National Healthcare Quality and Disparities Report
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Topics
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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 23 of 23 Research Studies DisplayedMcAlearney AS, Hefner JL, MacEwan SR
Care Team perspectives about an inpatient portal: benefits and challenges of patients' portal use during hospitalization.
This study’s goal was to get care team member’s point of view on the benefits and challenges of inpatient portal implementation and use. Brief in-person interviews with 433 care team members across a six-hospital health system were held to explore opinions about patients’ use. The Inpatient Portal Evaluation Framework was used to characterize benefits and challenges of portal use that care team members reported affected patients, themselves, and the collaborative work of those care teams with their patients.
AHRQ-funded; HS024379; HS024091; HS024767.
Citation: McAlearney AS, Hefner JL, MacEwan SR .
Care Team perspectives about an inpatient portal: benefits and challenges of patients' portal use during hospitalization.
Med Care Res Rev 2021 Oct;78(5):537-47. doi: 10.1177/1077558720925296..
Keywords: Teams, Health Information Technology (HIT), Inpatient Care
Atkinson MK, Singer SJ
Managing organizational constraints in innovation teams: a qualitative study across four health systems.
This study examined how interdisciplinary teams are affected by and manage external constraints over the lifecycle of their innovation project. The authors used a multimethod qualitative approach consisting of over 3 years of participant observation data to analyze how four interdisciplinary teams across different health system experienced and managed constraints as they pursued process innovations. Their findings point to several practical implications concerning innovation processes in healthcare: 1) how conditions in the organizational context, or constraints, can impede team progress at different stages of innovation; and 2) the collective efforts, or tactics, teams use to manage or work around those constraints to further progress on their innovations.
AHRQ-funded; HS024453.
Citation: Atkinson MK, Singer SJ .
Managing organizational constraints in innovation teams: a qualitative study across four health systems.
Med Care Res Rev 2021 Oct;78(5):521-36. doi: 10.1177/1077558720925993..
Keywords: Learning Health Systems, Health Systems, Teams
Sosa T, Sitterding M, Dewan M
Optimizing situation awareness to reduce emergency transfers in hospitalized children.
Interventions to improve care team situation awareness (SA) are associated with reduced rates of unrecognized clinical deterioration in hospitalized children. By addressing themes from recent safety events and emerging corruptors to SA in their system, the investigators aimed to decrease emergency transfers (ETs) to the ICU by 50% over 10 months. The investigators concluded that an innovative, proactive, and reliable process to predict, prevent, and respond to clinical deterioration was associated with a nearly 70% reduction in ETs.
AHRQ-funded; HS026975.
Citation: Sosa T, Sitterding M, Dewan M .
Optimizing situation awareness to reduce emergency transfers in hospitalized children.
Pediatrics 2021 Oct;148(4). doi: 10.1542/peds.2020-034603..
Keywords: Children/Adolescents, Emergency Department, Teams
Mathis MR, Yule S, Wu X
The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
The authors hypothesized that familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. They found that high team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk and high-risk patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality. They concluded that team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.
AHRQ-funded; HS026003.
Citation: Mathis MR, Yule S, Wu X .
The impact of team familiarity on intra and postoperative cardiac surgical outcomes.
Surgery 2021 Oct;170(4):1031-38. doi: 10.1016/j.surg.2021.05.020..
Keywords: Teams, Surgery, Heart Disease and Health, Cardiovascular Conditions, Outcomes
McGuier EA, Kolko DJ, Klem M
Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol.
Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review identified and summarized empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings.
AHRQ-funded; HS026862.
Citation: McGuier EA, Kolko DJ, Klem M .
Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol.
Syst Rev 2021 Jun 26;10(1):189. doi: 10.1186/s13643-021-01747-w..
Keywords: Teams, Implementation, Evidence-Based Practice
Manges KA, Wallace AS, Groves PS
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. The objective of this study was to determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments.
AHRQ-funded; HS026116.
Citation: Manges KA, Wallace AS, Groves PS .
Ready to go home? Assessment of shared mental models of the patient and discharging team regarding readiness for hospital discharge.
J Hosp Med 2021 Jun;16(6):326-32. doi: 10.12788/jhm.3464..
Keywords: Hospital Discharge, Teams, Care Management, Decision Making, Hospitals
Hollingsworth JM, Yu X, Yan PL
Provider care team segregation and operative mortality following coronary artery bypass grafting.
The purpose of this study was to examine whether provider care team segregation within hospitals contributes to the higher mortality rate of Black patients following coronary artery bypass grafting compared to their White counterparts. Using national Medicare data, findings showed that Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
AHRQ-funded; HS026908.
Citation: Hollingsworth JM, Yu X, Yan PL .
