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
51 to 75 of 143 Research Studies DisplayedGoss 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
Blecker S, Sontag D, Horwitz LI
Early identification of patients with acute decompensated heart failure.
The purpose of this study was to develop and test accuracies of various approaches to identify patients with acute decompensated heart failure (ADHF) with the use of data derived from the electronic health record. The authors concluded that machine learning algorithms with unstructured notes had the best performance for identification of ADHF and can improve provider efficiency for delivery of quality improvement interventions.
AHRQ-funded; HS023683.
Citation: Blecker S, Sontag D, Horwitz LI .
Early identification of patients with acute decompensated heart failure.
J Card Fail 2018 Jun;24(6):357-62. doi: 10.1016/j.cardfail.2017.08.458..
Keywords: Cardiovascular Conditions, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Heart Disease and Health
Sarkhel R, Socha JJ, Mount-Campbell A
HOW nurses identify hospitalized patients on their personal notes: findings from analyzing 'brains' headers with multiple raters.
Many nurses use handwritten notes in order to avoid using electronic health records to access information about patients. At the top of these notes are patient identifiers. By identifying aspects of good and suboptimal headers, the authors began to form a model of how to effectively support identifying patients during assessments and care activities. The primary finding was that nurses use room number as the primary patient identifier in the hospital setting, not the patient's last name.
AHRQ-funded; HS024379.
Citation: Sarkhel R, Socha JJ, Mount-Campbell A .
HOW nurses identify hospitalized patients on their personal notes: findings from analyzing 'brains' headers with multiple raters.
Proc Int Symp Hum Factors Ergon Healthc 2018 Jun;7(1):205-09. doi: 10.1177/2327857918071045..
Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Inpatient Care, Nursing
Hoffman SR, Vines AI, Halladay JR
Optimizing research in symptomatic uterine fibroids with development of a computable phenotype for use with electronic health records.
The objective of the study was to develop an electronic health record-based algorithm to identify women with symptomatic uterine fibroids for a comparative effectiveness study of medical or surgical treatments on quality-of-life measures. The study concluded that an electronic health record-based algorithm is capable of identifying cases of symptomatic uterine fibroids with moderate positive predictive value and may be an efficient approach for large-scale study recruitment.
AHRQ-funded; HS023418.
Citation: Hoffman SR, Vines AI, Halladay JR .
Optimizing research in symptomatic uterine fibroids with development of a computable phenotype for use with electronic health records.
Am J Obstet Gynecol 2018 Jun;218(6):610.e1-10.e7. doi: 10.1016/j.ajog.2018.02.002..
Keywords: Comparative Effectiveness, Electronic Health Records (EHRs), Research Methodologies, Women
Devine EB, Van Eaton E, Zadworny ME
Automating electronic clinical data capture for quality improvement and research: The CERTAIN Validation Project of Real World Evidence.
Washington State's Surgical Care Outcomes and Assessment Program (SCOAP) is a network of hospitals participating in quality improvement (QI) registries wherein data are manually abstracted from EHRs. To create the Comparative Effectiveness Research and Translation Network (CERTAIN), researchers semi-automated SCOAP data abstraction using a centralized federated data model, created a central data repository (CDR), and assessed whether these data could be used as real world evidence for QI and research. They concluded that semi-automated data abstraction may be useful, although raw data collected as a byproduct of health care delivery is not immediately available for use as real world evidence. New approaches to gathering and analyzing extant data are required.
AHRQ-funded; HS020025.
Citation: Devine EB, Van Eaton E, Zadworny ME .
Automating electronic clinical data capture for quality improvement and research: The CERTAIN Validation Project of Real World Evidence.
eGEMS 2018 May 22;6(1):8. doi: 10.5334/egems.211..
Keywords: Patient-Centered Outcomes Research, Quality Improvement, Registries, Surgery, Electronic Health Records (EHRs)
Skube SJ, Lindemann EA, Arsoniadis EG
Characterizing functional health status of surgical patients in clinical notes.
The researchers of this study hypothesize that important functional status data is contained in clinical notes. They found that several categories of phrases related to functional status including diagnoses, activity and care assessments, physical exam, functional scores, assistive equipment, symptoms, and surgical history were important factors. They conducted a chart review and compared functional health status level terms from the chart review to National Surgical Quality Improvement Program determinations.
AHRQ-funded; HS024532.
