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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 25 of 45 Research Studies DisplayedKakara M, Venkataramani AS
Earnings of US physicians with and without disabilities.
The researchers report that across industries, workers with disabilities earn less than workers without disabilities. As greater numbers of people with disabilities enter medicine, they face substantial challenges in medical education and higher risks of mistreatment at work. As physicians in older age groups grows, the incidence of disability increases. The purpose of this study was to explore possible disability earnings gaps in medicine. The study cohort included 92,469 physicians, 2.0% of whom reported having a disability. The study found that in the adjusted analyses of employed physicians, annual earned income was 20.8% lower and hourly earned income was 13.3% lower among physicians with disabilities. Physicians reporting disabilities worked an average of 110 hours fewer per year compared with those without disabilities. Estimated differences in annual income by disability status were similar after adjusting for hours worked and surgical specialty status and across age groups; estimates were much greater for disabilities affecting cognitive function, ambulation, independent living, and self-care than vision or hearing.
AHRQ-funded; HS026116.
Citation: Kakara M, Venkataramani AS .
Earnings of US physicians with and without disabilities.
JAMA Health Forum 2023 Dec; 4(12):e233954. doi: 10.1001/jamahealthforum.2023.3954..
Keywords: Provider: Physician, Disabilities
Graves JA, Lee D, Leszinsky L
Physician patient sharing relationships within insurance plan networks.
The purpose of this cross-sectional study was to assess patient relationships shared between primary care physicians (PCPs), cardiologists, and oncologists, and the level at which those relationships were indicated within insurance networks. The study found that on average, networks captured 64.6% of PCP-cardiology shared patient ties, and 61.8% of PCP-oncologist ties. Fewer than 50% of in-network ties were among physicians with a mutual organizational affiliation. After adjusting for the breadth of the network, the researchers found no evidence of differences in the shared patient percentage across insurance market segments or different types of networks. One exception was among national networks compared to local and regional networks, where national plans indicated fewer shared patient ties, especially in the narrowest networks.
AHRQ-funded; HS025976.
Citation: Graves JA, Lee D, Leszinsky L .
Physician patient sharing relationships within insurance plan networks.
Health Serv Res 2023 Oct;58(5):1056-65. doi: 10.1111/1475-6773.14138..
Keywords: Health Insurance, Provider: Physician, Medicare
Hendrix N, Bazemore A, Holmgren AJ
AHRQ Author: Eden AR
Variation in family physicians' experiences across different electronic health record platforms: a descriptive study.
This AHRQ-authored study analyzed variation in reported usability and satisfaction of family physicians across different electronic health records (EHRs). Participants included 3358 ABFM-certified family physicians who use an EHR with at least 50 total responding physicians. These physicians were given an Internet-based survey between December 2021 and October 2022. The EHR systems analyzed included: Epic, athenahealth, Practice Fusion, Allscripts, Cerner, Greenway, and eClinical Works. The EHRs with the most satisfaction included athenahealth or Epic, while physicians using Allscripts, Cerner, or Greenway were the least likely to be very satisfied. There was a great variation in satisfaction due to EHR-specific factors: this overall influence explained 48% of variation in the probability of being very satisfied with Epic, 46% with eClinical Works, 14% with athenahealth, and 49% with Cerner.
AHRQ-authored.
Citation: Hendrix N, Bazemore A, Holmgren AJ .
Variation in family physicians' experiences across different electronic health record platforms: a descriptive study.
J Gen Intern Med 2023 Oct; 38(13):2980-87. doi: 10.1007/s11606-023-08169-5..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician
Nguyen CA, Beaulieu ND, Wright AA
Organization of cancer specialists in US physician practices and health systems.
This study’s objective was to describe the supply of cancer specialists, the organization of cancer care within versus outside of health systems, and the distance to multispecialty cancer centers. The authors used the 2018 Health Systems and Provider Database from the National Bureau of Economic Research and 2018 Medicare data to identify 46,341 unique physicians providing cancer care. They stratified physicians by discipline (adult/pediatric medical oncologists, radiation oncologists, surgical/gynecologic oncologists, other surgeons performing cancer surgeries, or palliative care physicians), system type (National Cancer Institute [NCI] Cancer Center system, non-NCI academic system, nonacademic system, or nonsystem/independent practice), practice size, and composition (single disciplinary oncology, multidisciplinary oncology, or multispecialty). They computed the density of cancer specialists by county and calculated distances to the nearest NCI Cancer Center. Results found that more than half of all cancer specialists (57.8%) practiced in health systems, but 55.0% of cancer-related visits occurred in independent practices. A majority of system-based physicians were in large practices with more than 100 physicians, while those in independent practices were in smaller practices. Breakdown by specialty type showed that practices in NCI Cancer Center systems (95.2%), non-NCI academic systems (95.0%), and nonacademic systems (94.3%) were primarily multispecialty, while fewer independent practices (44.8%) were. Many rural areas had sparse cancer specialty density, where the median travel distance to an NCI Cancer Center was 98.7 miles. Higher-income areas had shorter distances to NCI Cancer centers than low-income areas, even for individuals in suburban and rural areas.
