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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 16 of 16 Research Studies Displayed
Henriksen K, Rodrick D, Grace EN
AHRQ Author: Henriksen K, Rodrick D, Grace EN, Shofer M, Brady, JP
Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment.
This article describes a grant initiative undertaken by AHRQ that brings design, systems engineering, and health care delivery research together to test new ideas that could make health care safer. Based on feedback received from project teams, lessons learned are emerging that find considerable variation among project teams in deploying the methodology and a longer-than-anticipated amount of time in bringing team members from different disciplines together where they learn to communicate and function as a team. Three narratives are generated in terms of what success might look like.
Citation: Henriksen K, Rodrick D, Grace EN . Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment. J Patient Saf 2021 Dec 1;17(8):e1685-e90. doi: 10.1097/pts.0000000000000577..
Keywords: Patient Safety, Healthcare Delivery, Learning Health Systems, Healthcare Systems
Chhabra KR, Sheetz KH, Regenbogen SE
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Researchers sought to measure the extent of variation in episode spending around total hip replacement for fee-for-service Medicare patients within and across hospital systems identified in the American Hospital Association Annual Survey. They found that average episode payments varied nearly as much within hospital systems as they did between the lowest- and highest-cost quintiles of systems, with variation driven by post-acute care utilization.
Citation: Chhabra KR, Sheetz KH, Regenbogen SE . Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success. Ann Surg 2021 Dec 1;274(6):e1078-e84. doi: 10.1097/sla.0000000000003741..
Keywords: Surgery, Healthcare Systems, Medicare, Healthcare Costs, Hospitals
Baskin AS, Wang T, Miller J
A health systems ethical framework for de-implementation in health care.
De-implementation is the ethical obligation to eliminate health care practices which are unnecessary, lacking in evidence, harmful, and/ or prevent the spending of resources on more beneficial services. The purpose of this study was to apply Krubiner and Hyder’s bioethical framework for health systems activity to the analysis of de-implementation ethics in the broader context of health care systems. The focus was specifically on ethics principles relevant to de-implementation which serve to call for or facilitate low value surgery. The authors identified the 5 health systems principles from Krubiner and Hyder’s 11 most relevant to the topic of de-implementation. These included: evidence and effectiveness, transparency and public engagement, efficiency, responsiveness, and collaboration. The study concluded that a health-systems framework allows for consideration of the factors which impact de-implementation, and gives providers to ability to think about new ways to address barriers to the reduction of low-value care.
Citation: Baskin AS, Wang T, Miller J . A health systems ethical framework for de-implementation in health care. J Surg Res 2021 Nov;267:151-58. doi: 10.1016/j.jss.2021.05.006..
Keywords: Healthcare Systems, Healthcare Delivery
Ganguli I, Morden NE, Yang CW
Low-value care at the actionable level of individual health systems.
This study measured and reported low-value care use across and within individual health systems and to identify system characteristics associated with higher use using Medicare administrative data. This retrospective cohort study was conducted using 11,637,763 Medicare beneficiaries in 556 health systems in the AHRQ Compendium of US Health Systems. These Medicare beneficiaries were enrolled in Medicare Parts A and B for at least 12 months in 2016 or 2017. The most common low-value services include preoperative laboratory testing, prostate-specific antigen testing in men older than 70 years, and use of antipsychotic medications in patients with dementia. Forty-one low-value services were measured based on the Milliman MedInsight Health Waste Calculator. In multivariable analysis, the health system characteristics associated with higher use of low-value care were a smaller proportion of primary care physicians for systems with less than the median percentage of primary care physicians vs -0.16 for those with more than the median percentage of primary care physicians; no major teaching hospital without a teaching hospital vs -0.18 with a teaching hospital; larger proportion of non-White patients for systems with >20% of non-White beneficiaries vs -0.06 for systems with ≤20% of non-White beneficiaries; headquartered in the South or West for the South and 0.22 for the West compared with -0.09 for the Northeast and -0.44 for the Midwest;, and serving areas with more health care spending for areas above the median level of spending vs -0.24 for areas below the median level of spending.
Citation: Ganguli I, Morden NE, Yang CW . Low-value care at the actionable level of individual health systems. JAMA Intern Med 2021 Nov;181(11):1490-500. doi: 10.1001/jamainternmed.2021.5531..
Keywords: Healthcare Systems, Value, Primary 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.
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, Healthcare Systems, Innovations and Emerging Issues, Teams
Khodyakov D, Buttorff C, Xenakis L
Alignment between objective and subjective assessments of health system performance: findings from a mixed-methods study.
