National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Behavioral Health (6)
- Care Management (3)
- Chronic Conditions (4)
- Communication (1)
- Community-Based Practice (5)
- Comparative Effectiveness (1)
- Cultural Competence (1)
- Education: Continuing Medical Education (1)
- Electronic Health Records (EHRs) (2)
- Guidelines (1)
- (-) Healthcare Delivery (24)
- Health Information Technology (HIT) (2)
- Health Insurance (4)
- Health Services Research (HSR) (1)
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- Implementation (3)
- Low-Income (1)
- Medicare (1)
- Organizational Change (2)
- Patient-Centered Healthcare (9)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (1)
- Patient Experience (1)
- Patient Self-Management (1)
- Practice Improvement (2)
- (-) Primary Care (24)
- Primary Care: Models of Care (5)
- Provider (2)
- Public Health (1)
- Quality Improvement (2)
- Quality of Care (1)
- Shared Decision Making (1)
- Social Determinants of Health (1)
- Teams (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 24 of 24 Research Studies DisplayedBierman AS, Tinetti ME
AHRQ Author: Bierman AS
Precision medicine to precision care: managing multimorbidity.
Multimorbidity is the most common condition managed in practice. The authors argue that health-care delivery must be transformed to provide precision care to people with multimorbidity. Accomplishing this transition will require a change in practice, research, and policy from disease-specific to patient-centered models of care delivery.
AHRQ-authored.
Citation: Bierman AS, Tinetti ME .
Precision medicine to precision care: managing multimorbidity.
Lancet 2016 Dec 3;388(10061):2721-23. doi: 10.1016/s0140-6736(16)32232-2.
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Keywords: Healthcare Delivery, Chronic Conditions, Guidelines, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care
Fraze T, Lewis VA, Rodriguez HP
Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients.
The authors examined how accountable care organizations (ACOs) addressed the nonmedical needs of their patients. They found that ACOs most commonly addressed the need for transportation, housing, and food insecurity, which they identified through the primary care visit or care transformation programs. They concluded that their findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations.
AHRQ-funded; HS024792.
Citation: Fraze T, Lewis VA, Rodriguez HP .
Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients.
Health Aff 2016 Nov;35(11):2109-15. doi: 10.1377/hlthaff.2016.0727.
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Keywords: Social Determinants of Health, Patient-Centered Healthcare, Health Insurance, Healthcare Delivery, Primary Care, Public Health
Holtrop JS, Potworowski G, Fitzpatrick L
Effect of care management program structure on implementation: a normalization process theory analysis.
This study used normalization process theory (NPT) to understand how care management structure affected how well care management became routine in practice. It concluded that, although care management can introduce many new changes into delivery of clinical practice, implementing it successfully as a new complex intervention is possible. NPT can be helpful in explaining differences in implementing a new care management program.
AHRQ-funded; HS020108.
Citation: Holtrop JS, Potworowski G, Fitzpatrick L .
Effect of care management program structure on implementation: a normalization process theory analysis.
BMC Health Serv Res 2016 Aug 15;16(a):386. doi: 10.1186/s12913-016-1613-1.
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Keywords: Care Management, Chronic Conditions, Primary Care, Healthcare Delivery
Luo Z, Chen Q, Annis AM
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
Two contrasting strategies of chronic care management include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). The researchers aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. They found that in a commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year.
AHRQ-funded; HS020108.
Citation: Luo Z, Chen Q, Annis AM .
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
J Gen Intern Med 2016 Jul;31(7):762-70. doi: 10.1007/s11606-016-3617-2.
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Keywords: Chronic Conditions, Care Management, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Comparative Effectiveness, Patient-Centered Outcomes Research, Health Insurance
Shoemaker SJ, Parchman ML, Fuda KK
AHRQ Author: Ricciardi
A review of instruments to measure interprofessional team-based primary care.
