National Healthcare Quality and Disparities Report
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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
26 to 50 of 143 Research Studies DisplayedBush RA, Perez A, Baum T
A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care.
In this study, a systematic review, was conducted, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999 - 2017 of human subject peer-reviewed articles in English containing original research about the electronic health record and palliative care. The review identified five major areas in which the EHR is used to support PC.
AHRQ-funded; HS022404.
Citation: Bush RA, Perez A, Baum T .
A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care.
JAMIA Open 2018 Oct 1;1(2):294-303. doi: 10.1093/jamiaopen/ooy028..
Keywords: Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Palliative Care
Bordley J, Sakata KK, Bierman J
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
The electronic health record is a primary source of information for all professional groups participating in ICU rounds. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, the investigators created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making.
AHRQ-funded; HS023793.
Citation: Bordley J, Sakata KK, Bierman J .
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
Crit Care Med 2018 Oct;46(10):1570-76. doi: 10.1097/ccm.0000000000003302..
Keywords: Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Teams
Rao G, Naureckas S, Datta A
Pediatric hypertension: diagnostic patterns derived from electronic health records.
This study examined the rates of diagnostic for pediatric hypertension using electronic health records (EHRs). The rates of diagnosis were very low (6.1%) among 1478 children identified as hypertensive. Rates of diagnosis improved in children aged 12 and above but was very low for children aged 6 and under. Underdiagnosis can lead to organ failure and increased risk for adult hypertension.
AHRQ-funded; HS024100.
Citation: Rao G, Naureckas S, Datta A .
Pediatric hypertension: diagnostic patterns derived from electronic health records.
Diagnosis 2018 Sep;5(3):157-60. doi: 10.1515/dx-2018-0010..
Keywords: Children/Adolescents, Blood Pressure, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT)
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
Meyers S, Claire Simon K, Bergman-Bock S
Structured clinical documentation to improve quality and support practice-based research in headache.
The authors developed a proprietary toolkit to aid clinicians when creating clinical documentation in electronic medical records (EMRs). This toolkit will help clinicians provide discrete data and not unstructured free text which many clinicians enter into the EMR. The toolkit collects hundreds of fields of data and interprets score tests for a number of difference assessment tools for anxiety disorder, depression, migraine disability, and insomnia. The toolkit was used at 4346 initial patient visits as of April 1, 2018. The toolkit is being shared with other clinics as part of the Neurology Practice-Based Research Network.
AHRQ-funded; HS024057.
Citation: Meyers S, Claire Simon K, Bergman-Bock S .
Structured clinical documentation to improve quality and support practice-based research in headache.
Headache 2018 Sep;58(8):1211-18. doi: 10.1111/head.13348..
Keywords: Quality Improvement, Quality of Life, Tools & Toolkits, Neurological Disorders, Electronic Health Records (EHRs), Health Information Technology (HIT), Practice-Based Research Network (PBRN)
Marino M, Angier H, Valenzuela S
Medicaid coverage accuracy in electronic health records.
The objective of the study was to evaluate the validity of electronic health record (EHR) data for monitoring longitudinal Medicaid coverage and assess variation by patient demographics, visit types, and clinic characteristics. The researchers conducted a retrospective, observational study comparing Medicaid status agreement between Oregon community health center EHR data linked at the patient-level to Medicaid enrollment data (gold standard).
AHRQ-funded; HS024270.
Citation: Marino M, Angier H, Valenzuela S .
Medicaid coverage accuracy in electronic health records.
Prev Med Rep 2018 Sep;11:297-304. doi: 10.1016/j.pmedr.2018.07.009..
Keywords: Electronic Health Records (EHRs), Health Insurance, Health Services Research (HSR), Medicaid, Policy
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
Taylor JO, Hartzler AL, Osterhage KP
Monitoring for change: the role of family and friends in helping older adults manage personal health information.
Although family and friends (FF) often play a significant support role in the health of older adults (OA), little is known about their role in personal health information management (PHIM). To address this gap and inform the design of PHIM tools, the investigators described the work, needs, and barriers of FF in the context of PHIM for OAs.
AHRQ-funded; HS022106.
Citation: Taylor JO, Hartzler AL, Osterhage KP .
Monitoring for change: the role of family and friends in helping older adults manage personal health information.
J Am Med Inform Assoc 2018 Aug;25(8):989-99. doi: 10.1093/jamia/ocy037..
Keywords: Caregiving, Elderly, Electronic Health Records (EHRs), Health Information Technology (HIT)
Sharko M, Wilcox L, Hong MK
Variability in adolescent portal privacy features: how the unique privacy needs of the adolescent patient create a complex decision-making process.
Medical privacy policies, which are clear-cut for adults and young children, become ambiguous during adolescence. Yet medical organizations must establish unambiguous rules about patient and parental access to electronic patient portals. In this paper, the investigators conducted a national interview study to characterize the diversity in adolescent portal policies across a range of institutions and determine the factors influencing decisions about these policies.
