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 215 Research Studies DisplayedCohen DJ, Wyte-Lake T, Dorr DA
Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs.
The authors sought to identify the unmet information needs of clinical teams delivering care to patients with complex medical, social, and economic needs, and to propose principles for redesigning electronic health records (EHR) to address these needs. They concluded that developing EHR tools that are simple, accessible, easy to use, and able to be updated by a range of professionals is critical. They recommended that the identified information needs and design principles inform developers and implementers working in community health centers and other settings where complex patients receive care.
AHRQ-funded; HS023324.
Citation: Cohen DJ, Wyte-Lake T, Dorr DA .
Unmet information needs of clinical teams delivering care to complex patients and design strategies to address those needs.
J Am Med Inform Assoc 2020 May;27(5):690-99. doi: 10.1093/jamia/ocaa010..
Keywords: Healthcare Delivery, Teams, Electronic Health Records (EHRs), Health Information Technology (HIT), Social Determinants of Health, Community-Based Practice, Primary Care
Ramirez-Zohfeld V, Seltzer A, Xiong L
Use of electronic health records by older adults, 85 years and older, and their caregivers.
Healthcare providers may not offer patient portal (PP) access to electronic health records (EHRs) to their patients older than 85 years, due to the false impression that they do not utilize technology. It is imperative that older adults be given equal opportunity to use technology in regard to their healthcare. The objective of this study was to characterize the content and frequency of use of PP messaging tethered to EHRs by older adults, aged 85 years and older, and their caregivers.
AHRQ-funded; HSO24071.
Citation: Ramirez-Zohfeld V, Seltzer A, Xiong L .
Use of electronic health records by older adults, 85 years and older, and their caregivers.
J Am Geriatr Soc 2020 May;68(5):1078-82. doi: 10.1111/jgs.16393..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Elderly, Caregiving
Hernandez-Boussard T, Blayney DW, Brooks JD
Leveraging digital data to inform and improve quality cancer care.
Efficient capture of routine clinical care and patient outcomes is needed at a population-level, as is evidence on important treatment-related side effects and their effect on well-being and clinical outcomes. The increasing availability of electronic health records (EHR) offers new opportunities to generate population-level patient-centered evidence on oncologic care that can better guide treatment decisions and patient-valued care. This study discussed how to leverage digital data to inform and improve quality cancer care.
AHRQ-funded; R01 HS024096.
Citation: Hernandez-Boussard T, Blayney DW, Brooks JD .
Leveraging digital data to inform and improve quality cancer care.
Cancer Epidemiol Biomarkers Prev 2020 Apr;29(4):816-22. doi: 10.1158/1055-9965.Epi-19-0873..
Keywords: Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Evidence-Based Practice
Adler-Milstein J, Zhao W, Willard-Grace R
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
This study examined whether objective measures of electronic health record (EHR) use-related to time, volume of work, and proficiency are associated with either exhaustion or cynicism. The authors combined Maslach Burnout Inventory survey measures with objective, vendor-defined EHR use measures from log files. Data was collected from all primary care clinics of a large, urban medical academic center in early 2018. One-third of clinicians had high cynicism and 51% had high emotional exhaustion. The clinicians with the most exhaustion spent time using the EHR after hours.
AHRQ-funded; HS022241.
Citation: Adler-Milstein J, Zhao W, Willard-Grace R .
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
J Am Med Inform Assoc 2020 Apr;27(4):531-38. doi: 10.1093/jamia/ocz220..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Clinician, Provider: Physician, Provider, Primary Care
Rangachari P, Dellsperger KC, Rethemeyer RK
A health system's pilot experience with using mobile Social Knowledge Networking (SKN) technology to enable meaningful Use of EHR medication reconciliation technology.