The study’s aims were to develop a conceptual framework of high-functioning primary care teams to identify and review instruments that measure the constructs identified in the framework. The majority of instruments were surveys, and the remainder were observational checklists. They addressed multiple constructs, most commonly communication, heedful interrelating , respectful interactions, and shared explicit goals.
AHRQ-authored.
Citation: Shoemaker SJ, Parchman ML, Fuda KK .
A review of instruments to measure interprofessional team-based primary care.
J Interprof Care 2016 Jul;30(4):423-32. doi: 10.3109/13561820.2016.1154023..
Keywords: Communication, Healthcare Delivery, Primary Care, Teams
Hung D, Gray C, Martinez M
AHRQ Author: Harrison MI
Acceptance of Lean redesigns in primary care: a contextual analysis.
The aim of this study was to identify contextual factors most critical to implementing and scaling Lean redesigns across all primary care clinics in a large, ambulatory care delivery system. It found that acceptance was influenced by time and intensity of exposure to changes, "top-down" versus "bottom-up" implementation styles, and degrees of employee engagement in developing new workflows.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung D, Gray C, Martinez M .
Acceptance of Lean redesigns in primary care: a contextual analysis.
Health Care Manage Rev 2016 Jul/Sep;42(3):203-12. doi: 10.1097/hmr.0000000000000106.
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Keywords: Healthcare Delivery, Primary Care, Quality Improvement
Tucker CM, Wall WA, Wippold G
Development of an inventory for health-care office staff to self-assess their patient-centered cultural sensitivity.
The researchers sought to determine the psychometric properties of the Tucker-Culturally Sensitive Health Care Office Staff Inventory-Self-Assessment Form (T-CSHCOSI-SAF). They found that this inventory has 2 factors with high internal consistency reliability. They concluded that the T-CSHCOSI-SAF is a useful inventory for health-care office staff to assess their own level of patient-centered cultural sensitivity and that it can be used in the development and implementation of trainings to promote patient-centered cultural sensitivity of health-care office staff.
AHRQ-funded; HS013151; HS010726.
Citation: Tucker CM, Wall WA, Wippold G .
Development of an inventory for health-care office staff to self-assess their patient-centered cultural sensitivity.
Health Serv Res Manag Epidemiol 2016 Apr 27;3. doi: 10.1177/2333392816629600.
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Keywords: Healthcare Delivery, Cultural Competence, Patient-Centered Healthcare, Primary Care, Provider
Nguyen OK, Makam AN, Halm EA
National use of safety-net clinics for primary care among adults with non-Medicaid insurance in the United States.
This study described the prevalence, characteristics, and predictors of safety-net use for primary care among non-Medicaid insured adults (i.e., those with private insurance or Medicare). It concluded that safety net clinics are important primary care delivery sites for non-Medicaid insured minority and low-income populations with a high burden of chronic illness.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Makam AN, Halm EA .
National use of safety-net clinics for primary care among adults with non-Medicaid insurance in the United States.
PLoS One 2016 Mar 30;11(3):e0151610. doi: 10.1371/journal.pone.0151610.
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Keywords: Primary Care, Health Insurance, Medicare, Low-Income, Healthcare Delivery
McMahon LF, Tipimeni R, Chopra V
Health system loyalty programs: An innovation in customer care and service.
Loyalty programs could empower patients to manage their health in new and innovative ways while enhancing the business model for health systems. The authors argue that by providing both better appreciation/customer service and high-quality technical care, loyalty programs may offer a new way to attract and retain patients within a health system.
AHRQ-funded; HS022835.
Citation: McMahon LF, Tipimeni R, Chopra V .
Health system loyalty programs: An innovation in customer care and service.
JAMA 2016 Mar 1;315(9):863-4. doi: 10.1001/jama.2015.19463..
Keywords: Healthcare Delivery, Patient Experience, Primary Care, Patient Self-Management, Patient Adherence/Compliance
Stults CD, McCuistion MH, Frosch DL
Shared medical appointments: a promising innovation to improve patient engagement and ease the primary care provider shortage.
