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
- Adverse Drug Events (ADE) (9)
- Adverse Events (6)
- Anxiety (1)
- Behavioral Health (1)
- Blood Pressure (1)
- Care Management (1)
- Centers for Education and Research on Therapeutics (CERTs) (2)
- Children/Adolescents (1)
- Clinical Decision Support (CDS) (3)
- Data (2)
- Depression (1)
- Diabetes (3)
- Diagnostic Safety and Quality (1)
- (-) Electronic Health Records (EHRs) (20)
- Health Information Technology (HIT) (15)
- Hospitalization (1)
- Hospitals (1)
- Medical Errors (3)
- (-) Medication (20)
- Medication: Safety (7)
- Outcomes (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (1)
- Patient Adherence/Compliance (1)
- Patient and Family Engagement (1)
- Patient Safety (13)
- Prevention (2)
- Primary Care (2)
- Quality of Care (2)
- Risk (2)
- Vitamins and Supplements (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedWright A, Aaron S, Seger DL
Reduced effectiveness of interruptive drug-drug interaction alerts after conversion to a commercial electronic health record.
This study examined the effects of conversion from a homegrown electronic health record (EHR) system to a commercial system on the effectiveness of drug-drug interaction (DDI) alert. The EHR system included 3277 clinicians in the before and after studies. There was a marked decrease in the acceptance rate (100 to 8.4% for severe alerts, 29.3 to 7.5% for medium severity) at first. The least severe alerts were then disabled, which lowered the alert burden by 50.5% which rose the acceptance of Tier 1 alerts to 12.7%. However, there was no clear explanation after that why the acceptance rate remained so much lower. The authors believe that workflow factors were probably the predominant reasons.
AHRQ-funded; HS016970.
Citation: Wright A, Aaron S, Seger DL .
Reduced effectiveness of interruptive drug-drug interaction alerts after conversion to a commercial electronic health record.
J Gen Intern Med 2018 Nov;33(11):1868-76. doi: 10.1007/s11606-018-4415-9..
Keywords: Adverse Drug Events (ADE), Medication, Adverse Events, Medical Errors, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Prey JE, Polubriaginof F, Grossman LV
Engaging hospital patients in the medication reconciliation process using tablet computers.
Researchers conducted a pilot study to determine whether patients’ use of an electronic home medication review tool on a table computer could improve medication safety before or after hospitalization. Patients were randomized to the tool and out of 76 patients approached, 65 participated. About three-quarters (74%) made changes to their home medication list. Out of that total, 74% of the changes identified had a significant or greater potential severity, and 49% had a greater than 50-50 chance of harm. This medication reconciliation tool showed great potential to improve medication safety during and after hospitalization.
AHRQ-funded; HS021816.
Citation: Prey JE, Polubriaginof F, Grossman LV .
Engaging hospital patients in the medication reconciliation process using tablet computers.
J Am Med Inform Assoc 2018 Nov;25(11):1460-69. doi: 10.1093/jamia/ocy115..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Hospitals, Medication, Medication: Safety, Patient and Family Engagement, Patient Safety, Prevention
Ratwani RM, Savage E, Will A
Identifying electronic health record usability and safety challenges in pediatric settings.
To understand specific usability issues and medication errors in the care of children, the investigators analyzed 9,000 patient safety reports, made in the period 2012-17, from three different health care institutions that were likely related to EHR use. They found: the general pattern of usability challenges and medication errors were the same across the three sites; the most common usability challenges were associated with system feedback and the visual display; and the most common medication error was improper dosing.
AHRQ-funded; HS023701.
Citation: Ratwani RM, Savage E, Will A .
Identifying electronic health record usability and safety challenges in pediatric settings.
Health Aff 2018 Nov;37(11):1752-59. doi: 10.1377/hlthaff.2018.0699..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Children/Adolescents
Bates DW, Singh H
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
This paper comments on the progress made in improving patient safety since the 1999 report from The Institute of Medicine titled “To Err is Human” was published. This landmark report highlighted problem areas, and since then there has been a number of effective interventions to prevent hospital-acquired infections and improve medication safety. Additional areas for improvement have also been identified in the past two decades, including outpatient care, diagnostic, errors and the use of health information technology. The authors believe that electronic data developments can help increase patient safety even further.