AHRQ-funded; HS024072.
Citation: Nguyen CA, Beaulieu ND, Wright AA .
Organization of cancer specialists in US physician practices and health systems.
J Clin Oncol 2023 Sep 10; 41(26):4226-35. doi: 10.1200/jco.23.00626..
Keywords: Cancer, Provider: Physician, Workforce
Pillado EB, Li RD, Eng JS
Defining sources and ramifications of mistreatment among female vascular surgery trainees.
This study examined mistreatment that occurred during training of vascular surgeon trainees and categorizes and identifies the sources. This cross-sectional study was an anonymous survey administered after the 2021 Vascular Surgery In-Training Examination. The survey represented all 125 vascular surgery training programs with 510 trainees (66.9% male) participating in the survey (83.6% response rate). Mistreatment was reported by 54.8% of trainees, with twice as many women reporting as men (82.3% vs 41.0%). Women reported higher rates of being shouted at (44.1% vs 21.1%); repeatedly reminded of errors (24.3% vs 16.1%); ignored/treated hostilely (28.9% vs 10.5%); subjected to crude/sexually demeaning remarks, stories, or jokes (19.2% vs 2.1%); evaluated by different standards (29.3% vs 2.1%); and mistaken for a non-physician (75.2% vs 3.5%). Patients and their families were given as the most common source of sexual harassment (66.7%), gender discrimination (90.4%), and racial discrimination (74.4%). Compared with men, women more frequently felt unprepared to respond to the behavior in the moment (10.4% vs 4.6%), did not know how to report mistreatment at their institution (7.6% vs 3.2%), and did not believe that their institution would take their mistreatment report seriously (9.0% vs 3.9%).
AHRQ-funded; HS024516.
Citation: Pillado EB, Li RD, Eng JS .
Defining sources and ramifications of mistreatment among female vascular surgery trainees.
J Vasc Surg 2023 Sep; 78(3):797-804. doi: 10.1016/j.jvs.2023.03.504..
Keywords: Provider: Physician, Education: Continuing Medical Education
Zamudio J, Woodward J, Kanji FF
Demands of surgical teams in robotic-assisted surgery: an assessment of intraoperative workload within different surgical specialties.
Existing approaches to evaluating workload in robotic-assisted surgery (RAS) focus on surgeons and lack real-world data. The purpose of this study was to understand how workload differs by role and specialty aids to identify effective ways to optimize workload. The researchers administered SURG-TLX surveys to surgical staff at three sites. 188 questionnaires were obtained across 90 RAS procedures. Significantly higher aggregate scores were reported for gynecology and urology than for general. Surgeons reported significantly higher scores for task complexity than both technicians and nurses.
AHRQ-funded; HS026491.
Citation: Zamudio J, Woodward J, Kanji FF .
Demands of surgical teams in robotic-assisted surgery: an assessment of intraoperative workload within different surgical specialties.
Am J Surg 2023 Sep; 6(3):365-70. doi: 10.1016/j.amjsurg.2023.06.010..
Keywords: Surgery, Provider: Physician
Wurcel AG, Zubiago J, Reyes J
Surgeons' perspectives on valve surgery in people with drug use-associated infective endocarditis.
Hospitalizations for drug-use associated infective endocarditis (DUA-IE) have contributed to increasing surgical consultations for valve replacement. Little is known about cardiothoracic surgeons' perspectives on the decision-making process around operations for people with DUA-IE. The purpose of this semiqualitative, multisite study was to collect the perspectives of cardiothoracic surgeons on initial and repeat valve surgery for people with DUA-IE. The researchers conducted purposeful sampling of surgeons at 7 hospitals: University of Alabama, Boston Medical Center, Massachusetts General Hospital, University of North Carolina-Chapel Hill, Rhode Island Hospital-Brown University, Tufts Medical Center, and Vanderbilt University Medical Center. Nineteen cardiothoracic surgeons (53% acceptance) were interviewed. The study found that perceptions of the drivers of addiction varied as did the approaches to repeat valve operations. There were mixed perspectives on multidisciplinary meetings, although many surgeons indicated interest in more efficient meetings and more intensive postoperative and posthospitalization multidisciplinary care.
AHRQ-funded; HS026008.
Citation: Wurcel AG, Zubiago J, Reyes J .
Surgeons' perspectives on valve surgery in people with drug use-associated infective endocarditis.