Provider care team segregation and operative mortality following coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2021 May;14(5):e007778. doi: 10.1161/circoutcomes.120.007778..
Keywords: Surgery, Heart Disease and Health, Cardiovascular Conditions, Mortality, Teams, Healthcare Delivery, Racial and Ethnic Minorities
Kuo YF, Agrawal P, Chou LN
Assessing association between team structure and health outcome and cost by social network analysis.
Researchers sought to assess the impact of team structure composition and degree of collaboration among various providers on process and outcomes of primary care. Their findings showed that highly connected primary care practices with high collaborative care and less top-down MD-centered authority have lower odds of hospitalization, fewer emergency room admissions, and lower total spending. They concluded that these findings likely reflect better communication and more coordinated care of older patients.
AHRQ-funded; HS020642.
Citation: Kuo YF, Agrawal P, Chou LN .
Assessing association between team structure and health outcome and cost by social network analysis.
J Am Geriatr Soc 2021 Apr;69(4):946-54. doi: 10.1111/jgs.16962..
Keywords: Elderly, Teams, Healthcare Delivery, Primary Care, Primary Care: Models of Care, Care Coordination
Baloh J, Zhu X, Ward MM
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
This study looked at the influences on sustainment of internal facilitation activities. For two years the authors followed 10 small rural hospitals implementing TeamSTEPPS, a patient safety program. Factors the authors examined were the influence of senior management support (SMS), middle management support (MMS), facilitator team time availability (TIME), and team continuity (CONTINUITY). Five hospitals sustained facilitation activities and they found that the combination of SMS, MMS, and CONTINUITY was a sufficient condition for sustainment. The five other hospitals that did not sustain facilitation activities either lacked MMS or lacked both TIME and CONTINUITY. They also discussed the implications for research and practice.
AHRQ-funded; HS024112; HS018396.
Citation: Baloh J, Zhu X, Ward MM .
What influences sustainment and nonsustainment of facilitation activities in implementation? Analysis of organizational factors in hospitals implementing TeamSTEPPS.
Med Care Res Rev 2021 Apr;78(2):146-56. doi: 10.1177/1077558719848267..
Keywords: TeamSTEPPS, Teams, Implementation, Hospitals, Patient Safety, Rural Health, Organizational Change
Rosenman ED, Misisco A, Olenick J
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
This study assessed and compared team leadership and patient care in trauma resuscitations led by male and female physicians. A secondary analysis of data from a larger randomized controlled trial using video recordings of resuscitations at a Level 1 trauma center from April 2016 to December 2017 was conducted. A total of 60 participants and 120 video observations were included in the analysis. There was a weak positive effect for female leaders for both patient care and team leadership. Gender-based advantages to team leadership and clinical care were not conclusive with the exception of rejecting a strong male advantage to team leadership.
AHRQ-funded; HS022458.
Citation: Rosenman ED, Misisco A, Olenick J .
Does team leader gender matter? A Bayesian reconciliation of leadership and patient care during trauma resuscitations.
J Am Coll Emerg Physicians Open 2021 Feb;2(1):e12348. doi: 10.1002/emp2.12348..
Keywords: Teams, Trauma, Critical Care, Provider: Physician, Provider
Kuo YF, Lin YL, D Jupiter, et al.
How to identify team-based primary care in the United States using Medicare data.
The authors assessed whether analyses using different sets of Medicare data can produce results similar to those from analyses using 100% data from an entire state in identifying primary care teams through social network analysis. They found that, depending on specific study purposes, researchers could use either 100% data from Medicare beneficiaries in randomly selected primary care services areas or data from a 20% national sample of Medicare beneficiaries to study team-based primary care in the United States.
AHRQ-funded; HS020642.
Citation: Kuo YF, Lin YL, D Jupiter, et al..
How to identify team-based primary care in the United States using Medicare data.
Med Care 2021 Feb;59(2):118-22. doi: 10.1097/mlr.0000000000001478.
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Keywords: Teams, Primary Care: Models of Care, Primary Care, Medicare, Health Services Research (HSR), Healthcare Delivery
Hung DY, Truong QA, Liang SY
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
Investigators examined 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. They found that Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks, thus supporting the use of Lean techniques to engage teams in routine aspects of patient care. They recommended more research to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.
AHRQ-funded; HS024529.
Citation: Hung DY, Truong QA, Liang SY .
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
J Gen Intern Med 2021 Feb;36(2):274-79. doi: 10.1007/s11606-020-06317-9..