AHRQ-funded; HS022087; HS017820.
Citation: Bates DW, Singh H .
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
Health Aff 2018 Nov;37(11):1736-43. doi: 10.1377/hlthaff.2018.0738..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Prevention
Blumenthal KG, Li Y, Acker WW
Multiple drug intolerance syndrome and multiple drug allergy syndrome: epidemiology and associations with anxiety and depression.
In this study, the authors used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. The investigators concluded that: 1.) while 6% of patients had MDIS, only 1% had MDAS; 2.) MDIS was associated with both anxiety and depression; 3.) patients with both anxiety and depression had an almost twofold increased odds of MDIS; 4.) MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety.
AHRQ-funded; HS022728.
Citation: Blumenthal KG, Li Y, Acker WW .
Multiple drug intolerance syndrome and multiple drug allergy syndrome: epidemiology and associations with anxiety and depression.
Allergy 2018 Oct;73(10):2012-23. doi: 10.1111/all.13440..
Keywords: Adverse Drug Events (ADE), Adverse Events, Anxiety, Depression, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Behavioral Health, Patient Safety
Ramirez M, Maranon R, Fu J
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
The purpose of this study was to evaluate provider responses to a narrowly targeted Best Practice Advisory (BPA) alert regarding the intensification of blood pressure medications for persons with diabetes before and after implementation of a ‘chart closure’ hard stop. Researchers designed a BPA that sent alerts via an electronic health record system during outpatient encounters when patients with diabetes had elevated blood pressures and were not on angiotensin receptor blocking medications. These alerts were implemented in eight primary care practices within UCLA Health. Data on provider responses to the alerts was compared before and after implementing a ‘chart closure’ hard stop. Providers responded to alerts more often after the ‘chart closure’ hard stop was implemented. The researchers conclude that targeting specific omitted medication classes can produce specific alerts that may reduce alert fatigue, and that using a ‘chart closure’ hard stop may prompt providers to take action without major disruptions to their workflow.
AHRQ-funded; HS000046.
Citation: Ramirez M, Maranon R, Fu J .
Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a "chart closure" hard stop.
J Am Med Inform Assoc 2018 Sep;25(9):1167-74. doi: 10.1093/jamia/ocy073..
Keywords: Blood Pressure, Diabetes, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Care Management
Wong A, Plasek JM, Montecalvo SP
Natural language processing and its implications for the future of medication safety: a narrative review of recent advances and challenges.
This review illustrates the fundamentals of natural language processing (NLP) and discusses the application the NLPs to medication safety in four data sources: electronic health records, Internet-based data, published literature, and reporting systems. The benefit of NLP is its time-saving features in association with the automation of medication safety tasks, as well as the potential for near real-time identification of adverse events, such as incidents posted on social media that might otherwise go unanalyzed. However, NLP is limited by a lack of data sharing between health care organizations, which inhibits wider adverse event monitoring across populations. The authors anticipate that future work on NLPs will focus on integrating of data sources from different domains to more quickly identify potential adverse events and to improve clinical decision support regarding patients’ estimated risks for specific adverse events.
AHRQ-funded; HS022728; HS024264; HS025375.
Citation: Wong A, Plasek JM, Montecalvo SP .
Natural language processing and its implications for the future of medication safety: a narrative review of recent advances and challenges.
Pharmacotherapy 2018 Aug;38(8):822-41. doi: 10.1002/phar.2151..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety, Patient Safety
Flory JH, Keating SJ, Siscovick D
Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record.
Non-persistence may be a significant barrier to the use of metformin. The objective of this study was to assess reasons for metformin non-persistence, and whether initial metformin dosing or use of extended release (ER) formulations affect persistence to metformin therapy. The investigators concluded that their data supported the routine prescribing of low starting doses of metformin as a tool to improve persistence.
AHRQ-funded; HS023898.
Citation: Flory JH, Keating SJ, Siscovick D .
Identifying prevalence and risk factors for metformin non-persistence: a retrospective cohort study using an electronic health record.
BMJ Open 2018 Jul 23;8(7):e021505. doi: 10.1136/bmjopen-2018-021505..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Patient Adherence/Compliance, Outcomes, Patient-Centered Outcomes Research, Risk
Walsh KE, Marsolo KA, Davis C
Accuracy of the medication list in the electronic health record-implications for care, research, and improvement.
