National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Care Management (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Children/Adolescents (2)
- Chronic Conditions (1)
- (-) Clinical Decision Support (CDS) (13)
- Dementia (1)
- Diagnostic Safety and Quality (1)
- (-) Electronic Health Records (EHRs) (13)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (2)
- Genetics (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (13)
- Hospitalization (1)
- Hospitals (1)
- Medical Errors (1)
- Medication (2)
- Medication: Safety (1)
- Neurological Disorders (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (4)
- Primary Care (2)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Shared Decision Making (7)
- Urinary Tract Infection (UTI) (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 13 of 13 Research Studies DisplayedCurran RL, Kukhareva PV, Taft T
Integrated displays to improve chronic disease management in ambulatory care: a SMART on FHIR application informed by mixed-methods user testing.
This study’s objective was to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. The authors designed an application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). They used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Two patient scenarios were presented to the participants using the regular EHR with and without access to their prototype. Results measured was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. The 13 participants complete more recommended care using the prototype (81% vs 48%) and recommended tasks per minute over long sessions. Keystrokes per task were also lower with the prototype (6 vs 18). While there was a learning curve for this application, it will increase efficiency and patient care with practice.
AHRQ-funded; HS026198.
Citation: Curran RL, Kukhareva PV, Taft T .
Integrated displays to improve chronic disease management in ambulatory care: a SMART on FHIR application informed by mixed-methods user testing.
J Am Med Inform Assoc 2020 Aug;27(8):1225-34. doi: 10.1093/jamia/ocaa099..
Keywords: Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Care Management, Ambulatory Care and Surgery, Clinical Decision Support (CDS), Shared Decision Making
Wang L, Blackley SV, Blumenthal KG
A dynamic reaction picklist for improving allergy reaction documentation in the electronic health record.
Incomplete and static reaction picklists in the allergy module led to free-text and missing entries that inhibit the clinical decision support intended to prevent adverse drug reactions. In this study, the investigators developed a novel, data-driven, "dynamic" reaction picklist to improve allergy documentation in the electronic health record (EHR). The investigators concluded that their dynamic reaction picklist was superior to the static picklist and suggested proper reactions for allergy documentation.
AHRQ-funded; HS025375.
Citation: Wang L, Blackley SV, Blumenthal KG .
A dynamic reaction picklist for improving allergy reaction documentation in the electronic health record.
J Am Med Inform Assoc 2020 Jun;27(6):917-23. doi: 10.1093/jamia/ocaa042..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Clinical Decision Support (CDS)
Classen DC, Holmgren AJ, Co Z
National trends in the safety performance of electronic health record systems from 2009 to 2018.
This study examined trends in the safety performance of electronic health records (EHRs) in hospitals from 2009 to 2018. The Leapfrog Health IT Safety Measure test was administered by the Leapfrog Group from July 2018 to December 1, 2019. Overall mean performance scores increased from 53.9% in 2009 to 65.6% in 2018. Mean hospital scores for categories representing basic clinical decision support increased from 69.8% in 2009 to 85.6% in 2018. Advanced decision clinical support also increased from 29.5% in 2009 to 46.1%. These results showed great improvement, but there is still substantial safety risk in current hospital EHR systems.
AHRQ-funded; HS023696.
Citation: Classen DC, Holmgren AJ, Co Z .
National trends in the safety performance of electronic health record systems from 2009 to 2018.
JAMA Netw Open 2020 May;3(5):e205547. doi: 10.1001/jamanetworkopen.2020.5547..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Patient Safety, Quality Measures, Clinical Decision Support (CDS), Quality Indicators (QIs)
Holmgren AJ, Co Z, Newmark L
Assessing the safety of electronic health records: a national longitudinal study of medication-related decision support.
The authors tested how well EHRs prevented medication errors with the potential for patient harm. Data from a national, longitudinal sample of 1527 hospitals in the US from 2009-16 who took a safety performance assessment test using simulated medication orders was used. The authors found that hospital medication order safety performance improved over time. They conclude that intentional quality improvement efforts appear to be a critical part of high safety performance and may indicate the importance of a culture of safety.