In fall 2016, a two-year grant was secured from AHRQ, to pilot a mobile Social Knowledge Networking (SKN) system on Electronic Health Record (EHR) Medication Reconciliation (MedRec), to enable Augusta University (AU) Health System, to progress from "limited-use" of EHR-MedRec technology, to "meaningful-use." This paper describes a health system's experiences with the pilot initiative; and discusses lessons learned, in regard to the potential of a mobile SKN system to enable Meaningful Use of EHR-MedRec technology.
AHRQ-funded; HS024335.
Citation: Rangachari P, Dellsperger KC, Rethemeyer RK .
A health system's pilot experience with using mobile Social Knowledge Networking (SKN) technology to enable meaningful Use of EHR medication reconciliation technology.
AMIA Annu Symp Proc 2020 Mar 4;2019:745-54..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication
Corby S, Gold JA, Mohan V
A sociotechnical multiple perspectives approach to the use of medical scribes: a deeper dive into the scribe-provider interaction.
This study’s objective was examine the scribe-provider relationship at healthcare organizations. Scribes help providers with electronic health records to alleviate provider burnout and increase clinical efficiency. Participants in the study included 81 clinicians (30 providers, 27 scribes, and 24 administrators) across five sites. The analysis generated six subthemes: characteristics of an ideal scribe, characteristics of a good provider, provider variability, quality of the scribe-provider relationship, negative side of the relationship, and evaluation and supervision of scribes.
AHRQ-funded; HS025141.
Citation: Corby S, Gold JA, Mohan V .
A sociotechnical multiple perspectives approach to the use of medical scribes: a deeper dive into the scribe-provider interaction.
AMIA Annu Symp Proc 2020 Mar 4;2019:333-42..
Keywords: Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Sakaguchi-Tang DK, Turner AM, Taylor JO
Connected personas: translating the complexity of older adult personal health information management for designers of health information technologies.
HumanHuman-centered design (HCD) can be used to communicate research study findings to designers of health information technologies (HIT). In this paper, the investigators describe how they used the HCD approach to develop personas, scenarios, and design guidelines for designers with the aim that it would lead to new HIT designs that support the autonomy and health of older adults.
AHRQ-funded; HS022106.
Citation: Sakaguchi-Tang DK, Turner AM, Taylor JO .
Connected personas: translating the complexity of older adult personal health information management for designers of health information technologies.
AMIA Annu Symp Proc 2020 Mar 4;2019:1177-86..
Keywords: Elderly, Electronic Health Records (EHRs), Health Information Technology (HIT)
Sittig DF, Wright A, Coiera E
Current challenges in health information technology-related patient safety.
In this study, the investigators identified and described nine key short-term, challenges to help healthcare organizations, health information technology developers, researchers, policymakers, and funders focus their efforts on health information technology-related patient safety. The investigators indicate that these challenges represent key "to-do's" that must be completed before we can expect to have safe, reliable, and efficient health information technology-based systems required to care for patients.
Citation: Sittig DF, Wright A, Coiera E .
Current challenges in health information technology-related patient safety.
Health Informatics J 2020 Mar;26(1):181-89. doi: 10.1177/1460458218814893..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Banerji A, Lai KH, Li Y
Natural language processing combined with ICD-9-CM codes as a novel method to study the epidemiology of allergic drug reactions.
Researchers sought to develop and validate a novel informatics method based on natural language processing (NLP) in combination with ICD-9-CM codes that identifies allergic drug reactions in the electronic health record. They found that using NLP with ICD-9-CM codes improved identification of allergic drug reactions, and they concluded that the resulting decrease in manual chart review effort will facilitate large epidemiology studies of this understudied area.
AHRQ-funded; HS024264; HS025375.
Citation: Banerji A, Lai KH, Li Y .
Natural language processing combined with ICD-9-CM codes as a novel method to study the epidemiology of allergic drug reactions.
J Allergy Clin Immunol Pract 2020 Mar;8(3):1032-38.e1. doi: 10.1016/j.jaip.2019.12.007..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Sieck CJ, Pearl N, Bright TJ
A qualitative study of physician perspectives on adaptation to electronic health records.
their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, the investigators conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation.