This study was a survey of health system executives to examine whether their performance assessments match objective performance assessments and qualitatively explore ways to achieve high performance. Interviews were conducted with 138 C-suite executives of 24 health systems in California, Minnesota, Washington, and Wisconsin between 2017 and 2019. The interviews were focused on executives’ perceptions of their own health system’s performance and factors they perceived generally contributed to high performance. The authors grouped health systems based on objective performance levels used in sampling and compared the ratings to executives’ subjective performance assessments. There was poor agreement between objective and subjective performance assessments. Executives whose views were inconsistent with objective assessments did not cite clinical care quality as their basis for their assessment but focused instead on market competition, financial performance, and high customer satisfaction and loyalty. Executives who cited clinical quality metrics had subjective ratings consistent with objective ratings.
Citation: Khodyakov D, Buttorff C, Xenakis L . Alignment between objective and subjective assessments of health system performance: findings from a mixed-methods study. J Healthc Manag 2021 Sep-Oct;66(5):380-94. doi: 10.1097/jhm-d-20-00249..
Keywords: Healthcare Systems, Quality of Care, Practice Improvement, Provider Performance
Siddique SM, Tipton K, Leas B
Interventions to reduce hospital length of stay in high-risk populations: a systematic review.
Many strategies to reduce hospital length of stay (LOS) have been implemented, but few studies have evaluated hospital-led interventions focused on high-risk populations. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study to further evaluate system-level interventions for LOS reduction. The objective of this study was to identify and synthesize evidence regarding potential systems-level strategies to reduce LOS for patients at high risk for prolonged LOS.
Citation: Siddique SM, Tipton K, Leas B . Interventions to reduce hospital length of stay in high-risk populations: a systematic review. JAMA Netw Open 2021 Sep;4(9):e2125846. doi: 10.1001/jamanetworkopen.2021.25846..
Keywords: Learning Health Systems, Healthcare Systems, Evidence-Based Practice, Hospital Discharge, Risk, Inpatient Care, Care Management
Kandel ZK, Rittenhouse DR, Bibi S
The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices.
The Centers for Medicare and Medicaid Services' (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. The authors investigated whether SIM improved health information technology (HIT) and care management capabilities of physician practices. They found that the CMS SIM Initiative did not accelerate the adoption of ten foundational physician practice capabilities beyond national trends.
Citation: Kandel ZK, Rittenhouse DR, Bibi S . The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices. Med Care Res Rev 2021 Aug;78(4):350-60. doi: 10.1177/1077558719901217..
Keywords: Health Information Technology (HIT), Healthcare Delivery, Payment, Healthcare Systems, Innovations and Emerging Issues
Shi Y, Amill-Rosario A, Rudin RS
Barriers to using clinical decision support in ambulatory care: do clinics in health systems fare better?
In this study, the investigators quantified the use of clinical decision support (CDS) and the specific barriers reported by ambulatory clinics and examined whether CDS utilization and barriers differed based on clinics' affiliation with health systems, providing a benchmark for future empirical research and policies related to this topic.
Citation: Shi Y, Amill-Rosario A, Rudin RS . Barriers to using clinical decision support in ambulatory care: do clinics in health systems fare better? J Am Med Inform Assoc 2021 Jul 30;28(8):1667-75. doi: 10.1093/jamia/ocab064..
Keywords: Clinical Decision Support (CDS), Decision Making, Ambulatory Care and Surgery, Health Information Technology (HIT), Healthcare Systems
Yano EM, Resnick A, Gluck M
AHRQ Author: Kwon H, Mistry KB
Accelerating learning healthcare system development through embedded research: career trajectories, training needs, and strategies for managing and supporting embedded researchers.
Health systems and organizations seeking to achieve learning healthcare system principles are increasingly relying on embedded research teams to optimize delivery of evidence-based, high-quality care that improves patient and staff experience alike. In February 2018, 115 attendees from multiple agencies, institutions and professional societies participated in a conference to accelerate development of learning healthcare systems through embedded research. This paper describes the process.
Citation: Yano EM, Resnick A, Gluck M . Accelerating learning healthcare system development through embedded research: career trajectories, training needs, and strategies for managing and supporting embedded researchers. Healthc 2021 Jun;8(Suppl 1):100479. doi: 10.1016/j.hjdsi.2020.100479..
Keywords: Learning Health Systems, Healthcare Systems, Health Services Research (HSR)
Shortell SM, Gottlieb DJ, Martinez Camblor P
Hospital-based health systems 20 years later: a taxonomy for policy research and analysis.
