National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (2)
- Clinical Decision Support (CDS) (1)
- Critical Care (2)
- Data (1)
- Diagnostic Safety and Quality (4)
- (-) Electronic Health Records (EHRs) (15)
- Health Information Technology (HIT) (10)
- Health Services Research (HSR) (1)
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- Intensive Care Unit (ICU) (3)
- Learning Health Systems (1)
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- Medication: Safety (2)
- Newborns/Infants (1)
- Patient Experience (1)
- (-) Patient Safety (15)
- Provider: Health Personnel (2)
- Provider: Pharmacist (1)
- Quality Improvement (2)
- Quality Measures (1)
- Quality of Care (1)
- Respiratory Conditions (1)
- Social Media (1)
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 15 of 15 Research Studies DisplayedBell SK, Bourgeois F, Dong J
Patient identification of diagnostic safety blindspots and participation in "good catches" through shared visit notes.
The goal of this study was to investigate whether sharing clinical notes with patients supported identification of potential breakdowns in the diagnostic process that might be difficult for clinical staff to observe -- "diagnostic safety blindspots." Researchers analyzed patient-reported ambulatory documentation errors among patients at 3 U.S. healthcare centers. Older, female, unemployed, disabled, or sicker patients, or patients who worked in healthcare, were more likely to identify blindspots; patients who self-identified as Black, Asian, multiple races and those with less formal education as well as those who deferred decision-making to their providers were less likely to report blindspots. The researchers concluded that patients who read notes have unique insight about potential errors in their medical records and that organizations should encourage patient review of notes and create systems to track patient-reported blindspots.
AHRQ-funded; HS027367.
Citation: Bell SK, Bourgeois F, Dong J .
Patient identification of diagnostic safety blindspots and participation in "good catches" through shared visit notes.
Milbank Q 2022 Dec; 100(4):1121-65. doi: 10.1111/1468-0009.12593..
Keywords: Diagnostic Safety and Quality, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Ozonoff A, Milliren CE, Fournier K A, Milliren CE, Fournier K
Electronic surveillance of patient safety events using natural language processing.
The purpose of this study was to describe the surveillance of reportable safety events captured in hospital data including free-text clinical notes. The researchers created a training data set for a machine learning model and applied the model to complete sets of clinical notes which were then reviewed to identify safety events of interest. The study found that in Phase 1, the researchers reviewed 2,342 clinical notes of the 21,362 gathered. 125 PIV events were identified, of which 44 cases (35%) were not identified by other patient safety systems. In Phase 2 of the study, the researchers identified 440 infiltrate events of the 60,735 clinical notes collected. The study classifier provided accuracy above 90%.
AHRQ-funded; HS026246.
Citation: Ozonoff A, Milliren CE, Fournier K A, Milliren CE, Fournier K .
Electronic surveillance of patient safety events using natural language processing.
Health Informatics J 2022 Oct-Dec; 28(4):14604582221132429. doi: 10.1177/14604582221132429..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety
Shafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Bradford A, Shofer M, Singh H
AHRQ Author: Shofer M, Singh H
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
This paper discusses Measure Dx, a new AHRQ resource that translates knowledge from diagnostic measurement research into actionable recommendations. This resource guides healthcare organizations to detect, analyze, and learn from diagnostic safety events as part of a continuous learning and feedback cycle. The goal of Measure Dx is to advance new frontiers in reducing preventable diagnostic harm to patients.
AHRQ-authored; AHRQ-funded; 233201500022I; HS027363.
Citation: Bradford A, Shofer M, Singh H .
Measure Dx: implementing pathways to discover and learn from diagnostic errors.
Int J Qual Health Care 2022 Sep 10;34(3). doi: 10.1093/intqhc/mzac068..
Keywords: Diagnostic Safety and Quality, Patient Safety, Quality Improvement, Quality of Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Systems, Learning Health Systems
Yerneni S, Shah S, Blackley SV
Heterogeneity of drug allergies and reaction lists in two U.S. healthcare systems' electronic health records.
This study compared adverse drug reaction (ADRs) picklists for clinicians in the electronic health record (EHR) allergy list for two different healthcare institutions. The authors used data from the EHRs of patients who visited the emergency department or outpatient clinics at Brigham and Women's Hospital (BWH) and University of Colorado Hospital (UCH) from 2013-2018. They investigated the reactions on each picklist and compared the top 40 reactions at each institution, as well as the top 10 reactions within each drug class. Out of 2,160,116 patients sampled, 30% reported active drug allergies. The most commonly reported drug class allergens were similar between the two institutions, however BWH’s picklist had 48 reactions while UCH’s had 160. Twenty-nine reactions were shared by both picklists. There was a lot more granularity with UCH’s picklist so that body locality, swelling and edema were described in much greater detail than for BWH. These picklists may partially explain variations in reported ADRs across healthcare systems.
