National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (7)
- (-) Adverse Events (14)
- Ambulatory Care and Surgery (1)
- Anxiety (1)
- Behavioral Health (1)
- Blood Pressure (1)
- Communication (1)
- Data (1)
- Depression (1)
- Diagnostic Safety and Quality (2)
- Elderly (1)
- (-) Electronic Health Records (EHRs) (14)
- Emergency Department (1)
- Falls (1)
- Healthcare-Associated Infections (HAIs) (1)
- Health Information Technology (HIT) (13)
- Hospitalization (2)
- Hospitals (2)
- Injuries and Wounds (1)
- Medical Errors (6)
- Medication (7)
- Medication: Safety (4)
- Patient and Family Engagement (1)
- Patient Safety (13)
- Prevention (4)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
- Quality of Care (2)
- Risk (3)
- Surgery (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 14 of 14 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
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
Grundmeier RW, Xiao R, Ross RK
Grundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, et al. Identifying surgical site infections in electronic health data using predictive models,.
The objective of this study was to prospectively derive and validate a prediction rule for detecting cases warranting investigation for surgical site infections (SSI) after ambulatory surgery. The investigators concluded that electronic health record data can facilitate SSI surveillance with adequate sensitivity and positive predictive value.
AHRQ-funded; HS020921.
Citation: Grundmeier RW, Xiao R, Ross RK .
Grundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, et al. Identifying surgical site infections in electronic health data using predictive models,.
J Am Med Inform Assoc 2018 Sep;25(9):1160-66. doi: 10.1093/jamia/ocy075..
Keywords: Healthcare-Associated Infections (HAIs), Injuries and Wounds, Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT), Risk, Patient Safety, Adverse Events, Ambulatory Care and Surgery
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
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
Muldoon MF, Kronish IM, Shimbo D
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
This paper reviews the manifestations and consequences of BP mismeasurement and misinterpretation in clinical practice and draw on recent research to propose a set of solutions that leverage available technologies to optimize hypertension care.
AHRQ-funded; HS024262.
Citation: Muldoon MF, Kronish IM, Shimbo D .
Of signal and noise: overcoming challenges in blood pressure measurement to optimize hypertension care.
Circ Cardiovasc Qual Outcomes 2018 May;11(5):e004543. doi: 10.1161/circoutcomes.117.004543..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Adverse Events, Medical Errors, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality of Care
Barbieri AL, Fadare O, Fan L
Challenges in communication from referring clinicians to pathologists in the electronic health record era.
This study reports on the role played by electronic health record inbox messages (EHRmsg) in a safety event involving pathology. Clinicians assumed that pathologists used EHRmsg as clinical care team members, however, pathologists rarely did. Communication gaps exist between primary clinicians and pathologists in the EHR era and they have potential to result in patient harm.
AHRQ-funded; HS022087.
Citation: Barbieri AL, Fadare O, Fan L .
Challenges in communication from referring clinicians to pathologists in the electronic health record era.
J Pathol Inform. 2018 Apr 2;9:8. doi: 10.4103/jpi.jpi_70_17..
Keywords: Adverse Events, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Patterson BW, Repplinger MD, Pulia MS
Using the Hendrich II Inpatient Fall Risk Screen to predict outpatient falls after emergency department visits.
This study examined the utility of using the Hendrich II Inpatient Fall Risk Screen to predict outpatient falls in elderly patients after emergency department (ED) visits. Individuals aged 65 and older seen in the ED from January 2013 to September 30, 2015 participated in the study. The Hendrich II screen was found to correlate with outpatient falls, but it is likely it would have little utility as a stand-alone fall screen. When the screen was combined with other potential confounders or predictors, the screen performed much better.
AHRQ-funded; HS024558.
Citation: Patterson BW, Repplinger MD, Pulia MS .
Using the Hendrich II Inpatient Fall Risk Screen to predict outpatient falls after emergency department visits.
J Am Geriatr Soc 2018 Apr;66(4):760-65. doi: 10.1111/jgs.15299..
Keywords: Elderly, Falls, Risk, Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT), Prevention, Patient Safety, Adverse Events
Howe JL, Adams KT, Hettinger AZ
Electronic health record usability issues and potential contribution to patient harm.
Researchers analyzed reports of possible patient harm that explicitly mentioned a major EHR vendor or product. They concluded that EHR usability may have been a contributing factor to some possible patient harm events. Only a small percentage of potential harm events were associated with EHR usability, but the analysis was conservative because safety reports only capture a small fraction of the actual number of safety incidents.
AHRQ-funded; HS023701.
Citation: Howe JL, Adams KT, Hettinger AZ .
Electronic health record usability issues and potential contribution to patient harm.
JAMA 2018 Mar 27;319(12):1276-78. doi: 10.1001/jama.2018.1171.
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Keywords: Adverse Events, Electronic Health Records (EHRs), Medical Errors, Patient Safety, Risk
Bhise V, Sittig DF, Vaghani V
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
Researchers refined the methods of the Institute of Healthcare Improvement's Global Trigger Tool application and leveraged electronic health record data to improve detection of preventable adverse events, including diagnostic errors. In the studied sample, preventable adverse events were identified, including adverse drug events, patient falls, procedure-related complications, and hospital-associated infections. The authors concluded that such e-triggers can help overcome limitations of currently available methods to detect preventable harm in hospitalized patients.
AHRQ-funded; HS022087; HS023602.
Citation: Bhise V, Sittig DF, Vaghani V .
An electronic trigger based on care escalation to identify preventable adverse events in hospitalised patients.
BMJ Qual Saf 2018 Mar;27(3):241-46. doi: 10.1136/bmjqs-2017-006975..
Keywords: Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Hospitals, Patient Safety, Prevention, Quality of Care, Quality Improvement, Quality Indicators (QIs)
Larsen E, Fong A, Wernz C
Implications of electronic health record downtime: an analysis of patient safety event reports.
Researchers sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) downtime periods by analyzing the narratives of patient safety event report data. They concluded that patient safety report data offer a lens into EHR downtime-related safety hazards. Important areas of risk during EHR downtime periods were patient identification and communication of clinical information.
AHRQ-funded; HS024350.
Citation: Larsen E, Fong A, Wernz C .
Implications of electronic health record downtime: an analysis of patient safety event reports.
J Am Med Inform Assoc 2018 Feb;25(2):187-91. doi: 10.1093/jamia/ocx057.
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Keywords: Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Patient Safety
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