National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (3)
- Adverse Drug Events (ADE) (1)
- Adverse Events (6)
- Alcohol Use (1)
- (-) Ambulatory Care and Surgery (44)
- Antibiotics (3)
- Antimicrobial Stewardship (2)
- Behavioral Health (4)
- Blood Pressure (1)
- Cancer (3)
- Care Coordination (1)
- Care Management (2)
- Catheter-Associated Urinary Tract Infection (CAUTI) (2)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (4)
- Chronic Conditions (3)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (1)
- Communication (1)
- Community-Based Practice (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (2)
- Critical Care (1)
- Decision Making (1)
- Depression (1)
- Diabetes (1)
- Diagnostic Safety and Quality (2)
- Digestive Disease and Health (1)
- Disparities (1)
- Electronic Health Records (EHRs) (8)
- Emergency Department (1)
- Emergency Medical Services (EMS) (2)
- Emergency Preparedness (1)
- Healthcare-Associated Infections (HAIs) (4)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (3)
- Healthcare Delivery (6)
- Health Information Exchange (HIE) (2)
- Health Information Technology (HIT) (12)
- Health Insurance (1)
- Health Services Research (HSR) (2)
- Health Status (1)
- Health Systems (3)
- Heart Disease and Health (1)
- Hospital Discharge (1)
- Hospitalization (3)
- Hospital Readmissions (2)
- Hospitals (1)
- Imaging (1)
- Implementation (1)
- Infectious Diseases (1)
- Injuries and Wounds (3)
- Maternal Care (1)
- Medicaid (2)
- Medical Errors (1)
- Medication (6)
- Medication: Safety (1)
- Neonatal Intensive Care Unit (NICU) (1)
- Nursing (2)
- Orthopedics (1)
- Outcomes (2)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Safety (6)
- Payment (2)
- Policy (1)
- Practice Improvement (1)
- Practice Patterns (5)
- Pregnancy (1)
- Prevention (1)
- Primary Care (6)
- Primary Care: Models of Care (1)
- Provider (3)
- Provider: Clinician (1)
- Provider: Nurse (1)
- Provider: Physician (2)
- Provider Performance (1)
- Public Health (2)
- Public Reporting (1)
- Quality Improvement (3)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
- Quality of Care (8)
- Research Methodologies (2)
- Respiratory Conditions (1)
- Risk (2)
- Screening (2)
- Skin Conditions (1)
- Substance Abuse (3)
- Surgery (7)
- Teams (1)
- Telehealth (2)
- Transitions of Care (1)
- Treatments (3)
- Urinary Tract Infection (UTI) (2)
- Women (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 44 Research Studies DisplayedFriese CR, Fauer AJ, Kuisell C
Patient-reported outcomes collected in ambulatory oncology practices: feasibility, patterns, and correlates.
The purpose of this study was to examine the feasibility of soliciting outcomes from adults who received chemotherapy treatment for cancer and to describe the patterns and correlates of patient-reported toxicities. Results determined that querying patients on chemotherapy treatment experiences and toxicities was feasible. Toxicity rates varied across practices, informing quality improvement. Toxicity severity and service use incidence exceed previously published trial data, particularly for pain, fatigue, and gastrointestinal issues. Open-text questions enabled exploration with newer treatment regimens.
AHRQ-funded; HS024914.
Citation: Friese CR, Fauer AJ, Kuisell C .
Patient-reported outcomes collected in ambulatory oncology practices: feasibility, patterns, and correlates.
Health Serv Res 2020 Dec;55(6):966-72. doi: 10.1111/1475-6773.13574..
Keywords: Ambulatory Care and Surgery, Cancer, Treatments, Quality of Care, Patient-Centered Outcomes Research, Outcomes
Agniel D, Haviland A, Shekelle P
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
The purpose of this study was to develop and evaluate a measure that ranks health care systems by ambulatory care quality. The authors concluded that their measure, using publicly reported data to produce valid, reliable, and stable ranks of ambulatory care quality for health care systems in Minnesota and California, could also be used in other applications.