Citation: Skube SJ, Lindemann EA, Arsoniadis EG .
Characterizing functional health status of surgical patients in clinical notes.
AMIA Jt Summits Transl Sci Proc 2018 May 18;2017:379-88..
Keywords: Health Status, Patient Safety, Risk, Surgery, Electronic Health Records (EHRs)
Hemler JR, Hall JD, Cholan RA
Practice facilitator strategies for addressing electronic health record data challenges for quality improvement: EvidenceNOW.
In this paper, the authors describe the strategies facilitators use to help practices perform quality improvement (QI) when complete or accurate performance data are not available. The investigators found facilitators faced practice-level EHR data challenges, such as a lack of clinical performance data, partial or incomplete clinical performance data, and inaccurate clinical performance data.
AHRQ-funded; HS023940.
Citation: Hemler JR, Hall JD, Cholan RA .
Practice facilitator strategies for addressing electronic health record data challenges for quality improvement: EvidenceNOW.
J Am Board Fam Med 2018 May-Jun;31(3):398-409. doi: 10.3122/jabfm.2018.03.170274..
Keywords: Electronic Health Records (EHRs), Quality Improvement, Evidence-Based Practice, Health Information Technology (HIT), Primary Care, Quality of Care
Stablein T, Loud KJ, DiCapua C
The catch to confidentiality: the use of electronic health records in adolescent health care.
This study examined the issues that the use of electronic health records (EHRs) have in pediatric practices in adolescent health care. Twenty-six pediatric health care providers were given in-depth interviews about their experiences using EHRs. Issues concerning privacy and confidentiality including longevity of EHRs were voiced. Some pediatric health care providers selectively omit or conceal information in order to protect adolescent confidentiality. These issues could impact having accurate documentation for a patient.
AHRQ-funded; HS021537.
Citation: Stablein T, Loud KJ, DiCapua C .
The catch to confidentiality: the use of electronic health records in adolescent health care.
J Adolesc Health 2018 May;62(5):577-82. doi: 10.1016/j.jadohealth.2017.11.296..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT)
Austrian JS, Jamin CT, Doty GR
Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay.
The goal of this study was to determine if an electronic health record (EHR) based sepsis alert system could improve quality of care and clinical outcomes for patients with sepsis. A patient-level, interrupted time series study of emergency department patients with severe sepsis or septic shock was conducted, with an intervention introduced at the approximate mid-point--a system of interruptive sepsis alerts triggered by abnormal vital signs or laboratory results. Mean length of stay for patients with sepsis decreased significantly following the introduction of the alert, but the alert system had no effect on mortality or other clinical or process measures. The researchers conclude that a more sophisticated algorithm for sepsis identification is needed to improve outcomes.
AHRQ-funded; HS023683.
Citation: Austrian JS, Jamin CT, Doty GR .
Impact of an emergency department electronic sepsis surveillance system on patient mortality and length of stay.
J Am Med Inform Assoc 2018 May;25(5):523-29. doi: 10.1093/jamia/ocx072..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Hospitals, Mortality, Outcomes, Quality Improvement, Quality of Care, Sepsis
Bordley J, Sakata KK, Bierman J
Medication history versus point-of-care platelet activity testing in patients with intracerebral hemorrhage.
This study evaluated whether reduced platelet activity detected by point-of-care (POC) testing was a better predictor of hematoma expansion and poor functional outcomes in patients with intracerebral hemorrhage (ICH) than a history of antiplatelet medication exposure. A history of antiplatelet medication use better identified patients at risk for hematoma growth and poor functional outcomes than POC measures of platelet activity after spontaneous ICH.
AHRQ-funded; HS023793.
Citation: Bordley J, Sakata KK, Bierman J .
Medication history versus point-of-care platelet activity testing in patients with intracerebral hemorrhage.
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
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
Yao Y, Ahn H, Stifter J
Continuity index measures in the acute care hospital setting: an analytic review and tests using electronic health record data and computer simulation.
This study examined continuity index measures in the acute care hospital setting. These measures can be used to examine the influence of nurse staffing patterns on patient outcomes. The researchers examined the behavior of continuity indexes as applied to clinical practice data that were collected with the Hands-On Automated Nursing Data System (HANDS) and data from computer simulation. The findings provided a deep understanding of the conceptual foundations and properties of various continuity measures.
AHRQ-funded; HS015054; HS023072.