Keywords: Primary Care, Quality Improvement, Quality of Care, Primary Care: Models of Care, Primary Care, Implementation, Workflow, Teams, Healthcare Delivery
Wang G, Wignall J, Kinard D
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
In this study, the investigators aimed to iteratively refine an implementation model for managing cloud-based longitudinal care plans (LCPs) for children with medical complexity (CMC). They conducted iterative 1-on-1 design sessions with CMC caregivers (ie, parents/legal guardians) and providers between August 2017 and March 2019. The investigators concluded that utilizing the management strategies, described in the article, when implementing cloud-based LCPs had the potential to improve team-based care across settings.
AHRQ-funded; HS024299.
Citation: Wang G, Wignall J, Kinard D .
An implementation model for managing cloud-based longitudinal care plans for children with medical complexity.
J Am Med Inform Assoc 2021 Jan 15;28(1):23-32. doi: 10.1093/jamia/ocaa207..
Keywords: Children/Adolescents, Implementation, Chronic Conditions, Care Management, Care Coordination, Health Information Exchange (HIE), Health Information Technology (HIT), Teams
Pestka DL, Paterson NL, Benedict KA
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
As part of a population health-focused primary care transformation, in 2019 a health system in Minnesota developed a primary care team to exclusively care for high-cost high-need patients. Through its development and implementation, the team has discovered several key lessons in delivering care to complex patients. In this paper, the authors discuss lessons learned from their research.
AHRQ-funded; HS026379.
Citation: Pestka DL, Paterson NL, Benedict KA .
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
J Prim Care Community Health 2021 Jan-Dec;12:21501327211023888. doi: 10.1177/21501327211023888..
Keywords: Primary Care, Primary Care: Models of Care, Healthcare Delivery, Teams, Communication, Implementation
Miller-Rosales C, Rodriguez HP
Interdisciplinary primary care team expertise and diabetes care management.
Researchers examined whether care team role expertise is associated with patients' experiences of chronic care for type 2 diabetes and whether the relationship is stronger for small community health center (CHC) sites. Results of surveys conducted with adults with diabetes that assessed nonphysician team roles involved in managing their chronic care were integrated with clinical and administrative data from 14 CHCs. They found that patients with access to care team expertise in self-management support, including diabetes educators, nutritionists, community health workers, and other general staff report better experiences of chronic care. They concluded that these team roles may reduce barriers to patient self-management and improve patients' overall experiences of chronic care, particularly in small CHC sites.
Citation: Miller-Rosales C, Rodriguez HP .
Interdisciplinary primary care team expertise and diabetes care management.
J Am Board Fam Med 2021 Jan-Feb;34(1):151-61. doi: 10.3122/jabfm.2021.01.200187..
Keywords: Primary Care, Diabetes, Teams, Care Management, Community-Based Practice
Van der Wees PJ, Friedberg MW, Guzman EA
Comparing the implementation of team approaches for improving diabetes care in community health centers.
The researchers sought to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. They found that CHW and MA responsibilities converged over time to focus on health coaching of diabetic patients, with the MA health coaches experiencing difficulty in allocating dedicated time due to other responsibilities. Time constraints also limited the personal introduction of patients to health coaches by clinicians. Participants highlighted the importance of a supportive team climate and proactive leadership as important enablers for MAs and CHWs to implement their health coaching responsibilities. This study suggests that a flexible approach to implementing health coaching is more important than fidelity to rigid models that do not allow for variable allocation of responsibilities across team members.
AHRQ-funded; HS020120.
Citation: Van der Wees PJ, Friedberg MW, Guzman EA .
Comparing the implementation of team approaches for improving diabetes care in community health centers.
BMC Health Serv Res 2014 Dec 3;14:608. doi: 10.1186/s12913-014-0608-z.
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Keywords: Community-Based Practice, Diabetes, Patient-Centered Healthcare, Quality Improvement, Teams
Chin DL, Wilson MH, Bang H
Comparing patient outcomes of academician-preceptors, hospitalist-preceptors, and hospitalists on internal medicine services in an academic medical center.
The aim of this study was to compare patient outcomes between hospitalist-preceptors and hospitalists working alone, and between hospitalist-preceptors and academician-preceptors. The researchers found that preceptor-led medicine services were associated with more readmissions within 30 days, shorter lengths of stay, and lower index admission-associated costs. However, they also found that when considering cumulative hospitalization costs, patients discharged by academician-preceptors incurred the highest cost and hospitalist-preceptors incurred the lowest cost.
AHRQ-funded; HS022236.
Citation: Chin DL, Wilson MH, Bang H .
Comparing patient outcomes of academician-preceptors, hospitalist-preceptors, and hospitalists on internal medicine services in an academic medical center.
J Gen Intern Med 2014 Dec;29(12):1672-8. doi: 10.1007/s11606-014-2982-y.