AHRQ-funded; HS024067.
Citation: Agniel D, Haviland A, Shekelle P .
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
Ann Intern Med 2020 Nov 17;173(10):791-98. doi: 10.7326/m20-0718..
Keywords: Health Systems, Ambulatory Care and Surgery, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance, Healthcare Delivery
Rinke ML, Oyeku SO, Ford WJH
Costs of ambulatory pediatric healthcare-associated infections: Central-line-associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs).
Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This retrospective case control study estimated additional costs associated with pediatric ambulatory central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery. The authors concluded that ambulatory HAI in pediatric patients were associated with significant additional costs.
AHRQ-funded; HS024432.
Citation: Rinke ML, Oyeku SO, Ford WJH .
Costs of ambulatory pediatric healthcare-associated infections: Central-line-associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs).
Infect Control Hosp Epidemiol 2020 Nov;41(11):1292-97. doi: 10.1017/ice.2020.305..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Ambulatory Care and Surgery, Healthcare Costs, Surgery
Yang J, Landrum MB, Zhou L
Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts.
The purpose of this study was to examine changes in outpatient visits for mental health and/or substance use disorders (MH/SUD) in an integrated healthcare organization during the initial Massachusetts COVID-19 surge and partial state reopening. The investigators concluded that MH/SUD visit volume increased during the COVID surge and was supported by rapidly-scaled telemedicine.
AHRQ-funded; HS025375.
Citation: Yang J, Landrum MB, Zhou L .
Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts.
Gen Hosp Psychiatry 2020 Nov-Dec;67:100-06. doi: 10.1016/j.genhosppsych.2020.09.004..
Keywords: Behavioral Health, Substance Abuse, COVID-19, Disparities, Access to Care, Ambulatory Care and Surgery, Telehealth, Health Information Technology (HIT)
Santosa KB, Keane AM, Keller M
Inpatient versus outpatient management of negative pressure wound therapy in pediatric patients.
Negative pressure wound therapy (NPWT) is commonly used to manage complex wounds in the pediatric population. With recently developed portable NPWT devices, providers have the opportunity to transition NPWT to the outpatient setting. However, there are no studies describing outpatient NPWT in pediatric patients. Therefore, the purpose of this study was to leverage a population-level analysis to advance current knowledge about outpatient NPWT use in pediatric patients.
AHRQ-funded; HS019455.
Citation: Santosa KB, Keane AM, Keller M .
Inpatient versus outpatient management of negative pressure wound therapy in pediatric patients.
J Surg Res 2020 Oct;254:197-205. doi: 10.1016/j.jss.2020.04.025..
Keywords: Children/Adolescents, Injuries and Wounds, Treatments, Care Management, Ambulatory Care and Surgery, Hospitalization
Fischer SH, Rudin RS, Shi Y
Trends in the use of computerized physician order entry by health-system affiliated ambulatory clinics in the United States, 2014-2016.
This study examined trends in the use of computerized physical order entry (CPOE) by health-system affiliated ambulatory clinics from 2014-2016 in the United States. A total of 19,109 ambulatory clinics that participated in all 3 years of the Healthcare Information and Management Systems Society Analytics survey was analyzed. They calculated descriptive statistics to examine overall trends in use, location of order entry, and system-level use of CPOE. The use of CPOE increased from than 9 percentage points from 2015 to 2016, from 58% to 67%. Larger clinics and those affiliated with multi-health hospital systems were more likely to use CPOE.
AHRQ-funded; HS024067.
Citation: Fischer SH, Rudin RS, Shi Y .
Trends in the use of computerized physician order entry by health-system affiliated ambulatory clinics in the United States, 2014-2016.
BMC Health Serv Res 2020 Sep 7;20(1):836. doi: 10.1186/s12913-020-05679-4..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Health Systems
McClellan C, Maclean JC, Saloner B
AHRQ Author: McClellan C
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
This study provided the first population-level evidence on the effects of Medicaid health homes (HH) on behavioral health care service use. As of 2016, 16 states had adopted an HH for enrollees with serious mental illness and/or substance use disorder. Using data from the National Survey on Drug Use and Health, the authors found that HH adoption increased service use among enrollees and enrollee self-reported health improved post-HH.