The authors examined the patient's perspective on participation in shared medical appointments (SMAs). They conducted five focus groups in the San Francisco Bay Area. They concluded that SMAs improve access, engagement with physicians and other patients, and knowledge of patients' health, as well as also helping to ease the workload for primary care physicians.
AHRQ-funded; HS019167.
Citation: Stults CD, McCuistion MH, Frosch DL .
Shared medical appointments: a promising innovation to improve patient engagement and ease the primary care provider shortage.
Popul Health Manag 2016 Feb;19(1):11-6. doi: 10.1089/pop.2015.0008.
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Keywords: Patient and Family Engagement, Primary Care, Healthcare Delivery
Stults CD, McClellan S, Panattoni L
Estimating the human resource costs of developing and implementing shared medical appointments in primary care.
The authors conducted interviews to estimate the human resource costs for developing and implementing a program to support shared medical appointments (SMAs) and an additional SMA on cancer survivorship. They found that introducing new providers or a new type of SMA may require relatively modest incremental organizational resources and provider time. They concluded that time and cost could possibly be further decreased by leveraging relevant materials from existing SMAs.
AHRQ-funded; HS022631.
Citation: Stults CD, McClellan S, Panattoni L .
Estimating the human resource costs of developing and implementing shared medical appointments in primary care.
J Ambul Care Manage 2016 Jan-Mar;39(1):23-31. doi: 10.1097/jac.0000000000000084.
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Keywords: Primary Care: Models of Care, Primary Care, Healthcare Delivery, Implementation
Phillips RL, Jr., Bazemore AW, DeVoe JE
A family medicine health technology strategy for achieving the triple aim for US health care.
To inform the Family Medicine for America's Health (FMAHealth) initiative, this paper explores strategies and tactics that family medicine could pursue to improve the utility of technology for primary care and to help primary care become a leader in rapid development, testing, and implementation of new technologies. These strategies were also designed with a broader stakeholder audience in mind, intending to reach beyond the work being done by FMAHealth.
AHRQ-funded; HS022583.
Citation: Phillips RL, Jr., Bazemore AW, DeVoe JE .
A family medicine health technology strategy for achieving the triple aim for US health care.
Fam Med 2015 Sep;47(8):628-35.
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Keywords: Electronic Health Records (EHRs), Healthcare Delivery, Primary Care, Health Information Technology (HIT)
Davis MM, Balasubramanian BA, Cifuentes M
Clinician staffing, scheduling, and engagement strategies among primary care practices delivering integrated care.
This study examined the interrelationship among behavioral health clinician staffing, scheduling, and a primary care practice's approach to delivering integrated care. It concluded that practices' approaches to staffing by primary care clinicians and behavioral health clinicians, scheduling, and delivery of integrated care mutually influenced each other and were shaped by the local context.
AHRQ-funded; HS022981.
Citation: Davis MM, Balasubramanian BA, Cifuentes M .
Clinician staffing, scheduling, and engagement strategies among primary care practices delivering integrated care.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S32-40. doi: 10.3122/jabfm.2015.S1.150087.
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Keywords: Behavioral Health, Patient-Centered Healthcare, Healthcare Delivery, Primary Care: Models of Care, Primary Care, Community-Based Practice
Gunn R, Davis MM, Hall J
Designing clinical space for the delivery of integrated behavioral health and primary care.
This study sought to describe features of the physical space in which practices integrating primary care and behavioral health care work and to identify the arrangements that enable integration of care. Two dominant spatial layouts emerged across practices: type-1 layouts were characterized by having primary care clinicians (PCCs) and behavioral health clinicians (BHCs) located in separate work areas, and type-2 layouts had BHCs and PCCs sharing work space.
AHRQ-funded; HS022981.
Citation: Gunn R, Davis MM, Hall J .
Designing clinical space for the delivery of integrated behavioral health and primary care.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S52-62. doi: 10.3122/jabfm.2015.S1.150053.