Citation: Yao Y, Ahn H, Stifter J .
Continuity index measures in the acute care hospital setting: an analytic review and tests using electronic health record data and computer simulation.
J Nurs Meas 2018 Apr 1;26(1):20-35. doi: 10.1891/1061-3749.26.1.20..
Keywords: Transitions of Care, Care Coordination, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Provider, Hospitals, Outcomes
Deakyne Davies SJ, Grundmeier RW, Campos DA
The pediatric emergency care applied research network registry: a multicenter electronic health record registry of pediatric emergency care.
In this paper, the authors described the Pediatric Emergency Care Applied Research Network (PECARN) Registry, which demonstrates that emergency department (ED) data from disparate health systems and EHR vendors can be harmonized for use in a single registry with a common data model. The authors concluded that the Registry is a robust harmonized clinical registry that includes data from diverse patients, sites, and EHR vendors derived via data extraction, deidentification, and secure submission to a central data coordinating center. They suggested that the data provided be used for benchmarking, clinical quality improvement, and comparative effectiveness research.
AHRQ-funded; HS020270.
Citation: Deakyne Davies SJ, Grundmeier RW, Campos DA .
The pediatric emergency care applied research network registry: a multicenter electronic health record registry of pediatric emergency care.
Appl Clin Inform 2018 Apr;9(2):366-76. doi: 10.1055/s-0038-1651496..
Keywords: Children/Adolescents, Registries, Emergency Department, Electronic Health Records (EHRs), Health Information Technology (HIT)
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
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
Wald JS, Haque SN, Rizk S
AHRQ Author: Lomotan EA
Enhancing health IT functionality for children: the 2015 Children's EHR Format.
A multistakeholder work group identified and refined 47 items on the basis of earlier requirements to form the 2015 Children's EHR Format Priority List and developed 16 recommended uses of the Format. The full report of the Format enhancement activities is publicly available. In this article, the authors aim to promote awareness of these high priority EHR functional requirements for the care of children.
AHRQ-authored; AHRQ-funded; 290200900021I.
Citation: Wald JS, Haque SN, Rizk S .
Enhancing health IT functionality for children: the 2015 Children's EHR Format.
Pediatrics 2018 Apr;141(4):pii: e20163894. doi: 10.1542/peds.2016-3894.
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Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Children/Adolescents
Arthurs BJ, Mohan V, McGrath K
Impact of passive laboratory alerts on navigating electronic health records in intensive care simulations. Sage Open 2018 Apr/Jun;8(2).
This study examined whether the use of passive alerts highlighting abnormal results in electronic health records (EHRs) contribute to alert fatigue among clinicians. Researchers employed eye tracking during chart review. Passive alerts were associated with reduced gaze fixations. However, the alerts had no impact on the duration of physician trainees reviewing laboratory results and charts or identification of patient safety issues.
AHRQ-funded; HS023793; HS021637.
Citation: Arthurs BJ, Mohan V, McGrath K .
Impact of passive laboratory alerts on navigating electronic health records in intensive care simulations. Sage Open 2018 Apr/Jun;8(2).
Sage Open 2018 Apr/Jun;8(2)..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Patient Safety, Provider
Grossman LV, Choi SW, Collins S
Implementation of acute care patient portals: recommendations on utility and use from six early adopters.
This paper provides recommendations on how to most effectively implement advanced features of acute care patient portals, including: (1) patient-provider communication, (2) care plan information, (3) clinical data viewing, (4) patient education, (5) patient safety, (6) caregiver access, and (7) hospital amenities. One specific recommendation was that stakeholders in acute care patient portals should consider the benefits and challenges of generic and structured electronic care team messaging.
AHRQ-funded; HS021816; HS023613; HS023535; HS024349.
Citation: Grossman LV, Choi SW, Collins S .
Implementation of acute care patient portals: recommendations on utility and use from six early adopters.
J Am Med Inform Assoc 2018 Apr;25(4):370-79. doi: 10.1093/jamia/ocx074.
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Keywords: Critical Care, Electronic Health Records (EHRs), Patient Safety, Clinician-Patient Communication, Web-Based
Street RL, Liu L, Farber NJ
Keystrokes, mouse clicks, and gazing at the computer: how physician interaction with the EHR affects patient participation.