AHRQ-authored.
Citation: McClellan C, Maclean JC, Saloner B .
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
Health Econ 2020 Sep;29(9):1086-97. doi: 10.1002/hec.4027..
Keywords: Behavioral Health, Medicaid, Substance Abuse, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Patient-Centered Outcomes Research
Rhee TG, Olfson M, Nierenberg AA
20-year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings.
Pharmacological options for treating bipolar disorder have increased over the past 20 years, with several second-generation antipsychotics receiving regulatory approval in the 1990s. In this study the authors describe trends in use of pharmacological agents in the outpatient management of bipolar disorder. The authors concluded that substantial changes occurred in the treatment of bipolar disorder over the past 20 years, with second-generation antipsychotics in large measure supplanting traditional mood stabilizers.
AHRQ-funded; HS023000.
Citation: Rhee TG, Olfson M, Nierenberg AA .
20-year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings.
Am J Psychiatry 2020 Aug;177(8):706-15. doi: 10.1176/appi.ajp.2020.19091000..
Keywords: Behavioral Health, Medication, Practice Patterns, Ambulatory Care and Surgery, Provider: Physician, Provider
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.
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), Decision Making
Rinke ML, Oyeku SO, Heo M
Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): incidence, risk factors, and patient outcomes.
Catheter-associated urinary tract infections (CAUTIs) occur frequently in pediatric inpatients, and they are associated with increased morbidity and cost. Few studies have investigated ambulatory CAUTIs, despite at-risk children utilizing home urinary catheterization. This retrospective cohort and case-control study determined incidence, risk factors, and outcomes of pediatric patients with ambulatory CAUTI. The investigators concluded that pediatric ambulatory CAUTIs occurred in 18% of patients with catheters; they were associated with morbidity and healthcare utilization. Ambulatory indwelling catheter CAUTI incidence exceeded national inpatient incidence.
AHRQ-funded; HS024432.
Citation: Rinke ML, Oyeku SO, Heo M .
Pediatric ambulatory catheter-associated urinary tract infections (CAUTIs): incidence, risk factors, and patient outcomes.
Infect Control Hosp Epidemiol 2020 Aug;41(8):891-99. doi: 10.1017/ice.2020.204..
Keywords: Children/Adolescents, Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Risk, Ambulatory Care and Surgery, Adverse Events
Lafferty M, Fauer A, Wright N
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care. The authors identified four primary themes from the analysis that affect delays. They suggest future investigations to examine nurses' communication practices in the context of timely chemotherapy administration since communication and documentation technologies within healthcare settings continuously evolve.
AHRQ-funded; HS024914.
Citation: Lafferty M, Fauer A, Wright N .
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
Oncol Nurs Forum 2020 Jul 1;47(4):417-27. doi: 10.1188/20.Onf.417-427..
Keywords: Treatments, Cancer, Ambulatory Care and Surgery, Quality of Care, Clinician-Patient Communication, Communication, Provider: Nurse, Provider, Nursing, Chronic Conditions
Varley AL, Kripalani S, Spain T
Understanding factors influencing quality improvement capacity among ambulatory care practices across the MidSouth region: an exploratory qualitative study.
Success in choosing and implementing quality metrics, necessary in a value-based care model, depends on quality improvement (QI) capacity-the shared knowledge, understanding, and commitment to continuous improvement. In this study, the investigators set out to explore factors influencing QI capacity among ambulatory care practices in the MidSouth Practice Transformation Network. Their findings provide insight into factors influencing the adoption and implementation of QI metrics across a diverse group of ambulatory care practices.
AHRQ-funded; HS013852.
Citation: Varley AL, Kripalani S, Spain T .
Understanding factors influencing quality improvement capacity among ambulatory care practices across the MidSouth region: an exploratory qualitative study.
