS023898.
Citation: Flory JH, Keating SJ, Siscovick D .
Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record.
BMJ Open 2018 Jul 23;8(7):e021505. doi: 10.1136/bmjopen-2018-021505..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Patient Adherence/Compliance, Outcomes, Patient-Centered Outcomes Research, Risk
Walsh KE, Marsolo KA, Davis C
Accuracy of the medication list in the electronic health record-implications for care, research, and improvement.
Electronic medication lists may be useful in clinical decision support and research, but their accuracy is not well described. The aim of this study was to assess the completeness of the medication list compared to the clinical narrative in the electronic health record. The study found that there was a range in the accuracy of the medication list compared to the clinical narrative.
AHRQ-funded; HS022974.
Citation: Walsh KE, Marsolo KA, Davis C .
Accuracy of the medication list in the electronic health record-implications for care, research, and improvement.
J Am Med Inform Assoc 2018 Jul;25(7):909-12. doi: 10.1093/jamia/ocy027..
Keywords: Electronic Health Records (EHRs), Quality of Care, Medication, Patient-Centered Healthcare, Patient Safety
Walsh KE, Marsolo KA, Davis C
Accuracy of the medication list in the electronic health record-implications for care, research, and improvement.
Electronic medication lists may be useful in clinical decision support and research, but their accuracy is not well described. The aim of this study was to assess the completeness of the medication list compared to the clinical narrative in the electronic health record. The study found that there was a range in the accuracy of the medication list compared to the clinical narrative.
AHRQ-funded; HS022974.
Citation: Walsh KE, Marsolo KA, Davis C .
Accuracy of the medication list in the electronic health record-implications for care, research, and improvement.
J Am Med Inform Assoc 2018 Jul;25(7):909-12. doi: 10.1093/jamia/ocy027..
Keywords: Electronic Health Records (EHRs), Quality of Care, Medication, Patient-Centered Healthcare, Patient Safety
Goss FR, Lai KH, Topaz M
A value set for documenting adverse reactions in electronic health records.
In this study, the investigators developed a value set for encoding adverse reactions using a large dataset from one health system, enriched by reactions from 2 large external resources. This integrated value set included clinically important severe and hypersensitivity reactions. The work contributed a value set, harmonized with existing data, to improve the consistency and accuracy of reaction documentation in electronic health records, providing the necessary building blocks for more intelligent clinical decision support for allergies and adverse reactions.
AHRQ-funded; HS022728.
Citation: Goss FR, Lai KH, Topaz M .
A value set for documenting adverse reactions in electronic health records.
J Am Med Inform Assoc 2018 Jun;25(6):661-69. doi: 10.1093/jamia/ocx139..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Medication, Data, Health Information Technology (HIT), Patient Safety
Rangachari P, Dellsperger KC, Fallaw D
Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.
Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from "limited use" of EHR Medication Reconciliation (MedRec) Technology, to "meaningful use." Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. The purpose of this paper is to describe the methods and results of Phase 1.
AHRQ-funded; HS024335.
Citation: Rangachari P, Dellsperger KC, Fallaw D .
Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.
J Hosp Adm 2018 Apr;7(2):36-49. doi: 10.5430/jha.v7n2p36.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication: Safety, Medication, Patient Safety
Rangachari P
Implementing a Social Knowledge Networking (SKN) system to enable meaningful use of an EHR medication reconciliation system.
The study examined user-engagement in the SKN system and associations between "SKN use" and "meaningful use" of electronic health record (EHR). The prospective implementation design is expected to generate context-sensitive strategies for meaningful use and successful implementation of EHR Medication Reconciliation (MedRec) and thereby make substantial contributions to the patient safety and risk management literature.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Implementing a Social Knowledge Networking (SKN) system to enable meaningful use of an EHR medication reconciliation system.
Risk Manag Healthc Policy 2018 Mar 26;11:45-53. doi: 10.2147/rmhp.s152313.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Patient Safety, Risk
Wong A, Seger DL, Slight SP
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
The aim of this study was to determine the rate of anaphylaxis overrides, the reasons for these overrides, whether the overrides were appropriate, and if harm occurred from overrides. Overrides of 'definite' anaphylaxis drug-allergy interactions were common and often appropriate. Most overrides were due to desensitizations.
AHRQ-funded; HS021094.
Citation: Wong A, Seger DL, Slight SP .
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
Drug Saf 2018 Mar;41(3):297-302. doi: 10.1007/s40264-017-0615-1.
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Keywords: Adverse Drug Events (ADE), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Medication: Safety, Medication
Cornu P, Phansalkar S, Seger DL
High-priority and low-priority drug-drug interactions in different international electronic health record systems: a comparative study.
The purpose of this comparative retrospective study was to investigate whether alert warnings for high-priority and low-priority drug-drug interactions were present in five international electronic health record systems, to compare and contrast the severity level assigned to them, and to establish the proportion of alerts that were overridden.
AHRQ-funded; HS021094.
Citation: Cornu P, Phansalkar S, Seger DL .
High-priority and low-priority drug-drug interactions in different international electronic health record systems: a comparative study.
Int J Med Inform 2018 Mar;111:165-71. doi: 10.1016/j.ijmedinf.2017.12.027..
Keywords: Adverse Drug Events (ADE), Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety
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
Schmittdiel JA, Raebel MA, Dyer W
Prescription medication burden in patients with newly diagnosed diabetes: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) study.
The purpose of this study is to use electronic health records to examine how many classes of drugs are used by newly diagnosed patients with diabetes immediately before and after the diagnosis of diabetes. Before diagnosis, these patients are using an average of 5 drug classes, and afterwards, use rises to an average of 6.6. Between 2005 and 2009, the average number of drug classes used after diagnosis decreased slightly.
AHRQ-funded; HS01985
Citation: Schmittdiel JA, Raebel MA, Dyer W .
Prescription medication burden in patients with newly diagnosed diabetes: a SUrveillance, PREvention, and ManagEment of Diabetes Mellitus (SUPREME-DM) study.
J Am Pharm Assoc 2014 Jul-Aug;54(4):374-82. doi: 10.1331/JAPhA.2014.13195..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Medication
Kirkendall ES, Spires WL, Mottes TA
Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm.
The authors described an approach and provided a technical framework for the creation of risk-stratifying acute kidney injury (AKI) triggers and the development of an application to manage the AKI trigger data. Their report summarizes the construction of a trigger-based application, the performance of the triggers, and the challenges uncovered during the design, build, and implementation of the system.
AHRQ-funded; HS021114.
Citation: Kirkendall ES, Spires WL, Mottes TA .
Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm.
Appl Clin Inform 2014 Apr 2;5(2):313-33. doi: 10.4338/aci-2013-12-ra-0102.
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Keywords: Adverse Drug Events (ADE), Children/Adolescents, Medication, Health Information Technology (HIT), Electronic Health Records (EHRs)