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
76 to 100 of 143 Research Studies DisplayedMohan V, Scholl G, Gold JA
Use of EHR-based simulation to diagnose aetiology of information gathering issues in struggling learners: a proof of concept study.
The researchers previously documented that high-fidelity EHR-based simulation improves EHR usability and, when combined with eye and screen tracking, generates important measures of usability. They hypothesised that the same simulation exercise could help distinguish whether learners had difficulty in knowledge, information gathering or information processing. In this paper, they report the results of the first three struggling learners who participated in this exercise.
AHRQ-funded; HS023793; HS021637.
Citation: Mohan V, Scholl G, Gold JA .
Use of EHR-based simulation to diagnose aetiology of information gathering issues in struggling learners: a proof of concept study.
BMJ Simul Technol Enhanc Learn 2018 Apr;4(2):92-94. doi: 10.1136/bmjstel-2017-000217.
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Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Services Research (HSR), Training
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
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
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)
DuGoff EH, Walden E, Ronk K
Can claims data algorithms identify the physician of record?
This study sought to determine the agreement of the primary care physician (PCP) identified by claims algorithms with the PCP of record in electronic health record data. It concluded that researchers may be more likely to identify a patient's PCP when focusing on primary care visits only; however, these algorithms perform less well among vulnerable populations and those experiencing fragmented care.
AHRQ-funded; HS021899.
Citation: DuGoff EH, Walden E, Ronk K .
Can claims data algorithms identify the physician of record?
Med Care 2018 Mar;56(3):e16-e20. doi: 10.1097/mlr.0000000000000709.
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Keywords: Diabetes, Elderly, Electronic Health Records (EHRs), Primary Care
Kan HJ, Kharrazi H, Leff B
Defining and assessing geriatric risk factors and associated health care utilization among older adults using claims and electronic health records.
This study used electronic health records (EHRs) to identify patients with factors associated with geriatric risk for hospitalization among older adults. Prevalence was estimated using claims, structured EHRs, and unstructured EHRs. Odds were calculated on the occurrence of hospitalizations for patients with 1 or 2 and greater risk factors.
AHRQ-funded; HS000029.
Citation: Kan HJ, Kharrazi H, Leff B .
Defining and assessing geriatric risk factors and associated health care utilization among older adults using claims and electronic health records.
Med Care 2018 Mar;56(3):233-39. doi: 10.1097/mlr.0000000000000865..
Keywords: Elderly, Hospitalization, Healthcare Utilization, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Harris AD, Sbarra AN, Leekha S
Electronically available comorbid conditions for risk prediction of healthcare-associated Clostridium difficile infection.
This study analyzed whether electronically available comorbid conditions are risk factors for Centers for Disease Control and Prevention (CDC)-defined, hospital-onset Clostridium difficile infection (CDI) after controlling for antibiotic and gastric acid suppression therapy use. It concluded that comorbid conditions are important risk factors for CDI.
AHRQ-funded; HS022291.
Citation: Harris AD, Sbarra AN, Leekha S .
Electronically available comorbid conditions for risk prediction of healthcare-associated Clostridium difficile infection.
Infect Control Hosp Epidemiol 2018 Mar;39(3):297-301. doi: 10.1017/ice.2018.10.
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Keywords: Clostridium difficile Infections, Electronic Health Records (EHRs), Healthcare-Associated Infections (HAIs), 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
Rasmussen E, Fosnacht Morgan AM, Munson R
Use of an electronic medical record to track adherence to the mediterranean diet in a US neurology clinical practice.
The authors of this paper describe their experience with routinely capturing and analyzing Mediterranean diet data via structured clinical documentation support tools built into the electronic medical record and describe adherence to the Mediterranean diet in patients at risk for either stroke or dementia in a US neurology clinical practice.
AHRQ-funded; HS024057.
Citation: Rasmussen E, Fosnacht Morgan AM, Munson R .