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Keywords: Behavioral Health, Healthcare Delivery, Patient-Centered Healthcare, Primary Care
Cohen DJ, Davis M, Balasubramanian BA
Integrating behavioral health and primary care: consulting, coordinating and collaborating among professionals.
This paper sought to describe how clinicians from different backgrounds interact to deliver integrated behavioral and primary health care, and the contextual factors that shape such interactions. It concluded that primary care and behavioral health clinicians, through their interactions, consult, coordinate, and collaborate with each other to solve patients' problems.
AHRQ-funded; HS022981.
Citation: Cohen DJ, Davis M, Balasubramanian BA .
Integrating behavioral health and primary care: consulting, coordinating and collaborating among professionals.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S21-31. doi: 10.3122/jabfm.2015.S1.150042.
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Keywords: Healthcare Delivery, Community-Based Practice, Shared Decision Making, Behavioral Health, Primary Care
Hall J, Cohen DJ, Davis M
Preparing the workforce for behavioral health and primary care integration.
The researchers sought to identify how organizations prepare clinicians to work together to integrate behavioral health and primary care. They concluded that insufficient training capacity and practical experience opportunities continue to be major barriers to supplying the workforce needed for effective behavioral health and primary care integration. Until the training capacity grows to meet the demand, practices must put forth considerable effort and resources to train their own employees.
AHRQ-funded; HS022981.
Citation: Hall J, Cohen DJ, Davis M .
Preparing the workforce for behavioral health and primary care integration.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S41-51. doi: 10.3122/jabfm.2015.S1.150054.
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Keywords: Patient-Centered Healthcare, Healthcare Delivery, Primary Care: Models of Care, Primary Care, Behavioral Health, Training, Community-Based Practice
Balasubramanian BA, Fernald D, Dickinson LM
REACH of interventions integrating primary care and behavioral health.
This study reports REACH (the extent to which an intervention or program was delivered to the identified target population) of interventions integrating primary care and behavioral health implemented by real-world practices. Practices that implemented systematic protocols to identify patients needing integrated care had a significantly higher screening REACH compared with practices that used clinicians' discretion.
AHRQ-funded; HS022981.
Citation: Balasubramanian BA, Fernald D, Dickinson LM .
REACH of interventions integrating primary care and behavioral health.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S73-85. doi: 10.3122/jabfm.2015.S1.150055.
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Keywords: Behavioral Health, Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Community-Based Practice, Implementation, Community-Based Practice, Implementation
Cohen DJ, Balasubramanian BA, Davis M
Understanding care integration from the ground up: five organizing constructs that shape integrated practices.
The authors identified 5 key organizing constructs influencing integration of primary care and behavioral health. They concluded that the interaction among 5 organizing constructs and practice context produces diverse expressions of integrated care. These constructs provide a framework for understanding how primary care and behavioral health services can be integrated in routine practice.
AHRQ-funded; HS022981.
Citation: Cohen DJ, Balasubramanian BA, Davis M .
Understanding care integration from the ground up: five organizing constructs that shape integrated practices.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S7-20. doi: 10.3122/jabfm.2015.S1.150050.
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Keywords: Behavioral Health, Healthcare Delivery, Community-Based Practice, Primary Care
Fontaine P, Whitebird R, Solberg LI
Minnesota's early experience with medical home implementation: viewpoints from the front lines.
This study aimed to identify the facilitators and barriers encountered by nine diverse primary care practices selected from the first 80 to achieve patient-centered medical home (PCMH) certification in Minnesota. It found that facilitators to achieve PCMH certification included a requirement for patient involvement, which pushed practices to create patient-centered innovations, and new reimbursement models based on quality indicators for a population.
AHRQ-funded; HS019161.
Citation: Fontaine P, Whitebird R, Solberg LI .
Minnesota's early experience with medical home implementation: viewpoints from the front lines.
J Gen Intern Med 2015 Jul;30(7):899-906. doi: 10.1007/s11606-014-3136-y..