Electronic medication lists may be useful in clinical decision support and research, but their accuracy is not well described. The aim of this study was to assess the completeness of the medication list compared to the clinical narrative in the electronic health record. The study found that there was a range in the accuracy of the medication list compared to the clinical narrative.
AHRQ-funded; HS022974.
Citation: Walsh KE, Marsolo KA, Davis C .
Accuracy of the medication list in the electronic health record-implications for care, research, and improvement.
J Am Med Inform Assoc 2018 Jul;25(7):909-12. doi: 10.1093/jamia/ocy027..
Keywords: Electronic Health Records (EHRs), Quality of Care, Medication, Patient-Centered Healthcare, Patient Safety
Walsh KE, Marsolo KA, Davis C
Accuracy of the medication list in the electronic health record-implications for care, research, and improvement.
Electronic medication lists may be useful in clinical decision support and research, but their accuracy is not well described. The aim of this study was to assess the completeness of the medication list compared to the clinical narrative in the electronic health record. The study found that there was a range in the accuracy of the medication list compared to the clinical narrative.
AHRQ-funded; HS022974.
Citation: Walsh KE, Marsolo KA, Davis C .
Accuracy of the medication list in the electronic health record-implications for care, research, and improvement.
J Am Med Inform Assoc 2018 Jul;25(7):909-12. doi: 10.1093/jamia/ocy027..
Keywords: Electronic Health Records (EHRs), Quality of Care, Medication, Patient-Centered Healthcare, Patient Safety
Goss FR, Lai KH, Topaz M
A value set for documenting adverse reactions in electronic health records.
In this study, the investigators developed a value set for encoding adverse reactions using a large dataset from one health system, enriched by reactions from 2 large external resources. This integrated value set included clinically important severe and hypersensitivity reactions. The work contributed a value set, harmonized with existing data, to improve the consistency and accuracy of reaction documentation in electronic health records, providing the necessary building blocks for more intelligent clinical decision support for allergies and adverse reactions.
AHRQ-funded; HS022728.
Citation: Goss FR, Lai KH, Topaz M .
A value set for documenting adverse reactions in electronic health records.
J Am Med Inform Assoc 2018 Jun;25(6):661-69. doi: 10.1093/jamia/ocx139..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Medication, Data, Health Information Technology (HIT), Patient Safety
Rangachari P, Dellsperger KC, Fallaw D
Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.
Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from "limited use" of EHR Medication Reconciliation (MedRec) Technology, to "meaningful use." Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. The purpose of this paper is to describe the methods and results of Phase 1.
AHRQ-funded; HS024335.
Citation: Rangachari P, Dellsperger KC, Fallaw D .
Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.
J Hosp Adm 2018 Apr;7(2):36-49. doi: 10.5430/jha.v7n2p36.
.
.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication: Safety, Medication, Patient Safety
Rangachari P
Implementing a Social Knowledge Networking (SKN) system to enable meaningful use of an EHR medication reconciliation system.
The study examined user-engagement in the SKN system and associations between "SKN use" and "meaningful use" of electronic health record (EHR). The prospective implementation design is expected to generate context-sensitive strategies for meaningful use and successful implementation of EHR Medication Reconciliation (MedRec) and thereby make substantial contributions to the patient safety and risk management literature.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Implementing a Social Knowledge Networking (SKN) system to enable meaningful use of an EHR medication reconciliation system.
Risk Manag Healthc Policy 2018 Mar 26;11:45-53. doi: 10.2147/rmhp.s152313.
.
.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Patient Safety, Risk
Wong A, Seger DL, Slight SP
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
The aim of this study was to determine the rate of anaphylaxis overrides, the reasons for these overrides, whether the overrides were appropriate, and if harm occurred from overrides. Overrides of 'definite' anaphylaxis drug-allergy interactions were common and often appropriate. Most overrides were due to desensitizations.
AHRQ-funded; HS021094.
Citation: Wong A, Seger DL, Slight SP .
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
Drug Saf 2018 Mar;41(3):297-302. doi: 10.1007/s40264-017-0615-1.
.
.
Keywords: Adverse Drug Events (ADE), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Medication: Safety, Medication
Cornu P, Phansalkar S, Seger DL
High-priority and low-priority drug-drug interactions in different international electronic health record systems: a comparative study.