AHRQ-funded; HS021531.
Citation: Sharko M, Wilcox L, Hong MK .
Variability in adolescent portal privacy features: how the unique privacy needs of the adolescent patient create a complex decision-making process.
J Am Med Inform Assoc 2018 Aug;25(8):1008-17. doi: 10.1093/jamia/ocy042..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Policy
Lewis Gilbert A, McCord AL, Ouyang F
Characteristics associated with confidential consultation for adolescents in primary care.
This study examines how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. The study found that provider training is needed to reinforce the importance of confidential consultation for all adolescents.
AHRQ-funded; HS022681.
Citation: Lewis Gilbert A, McCord AL, Ouyang F .
Characteristics associated with confidential consultation for adolescents in primary care.
J Pediatr 2018 Aug;199:79-84.e1. doi: 10.1016/j.jpeds.2018.02.044..
Keywords: Children/Adolescents, Education: Continuing Medical Education, Electronic Health Records (EHRs), Primary Care, Training
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
Meyerhoefer CD, Sherer SA, Deily ME
Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.
This study examined how the installation of an ambulatory EHR at OB/GYN practices and its subsequent interface with an inpatient perinatal EHR affected providers' satisfaction with the transmission of clinical information and patients' ratings of their care experience. The study concluded that dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction.
AHRQ-funded; HS018649.
Citation: Meyerhoefer CD, Sherer SA, Deily ME .
Provider and patient satisfaction with the integration of ambulatory and hospital EHR systems.
J Am Med Inform Assoc 2018 Aug;25(8):1054-63. doi: 10.1093/jamia/ocy048..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Patient Experience, System Design
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
Colin NV, Cholan RA, Sachdeva B
Understanding the impact of variations in measurement period reporting for electronic clinical quality measures.
The purpose of the study was to understand the impact of varying measurement period on the calculation of electronic Clinical Quality Measures (eCQMs). Variations in measurement periods were associated with variation in performance between clinics for 3 of the 4 eCQMs, but did not have significant differences when calculated within clinics. Variations from standard measurement periods may reflect poor data quality and accuracy.
AHRQ-funded; HS023908.
Citation: Colin NV, Cholan RA, Sachdeva B .
Understanding the impact of variations in measurement period reporting for electronic clinical quality measures.
eGEMS 2018 Jul 19;6(1):17. doi: 10.5334/egems.235..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Measures, Quality Improvement, Quality of Care
Walker DM, Hefner JL, Sieck CJ
Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective.
Inpatient portals are emerging as an important tool to support patient care and are increasingly being adopted in hospitals. However, best practices concerning the implementation, use, and impact of these portals are poorly understood. To improve evaluation and implementation efforts, this paper develops a logic model that can help researchers and hospital managers in deploying and assessing the impact of inpatient portals.
AHRQ-funded; HS024349; HS024091.
Citation: Walker DM, Hefner JL, Sieck CJ .
Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective.
J Med Syst 2018 Jul 16;42(9):158. doi: 10.1007/s10916-018-1009-3..
Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Hospitals, Web-Based
Denton CA, Soni HC, Kannampallil TG
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
In this article, the authors investigated the perceived effects of electronic health record (EHR) use on clinical workflow and meaningful use (MU) performance metrics. The investigators concluded that physicians' perception of EHRs was likely to influence their practices. They suggested that with negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.
AHRQ-funded; HS022670.
Citation: Denton CA, Soni HC, Kannampallil TG .
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
Appl Clin Inform 2018 Jul;9(3):725-33. doi: 10.1055/s-0038-1668553..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Workflow, Provider: Physician, Provider
Dowding D, Merrill JA
The development of heuristics for evaluation of dashboard visualizations.
Heuristic evaluation is used in human-computer interaction studies to assess the usability of information systems. This article develops a heuristic evaluation checklist that can be used to evaluate systems that produce information visualizations. The authors suggest that a checklist of usability heuristics for evaluating information visualization systems can contribute to assuring high quality in electronic data systems developed for health care.
AHRQ-funded; HS023855.
Citation: Dowding D, Merrill JA .
The development of heuristics for evaluation of dashboard visualizations.
Appl Clin Inform 2018 Jul;9(3):511-18. doi: 10.1055/s-0038-1666842..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider Performance, Quality of Care, Quality Improvement
Hedderson MM, Brown SD, Ehrlich SF
A tailored letter based on electronic health record data improves gestational weight gain among women with gestational diabetes mellitus: the Gestational Diabetes' Effects on Moms (GEM) cluster-randomized controlled trial.
The purpose of this study was to evaluate whether a tailored letter improved gestational weight gain (GWG) and whether GWG mediated a multicomponent intervention's effect on postpartum weight retention among women with gestational diabetes mellitus (GDM). The authors concluded that a tailored electronic health record-based letter improved GWG, which mediated the effect of a multicomponent intervention in reducing postpartum weight retention.