Ann Thorac Surg 2023 Sep; 116(3):492-98. doi: 10.1016/j.athoracsur.2021.12.068..
Keywords: Surgery, Provider: Physician, Substance Abuse
Miller ME, Rahim MQ, Coven SL
Pediatric hematology and oncology physician and nurse practitioner views of the HPV vaccine and barriers to administration.
This study’s goal was to examine provider views regarding HPV vaccination for pediatric survivors of cancer and pediatric patients with sickle cell disease. The authors conducted qualitative interviews with 20 pediatric hematology/oncology physicians and nurse practitioners. They found that 90% of interviewees support HPV vaccination in their population. The number of providers who reported that they counsel about HPV or provide HPV vaccination was 45%, even in stem cell and sickle cell clinics, where other childhood vaccines are commonly provided. Clinicians identified provider-level, clinic-level, and system-level barriers to giving the HPV vaccination, that included but was not limited to time/flow constraints, lack of resources, and continued education regarding the HPV vaccine.
AHRQ-funded; HS026390.
Citation: Miller ME, Rahim MQ, Coven SL .
Pediatric hematology and oncology physician and nurse practitioner views of the HPV vaccine and barriers to administration.
Hum Vaccin Immunother 2023 Aug 1; 19(2):2224089. doi: 10.1080/21645515.2023.2224089..
Keywords: Vaccination, Sexual Health, Infectious Diseases, Prevention, Provider: Clinician, Provider: Physician
Slade EP, Wu RJ, Meiselbach MK
Psychiatrist and nonpsychiatrist physician network breadth in dual eligible special needs plans.
This study’s purpose was to compare the breadths of psychiatrist and nonpsychiatrist provider networks in Dual Eligible Special Needs Plans (D-SNPs) and other Medicare and Medicaid Advantage (MA) plans. D-SNP is a type of Medicare Advantage (MA) plan for individuals who have both Medicare and Medicaid coverage. The authors examined MA plan provider network data that was merged with plan service areas and a nationwide provider database to form a data set with 843 observations on networks subclassified by state and network type (D-SNP or other MA) covering 42 U.S. states and Washington, D.C. Mean psychiatrist network breadth was 0.319 in D-SNPs and 0.299 in other MA plans. Nonpsychiatrist network breadth was 0.346 in D-SNPs and 0.358 in other MA plans. Psychiatrist networks were narrower than nonpsychiatrist networks (0.303 vs. 0.355), but mean psychiatrist network breadth did not differ between D-SNPs and other MA plans. In regression analyses, the psychiatrist-nonpsychiatrist breadth difference was smaller in D-SNPs (-0.031) than in other MA plans (-0.060).
AHRQ-funded; HS000029.
Citation: Slade EP, Wu RJ, Meiselbach MK .
Psychiatrist and nonpsychiatrist physician network breadth in dual eligible special needs plans.
Psychiatr Serv 2023 Aug; 74(8):816-22. doi: 10.1176/appi.ps.20220239..
Keywords: Behavioral Health, Medicare, Provider: Physician
Rao G, Ufholz K, Saroufim P
Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care.
The objective of this study was to identify the incidence, rate of physician recognition, diagnostic practices, and cancer outcomes for unintentional weight loss. Researchers completed a secondary analysis of structured and unstructured EHR data collected from adult, established primary care patients with a minimum of two weight measurements in 2020 and in 2021. The results indicated that unintentional weight loss is poorly recognized across a diverse range of patients. The researchers concluded that lack of research-informed guidance may explain low rates of recognition and variability in diagnostic practices.
AHRQ-funded; HS029358.
Citation: Rao G, Ufholz K, Saroufim P .
Recognition, diagnostic practices, and cancer outcomes among patients with unintentional weight loss (UWL) in primary care.
Diagnosis 2023 Aug 1; 10(3):267-74. doi: 10.1515/dx-2023-0002..
Keywords: Cancer, Primary Care, Diagnostic Safety and Quality, Provider: Physician
Bamdad MC, Vitous CA, Rivard SJ
What we talk about when we talk about coping: a qualitative study of surgery resident's coping after complications and deaths.
The purpose of this study was to examine how surgery residents cope with negative patient outcomes including complications and death. There has been a dearth of scholarly work examining surgery resident coping strategies. The researchers included 28 mid-level and senior residents from 14 academic, community, and hybrid training programs across the United States to participate in interviews. The study found that residents described both internal and external strategies for how they cope with complications and deaths. Internal strategies included compartmentalization of emotions or experiences, thoughts of forgiveness, a sense of inevitability, and beliefs surrounding resilience. External strategies included support from colleagues and mentors, personal practices or rituals, such as exercise or psychotherapy, and commitment to change.