The purpose of this study was to investigate whether the different ways physicians interact with the computer vary in their effects on patient participation in the consultation, physicians' efforts to facilitate patient involvement, and silence. The investigators found that patients may be more reluctant to actively participate in medical encounters when physicians are more physically engaged with the computer (e.g., keyboard activity) than when their behavior is less demonstrative (e.g., gazing at EHR).
AHRQ-funded; HS021290.
Citation: Street RL, Liu L, Farber NJ .
Keystrokes, mouse clicks, and gazing at the computer: how physician interaction with the EHR affects patient participation.
J Gen Intern Med 2018 Apr;33(4):423-28. doi: 10.1007/s11606-017-4228-2..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Patient and Family Engagement, Clinician-Patient Communication
Dudding KM, Gephart SM, Carrington JM
Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records.
The purposes of this study were to describe unintended consequences of use of electronic health records for neonatal nurses and to explore relationships between the phenomena and characteristics of the nurse and the electronic health record. The most frequent unintended consequences of electronic health record use were due to interruptions, followed by a heavier workload due to the electronic health record.
AHRQ-funded; HS022908.
Citation: Dudding KM, Gephart SM, Carrington JM .
Neonatal nurses experience unintended consequences and risks to patient safety with electronic health records.
Comput Inform Nurs 2018 Apr;36(4):167-76. doi: 10.1097/cin.0000000000000406.
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Keywords: Electronic Health Records (EHRs), Neonatal Intensive Care Unit (NICU), Newborns/Infants, Nursing, Patient Safety
Giardina TD, Baldwin J, Nystrom DT
Patient perceptions of receiving test results via online portals: a mixed-methods study.
The researchers conducted a mixed-methods study to explore patients' experiences and preferences when accessing their test results via online portals. They found that nearly two-thirds (63 percent) did not receive any explanatory information or test result interpretation at the time they received the result. Patients experienced negative emotions often with abnormal results, but sometimes even with normal results.
AHRQ-funded; HS023602; HS022087.
Citation: Giardina TD, Baldwin J, Nystrom DT .
Patient perceptions of receiving test results via online portals: a mixed-methods study.
J Am Med Inform Assoc 2018 Apr;25(4):440-46. doi: 10.1093/jamia/ocx140.
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Keywords: Electronic Health Records (EHRs), Patient Experience, Patient and Family Engagement, Clinician-Patient Communication, Web-Based
Sequist TD, Holliday AM, Orav EJ
Physician and patient tools to improve chronic kidney disease care.
This study sought to determine if electronic health record (EHR) tools and patient engagement can improve the quality of chronic kidney disease (CKD) care. It found that, among high-risk patients, those in the intervention arm were significantly more likely to have an office visit with a nephrologist compared with those in the control arm.
AHRQ-funded; HS018226.
Citation: Sequist TD, Holliday AM, Orav EJ .
Physician and patient tools to improve chronic kidney disease care.
Am J Manag Care 2018 Apr;24(4):e107-e14.
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Keywords: Chronic Conditions, Electronic Health Records (EHRs), Kidney Disease and Health, Patient and Family Engagement, Quality Improvement
Cohen DJ, Dorr DA, Knierim K
Primary care practices' abilities and challenges in using electronic health record data for quality improvement.
Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. This study concluded that the current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Dorr DA, Knierim K .
Primary care practices' abilities and challenges in using electronic health record data for quality improvement.
Health Aff 2018 Apr;37(4):635-43. doi: 10.1377/hlthaff.2017.1254.
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Keywords: Electronic Health Records (EHRs), Primary Care, Quality Improvement, Quality of Care, Health Information Technology (HIT), Payment
Mold JW, Walsh M, Chou AF
The alarming rate of major disruptive events in primary care practices in Oklahoma.
This study documented the rates of major disruptive events in a cohort of primary care practices in Oklahoma. During the first year of the project, 89 major disruptive events occurred in 67 (32 percent) practices, with 20 practices experiencing multiple events. The major disruptive events reported most often during both periods were loss of personnel and implementation of electronic health records and billing systems.
AHRQ-funded; HS023919.
Citation: Mold JW, Walsh M, Chou AF .
The alarming rate of major disruptive events in primary care practices in Oklahoma.
Ann Fam Med 2018 Apr;16(Suppl 1):S52-s57. doi: 10.1370/afm.2201.
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Keywords: Electronic Health Records (EHRs), Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Quality Improvement