Qual Manag Health Care 2020 Jul/Sep;29(3):136-41. doi: 10.1097/qmh.0000000000000255..
Keywords: Quality Improvement, Quality of Care, Ambulatory Care and Surgery, Practice Improvement
Di Tosto G, McAlearney AS, Fareed N
Metrics for outpatient portal use based on log file analysis: algorithm development.
This study’s goal was to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. The authors developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. They found that function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. They hope to promote the replicability of their study at other institutions and to contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.
AHRQ-funded; HS024091; HS024349; HS024379.
Citation: Di Tosto G, McAlearney AS, Fareed N .
Metrics for outpatient portal use based on log file analysis: algorithm development.
J Med Internet Res 2020 Jun 12;22(6):e16849. doi: 10.2196/16849..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Health Services Research (HSR), Research Methodologies
Fritz SA, Shapiro DJ, Hersh AL
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
This study looked at national trends in the incidence of outpatient visits for skin infections from 2000-2015, which peaked in 2010-2013, followed by a plateau in 2014 and 2015. Cephalexin was the most frequently prescribed antibiotic at the beginning of the study, with trimethoprim-sulfamethoxazole then becoming the most frequently prescribed by the end of the study period.
AHRQ-funded; HS021736; HS024269.
Citation: Fritz SA, Shapiro DJ, Hersh AL .
National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000-2015.
Clin Infect Dis 2020 Jun 10;70(12):2715-18. doi: 10.1093/cid/ciz977..
Keywords: Skin Conditions, Ambulatory Care and Surgery, Emergency Department, Antibiotics, Medication
Brown TT, Guo C, Whaley C
Reference-based benefits for colonoscopy and arthroscopy: large differences in patient payments across procedures but similar behavioral responses.
This study examined how reference-based benefits (RBB) affect out-of-pocket payments across outpatient procedures. The California Public Employees’ Retirement System (CalPERS) applied RBB only to outpatient procedures performed in a hospital outpatient department (HOPD) and not to outpatient procedures performed in a lower cost ambulatory surgery center. Claims from 2009-2013 on arthroscopy and colonoscopy services were analyzed. CalPERS patients paid an average of 63.9% more for HOPDs than ambulatory surgery centers in 2012, but for arthroscopy there was no statistically different cost sharing. This led to high-priced HOPDs being less likely to be chosen by CalPERS patients for both procedures.
AHRQ-funded; HS022098.
Citation: Brown TT, Guo C, Whaley C .
Reference-based benefits for colonoscopy and arthroscopy: large differences in patient payments across procedures but similar behavioral responses.
Med Care Res Rev 2020 Jun;77(3):261-73. doi: 10.1177/1077558718793325..
Keywords: Payment, Healthcare Costs, Health Insurance, Ambulatory Care and Surgery
Kuhns LM, Carlino B, Greeley K
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
This study looked at rates of substance use screening and related documentation among adolescents aged 12-17 in outpatient pediatric clinics in a large academic medical center. The authors abstracted a random sample of 127 records and coded clinical notes to describe screening cases and related characteristics. They then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and identify related factors. Rates of screening by providers was 72% for each common substance and a total of 6% of patients reported substance use during screening.
AHRQ-funded; HS026385.
Citation: Kuhns LM, Carlino B, Greeley K .
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
Subst Abuse Treat Prev Policy 2020 May 25;15(1):36. doi: 10.1186/s13011-020-00276-4..
Keywords: Children/Adolescents, Substance Abuse, Screening, Ambulatory Care and Surgery, Alcohol Use, Practice Patterns, Primary Care
Rowe TA, Linder JA
Delayed antibiotic prescriptions in ambulatory care: reconsidering a problematic practice.
In this paper, the authors discuss delayed or backup antibiotic prescriptions, which are given to ambulatory patients with the expectation that the patient will pick up or fill the prescription if he or she is not improving within a few days. They discuss the drawbacks of delayed antibiotic prescriptions and the options for clinicians.