AHRQ-funded; HS024767.
Citation: Sieck CJ, Pearl N, Bright TJ .
A qualitative study of physician perspectives on adaptation to electronic health records.
BMC Med Inform Decis Mak 2020 Feb 10;20(1):25. doi: 10.1186/s12911-020-1030-6..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Scott HF, Colborn KL, Sevick CJ
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
The purpose of this observational cohort study was to derive and validate a model of risk of septic shock among children with suspected sepsis, using data known in the electronic health record at hospital arrival. The investigators concluded that their model estimated the risk of septic shock in children at hospital arrival earlier than existing models. They indicate it leveraged the predictive value of routine electronic health record data through a modern predictive algorithm and suggest it has the potential to enhance clinical risk stratification in the critical moments before deterioration.
AHRQ-funded; HS025696.
Citation: Scott HF, Colborn KL, Sevick CJ .
Development and validation of a predictive model of the risk of pediatric septic shock using data known at the time of hospital arrival.
J Pediatr 2020 Feb;217:145-51.e6. doi: 10.1016/j.jpeds.2019.09.079..
Keywords: Children/Adolescents, Sepsis, Emergency Department, Hospitals, Risk, Electronic Health Records (EHRs), Health Information Technology (HIT)
Businger AC, Fuller TE, Schnipper JL
Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.
This paper describes the challenges, recommendations and lessons learned while developing and implementing a Patient Safety Learning Laboratory (PSLL) project, which is comprised of a suite of HIT tools integrated with a newly implemented Electronic Health Record (EHR) vendor system in the acute care setting of a large academic medical center. The PSLL Administrative Core engaged stakeholders and study personnel throughout all phases of the project. Challenges to implementation included stakeholder engagement, project scope and complexity, technology and governance, and team structure. Some changes were implemented during the trial and others were labeled as lessons learned for future iterative interventions. A willingness to think outside of current workflows and processes to change health system culture around adverse event prevention was one of the keys to success.
AHRQ-funded; HS023535.
Citation: Businger AC, Fuller TE, Schnipper JL .
Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.
J Am Med Inform Assoc 2020 Feb;27(2):301-07. doi: 10.1093/jamia/ocz193.
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Keywords: Patient Safety, Implementation, Health Information Technology (HIT), Quality Improvement, Quality of Care, Patient-Centered Healthcare, Electronic Health Records (EHRs), Evidence-Based Practice
Gandrup J, Li J, Izadi Z
Three quality improvement initiatives and performance of rheumatoid arthritis disease activity measures in electronic health records: results from an interrupted time series study.
This study evaluated the effect of 3 HIT initiatives on the performance of rheumatoid arthritis (RA) disease activity measures and outcomes in an academic rheumatology clinic. The three initiatives implemented to facilitate performance of the Clinical Disease Activity Index (CDAI) were: 1) an EHR flowsheet to input scores, 2) peer performance reports, and 3) an EHR Smartform including a CDAI calculator. Data from 995 patients with 8,040 encounters between 2012 and 2017 was included. Electronic capture of CDAI scores increased from 0% to 64%. Peer performance reporting and the SmartForm kept performance stable. Physician satisfaction increased after SmartForm implementation.
AHRQ-funded; HS025638.
Citation: Gandrup J, Li J, Izadi Z .
Three quality improvement initiatives and performance of rheumatoid arthritis disease activity measures in electronic health records: results from an interrupted time series study.
Arthritis Care Res 2020 Feb;72(2):283-91. doi: 10.1002/acr.23848..
Keywords: Arthritis, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care
Owodunni OP, Haut ER, Shaffer DL
Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: is there a differential effect by race?