AHRQ-funded; HS025375.
Citation: Yerneni S, Shah S, Blackley SV .
Heterogeneity of drug allergies and reaction lists in two U.S. healthcare systems' electronic health records.
Appl Clin Inform 2022 May 26;13(3):741-51. doi: 10.1055/a-1862-9425..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Patient Safety
Giardina TD, Choi DT, Upadhyay DK
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
This study’s objective was to test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes in an electronic health record (EHR) system. Patients aged 18-85 years in a large integrated health system who actively used the patient portal were invited to respond to an online questionnaire if an EHR algorithm detected any recent visit following an initial primary care consultation. The authors developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to the diagnostic process based on notes review and recall of recent “at-risk” visits. The algorithm identified 1282 eligible patients, of whom 486 responded. Of the 418 patients included in the analysis, 51 patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements "The care plan the provider developed for me addressed all my medical concerns", "I trust the provider that I saw during my visit" and agreed with the statement "I did not have a good feeling about my visit".
AHRQ-funded; HS027363; HS025474.
Citation: Giardina TD, Choi DT, Upadhyay DK .
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
J Am Med Inform Assoc 2022 May 11;29(6):1091-100. doi: 10.1093/jamia/ocac036..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Patient Safety
Press A, Khan S, McCullagh L
Avoiding alert fatigue in pulmonary embolism decision support: a new method to examine 'trigger rates.'
The authors developed a new and innovative usability process named 'sensitivity and specificity trigger analysis' (SSTA) as part of a larger project around a pulmonary embolism decision support tool. They explored a unique methodology, SSTA, used to limit inaccurate triggering of a clinical decision support tool prior to integration into the electronic health record. They concluded that their methodology can be applied to other studies aiming to decrease triggering rates and increase adoption rates of previously validated clinical decision support system tools.
AHRQ-funded; HS022061.
Citation: Press A, Khan S, McCullagh L .
Avoiding alert fatigue in pulmonary embolism decision support: a new method to examine 'trigger rates.'
Evid Based Med 2016 Dec;21(6):203-07. doi: 10.1136/ebmed-2016-110440.
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Keywords: Clinical Decision Support (CDS), Respiratory Conditions, Electronic Health Records (EHRs), Provider: Health Personnel, Patient Safety
Russo E, Sittig DF, Murphy DR
Challenges in patient safety improvement research in the era of electronic health records.
The researchers used a case study involving a project on missed or delayed follow-up of test results to discuss real-world challenges in using electronic health records data for patient safety research. They suggested that many current data access and security policies and procedures must be rewritten and standardized across health care organization sin order to advance progress toward safer health care.
AHRQ-funded; HS022901.
Citation: Russo E, Sittig DF, Murphy DR .
Challenges in patient safety improvement research in the era of electronic health records.
Healthc 2016 Dec;4(4):285-90. doi: 10.1016/j.hjdsi.2016.06.005.
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Keywords: Electronic Health Records (EHRs), Health Services Research (HSR), Health Information Technology (HIT), Patient Safety, Quality Improvement
Gold JA, Stephenson LE, Gorsuch A
Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.
The researchers reported on their use of eye- and screen-tracking technology to understand factors associated with poor error recognition during an intensive care unit-based electronic health record simulation. They concluded that eye tracking can be successfully integrated into electronic health record-based simulation and provides a surrogate measure of cognitive decision making and electronic health record usability.
AHRQ-funded; HS021637.
Citation: Gold JA, Stephenson LE, Gorsuch A .
Feasibility of utilizing a commercial eye tracker to assess electronic health record use during patient simulation.
Health Informatics J 2016 Sep;22(3):744-57. doi: 10.1177/1460458215590250.
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Keywords: Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety
Sakata KK, Stephenson LS, Mulanax A
Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients.
The authors conducted this study to determine how each professional group - physicians, nurses, and pharmacists - reviews electronic health records (EHR) data in preparation for rounds and their ability to identify patient safety issues. They found significant and non-overlapping differences in individual profession recognition of patient safety issues in the EHR which may be attributed to differences in EHR use.
AHRQ-funded; HS023793; HS021637.
