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 (1)
- Adverse Events (2)
- Blood Pressure (1)
- Burnout (2)
- Cancer (1)
- Cancer: Colorectal Cancer (1)
- Cardiovascular Conditions (12)
- Care Coordination (1)
- Care Management (2)
- Children/Adolescents (1)
- Chronic Conditions (4)
- Clinician-Patient Communication (1)
- Colonoscopy (1)
- Communication (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (6)
- Diabetes (2)
- Diagnostic Safety and Quality (2)
- Elderly (1)
- Electronic Health Records (EHRs) (5)
- Evidence-Based Practice (12)
- Guidelines (1)
- Healthcare Costs (2)
- Healthcare Delivery (9)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (6)
- Health Literacy (1)
- Health Services Research (HSR) (1)
- Heart Disease and Health (7)
- Implementation (7)
- Long-Term Care (1)
- Medicaid (1)
- Medical Errors (2)
- Medication (1)
- Nursing Homes (1)
- Organizational Change (6)
- Outcomes (2)
- Patient-Centered Healthcare (15)
- Patient-Centered Outcomes Research (6)
- Patient and Family Engagement (1)
- Patient Experience (7)
- Patient Safety (2)
- Practice Improvement (8)
- Prevention (3)
- (-) Primary Care (55)
- Primary Care: Models of Care (10)
- Provider (5)
- Provider: Clinician (1)
- Provider: Nurse (2)
- Provider: Physician (1)
- Provider Performance (3)
- Public Reporting (1)
- Quality Improvement (35)
- Quality Indicators (QIs) (4)
- Quality Measures (5)
- (-) Quality of Care (55)
- Racial and Ethnic Minorities (1)
- Risk (1)
- Rural Health (1)
- Screening (1)
- Stress (1)
- Teams (6)
- Tobacco Use (1)
- Tools & Toolkits (1)
- Transitions of Care (1)
- Uninsured (1)
- Urban Health (2)
- Vulnerable Populations (2)
- Workflow (5)
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
26 to 50 of 55 Research Studies DisplayedFowler FJ, Cosenza C, Cripps LA
The effect of administration mode on CAHPS survey response rates and results: a comparison of mail and web-based approaches.
The researchers compared response rates, respondents' characteristics, and substantive results for CAHPS surveys administered using web and mail protocols. They found that response rates to surveys administered using the Internet protocols were lower than for the surveys administered by mail, but characteristics of respondents and survey answers were very similar across protocols. Respondents without email addresses tended to be older, less educated, and more likely to be male than those with email addresses, and there were a few differences in their responses.
AHRQ-funded; HS016978.
Citation: Fowler FJ, Cosenza C, Cripps LA .
The effect of administration mode on CAHPS survey response rates and results: a comparison of mail and web-based approaches.
Health Serv Res 2019 Jun;54(3):714-21. doi: 10.1111/1475-6773.13109..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Information Technology (HIT), Patient Experience, Primary Care, Quality of Care, Quality Improvement
Etz RS, Zyzanski SJ, Gonzalez MM
A new comprehensive measure of high-value aspects of primary care.
The authors of this article sought to develop and evaluate a concise measure of primary care grounded in the experience of patients, clinicians, and health care payers. They found that the person-centered primary care measure reliably assesses the aspects of care thought to represent high-value primary care by patients, clinicians, and payers. They recommended that the measure is ready for further validation and outcome analyses, and for use in focusing attention on what matters about primary care, while reducing measurement burden.
AHRQ-funded; HS025312.
Citation: Etz RS, Zyzanski SJ, Gonzalez MM .
A new comprehensive measure of high-value aspects of primary care.
Ann Fam Med 2019 May;17(3):221-30. doi: 10.1370/afm.2393..
Keywords: Primary Care, Quality of Care, Quality Measures
Lindner S, Solberg LI, Miller WL
Does ownership make a difference in primary care practice?
This study looked into whether ownership of a primary care practice makes a difference in structural characteristics, quality improvement practices, and cardiovascular preventive care. This analysis was done was part of an evaluation of the EvidenceNOW: Advancing Heart Health in Primary Care Initiative by AHRQ. Physician-owned practices, health system or medical group practices, and Federally Qualified Health Centers (FQHCs) were compared using 15 survey-based measures, and 4 electronic health record-based cardiovascular disease (CVD) prevention quality measures known as ABCS (aspirin prevention, blood pressure control, cholesterol management, and smoking cessation support). Physician-owned practices were solo 45% of the time as opposed to 8.1% for health system practices and 12.8% for FQHCs. FQHCs were more likely to use quality improvement practices followed by health system practices. ABCS use was similar across ownership types with the exception of smoking cessation support.