Venous thromboembolism (VTE) is a leading cause of preventable harm, and disparities observed in prevention practices. In this study, the investigators examined the impact of a patient-centered VTE education bundle on the non-administration of preventive prophylaxis by race. The investigators found that the patient education materials, developed collaboratively with a diverse group of patients, improved patient's understanding and the importance of VTE prevention through prophylaxis.
AHRQ-funded; HS024547.
Citation: Owodunni OP, Haut ER, Shaffer DL .
Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: is there a differential effect by race?
PLoS One 2020 Jan 16;15(1):e0227339. doi: 10.1371/journal.pone.0227339..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Healthcare, Blood Clots, Prevention, Inpatient Care, Health Literacy, Education: Patient and Caregiver
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
Adler-Milstein J, Adelman JS, Tai-Seale M
EHR audit logs: a new goldmine for health services research?
This article discusses the possible usefulness of electronic health record (EHR) audit log data to support health services research and for those studying healthcare processes and outcomes. The authors offer a framework for the potential uses in quality domains as defined by the National Academy of Medicine. The article also discusses challenges of working with audit log data.
AHRQ-funded; HS022670; HS023704; HS024538; HS019167.
Citation: Adler-Milstein J, Adelman JS, Tai-Seale M .
EHR audit logs: a new goldmine for health services research?
J Biomed Inform 2020 Jan;101:103343. doi: 10.1016/j.jbi.2019.103343..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR)
Shi Y, Amill-Rosario A, Rudin RS
Health information technology for ambulatory care in health systems.
The adoption and use of health information technology (IT) by health systems in ambulatory care can be an important driver of care quality. In this study, the authors examine recent trends in health IT adoption by health system-affiliated ambulatory clinics in the context of the federal government's Meaningful Use and Promoting Interoperability programs.
AHRQ-funded; HS024067.
Citation: Shi Y, Amill-Rosario A, Rudin RS .
Health information technology for ambulatory care in health systems.
Am J Manag Care 2020 Jan;26(1):32-38..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Health Systems, Healthcare Delivery
Simon KC, Reams N, Beltran E
Optimizing the electronic medical record to improve patient care and conduct quality improvement initiatives in a concussion specialty clinic.
The purpose of this study was to use the electronic medical record (EMR) to optimize patient care, facilitate documentation, and support quality improvement and practice-based research in a concussion (mild traumatic brain injury; mTBI) clinic. The investigators built a customized structured clinical documentation support (SCDS) toolkit for patients in a concussion specialty clinic. The toolkit collected hundreds of fields of discrete,
AHRQ-funded; HS024057.
Citation: Simon KC, Reams N, Beltran E .
Optimizing the electronic medical record to improve patient care and conduct quality improvement initiatives in a concussion specialty clinic.
Brain Inj 2020;34(1):62-67. doi: 10.1080/02699052.2019.1680867..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Brain Injury, Neurological Disorders
Liss DT, Peprah YA, Brown T
Using electronic health records to measure quality improvement efforts: findings from a large practice facilitation initiative.
This study described primary care practices' ability to obtain measures with reporting periods aligning with a large quality improvement initiative. Facilitators reported barriers to data collection such as practices lacking optional EHR features, and EHRs' inability to produce reporting periods across two calendar years. The authors conclude that EHR vendors' compliance with federal reporting requirements is not necessarily sufficient to support real-world quality improvement work. They recommended improvements in the flexibility and usability of EHRs' quality measurement functions, particularly for smaller practices.
AHRQ-funded; HS023921.
Citation: Liss DT, Peprah YA, Brown T .
Using electronic health records to measure quality improvement efforts: findings from a large practice facilitation initiative.
Jt Comm J Qual Patient Saf 2020 Jan;46(1):11-17. doi: 10.1016/j.jcjq.2019.09.006..
Keywords: Patient-Centered Outcomes Research, Evidence-Based Practice, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Quality of Care
Pacheco TB, Hettinger AZ, Ratwani RM
Identifying potential patient safety issues from the federal electronic health record surveillance program.