Use of an electronic medical record to track adherence to the mediterranean diet in a US neurology clinical practice.
Mayo Clin Proc Innov Qual Outcomes 2018 Mar;2(1):49-59. doi: 10.1016/j.mayocpiqo.2017.12.003..
Keywords: Electronic Health Records (EHRs), Nutrition, Patient Adherence/Compliance
Huber MT, Highland JD, Krishnamoorthi VR
Utilizing the electronic health record to improve advance care planning: a systematic review.
This review aimed to identify EHR interventions previously utilized to improve advance care plans. The most common reported outcomes were documentation of an advance care planning conversation in the EHR (n = 7) and the placement of code status orders (n = 7). All studies reporting efficacy (n = 9) demonstrated an improvement in 1 or more advance care planning outcomes.
AHRQ-funded; HS000078.
Citation: Huber MT, Highland JD, Krishnamoorthi VR .
Utilizing the electronic health record to improve advance care planning: a systematic review.
Am J Hosp Palliat Care 2018 Mar;35(3):532-41. doi: 10.1177/1049909117715217.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Care Management
Deans KJ, Minneci PC, Nacion KM
Health care quality measures for children and adolescents in foster care: feasibility testing in electronic records.
The objective of the study is to identify healthcare quality measures for young children and adolescents in foster care and to test whether the data required to calculate these measures can be feasibly extracted and interpreted within an electronic health records or within the Statewide Automated Child Welfare Information System. It found that electronic health records and the Statewide System data frequently lacked important information on foster care youth essential for calculating the measures.
AHRQ-funded; HS020503.
Citation: Deans KJ, Minneci PC, Nacion KM .
Health care quality measures for children and adolescents in foster care: feasibility testing in electronic records.
BMC Pediatr 2018 Feb 22;18(1):79. doi: 10.1186/s12887-018-1064-4.
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Keywords: Children/Adolescents, Electronic Health Records (EHRs), Quality Measures, Vulnerable Populations
Murphy DR, Meyer AND, Vaghani V
Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care.
Because of the unique clinical, logistic, and legal aspects of mammography, this study was conducted to evaluate the effectiveness of a trigger to flag delayed follow-up on mammography. The investigators found that care delays appeared to continue despite federal laws requiring patient notification of mammographic results within 30 days. They suggest that clinical application of mammography-related triggers could help detect these delays.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer AND, Vaghani V .
Electronic triggers to identify delays in follow-up of mammography: harnessing the power of big data in health care.
J Am Coll Radiol 2018 Feb;15(2):287-95. doi: 10.1016/j.jacr.2017.10.001..
Keywords: Cancer: Breast Cancer, Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Imaging, Diagnostic Safety and Quality, Prevention, Women
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
Yen PY, Walker DM, Smith JMG
Usability evaluation of a commercial inpatient portal.
The authors aimed to understand how users interact with, learn to use, and communicate with their providers through an inpatient portal. They found that participants frequently made operational errors in navigation and assuming non-existent functionalities; participants' learning styles varied, with age as a potential factor that influenced how they learned MyChart Bedside; and participants preferred to message providers individually and wanted feedback on status. They concluded that, for inpatient portals to be effective in promoting patient engagement, it remains critical for technology developers and hospital administrators to understand how users interact with this technology and the resources that may be necessary to support its use.
AHRQ-funded; HS024091.
Citation: Yen PY, Walker DM, Smith JMG .
Usability evaluation of a commercial inpatient portal.
Int J Med Inform 2018 Feb;110:10-18. doi: 10.1016/j.ijmedinf.2017.11.007.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Inpatient Care, Patient and Family Engagement, Web-Based
Huhdanpaa HT, Tan WK, Rundell SD
Using natural language processing of free-text radiology reports to identify type 1 modic endplate changes.