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Keywords: Comparative Effectiveness, Hospital Readmissions, Patient-Centered Outcomes Research, Teams
Fiscella K
Tackling disparities in influenza vaccination in primary care: it takes a team.
This article discusses a study in the same issue by Maurer. Fiscella describes reasons involving influenza vaccination disparities and points out that the emergence of accountable care organizations creates opportunities for better integration of primary care and public health.
AHRQ-funded; HS022440.
Citation: Fiscella K .
Tackling disparities in influenza vaccination in primary care: it takes a team.
J Gen Intern Med 2014 Dec;29(12):1579-81. doi: 10.1007/s11606-014-2999-2.
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Keywords: Disparities, Influenza, Primary Care, Teams, Vaccination
Carayon P, Li Y, Kelly MM
Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital.
In this study, the researchers implemented and evaluated the use of a stimulated recall methodology for collective confrontation in the context of family-centered rounds (FCRs). They concluded that their study demonstrated the value of the stimulated recall methodology to identify a range of work system factors that either positively or negatively influence family engagement during FCRs.
AHRQ-funded; HS018680.
Citation: Carayon P, Li Y, Kelly MM .
Stimulated recall methodology for assessing work system barriers and facilitators in family-centered rounds in a pediatric hospital.
Appl Ergon 2014 Nov;45(6):1540-6. doi: 10.1016/j.apergo.2014.05.001..
Keywords: Hospitals, Children/Adolescents, Teams, Research Methodologies
Nguyen V, Okafor N, Zhang J
Using TURF to understand the functions of interruptions.
TURF stands for Task, User, Representation, and Function (TURF) analyses. This paper explores interruptions as an emergent feature of communication in teams. The authors focus on emergency medicine as this complex environment requires team based concurrent management of multiple patients coping with limited resources in a life-critical and interruption-laden environment. They classify interruptions into those activities that support required work and those interruptions that create unnecessary breaks in workflow.
AHRQ-funded; HS021236; HS017586.
Citation: Nguyen V, Okafor N, Zhang J .
Using TURF to understand the functions of interruptions.
AMIA Annu Symp Proc 2014 Nov;2014:917-23..
Keywords: Communication, Emergency Department, Health Information Technology (HIT), Teams
Huang LC, Conley D, Lipsitz S
The Surgical Safety Checklist and teamwork coaching tools: a study of inter-rater reliability.
The authors assessed the inter-rater reliability (IRR) of two novel observation tools for measuring surgical safety checklist performance and teamwork. They found that both the Checklist Coaching Tool and the Surgical Teamwork Tool demonstrated substantial IRR and required limited training to use, indicating that both instruments may be used to observe checklist performance and teamwork in the operating room. They recommended that further refinement and calibration of observer expectations, particularly in rating teamwork, could improve the utility of the tools.
AHRQ-funded; HS019631.
Citation: Huang LC, Conley D, Lipsitz S .
The Surgical Safety Checklist and teamwork coaching tools: a study of inter-rater reliability.
BMJ Qual Saf 2014 Aug;23(8):639-50. doi: 10.1136/bmjqs-2013-002446.
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Keywords: Patient Safety, Surgery, Tools & Toolkits, Teams, Adverse Events, Medical Errors, Prevention
Everett CM, Thorpe CT, Palta M
The roles of primary care PAs and NPs caring for older adults with diabetes.
The investigators proposed a multidimensional characterization of PA and NP roles on panels of primary care patients with diabetes. They found that PAs and NPs in primary care perform a variety of roles and frequently perform multiple roles within a clinic.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett CM, Thorpe CT, Palta M .
The roles of primary care PAs and NPs caring for older adults with diabetes.
Jaapa 2014 Apr;27(4):45-9. doi: 10.1097/01.jaa.0000444736.16669.76.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams
Streiff MB, Brady JP, Grant AM
AHRQ Author: Brady JP
CDC Grand Rounds: preventing hospital-associated venous thromboembolism.
Approximately half of new venous thromboembolism (VTE) cases occur during a hospital stay or within 90 days of an inpatient admission or surgical procedure, and many are not diagnosed until after discharge. Prevention of VTE can be complicated as physicians must balance the risk for thrombosis with the risk for bleeding from anticoagulants. A collaborative, team-based approach to care is needed for significant and sustained improvement, and it also offers efficiency and capacity to tackle other patient safety problems.
AHRQ-authored.
Citation: Streiff MB, Brady JP, Grant AM .
CDC Grand Rounds: preventing hospital-associated venous thromboembolism.
MMWR Morb Mortal Wkly Rep 2014 Mar 7;63(9):190-3.
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Keywords: Blood Clots, Healthcare-Associated Infections (HAIs), Hospitalization, Prevention, Teams