AHRQ-funded; HS023696.
Citation: Holmgren AJ, Co Z, Newmark L .
Assessing the safety of electronic health records: a national longitudinal study of medication-related decision support.
BMJ Qual Saf 2020 Jan;29(1):52-59. doi: 10.1136/bmjqs-2019-009609..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Medication, Electronic Prescribing (E-Prescribing), Medication: Safety, Clinical Decision Support (CDS), Shared Decision Making
Barnes DE, Zhou J, Walker RL
Development and validation of eRADAR: a tool using EHR Data to detect unrecognized dementia.
The goal of this retrospective cohort study was to develop and validate an electronic health record (EHR)-based tool to help detect patients with unrecognized dementia. The tool was named EHR Risk of Alzheimer’s and Dementia Assessment Rule (eRADAR). This study was conducted at Kaiser Permanente Washington (KPWA) using participants in the Adult Changes in Thought (ACT) study who undergo comprehensive testing every 2 years to detect and diagnose dementia and have linked KPWA EHR data. Overall, 1015 ACT visits resulted in a diagnosis of incident dementia, of which 49% were previously unrecognized in the EHR. The final 31-predictor model included markers of dementia-related symptoms, healthcare utilization patterns, and dementia risk factors. The study showed good discrimination in the development interval and validation samples.
AHRQ-funded; HS022982.
Citation: Barnes DE, Zhou J, Walker RL .
Development and validation of eRADAR: a tool using EHR Data to detect unrecognized dementia.
J Am Geriatr Soc 2020 Jan;68(1):103-11. doi: 10.1111/jgs.16182..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Dementia, Neurological Disorders, Diagnostic Safety and Quality, Clinical Decision Support (CDS), Shared Decision Making
Lambert BL, Galanter W, Liu KL
Automated detection of wrong-drug prescribing errors.
Investigators assessed the specificity of an algorithm designed to detect look-alike/sound-alike (LASA) medication prescribing errors in electronic health record (EHR) data. They found that automated detection of LASA medication errors is feasible and can reveal errors not currently detected by other means. Additionally, real-time error detection is not possible with the current system. They suggested that further development should replicate their analysis in other health systems and on a larger set of medications and should decrease clinician time spent reviewing false-positive triggers by increasing specificity.
AHRQ-funded; HS021093.
Citation: Lambert BL, Galanter W, Liu KL .
Automated detection of wrong-drug prescribing errors.
BMJ Qual Saf 2019 Nov;28(11):908-15. doi: 10.1136/bmjqs-2019-009420..
Keywords: Adverse Drug Events (ADE), Adverse Events, Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Patient Safety
Cochran AL, Rathouz PJ, Kocher KE
A latent variable approach to potential outcomes for emergency department admission decisions.
The authors sought to provide a general framework to evaluate admission decisions from electronic healthcare records. They estimated that while admitting a patient with higher latent needs reduced the 30-day risk of revisiting the emergency department or later being admitted through the emergency department by over 79%, admitting a patient with lower latent needs actually increased these 30-day risks by 3.0% and 7.6%, respectively.
AHRQ-funded; HS024160.
Citation: Cochran AL, Rathouz PJ, Kocher KE .
A latent variable approach to potential outcomes for emergency department admission decisions.
Stat Med 2019 Sep 10;38(20):3911-35. doi: 10.1002/sim.8210..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Clinical Decision Support (CDS), Shared Decision Making, Hospitalization
Patterson BW, Pulia MS, Ravi S
Scope and influence of electronic health record-integrated clinical decision support in the emergency department: a systematic review.
This systematic review examined the scope and influence of electronic health record-integrated clinical decision support (CDS) technologies implemented in hospital emergency departments. A literature search was conducted using 4 databases from the inception of these CDS systems through January 2018. Out of 2,558 potential studies identified, 42 met inclusion criteria. Common uses for CDS technologies included medication and radiology ordering practices, and more comprehensive systems supporting diagnosis and treatment for specific diseases. The majority of studies (83%) reported positive effects on outcomes, with most studies using a pre-post experimental design (76%). The authors concluded that although most studies show positive effects of CDS technologies, many of the studies were small and poorly controlled.