AHRQ-funded; HS023940.
Citation: Lindner S, Solberg LI, Miller WL .
Does ownership make a difference in primary care practice?
J Am Board Fam Med 2019 May-Jun;32(3):398-407. doi: 10.3122/jabfm.2019.03.180271..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Primary Care, Evidence-Based Practice, Quality Improvement, Quality of Care, Healthcare Delivery
Hung DY, Harrison MI, Liang SY
AHRQ Author: Harrison MI
Contextual conditions and performance improvement in primary care.
This study examined organizational features of primary care clinics that had gone through Lean redesigns and had experienced the greatest performance improvements. They surveyed 1333 physicians and staff in 43 primary care clinics across a large primary care system. They found that clinics with prior experience with quality improvement had the highest increases in efficiency. Clinics reporting the highest levels of burnout and work stress before the redesign also made efficiency gains. Physician productivity gains was associated with a history of change, staff participation and leadership support. The greatest improvements in patient satisfaction occurred where there was the lowest stress levels with highest levels of teamwork, staff engagement and leadership support.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Harrison MI, Liang SY .
Contextual conditions and performance improvement in primary care.
Qual Manag Health Care 2019 Apr/Jun;28(2):70-77. doi: 10.1097/qmh.0000000000000198..
Keywords: Organizational Change, Healthcare Delivery, Primary Care, Provider Performance, Quality Improvement, Quality of Care, Workflow
Wu SS, Chan KS, Bae J
Electronic clinical reminder and quality of primary diabetes care.
The goal of this retrospective cohort study was to examine the association of EMR's clinical reminder use with a comprehensive set of diabetes quality metrics in office-based physicians and within solo- versus multi-physician practices. Data on visits made by adults with diabetes were identified from the National Ambulatory Medical Care Survey and a multiple logistic regression was used to test for associations between clinical reminder use and recommended services by the American Diabetes Association. The researchers found no statistically significant relationship that suggests clinical reminder use improves diabetes process guidelines for solo practices, and they conclude that other resource efforts are needed to reduce gaps in primary diabetes care.
AHRQ-funded; HS000029.
Citation: Wu SS, Chan KS, Bae J .
Electronic clinical reminder and quality of primary diabetes care.
Prim Care Diabetes 2019 Apr;13(2):150-57. doi: 10.1016/j.pcd.2018.08.007..
Keywords: Care Management, Chronic Conditions, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Quality of Care
Bundy DG, Singh H, Stein RE
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
This paper discusses the results of Project RedDE, which was a virtual collaborative quality improvement study to reduce diagnostic errors in pediatric primary care practices. Forty-three practices were initially recruited, with a total of 31 practices left at the end due to practice dropout and two participating practices merging. This study was a randomized controlled trial targeting three common diagnostic errors (missed diagnoses of adolescent depression, abnormal blood pressure, and lack of followup for abnormal laboratory results). Contamination across study groups was a recurring problem, but risk mitigations were used. Electronic health records contributed to teams’ success.
AHRQ-funded; HS203608.
Citation: Bundy DG, Singh H, Stein RE .
The design and conduct of Project RedDE: a cluster-randomized trial to reduce diagnostic errors in pediatric primary care.
Clin Trials 2019 Apr;16(2):154-64. doi: 10.1177/1740774518820522..
Keywords: Adverse Events, Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Prevention, Primary Care, Quality of Care, Quality Improvement
Hysong SJ, Amspoker AB, Hughes AM
Impact of team configuration and team stability on primary care quality.
This paper discusses an upcoming study on the impact of team configurations on primary care effectiveness in clinics in the Veterans Health Administration (VHA). Recommendations are based on the Patient-Centered Medical Home (PCMH) model. Researchers plan to extract data from over 7000 primary care teams in the VHA’s Team Assignment Reports (TAR).
AHRQ-funded; HS025982.
Citation: Hysong SJ, Amspoker AB, Hughes AM .
Impact of team configuration and team stability on primary care quality.
Implement Sci 2019 Mar 6;14(1):22. doi: 10.1186/s13012-019-0864-8..
Keywords: Primary Care, Primary Care: Models of Care, Quality of Care, Teams
Kwan BM, Fernald D, Ferrarone P
Implementation and evaluation of a laboratory safety process improvement toolkit.