AHRQ-funded; HS024930; HS026506; 2332015000201.
Citation: Rowe TA, Linder JA .
Delayed antibiotic prescriptions in ambulatory care: reconsidering a problematic practice.
JAMA 2020 May 12;323(18):1779-80. doi: 10.1001/jama.2020.2325..
Keywords: Antibiotics, Medication, Ambulatory Care and Surgery, Medication: Safety, Patient Safety, Antimicrobial Stewardship
Shaker MS, Oppenheimer J, Grayson M
COVID-19: pandemic contingency planning for the allergy and immunology clinic.
In the event of a global infectious pandemic, drastic measures may be needed that limit or require adjustment of ambulatory allergy services. However, no rationale for how to prioritize service shut down and patient care exists. A consensus-based ad-hoc expert panel of allergy/immunology specialists from the United States and Canada developed a service and patient prioritization schematic to temporarily triage allergy/immunology services. This paper describes the process, recommendations and feedback.
AHRQ-funded; HS024599.
Citation: Shaker MS, Oppenheimer J, Grayson M .
COVID-19: pandemic contingency planning for the allergy and immunology clinic.
J Allergy Clin Immunol Pract 2020 May;8(5):1477-88.e5. doi: 10.1016/j.jaip.2020.03.012..
Keywords: COVID-19, Respiratory Conditions, Emergency Preparedness, Public Health, Healthcare Delivery, Ambulatory Care and Surgery, Infectious Diseases
Dixon BE, Zhang Z, Amo JN
Improving notifiable disease case reporting through electronic information exchange-facilitated decision support: a controlled before-and-after trial.
This study examined the results of implementing an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities. They conducted a 2-year controlled before-and-after trial of a health information exchange (HIE) in Indiana. Data was analyzed from electronic prepopulated reports and paper and fax reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Provider reporting rates for chlamydia and gonorrhea increased significantly during the baseline period. During the intervention period they decreased significantly in control clinics. Completion and timeliness improved for both intervention and control clinics.
AHRQ-funded; HS020909.
Citation: Dixon BE, Zhang Z, Amo JN .
Improving notifiable disease case reporting through electronic information exchange-facilitated decision support: a controlled before-and-after trial.
Public Health Rep 2020 May/Jun;135(3):401-10. doi: 10.1177/0033354920914318..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Electronic Health Records (EHRs), Public Health, Public Reporting, Ambulatory Care and Surgery
Yuce TK, Ellis RJ, Merkow RP
Post-operative complications and readmissions following outpatient elective Nissen fundoplication.
Traditionally, laparoscopic Nissen fundoplication (LNF) has been considered an inpatient procedure. Advances in surgical and anesthetic techniques have led to a shift towards outpatient LNF procedures. However, differences in surgical outcomes between outpatient and inpatient LNF are poorly understood. The objectives of this study were (1) to describe the frequency of outpatient LNF in a national cohort and (2) to identify any differences in complications or readmission rates between outpatient and inpatient LNF.
AHRQ-funded; HS024516.
Citation: Yuce TK, Ellis RJ, Merkow RP .
Post-operative complications and readmissions following outpatient elective Nissen fundoplication.
Surg Endosc 2020 May;34(5):2143-48. doi: 10.1007/s00464-019-07020-5..
Keywords: Surgery, Hospital Readmissions, Adverse Events, Ambulatory Care and Surgery, Digestive Disease and Health, Patient Safety
Manojlovich M, Bedard L, Griggs JJ
Facilitators and barriers to recruiting ambulatory oncology practices into a large multisite study: mixed methods study.
The authors of this article aimed to describe the facilitators and barriers to recruiting ambulatory oncology practices into a large multisite study. They used a mixed methods design and 4 domains of the Consolidated Framework for Implementation Research to describe facilitators and barriers to recruitment. They identified numerous recruitment barriers and facilitators and devised strategies to enhance recruitment efforts. They concluded that researchers and clinicians can partner effectively to design and implement research protocols that ultimately benefit patients who are increasingly seeking care in ambulatory practices.