The purpose of this comparative retrospective study was to investigate whether alert warnings for high-priority and low-priority drug-drug interactions were present in five international electronic health record systems, to compare and contrast the severity level assigned to them, and to establish the proportion of alerts that were overridden.
AHRQ-funded; HS021094.
Citation: Cornu P, Phansalkar S, Seger DL .
High-priority and low-priority drug-drug interactions in different international electronic health record systems: a comparative study.
Int J Med Inform 2018 Mar;111:165-71. doi: 10.1016/j.ijmedinf.2017.12.027..
Keywords: Adverse Drug Events (ADE), Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety
Zhang R, Manohar N, Arsoniadis E
Evaluating term coverage of herbal and dietary supplements in electronic health records.
Some supplements can interact with prescription medications, potentially leading to clinically important and potentially preventable adverse reactions. Clinical notes and corresponding medication lists from an integrated healthcare system were extracted and compared with online databases. The authors found that, overall, about 40% of listed medications are supplements, most of which are included in medication lists as nutritional or miscellaneous products. They found gaps between supplement and standard medication terminologies and identified supplements which were not mentioned in the medication lists.
AHRQ-funded; HS022085.
Citation: Zhang R, Manohar N, Arsoniadis E .
Evaluating term coverage of herbal and dietary supplements in electronic health records.
AMIA Annu Symp Proc 2015 Nov 5;2015:1361-70.
.
.
Keywords: Adverse Drug Events (ADE), Data, Electronic Health Records (EHRs), Medication, Vitamins and Supplements
Slight SP, Berner ES, Glanter W
Meaningful use of electronic health records: experiences from the field and future opportunities.
AHRQ-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy. The conclusion was that although MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways.
AHRQ-funded.
Citation: Slight SP, Berner ES, Glanter W .
Meaningful use of electronic health records: experiences from the field and future opportunities.
JMIR Med Inform 2015 Sep 18;3(3):e30. doi: 10.2196/medinform.4457..
Keywords: Centers for Education and Research on Therapeutics (CERTs), Electronic Health Records (EHRs), Health Information Technology (HIT), Medication
Overby CL, Devine EB, Abernethy N
Making pharmacogenomic-based prescribing alerts more effective: a scenario-based pilot study with physicians.
This pilot study explored the communication effectiveness and clinical impact of using a prototype clinical decision support (CDS) system embedded in an electronic health record (EHR) to deliver pharmacogenomic (PGx) information to physicians. The proportion of physicians that saw a relative advantage to using PGx-CDS was 83 percent at the start and 94 percent at the conclusion of our study.
AHRQ-funded; HS014739.
Citation: Overby CL, Devine EB, Abernethy N .
Making pharmacogenomic-based prescribing alerts more effective: a scenario-based pilot study with physicians.
J Biomed Inform 2015 Jun;55:249-59. doi: 10.1016/j.jbi.2015.04.011..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Patient Safety
Tannenbaum D, Doctor JN, Persell SD
Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.
The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. It found that provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise.
AHRQ-funded; RC4 AG039115 (NIA/AHRQ).
Citation: Tannenbaum D, Doctor JN, Persell SD .
Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.
J Gen Intern Med 2015 Mar;30(3):298-304. doi: 10.1007/s11606-014-3051-2..
Keywords: Electronic Health Records (EHRs), Primary Care, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication
Przytula K, Bailey SC, Galanter WL
A primary care, electronic health record-based strategy to promote safe drug use: study protocol for a randomized controlled trial.
The researchers designed a health literacy-informed, electronic health record based strategy for promoting safe and effective prescription medication use among English and Spanish-speaking patients with diabetes mellitus. This paper provides an overview of their intervention, summarizes evaluation activities, and discusses the sustainability and potential dissemination of their novel strategy.
AHRQ-funded; HS021093.
Citation: Przytula K, Bailey SC, Galanter WL .
A primary care, electronic health record-based strategy to promote safe drug use: study protocol for a randomized controlled trial.
Trials 2015 Jan 27;16:17. doi: 10.1186/s13063-014-0524-x..
Keywords: Centers for Education and Research on Therapeutics (CERTs), Electronic Health Records (EHRs), Diabetes, Medication, Patient Safety