National Healthcare Quality and Disparities Report
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Topics
- Burnout (1)
- (-) Clinical Decision Support (CDS) (4)
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- Falls (1)
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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
1 to 4 of 4 Research Studies DisplayedMarafino BJ, Schuler A, Liu VX
Predicting preventable hospital readmissions with causal machine learning.
This study’s goal was to assess the feasibility and potential impact of predicting preventable hospital readmissions using causal machine learning applied to data from the implementation of a readmissions prevention intervention called the Transitions Program, which used electronic health records from Kaiser Permanent Northern California (KPNC). A total of 1,539,285 index hospitalizations meeting the inclusion criteria and occurring between June 2010 and December 2010 at 21 KPNC hospitals were analyzed. There was substantial heterogeneity in patients’ response to the intervention, with patients at somewhat lower risk appearing to have the largest predicted effects. The estimates appeared to be well calibrated. The results did suggest a mismatch between risk and treatment effects.
AHRQ-funded; HS022192.
Citation: Marafino BJ, Schuler A, Liu VX .
Predicting preventable hospital readmissions with causal machine learning.
Health Serv Res 2020 Dec;55(6):993-1002. doi: 10.1111/1475-6773.13586..
Keywords: Hospital Readmissions, Hospitals, Clinical Decision Support (CDS), Risk
Dykes PC, Burns Z, Adelman J
Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries: a nonrandomized controlled trial.
The purpose of this study was to assess whether a fall-prevention tool kit that engages patients and families in the fall-prevention process throughout hospitalization is associated with reduced falls and injurious falls. Findings showed that, in this nonrandomized controlled trial, implementation of a fall-prevention tool kit was associated with a significant reduction in falls and related injuries. A patient-care team partnership appeared to be beneficial for prevention of falls and fall-related injuries.
AHRQ-funded; HS023535.
Citation: Dykes PC, Burns Z, Adelman J .
Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries: a nonrandomized controlled trial.
JAMA Netw Open 2020 Nov 2;3(11):e2025889. doi: 10.1001/jamanetworkopen.2020.25889..
Keywords: Falls, Injuries and Wounds, Prevention, Tools & Toolkits, Patient and Family Engagement, Patient-Centered Healthcare, Clinical Decision Support (CDS), Hospitalization, Hospitals
Co Z, Holmgren AJ, Classen DC
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
This study evaluated the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in 2017 and 2018 and compared performances for fatal orders and nuisance orders each year. The authors evaluated 1599 hospitals that took the test by using their overall percentage scores along with the percentage of fatal orders appropriately alerted on and the percentage of nuisance orders incorrectly alerted on. Overall hospital scores improved from 58.1% in 2017 to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0%, but there no very little change in nuisance order performance (89.0% to 89.7%). Conclusions were that perhaps hospitals are not targeting the deadliest orders first and some hospitals may be achieving higher scores by over-alerting. This has the potential to cause clinician burnout and even worsen patient safety.
AHRQ-funded; HS023696.
Citation: Co Z, Holmgren AJ, Classen DC .
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
J Am Med Inform Assoc 2020 Aug;27(8):1252-58. doi: 10.1093/jamia/ocaa098..
Keywords: Medication: Safety, Medication, Patient Safety, Clinical Decision Support (CDS), Decision Making, Burnout, Hospitals, Health Information Technology (HIT), Quality of Care
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)