AHRQ-funded; HS024914.
Citation: Manojlovich M, Bedard L, Griggs JJ .
Facilitators and barriers to recruiting ambulatory oncology practices into a large multisite study: mixed methods study.
JMIR Cancer 2020 Apr 20;6(1):e14476. doi: 10.2196/14476..
Keywords: Ambulatory Care and Surgery, Health Services Research (HSR), Research Methodologies
Kohut MR, Keller SC, Linder JA
AHRQ Author: Miller MA
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Researchers conducted semi-structured interviews with clinicians to determine how they perceive demand for antibiotics in the outpatient setting. They conducted interviews with 25 clinicians from nine practices across three states. Patient demand was the most common reason why non-indicated antibiotics were prescribed. Clinicians felt that if they didn’t prescribe them they would experience repercussions in their reputation and practice and that certain patients are impossible to please without an antibiotic prescription regardless of the diagnosis.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Kohut MR, Keller SC, Linder JA .
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Fam Pract 2020 Mar 25;37(2):276-82. doi: 10.1093/fampra/cmz066..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Ambulatory Care and Surgery, Provider: Clinician, Provider: Physician, Provider
Nembhard IM, Buta E, Lee YSH
A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers.
The authors assessed effects of adding care coordination formally to nurses’ roles on care experiences of high-risk patients and clinician teamwork during the first 6 months of use. They conducted a quasi-experimental study in which changes in staff and patient experiences at six community health center practice locations that introduced the added-role approach for high-risk patients were compared to changes in six locations without the program in the same health system. They found that there were some positive effects of adding care coordination to nurses' role within 6 months of implementation, suggesting value in this improvement strategy. They concluded that addressing compatibility between coordination and other job demands is important when implementing this approach to coordination.
AHRQ-funded; HS016978.
Citation: Nembhard IM, Buta E, Lee YSH .
A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers.
BMC Health Serv Res 2020 Feb 24;20(1):137. doi: 10.1186/s12913-020-4986-0..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Care Coordination, Nursing, Patient Experience, Community-Based Practice, Patient-Centered Healthcare, Ambulatory Care and Surgery, Teams
Patterson ES, Su G, Sarkar U
Reducing delays to diagnosis in ambulatory care settings: a macrocognition perspective.
This study discusses contributors to diagnostic delays by physicians using a macrocognition theoretical perspective that can be mitigated by work system redesign in outpatient settings. Five macrocognition functions are discussed: sensemaking, re-planning, detecting problems, deciding, and coordinating. The authors suggest system redesign and the use of health information technology to support resilience strategies.
AHRQ-funded; HS023558.
Citation: Patterson ES, Su G, Sarkar U .
Reducing delays to diagnosis in ambulatory care settings: a macrocognition perspective.
Appl Ergon 2020 Jan;82:102965. doi: 10.1016/j.apergo.2019.102965..
Keywords: Ambulatory Care and Surgery, Diagnostic Safety and Quality, Quality of Care
Knox M, Murphy EJ, Leslie T
e-Consult implementation success: lessons from 5 county-based delivery systems.
This study evaluated organizational factors for e-consult implementation across five publicly financed, county-based health systems in California. Health system leaders whose systems received grant funding to plan and implement e-consult were interviewed to discuss platform selection, electronic health record compatibility, primary care clinician and specialist opinions, and project governance. Findings showed that three of the 5 systems successfully implemented e-consults. Existing primary care clinician-specialist relationships emerged as the strongest facilitator. E-consult-EHR technology integration was also important. These findings add to existing e-consult implementation literature that emphasizes reimbursement and leadership champions.
AHRQ-funded; HS022241.
Citation: Knox M, Murphy EJ, Leslie T .
e-Consult implementation success: lessons from 5 county-based delivery systems.
Am J Manag Care 2020 Jan;26(1):e21-e27. doi: 10.37765/ajmc.2020.42149..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Delivery, Implementation, Primary Care, Ambulatory Care and Surgery