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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 9 of 9 Research Studies Displayed
Misra-Hebert AD, Perzynski A, Rothberg MB
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
This mixed-methods comparative case study examined the implementation of team-based primary care models in a large integrated health system. Field observations of 9 practices were conducted along with 75 interviews and provider and staff surveys. The 9 practices were categorized into 3 groups: high, partial, and low update of the new models. Ability of the practices to implement the new team-based model depended on their ability to adapt to change and to adapt team roles in workflow.
Citation: Misra-Hebert AD, Perzynski A, Rothberg MB . Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system. J Gen Intern Med 2018 Nov;33(11):1928-36. doi: 10.1007/s11606-018-4611-7..
Keywords: Case Study, Healthcare Systems, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Harrison MI, Grantham S
AHRQ Author: Harrison MI
Learning from implementation setbacks: identifying and responding to contextual challenges.
The authors addressed organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. They found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics; however, team redesign was leading to improvements in chronic care and prevention and eased provider burden. Redesign and system leaders engaged in more thorough organizational learning. Their responses to challenges helped to strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health.
AHRQ-authored; AHRQ-funded; 2902010000341.
Citation: Harrison MI, Grantham S . Learning from implementation setbacks: identifying and responding to contextual challenges. Learn Health Syst 2018 Oct;2(4):e10068. doi: 10.1002/lrh2.10068..
Keywords: Organizational Change, Learning Health Systems, Healthcare Systems, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Implementation
Vest JR, Simon K
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
This study examined hospitals’ adoption of interoperability of health information technology (HIT). The relationship between hospitals’ intra- (within the same organization) and inter-system information exchange capabilities was explored using data from the 2010-2014 American Hospital Association’s Annual Health Information Technology Survey. As expected, there was more intra-system information exchange than inter-system but as time went on inter-system information exchange has increased. During the study period, hospitals were sharing 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange.
Citation: Vest JR, Simon K . Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange. J Am Med Inform Assoc 2018 Sep;25(9):1189-96. doi: 10.1093/jamia/ocy058..
Keywords: Health Information Exchange (HIE), Healthcare Systems, Health Information Technology (HIT), Hospitals
Poon BY, Shortell S, Rodriguez HP
Physician practice transitions to system ownership do not result in diminished practice responsiveness to patients.
The purpose of this study was to examine the extent to which physician-to-system ownership transitions were associated with declines in practice-reported patient responsiveness (PRPR). Data were collected from three nationally representative surveys of physician organizations - the National Survey of Large Physician Organizations/National Survey of Small- and Medium-Sized Physician Organizations and the National Survey of All-Size Physician Organizations - consisting of 40-minute interviews with medical directors, presidents, or chief executive officers. Multivariable regression estimated the effect of ownership on changes in PRPR, controlled for practice size, specialty composition, and market characteristics. The study results showed that practices that switched to system ownership did not have significantly lower PRPR at baseline, when compared to practices that were continuously physician-owned, but continuously system-owned practices did. Transitions to system ownership were associated with increased PRPR when compared to continuously physician ownership. Increased practice size and changes in specialty composition were associated with diminished PRPR.
Citation: Poon BY, Shortell S, Rodriguez HP . Physician practice transitions to system ownership do not result in diminished practice responsiveness to patients. Health Serv Res 2018 Aug;53(4):2268-84. doi: 10.1111/1475-6773.12804.
Keywords: Healthcare Delivery, Healthcare Systems, Patient Experience
Funk RJ, Owen-Smith J, Kaufman SA
Association of informal clinical integration of physicians with cardiac surgery payments.
This study examined how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. It found that when beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0 percent) and postacute care services (5.8 percent).
Citation: Funk RJ, Owen-Smith J, Kaufman SA . Association of informal clinical integration of physicians with cardiac surgery payments. JAMA Surg 2018 May;153(5):446-53. doi: 10.1001/jamasurg.2017.5150.
Keywords: Healthcare Costs, Payment, Healthcare Systems, Surgery, Value
Henke RM, Karaca Z, Moore B
AHRQ Author: Karaca Z, Wong HS
Impact of health system affiliation on hospital resource use intensity and quality of care.
This study assessed the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality. It found that hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge.
Citation: Henke RM, Karaca Z, Moore B . Impact of health system affiliation on hospital resource use intensity and quality of care. Health Serv Res 2018 Feb;53(1):63-86. doi: 10.1111/1475-6773.12631..
Keywords: Healthcare Costs, Quality of Care, Healthcare Systems, Healthcare Cost and Utilization Project (HCUP), Hospitals
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in health care organizations (HCOs). It summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
Citation: Rangachari P . Innovation implementation in the context of hospital QI: lessons learned and strategies for success. Innov Entrep Health 2018;5:1-14. doi: 10.2147/ieh.s151040.
Keywords: Evidence-Based Practice, Healthcare Systems, Health Information Technology (HIT), Innovations and Emerging Issues, Quality Improvement
Nix M, McNamara P, Genevro J
AHRQ Author: Nix M, McNamara P, Genevro J, Vargas N, Mistry K, Fournier A, Shofer M, Lomotan E, Miller T, Ricciardi R, Bierman AS
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
The authors examined AHRQ's experience with learning collaboratives to characterize their attributes, identify factors that might contribute to their success or failure, and assess the challenges they encountered. Building on the literature and insights from AHRQ's experience, they propose a taxonomy that can offer guidance to decision makers and funders about the factors they should consider in developing collaboratives.
Citation: Nix M, McNamara P, Genevro J . Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience. Health Aff 2018 Feb;37(2):205-12. doi: 10.1377/hlthaff.2017.1144.
Keywords: Healthcare Delivery, Healthcare Systems, Innovations and Emerging Issues, Quality of Care, Quality Improvement
Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.
In this paper, Rangachari (1) reviewed the theoretical literatures on technology use & implementation, and identified a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outlined a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identified strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.
Citation: Rangachari P . Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems. J Hosp Adm 2014 Dec;3(6):66-78. doi: 10.5430/jha.v3n6p66.
Keywords: Healthcare Systems, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Implementation