AHRQ-funded; HS024342; HS024558; HS022086.
Citation: Patterson BW, Pulia MS, Ravi S .
Scope and influence of electronic health record-integrated clinical decision support in the emergency department: a systematic review.
Ann Emerg Med 2019 Aug;74(2):285-96. doi: 10.1016/j.annemergmed.2018.10.034..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department
Powers EM, Shiffman RN, Melnick ER
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
Clinical decision support (CDS) hard-stop alerts-those in which the user is either prevented from taking an action altogether or allowed to proceed only with the external override of a third party-are increasingly common but can be problematic. To understand their appropriate application, the investigators explored 3 key questions: (1) To what extent are hard-stop alerts effective in improving patient health and healthcare delivery outcomes? (2) What are the adverse events and unintended consequences of hard-stop alerts? (3) How do hard-stop alerts compare to soft-stop alerts?
AHRQ-funded; HS024332.
Citation: Powers EM, Shiffman RN, Melnick ER .
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
J Am Med Inform Assoc 2018 Nov;25(11):1556-66. doi: 10.1093/jamia/ocy112..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Patient Safety
Welch BM, Eilbeck K, Del Fiol G
Technical desiderata for the integration of genomic data with clinical decision support.
The objective of this study is to develop and validate a guiding set of technical desiderata for supporting the clinical use of the whole genome sequence (WGS) through clinical decision support (CDS). A panel of domain experts in genomics and CDS developed a proposed set of seven additional requirements. These additional desiderata provide important guiding principles for the technical development of CDS capabilities for the clinical use of WGS information.
AHRQ-funded; HS018352.
Citation: Welch BM, Eilbeck K, Del Fiol G .
Technical desiderata for the integration of genomic data with clinical decision support.
J Biomed Inform 2014 Oct;51:3-7. doi: 10.1016/j.jbi.2014.05.014..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Genetics, Electronic Health Records (EHRs), Shared Decision Making
Baillie CA, Epps M, Hanish A
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
The researchers evaluated the usability and effectiveness of a computerized clinical decision support (CDS) intervention aimed at reducing the duration of urinary tract catheterizations. They found that usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time periods, as did CAUTIs per 1,000 patient-days. They concluded that the usability of the reminder was highly dependent on its user interface, with a homegrown version of the reminder resulting in higher impact than a stock reminder.
AHRQ-funded; HS016946.
Citation: Baillie CA, Epps M, Hanish A .
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
Infect Control Hosp Epidemiol 2014 Sep;35(9):1147-55. doi: 10.1086/677630.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Urinary Tract Infection (UTI)
Bauer NS, Carroll AE, Downs SM
Understanding the acceptability of a computer decision support system in pediatric primary care.
In this study, the investigators examine the attitudes and opinions of pediatric users' toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. The investigators found that pediatric users appreciated the system's automation and enhancements that allowed relevant and meaningful clinical data to be accessible at point of care.
AHRQ-funded; HS018453; HS017939.
Citation: Bauer NS, Carroll AE, Downs SM .
Understanding the acceptability of a computer decision support system in pediatric primary care.
J Am Med Inform Assoc 2014 Jan-Feb;21(1):146-53. doi: 10.1136/amiajnl-2013-001851..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care
Bauer NS, Carroll AE, Downs SM
Understanding the acceptability of a computer decision support system in pediatric primary care.
In this study, the investigators examine the attitudes and opinions of pediatric users' toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. The investigators found that pediatric users appreciated the system's automation and enhancements that allowed relevant and meaningful clinical data to be accessible at point of care.
AHRQ-funded; HS018453; HS017939.
Citation: Bauer NS, Carroll AE, Downs SM .
Understanding the acceptability of a computer decision support system in pediatric primary care.
J Am Med Inform Assoc 2014 Jan-Feb;21(1):146-53. doi: 10.1136/amiajnl-2013-001851..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care