This study’s goal was to determine the feasibility of using natural language processing (NLP) to convert text from electronic medical records reports of magnetic resonance (MR) imaging results into variables to identify patients with Type 1 Modic endplate changes in the spine. Those patients with Type 1 Modic endplace changes may be eligible for clinical trials. Using a rule-based algorithm in Java they found the prevalence was 10%. The results showed that specificity was higher than recall due to the high number of keywords used in lumbar spine reporting.
AHRQ-funded; HS022972.
Citation: Huhdanpaa HT, Tan WK, Rundell SD .
Using natural language processing of free-text radiology reports to identify type 1 modic endplate changes.
J Digit Imaging 2018 Feb;31(1):84-90. doi: 10.1007/s10278-017-0013-3..
Keywords: Electronic Health Records (EHRs), Imaging, Health Information Technology (HIT)
Graetz I, Huang J, Brand RJ
Bridging the digital divide: mobile access to personal health records among patients with diabetes.
The authors examined personal health record (PHR) use through a computer-based Web browser or mobile device. They found that mobile-ready PHRs may increase access among patients facing a digital divide in computer use, disproportionately reaching racial/ethnic minorities and lower socioeconomic status patients. They recommend continued efforts to increase equitable access to PHRs among patients with chronic conditions.
AHRQ-funded; HS015280.
Citation: Graetz I, Huang J, Brand RJ .
Bridging the digital divide: mobile access to personal health records among patients with diabetes.
Am J Manag Care 2018 Jan;24(1):43-48..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Racial and Ethnic Minorities, Social Determinants of Health
Murphy DR, Meyer A AND, Vaghani V
Development and validation of trigger algorithms to identify delays in diagnostic evaluation of gastroenterological cancer.
This study’s authors developed, refined, and tested trigger algorithms that identify patients with delayed follow-up evaluation of findings suspicious of colorectal cancer (CRC) or hepatocellular cancer (HCC). Using data from the Veterans Affairs electronic health record database, the researchers developed an algorithm that greatly reduces the number of record reviews necessary to identify delays in follow-up evaluations for patients with suspected CRC or HCC.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer A AND, Vaghani V .
Development and validation of trigger algorithms to identify delays in diagnostic evaluation of gastroenterological cancer.
Clin Gastroenterol Hepatol 2018 Jan;16(1):90-98. doi: 10.1016/j.cgh.2017.08.007..
Keywords: Cancer, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Services Research (HSR)
Murphy DR, Meyer A AND, Vaghani V
Development and validation of trigger algorithms to identify delays in diagnostic evaluation of gastroenterological cancer.
This study’s authors developed, refined, and tested trigger algorithms that identify patients with delayed follow-up evaluation of findings suspicious of colorectal cancer (CRC) or hepatocellular cancer (HCC). Using data from the Veterans Affairs electronic health record database, the researchers developed an algorithm that greatly reduces the number of record reviews necessary to identify delays in follow-up evaluations for patients with suspected CRC or HCC.
AHRQ-funded; HS022901.
Citation: Murphy DR, Meyer A AND, Vaghani V .
Development and validation of trigger algorithms to identify delays in diagnostic evaluation of gastroenterological cancer.
Clin Gastroenterol Hepatol 2018 Jan;16(1):90-98. doi: 10.1016/j.cgh.2017.08.007..
Keywords: Cancer, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Services Research (HSR)
Kannampallil TG, Denton CA, Shapiro JS
Efficiency of emergency physicians: insights from an observational study using EHR log files.
The authors investigated the nature of electronic health records use and their effect on an emergency department's throughput and efficiency. They found that longer time spent on reviewing information on the electronic health record is potentially associated with decreased emergency department throughput efficiency. The authors also note that balancing between these competing goals is a challenge for physicians, and implications for patient safety are discussed.
AHRQ-funded; HS022670.
Citation: Kannampallil TG, Denton CA, Shapiro JS .
Efficiency of emergency physicians: insights from an observational study using EHR log files.