AHRQ-funded; HS019367.
Citation: Hedderson MM, Brown SD, Ehrlich SF .
A tailored letter based on electronic health record data improves gestational weight gain among women with gestational diabetes mellitus: the Gestational Diabetes' Effects on Moms (GEM) cluster-randomized controlled trial.
Diabetes Care 2018 Jul;41(7):1370-77. doi: 10.2337/dc17-1133..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Lifestyle Changes, Patient-Centered Outcomes Research, Pregnancy, Women
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
Sittig DF, Salimi M, Aiyagari R
Adherence to recommended electronic health record safety practices across eight health care organizations.
The Safety Assurance Factors for EHR Resilience (SAFER) guides were released in 2014 to help health systems conduct proactive risk assessment of electronic health record (EHR)- safety related policies, processes, procedures, and configurations. This study examined the extent to which SAFER recommendations are followed. The study concluded that despite availability of recommendations on how to improve use of EHRs, most recommendations were not fully implemented. New national policy initiatives are needed to stimulate implementation of these best practices.
AHRQ-funded; HS024459; HS022087; HS023602.
Citation: Sittig DF, Salimi M, Aiyagari R .
Adherence to recommended electronic health record safety practices across eight health care organizations.
J Am Med Inform Assoc 2018 Jul;25(7):913-18. doi: 10.1093/jamia/ocy033..
Keywords: Electronic Health Records (EHRs), Guidelines, Health Information Technology (HIT), Patient Safety, Provider
Simon KC, Tideman S, Hillman L
Design and implementation of pragmatic clinical trials using the electronic medical record and an adaptive design.
The purpose of this study was to demonstrate the feasibility of pragmatic clinical trials comparing the effectiveness of treatments using the electronic medical record (EMR) and an adaptive assignment design. The authors suggest that the demonstration of successful pragmatic clinical trials based on a customized EMR and adaptive design is an important next step in achieving personalized medicine and provides a framework for future studies of comparative effectiveness.
AHRQ-funded; HS024057.
Citation: Simon KC, Tideman S, Hillman L .
Design and implementation of pragmatic clinical trials using the electronic medical record and an adaptive design.
JAMIA Open 2018 Jul;1(1):99-106. doi: 10.1093/jamiaopen/ooy017..
Keywords: Comparative Effectiveness, Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, System Design
Bush RA, Richardson AC, Cardona-Grau D
Patient portal usage in pediatric urology: is it meaningful use for everyone?
This study examined pediatric urology patient portal enrollment and activation patterns at a tertiary pediatric hospital in Southern California by race/ethnicity, preferred language, gender, and residential region. The study concluded that primary language and socioeconomic factors may be significant barriers to portal adoption. Patient education to reduce these barriers may increase portal acceptance and increase meaningfulness to the portal for patients/parents and providers.
AHRQ-funded; HS022404.
Citation: Bush RA, Richardson AC, Cardona-Grau D .
Patient portal usage in pediatric urology: is it meaningful use for everyone?
Urol Pract 2018 Jul;5(4):279-85. doi: 10.1016/j.urpr.2017.05.002..
Keywords: Education: Patient and Caregiver, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient and Family Engagement, Web-Based
Nystrom DT, Singh H, Baldwin J
Methods for patient-centered interface design of test result display in online portals.
However, current patient portals are not designed in a patient-centered way and little is known on how best to harness patients' information needs to inform user-centered interface design of portals. The researchers designed a patient-facing laboratory test result interface prototype based on requirement elicitation research and used a mixed-methods approach to evaluate this interface.
AHRQ-funded; HS023602.
Citation: Nystrom DT, Singh H, Baldwin J .
Methods for patient-centered interface design of test result display in online portals.
eGEMS 2018 Jun 26;6(1):15. doi: 10.5334/egems.255..
Keywords: Electronic Health Records (EHRs), Patient-Centered Healthcare, System Design, Web-Based
Polubriaginof FCG, Vanguri R, Quinnies K
Disease heritability inferred from familial relationships reported in medical records.
Electronic health records (EHRs) passively capture a wide range of clinically relevant data and provide a resource for studying the heritability of traits that are not typically accessible. This study used EHR data to compute heritability estimates for 500 disease phenotypes. These analyses provided a validation of the use of EHRs for genetics and disease research.
AHRQ-funded; HS021816; HS022961.
Citation: Polubriaginof FCG, Vanguri R, Quinnies K .
Disease heritability inferred from familial relationships reported in medical records.
Cell 2018 Jun 14;173(7):1692-704.e11. doi: 10.1016/j.cell.2018.04.032..
Keywords: Data, Family Health and History, Genetics, Health Information Technology (HIT), Electronic Health Records (EHRs)