Keywords: Patient-Centered Healthcare, Primary Care, Implementation, Organizational Change, Healthcare Delivery, Practice Improvement, Health Services Research (HSR)
Solberg LI, Stuck LH, Crain AL
Organizational factors and change strategies associated with medical home transformation.
The researchers surveyed leaders of the first 132 primary care practices in Minnesota to achieve medical home certification. The Change Process Capability Questionnaire survey and the Physician Practice Connections survey showed that 80% to 100% of these certified clinics had 15 of the 18 organizational factors important for improving care processes and that 60% to 90% had successfully used 16 improvement strategies.
AHRQ-funded; HS019161.
Citation: Solberg LI, Stuck LH, Crain AL .
Organizational factors and change strategies associated with medical home transformation.
Am J Med Qual 2015 Jul-Aug;30(4):337-44. doi: 10.1177/1062860614532307.
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Keywords: Patient-Centered Healthcare, Primary Care, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Healthcare Delivery
Annis AM, Holtrop JS, Tao M
Comparison of provider and plan-based targeting strategies for disease management.
The researchers described and contrasted the targeting methods and engagement outcomes for health plan-delivered disease management with those of a provider-delivered care management program. They concluded that both provide advantages and that an optimal model may be to combine the strengths of each approach to maximize benefits in care management.
AHRQ-funded; HS020108.
Citation: Annis AM, Holtrop JS, Tao M .
Comparison of provider and plan-based targeting strategies for disease management.
Am J Manag Care 2015 May;21(5):344-51.
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Keywords: Care Management, Primary Care, Health Insurance, Healthcare Delivery
Pylypchuk Y, Sarpong E
AHRQ Author: Pylypchuk Y, Sarpong E
Nurse practitioners and their effects on visits to primary care physicians.
The researchers examined the effects of visits to nurse practitioners (NPs) on the demand for primary care physician services. Using a system of simultaneous equations where states’ education requirements for NPs are an identifying exclusion restriction, they found that patients who visit an NP are significantly less likely to visit PCPs, and to receive prescribed medication, medical check-up, and diagnosis from PCPs.
AHRQ-authored
Citation: Pylypchuk Y, Sarpong E .
Nurse practitioners and their effects on visits to primary care physicians.
B E J Econom Anal Policy 2015 Apr;15(2):837–64..
Keywords: Healthcare Delivery, Education: Continuing Medical Education, Primary Care, Provider, Workforce
Jones JB, Weiner JP, Shah NR
The wired patient: patterns of electronic patient portal use among patients with cardiac disease or diabetes.
The researchers described the types and patterns of portal users in an integrated delivery system. They found naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features.
AHRQ-funded; HS016228.
Citation: Jones JB, Weiner JP, Shah NR .
The wired patient: patterns of electronic patient portal use among patients with cardiac disease or diabetes.
J Med Internet Res 2015 Feb 20;17(2):e42. doi: 10.2196/jmir.3157..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Primary Care, Healthcare Delivery, Chronic Conditions
van Weel C, Turnbull D, Whitehead E
AHRQ Author: Meyers D
International collaboration in innovating health systems.
A pre-conference workshop was organized at the 2014 North American Primary Care Research Group (NAPCRG) conference to explore international aspects of innovating health systems. Shifting to primary health care asks for a redirection of research towards the community setting. Four funding agencies, including AHRQ, presented their approaches towards innovation and translation support. Innovative approaches included trained implementation experts serving as change agents. Next steps included promotion of participatory research methodology as a meaningful tool for engagement with stakeholders and promotion of the value of international comparative outcome research for health systems’ innovation.
AHRQ-authored.
Citation: van Weel C, Turnbull D, Whitehead E .
International collaboration in innovating health systems.
Ann Fam Med 2015 Jan-Feb;13(1):86-7. doi: 10.1370/afm.1751.
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Keywords: Healthcare Delivery, Health Systems, Primary Care