Building on the original taxonomy of hospital-based health systems from 20 years ago, the investigators developed a new taxonomy to inform emerging public policy and practice developments. The study design included a cluster analysis of the 2016 AHA Annual Survey data to derive measures of differentiation, centralization, and integration to create categories or types of hospital-based health systems.
Citation: Shortell SM, Gottlieb DJ, Martinez Camblor P . Hospital-based health systems 20 years later: a taxonomy for policy research and analysis. Health Serv Res 2021 Jun;56(3):453-63. doi: 10.1111/1475-6773.13621..
Keywords: Hospitals, Healthcare Systems, Health Services Research (HSR), Policy
Harrison MI, Shortell SM
AHRQ Author: Harrison MI
Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation.
The authors have developed a comprehensive, multilevel framework to inform learning health systems (LHSs) research and practice in order to enhance both research on LHSs and practical steps toward their development. Drawing on the Consolidated Framework for Implementation Research, the social-ecological framework, and the organizational change framework, their new framework can help investigators and practitioners broadly scan and then investigate forces influencing improvement and learning and may point to otherwise unnoticed interactions among influential factors.
Citation: Harrison MI, Shortell SM . Multi-level analysis of the learning health system: Integrating contributions from research on organizations and implementation. Learn Health Syst 2021 Apr;5(2):e10226. doi: 10.1002/lrh2.10226..
Keywords: Learning Health Systems, Healthcare Systems, Implementation, Organizational Change
Diaz A, Chhabra KR, Dimick JB
Variations in surgical spending within hospital systems for complex cancer surgery.
Researchers sought to measure variations in episode spending within and across hospital systems among Medicare beneficiaries undergoing complex cancer surgery. They found wide variations in surgical episode spending both within and across hospital systems. They recommended that system leaders seek better understanding of variations in practices among their hospitals to standardize care and reduce variations in outcomes, use, and costs.
Citation: Diaz A, Chhabra KR, Dimick JB . Variations in surgical spending within hospital systems for complex cancer surgery. Cancer 2021 Feb 15;127(4):586-97. doi: 10.1002/cncr.33299..
Keywords: Surgery, Cancer, Healthcare Costs, Healthcare Systems, Hospitals
Lewis JA, Senft N, Chen H
Evidence-based smoking cessation treatment: a comparison by healthcare system.
The authors surveyed general medicine providers and specialists in a large academic health center (AHC) and its affiliated Veterans Health Administration (VHA) in the Mid-South in 2017 to determine the cross-sectional association of healthcare system in which the provider practiced (AHC versus VHA) with self-reported provision of evidence-based smoking cessation treatment at least once in the past 12 months. They found that VHA healthcare providers were significantly more likely to provide evidence-based smoking cessation treatment compared to AHC healthcare providers.
Citation: Lewis JA, Senft N, Chen H . Evidence-based smoking cessation treatment: a comparison by healthcare system. BMC Health Serv Res 2021 Jan 7;21(1):33. doi: 10.1186/s12913-020-06016-5..
Keywords: Healthcare Systems, Tobacco Use: Smoking Cessation, Tobacco Use, Evidence-Based Practice, Veterans, Substance Abuse
Kimmey L, Furukawa MF, Jones DJ
AHRQ Author: Furukawa MF
Geographic variation in the consolidation of physicians into health systems, 2016-18.
The authors asked the following questions: To what extent does consolidation of physicians into vertically integrated health systems vary across markets, and how did that change from 2016 to 2018? In this article, they used AHRQ data on health systems and commercial data on physician-system affiliation to describe metropolitan statistical area-level physician consolidation and to identify differences by region and metropolitan statistical area size.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Kimmey L, Furukawa MF, Jones DJ . Geographic variation in the consolidation of physicians into health systems, 2016-18. Health Aff 2021 Jan;40(1):165-69. doi: 10.1377/hlthaff.2020.00812..
Keywords: Healthcare Systems, Provider: Physician, Provider, Healthcare Delivery
Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems.
In this paper, Rangachari (1) reviewed the theoretical literatures on technology use & implementation, and identified a framework for understanding & overcoming unintended adverse consequences of implementing Electronic Health Records; (2) outlined a broad project proposal to test the applicability of the framework in enabling "meaningful use" of Electronic Health Records in a healthcare context; and (3) identified strategies for successful implementation of Electronic Health Records in hospitals & health systems, based on the literature review and application.
Citation: Rangachari P . Using social knowledge networking technology to enable meaningful use of electronic health record technology in hospitals and health systems. J Hosp Adm 2014 Dec;3(6):66-78. doi: 10.5430/jha.v3n6p66.
Keywords: Healthcare Systems, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals, Implementation