This study evaluated the quality and usefulness of the revised version of the AHRQ toolkit “Improving Your Office Testing Process”. The toolkit is designed to help primary care practices standardize their laboratory testing processes. Researchers evaluated 2 primary practices. Nineteen clinicians and staff provided survey data. The toolkit was given a positive rating by staff who thought it was easy to use and helped improve the quality improvement (QI) infrastructure.
AHRQ-funded; 233201500025I.
Citation: Kwan BM, Fernald D, Ferrarone P .
Implementation and evaluation of a laboratory safety process improvement toolkit.
J Am Board Fam Med 2019 Mar-Apr;32(2):136-45. doi: 10.3122/jabfm.2019.02.180109..
Keywords: Primary Care, Tools & Toolkits, Diagnostic Safety and Quality, Quality Improvement, Quality of Care
Shah T, Patel-Teague S, Kroupa L
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
In this study, the investigators evaluated the impact of a national, multicomponent, quality improvement (QI) programme designed to reduce low-value EHR notifications. The investigators found that, based on prior estimates on time to process notifications, this national QI programme potentially saved 1.5 hours per week per PCP to enable higher value work. The investigators also found that the number of daily notifications remained high, suggesting the need for additional multifaceted interventions and protected clinical time to help manage them.
AHRQ-funded; HS022087.
Citation: Shah T, Patel-Teague S, Kroupa L .
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
BMJ Qual Saf 2019 Jan;28(1):10-14. doi: 10.1136/bmjqs-2017-007447..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Improvement, Quality of Care, Primary Care, Primary Care: Models of Care
Hung DY, Gray CP, Truong QA
AHRQ Author: Harrison MI
Sustainment of lean redesigns for primary care teams.
This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. Results showed that staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. Change ownership and continued availability of time for improvement activities are also critical to the long-term success of Lean implementation in primary care.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Gray CP, Truong QA .
Sustainment of lean redesigns for primary care teams.
Qual Manag Health Care 2019 Jan/Mar;28(1):15-24. doi: 10.1097/qmh.0000000000000200..
Keywords: Primary Care, Workflow, Teams, Organizational Change, Quality Improvement, Quality of Care
Flieger SP
Impact of a patient-centered medical home pilot on utilization, quality, and costs and variation in medical homeness.
This study evaluated the impact of a patient-centered medical home (PCMH) pilot on utilization, costs, and quality and assessed variation in PCMH components. There were no statistically significant findings for utilization, cost, or quality in the expected direction. Medical Home Index (MHI) scores suggest variation in type and level of implemented features.
AHRQ-funded; HS021385.
Citation: Flieger SP .
Impact of a patient-centered medical home pilot on utilization, quality, and costs and variation in medical homeness.
J Ambul Care Manage 2017 Jul/Sep;40(3):228-37. doi: 10.1097/jac.0000000000000162.
.
.
Keywords: Patient-Centered Healthcare, Quality of Care, Primary Care, Healthcare Costs, Healthcare Utilization
Fiscella K, Mauksch L, Bodenheimer T
Improving care teams' functioning: recommendations from team science.
In this paper, the authors examine the application of team science to developing and sustaining primary care teams. They highlight six core team elements and conclude that implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief.
AHRQ-funded; HS022440.
Citation: Fiscella K, Mauksch L, Bodenheimer T .
Improving care teams' functioning: recommendations from team science.
Jt Comm J Qual Patient Saf 2017 Jul;43(7):361-68. doi: 10.1016/j.jcjq.2017.03.009..
Keywords: Teams, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care, Provider
Kerrissey M, Satterstrom P, Leydon N
Integrating: a managerial practice that enables implementation in fragmented health care environments.
This inductive qualitative study examines primary care clinics implementing improvement efforts in order to identify mechanisms that enable implementation despite common barriers, such as lack of time and fragmentation across stakeholder groups. It found that successfully implementing clinics exhibited the managerial practice of integrating, which was defined as achieving unity of effort among stakeholder groups in the pursuit of a shared and mutually developed goal.
AHRQ-funded; HS019508.
Citation: Kerrissey M, Satterstrom P, Leydon N .
Integrating: a managerial practice that enables implementation in fragmented health care environments.
Health Care Manage Rev 2017 Jul/Sep;42(3):213-25. doi: 10.1097/hmr.0000000000000114.