This research letter analyzed HHS’ Office of the National Coordinator (ONC) surveillance data on electronic health records (EHRs) to determine whether these vendor products may potentially create patient harm. The researchers analyzed records from 195 vendors and identified 3.7% total product IDs having a nonconformity issue that could be a contributing factor to a patient harm event. However, it is unknown whether these IDs might actually result in patient harm.
AHRQ-funded; HS025136; HS023701.
Citation: Pacheco TB, Hettinger AZ, Ratwani RM .
Identifying potential patient safety issues from the federal electronic health record surveillance program.
JAMA 2019 Dec 17;322(23):2339-40. doi: 10.1001/jama.2019.17242..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Conroy MB, McTigue KM, Bryce CL
Effect of electronic health record-based coaching on weight maintenance: a randomized trial.
This study compared long-term weight regain after participation in a weight loss management program using an electronic health record (EHR)-based weight maintenance intervention program. Participants were adult outpatients with a BMI of 25 kg/m2 or higher, had intentional weight loss of at least 5% in the previous 2 years, and had no bariatric procedures in the previous 5 years. The EHR tools included weight, diet and physical activity tracking sheets, standardized surveys and reminders. Patients were randomly assigned to the coaching or non-coaching group. They were tracked for 24 months with 24 scheduled contacts. Results showed patients who used the EHR tools plus coaching had less weight regain than patients using EHR tools alone.
AHRQ-funded; HS021162.
Citation: Conroy MB, McTigue KM, Bryce CL .
Effect of electronic health record-based coaching on weight maintenance: a randomized trial.
Ann Intern Med 2019 Dec 3;171(11):777-84. doi: 10.7326/m18-3337..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Obesity: Weight Management, Obesity, Lifestyle Changes
Horng S, Joseph JW, Calder S
Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system.
The purpose of this cohort study was to determine whether a simple visual aid was associated with a reduction in duplicate ordering of tests and medications. An interrupted time series model was used to analyze a series of consecutive patients who visited the emergency department of a large volume academic hospital. The researchers conclude that passive visual cues that provided just-in-time decision support were associated with reductions in unintentional duplicate orders for laboratory and radiology tests but not in unintentional duplicate medication orders.
AHRQ-funded; HS024288.
Citation: Horng S, Joseph JW, Calder S .
Assessment of unintentional duplicate orders by emergency department clinicians before and after implementation of a visual aid in the electronic health record ordering system.
JAMA Netw Open 2019 Dec 2;2(12):e1916499. doi: 10.1001/jamanetworkopen.2019.16499..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Patient-Centered Outcomes Research, Medication
Gomes KM, Ratwani RM
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
In this research letter, the authors studied usability of electronic health records (EHR) with the system usability scale (SUS). They found that SUS scores decreased for 44% of vendors. Clinician satisfaction with EHR usability is not improving for many widely used products, and the authors recommended increased focus on clinician end users during product design and development as well as optimized certification requirements in order to improve usability.
AHRQ-funded; HS025136.
Citation: Gomes KM, Ratwani RM .
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
JAMA Netw Open 2019 Dec 2;2(12):e1916651. doi: 10.1001/jamanetworkopen.2019.16651..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Chan B, Lyles C, Kaplan C
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
In this study, the authors investigated differences in overall and patterns of portal use for patients with resident and attending primary care providers (PCPs). They concluded that given the lower patient-portal use among residents' patients, residency programs should develop curricula to bolster trainee competence in using the patient-portal for communication and to enhance the patient-physician relationship.
AHRQ-funded; HS022981; HS022408.
Citation: Chan B, Lyles C, Kaplan C .
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
J Gen Intern Med 2018 Dec;33(12):2085-91. doi: 10.1007/s11606-018-4637-x..
Keywords: Clinician-Patient Communication, Education: Continuing Medical Education, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider, Provider: Physician