Citation: Sakata KK, Stephenson LS, Mulanax A .
Professional and interprofessional differences in electronic health records use and recognition of safety issues in critically ill patients.
J Interprof Care 2016 Sep;30(5):636-42. doi: 10.1080/13561820.2016.1193479.
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Keywords: Critical Care, Electronic Health Records (EHRs), Provider: Health Personnel, Intensive Care Unit (ICU), Patient Safety
Pevnick JM, Shane R, Schnipper JL
The problem with medication reconciliation.
The authors discussed medication reconciliation and the issue that benefits reaped by organizations focused on interventions have not generalized easily to other institutions. They specified that medication reconciliation interventions need to be carefully matched to organizational strengths, workflows, and goals based on institutional priorities, and that there are several broad recommendations that can be targeted to organizational leaders, clinicians and investigators.
AHRQ-funded; HS019598; HS023757.
Citation: Pevnick JM, Shane R, Schnipper JL .
The problem with medication reconciliation.
BMJ Qual Saf 2016 Sep;25(9):726-30. doi: 10.1136/bmjqs-2015-004734.
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Keywords: Electronic Health Records (EHRs), Medication, Patient Safety, Provider: Pharmacist
Topaz M, Seger DL, Slight SP
Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience.
The authors aimed to explore the common drug allergy alerts over the last 10 years and the reasons why providers tend to override these alerts. They found that alarmingly, alerts for immune mediated and life threatening reactions with definite allergen and prescribed medication matches were overridden 72.8 percent and 74.1 percent of the time, respectively.
AHRQ-funded; HS022728.
Citation: Topaz M, Seger DL, Slight SP .
Rising drug allergy alert overrides in electronic health records: an observational retrospective study of a decade of experience.
J Am Med Inform Assoc 2016 May;23(3):601-8. doi: 10.1093/jamia/ocv143.
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Keywords: Electronic Health Records (EHRs), Adverse Drug Events (ADE), Medication, Medication: Safety, Patient Safety
Plasek JM, Goss FR, Lai KH
Food entries in a large allergy data repository.
This study examined, encoded, and grouped foods that caused any adverse sensitivity in a large allergy repository using natural language processing and standard terminologies. It identified 158,552 food allergen records (2,140 unique terms) in the Partners repository, corresponding to 672 food allergen concepts. High-frequency groups included shellfish (19.3 percent), fruits or vegetables (18.4 percent), dairy (9.0 percent), and peanuts (8.5 percent).
AHRQ-funded; HS022728.
Citation: Plasek JM, Goss FR, Lai KH .
Food entries in a large allergy data repository.
J Am Med Inform Assoc 2016 Apr;23(e1):e79-87. doi: 10.1093/jamia/ocv128.
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Keywords: Data, Health Information Technology (HIT), Electronic Health Records (EHRs), Patient Safety
Singh H, Sittig DF
Measuring and improving patient safety through health information technology: the Health IT Safety Framework.
The authors propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns. A long term framework goal is to enable rigorous measurement that helps achieve the safety benefits of health IT in real-world clinical settings.
AHRQ-funded; HS022087.
Citation: Singh H, Sittig DF .
Measuring and improving patient safety through health information technology: the Health IT Safety Framework.
BMJ Qual Saf 2016 Apr;25(4):226-32. doi: 10.1136/bmjqs-2015-004486.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Health Information Technology (HIT), Patient Safety, Quality Measures
Topaz M, Lai K, Dhopeshwarkar N
Clinicians' reports in electronic health records versus patients' concerns in social media: A pilot study of adverse drug reactions of aspirin and atorvastatin.
The study’s objective was to compare electronic health record data and social media data to better understand differences and similarities between clinician-reported adverse drug reactions (ADRs) and patients' concerns regarding aspirin and atorvastatin. It found that the most frequently reported ADRs matched the most frequent patients' concerns. However, several less frequently reported reactions were more prevalent on social media (i.e., aspirin-induced hypoglycemia was discussed only on social media).
AHRQ-funded; HS022728.
Citation: Topaz M, Lai K, Dhopeshwarkar N .
Clinicians' reports in electronic health records versus patients' concerns in social media: A pilot study of adverse drug reactions of aspirin and atorvastatin.
Drug Saf 2016 Mar;39(3):241-50. doi: 10.1007/s40264-015-0381-x..
Keywords: Electronic Health Records (EHRs), Social Media, Health Information Technology (HIT), Adverse Drug Events (ADE), Patient Safety