.
.
Keywords: Primary Care, Quality Improvement, Organizational Change, Implementation, Quality of Care
Frasso R, Golinkoff A, Klusaritz H
How nurse-led practices perceive implementation of the patient-centered medical home.
The purpose of this study was to investigate the implementation of a Patient-Centered Medical Home (PCMH) model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. The investigators indicate that their data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators.
AHRQ-funded; HS019150.
Citation: Frasso R, Golinkoff A, Klusaritz H .
How nurse-led practices perceive implementation of the patient-centered medical home.
Appl Nurs Res 2017 Apr;34:34-39. doi: 10.1016/j.apnr.2017.02.005.
.
.
Keywords: Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Provider, Provider: Nurse, Quality of Care
Martino SC, Shaller D, Schlesinger M
CAHPS and comments: how closed-ended survey questions and narrative accounts interact in the assessment of patient experience.
The authors investigated whether content from patient narratives explains variation in patients' primary care provider (PCP) ratings beyond information from the closed-ended questions of CAHPS Clinician and Group Survey and whether the relative placement of closed- and open-ended survey questions affects either the content of narratives or the CAHPS composite scores. They found that incorporating a protocol for eliciting narratives into a patient experience survey resulted in minimal distortion of patient feedback, and narratives from sicker patients helped explain variation in provider ratings.
AHRQ-funded; HS016980; HS016978; HS021858.
Citation: Martino SC, Shaller D, Schlesinger M .
CAHPS and comments: how closed-ended survey questions and narrative accounts interact in the assessment of patient experience.
J Patient Exp 2017 Mar;4(1):37-45. doi: 10.1177/2374373516685940.
.
.
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Primary Care, Quality of Care, Quality Measures
Lindquist LA, Miller RK, Saltsman WS
SGIM-AMDA-AGS consensus best practice recommendations for transitioning patients' healthcare from skilled nursing facilities to the community.
The authors assembled a cross-cutting team of experts representing primary care physicians (PCPs), home care physicians, physicians who see patients in skilled nursing facilities (SNF physicians), skilled nursing facility medical directors, human factors engineers, transitional care researchers, geriatricians, internists, family practitioners, and three major organizations: AMDA, SGIM, and AGS. This team identified issues and developed best practices perceived as feasible for SNF physician and PCP practices to accomplish.
AHRQ-funded; HS022916.
Citation: Lindquist LA, Miller RK, Saltsman WS .
SGIM-AMDA-AGS consensus best practice recommendations for transitioning patients' healthcare from skilled nursing facilities to the community.
J Gen Intern Med 2017 Feb;32(2):199-203. doi: 10.1007/s11606-016-3850-8.
.
.
Keywords: Quality of Care, Long-Term Care, Nursing Homes, Primary Care, Transitions of Care
Quigley DD, Predmore ZS, Chen AY
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Researchers conducted interviews at 14 primary care practices undergoing patient-centered medical home (PCMH) transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. They concluded that full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy.
AHRQ-funded; HS000029.
Citation: Quigley DD, Predmore ZS, Chen AY .
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Qual Manag Health Care 2017 Jan/Mar;26(1):7-14. doi: 10.1097/qmh.0000000000000118.
.
.
Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams
Graetz I, Huang J, Brand R
The impact of electronic health records and teamwork on diabetes care quality.
The researchers examined whether team cohesion among primary care team members changed the association between EHR use and changes in clinical outcomes for patients with diabetes. They found that patients cared for by higher cohesion primary care teams experienced modest but statistically significantly greater EHR-related health outcome improvements, compared with patients cared for by providers practicing in lower cohesion teams.
AHRQ-funded; HS015280; HS021082.
Citation: Graetz I, Huang J, Brand R .
The impact of electronic health records and teamwork on diabetes care quality.
Am J Manag Care 2015 Dec;21(12):878-84.
.
.
Keywords: Diabetes, Electronic Health Records (EHRs), Quality of Care, Primary Care, Teams
Litvin CB, Ornstein SM, Wessell AM
"Meaningful" clinical quality measures for primary care physicians.
The authors systematically solicited recommendations from Meaningful Use (MU) exemplars to inform Stage 3 MU clinical quality measure (CQM) requirements. There was consensus that CQMs should be evidence-based and focus on high-priority conditions relevant to primary care providers. Participants thought the emphasis of CQMs should largely be on outcomes and that reporting of CQMs should limit the burden on providers.