Appl Clin Inform 2018 Jan;9(1):99-104. doi: 10.1055/s-0037-1621705..
Keywords: Electronic Health Records (EHRs), Emergency Department, Healthcare Delivery, Health Information Technology (HIT), Provider, Provider: Physician
Rumball-Smith J, Shekelle P, Damberg CL
Electronic health record "super-users" and "under-users" in ambulatory care practices.
This study explored variation in the extent of use of electronic health record (EHR)-based health information technology (IT) functionalities across US ambulatory care practices. It found that seventy-three percent of practices were not using EHR technologies to their full capability, and nearly 40 percent were classified as under-users. Under-user practices were more likely to be of smaller size, situated in the West, and located outside a metropolitan area.
AHRQ-funded; HS024067.
Citation: Rumball-Smith J, Shekelle P, Damberg CL .
Electronic health record "super-users" and "under-users" in ambulatory care practices.
Am J Manag Care 2018 Jan;24(1):26-31.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery
Ali SB, Romero J, Morrison K
Focus section health it usability: applying a task-technology fit model to adapt an electronic patient portal for patient work.
Although electronic patient portals are offered by most health care organizations, poor usability and poor fit to patient needs may pose barriers to adoption. In this study, the investigators collaborated with an academic hospital to conduct iterative user evaluation of a newly deployed portal designed to deliver inpatient data upon hospital discharge.
AHRQ-funded; HS021531.
Citation: Ali SB, Romero J, Morrison K .
Focus section health it usability: applying a task-technology fit model to adapt an electronic patient portal for patient work.
Appl Clin Inform 2018 Jan;9(1):174-84. doi: 10.1055/s-0038-1632396..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Information Technology (HIT), Web-Based
Lipira L, Kemp C, Domercant JW
The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.
Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. This study explored service readiness and other facility factors as predictors of Option B+ attrition in Haiti. The study found that several facility-level factors were associated with Option B+ attrition.
AHRQ-funded; HS013853.
Citation: Lipira L, Kemp C, Domercant JW .
The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.
Int Health 2018 Jan;10(1):54-62. doi: 10.1093/inthealth/ihx060..
Keywords: Breast Feeding, Electronic Health Records (EHRs), Human Immunodeficiency Virus (HIV), Prevention, Women
Payne TH, Alonso WD, Markiel JA
Using voice to create hospital progress notes: description of a mobile application and supporting system integrated with a commercial electronic health record.
The authors described the development and design of a smartphone app-based system to create inpatient progress notes using voice, commercial automatic speech recognition software, with text processing to recognize spoken voice commands and format the note, and integration with a commercial EHR. They found the system to be generally very reliable, accepted by physician users, and secure. They concluded that this approach provides an alternative to the use of keyboard and templates to create progress notes and may appeal to physicians who prefer voice to typing.
AHRQ-funded; HS023631.
Citation: Payne TH, Alonso WD, Markiel JA .
Using voice to create hospital progress notes: description of a mobile application and supporting system integrated with a commercial electronic health record.
J Biomed Inform 2018 Jan;77:91-96. doi: 10.1016/j.jbi.2017.12.004.
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Keywords: Health Information Technology (HIT), Inpatient Care, Electronic Health Records (EHRs)
Collinsworth AW, Masica AL, Priest EL
Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium.
This case study describes how an integrated health care delivery system modified its inpatient electronic health record to accelerate the implementation and evaluation of ABCDE bundle deployment as a safety and quality initiative for the prevention of delirium in intensive care unit patients.
AHRQ-funded; HS021459
Citation: Collinsworth AW, Masica AL, Priest EL .
Modifying the electronic health record to facilitate the implementation and evaluation of a bundled care program for intensive care unit delirium.
eGEMS. 2014;2(1):1121. doi: 10.13063/2327-9214.1121..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Intensive Care Unit (ICU), Patient Safety, Quality of Care