AHRQ-funded; HS022701; HS018984.
Citation: Litvin CB, Ornstein SM, Wessell AM .
"Meaningful" clinical quality measures for primary care physicians.
Am J Manag Care 2015 Oct;21(10):e583-90..
Keywords: Quality Indicators (QIs), Quality Measures, Primary Care, Quality of Care
Magill MK, Ehrenberger D, Scammon DL
The cost of sustaining a patient-centered medical home: experience from 2 states.
This study’s objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. It found that costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices.
AHRQ-funded; HS022620.
Citation: Magill MK, Ehrenberger D, Scammon DL .
The cost of sustaining a patient-centered medical home: experience from 2 states.
Ann Fam Med 2015 Sep;13(5):429-35. doi: 10.1370/afm.1851..
Keywords: Patient-Centered Healthcare, Healthcare Costs, Quality of Care, Primary Care
Linzer M, Poplau S, Grossman E
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
This study aimed to assess if improvements in work conditions reduce clinician stress and burnout. It found that burnout was more likely to improve with workflow interventions and with targeted QI projects than in controls. Also, interventions in communication or workflow led to greater improvements in clinician satisfaction.
AHRQ-funded; HS018160.
Citation: Linzer M, Poplau S, Grossman E .
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
J Gen Intern Med 2015 Aug;30(8):1105-11. doi: 10.1007/s11606-015-3235-4..
Keywords: Burnout, Stress, Primary Care, Workflow, Quality Improvement, Quality of Care, Communication
O'Malley AS, Rich EC, Maccarone A
Disentangling the linkage of primary care features to patient outcomes: A review of current literature, data sources, and measurement needs.
This paper reviews key primary care concepts and their definitions, notes the increasingly complex interplay between primary care and the broader health care system, and offers research priorities to support future measurement, delivery and understanding of the role of primary care features on health care costs and quality.
AHRQ-funded.
Citation: O'Malley AS, Rich EC, Maccarone A .
Disentangling the linkage of primary care features to patient outcomes: A review of current literature, data sources, and measurement needs.
J Gen Intern Med 2015 Aug;30 Suppl 3:S576-85. doi: 10.1007/s11606-015-3311-9..
Keywords: Primary Care, Quality of Care
Alexander JA, Markowitz AR, Paustian ML
Implementation of patient-centered medical homes in adult primary care practices.
This study examined the following research questions: Is the level of, and change in, implementation of patient-centered medical home (PCMH) associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results showed that both level and amount of change are independently and positively associated with measures of quality of care and use of preventive services.
AHRQ-funded; HS019147.
Citation: Alexander JA, Markowitz AR, Paustian ML .
Implementation of patient-centered medical homes in adult primary care practices.
Med Care Res Rev 2015 Aug;72(4):438-67. doi: 10.1177/1077558715579862.
.
.
Keywords: Care Management, Quality of Care, Patient-Centered Healthcare, Primary Care
O'Malley AS, Rich EC
Measuring comprehensiveness of primary care: challenges and opportunities.
This paper discusses challenges to measuring comprehensiveness for a primary care team’s patient panel, presents survey and claims-based measures of comprehensiveness, and provides suggestions for future research. The authors argue that developing valid and reliable measures of comprehensiveness could inform quality improvement efforts and help identify
providers in need of additional support.
providers in need of additional support.
AHRQ-funded.
Citation: O'Malley AS, Rich EC .
Measuring comprehensiveness of primary care: challenges and opportunities.
J Gen Intern Med 2015 Aug;30 Suppl 3:S568-75. doi: 10.1007/s11606-015-3300-z..
Keywords: Primary Care, Quality of Care
Chen LM, Sakshaug JW, Miller DC
The association among medical home readiness, quality, and care of vulnerable patients.
The researchers sought to examine the association among patient-centered medical home (PCMH) readiness, quality, and the care of vulnerable patients. They found that performance at PCMH-ready practices was higher for 3 of 9 quality indicators related to chronic disease management and preventive counseling (beta-blocker or diuretic prescribed for hypertension, diet counseling, exercise counseling).
AHRQ-funded; HS018346; HS020671; HS020927.
Citation: Chen LM, Sakshaug JW, Miller DC .
The association among medical home readiness, quality, and care of vulnerable patients.
Am J Manag Care 2015 Aug;21(8):e480-6..
Keywords: Patient-Centered Healthcare, Patient Safety, Quality of Care, Primary Care