AHRQ-funded; HS000053; HS026772.
Citation: Bamdad MC, Vitous CA, Rivard SJ .
What we talk about when we talk about coping: a qualitative study of surgery resident's coping after complications and deaths.
Ann Surg 2023 Aug 1; 278(2):e422-e28. doi: 10.1097/sla.0000000000005854..
Keywords: Provider: Physician, Surgery, Mortality
Quinn M, Fowler KE, Harrod M
Exploring sacred moments in hospitalized patients: an exploratory qualitative study.
This explorative qualitative study discusses the phenomena known as “sacred moments”, defined as brief periods of time in which people experience a deep interconnectedness that may possess spiritual qualities and emotions in acute care hospital settings. This study included in-depth interviews with patients and healthcare workers at two academic medical centers in the Midwestern United States. Semi-structured telephone interviews were conducted between August 2020 and April 2021 with 30 hospital healthcare workers and discharged patients with a recent hospital stay. Interviews were recorded and transcribed. Findings were organized into three main domains including (1) several common elements described by participants as marking these moments; (2) benefits experienced by both patients and healthcare workers; and (3) suggestions for fostering sacred moments within the hospital setting.
AHRQ-funded; HS028963.
Citation: Quinn M, Fowler KE, Harrod M .
Exploring sacred moments in hospitalized patients: an exploratory qualitative study.
J Gen Intern Med 2023 Jul; 38(9):2038-44. doi: 10.1007/s11606-022-07999-z..
Keywords: Patient and Family Engagement, Provider: Physician, Provider: Health Personnel
Isbell LM, Chimowitz H, Huff NR
A qualitative study of emergency physicians' and nurses' experiences caring for patients with psychiatric conditions and/or substance use disorders.
This study’s aim was to develop a comprehensive data-driven model of the complex challenges and unique dynamics associated with caring for patients with psychiatric conditions and/or substance use disorders (SUDs) in the emergency department (ED), as well as the effect on patient care quality. The authors conducted a preplanned topical analysis of grounded theory data obtained from semistructured interviews with 86 ED physicians and nurses from 8 hospitals in the Northeastern USA. Participants described in detail their experiences and challenges in caring for patients with psychiatric conditions and/or SUDs. The authors identified themes inductively using constant comparative analysis and developed a grounded model of physicians' and nurses' perceptions of challenges, biases, and effects on patient care. Challenges identified were emotional, diagnostic, and logistical. These challenges magnified existing health care system issues and social structures, which fuel and reinforce negative attitudes, expectations, and biases. This creates a cyclical process whereby challenges and biases associated with patients with psychiatric conditions and/or SUDs can reciprocally threaten patient care quality.
AHRQ-funded; HS025752.
Citation: Isbell LM, Chimowitz H, Huff NR .
A qualitative study of emergency physicians' and nurses' experiences caring for patients with psychiatric conditions and/or substance use disorders.
Ann Emerg Med 2023 Jun; 81(6):715-27. doi: 10.1016/j.annemergmed.2022.10.014..
Keywords: Behavioral Health, Substance Abuse, Emergency Department, Provider: Nurse, Provider: Physician
Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW
Documentation dynamics: note composition, burden, and physician efficiency.
This study’s objective was to analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. This cross-sectional study examined EHR metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. The authors calculated physician-level averages for four measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. They found that physicians in the top decile of note length demonstrated greater burden and lower efficiency than physicians in the median decile level, spending 39% more time in the EHR after hours and closing 5.6 percentage points fewer visits on the same day. Copy/paste use demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day and spending more time in the EHR after hours and on days off. Templated text such as Epic’s SmartTools demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
AHRQ-funded; HS026116.
Citation: Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW .
Documentation dynamics: note composition, burden, and physician efficiency.
Health Serv Res 2023 Jun; 58(3):674-85. doi: 10.1111/1475-6773.14097..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Hu FY, Tabata-Kelly M, Johnston FM
Surgeon-reported factors influencing adoption of quality standards for goal-concordant care in patients with advanced cancer: a qualitative study.
This study’s objective was to explore surgical oncologists' perspectives on factors influencing adoption of quality standards in patients with advanced cancer. While the American College of Surgeons has adopted a Geriatric Surgery Verification Program that includes communication standards designed to facilitate goal-concordant care, little is known about how surgeons believe these standards align with clinical practice. The authors conducted semistructured video-based interviews from November 2020 to January 2021 with academic surgical oncologists purposively sampled based on demographics, region, palliative care certification, and years in practice. These interviews addressed: (1) adherence to standards documenting care preferences for life-sustaining treatment, surrogate decision-maker, and goals of surgery; and (2) factors influencing their adoption into practice. Participants included 26 surgeons (57.7% male, 8.5 mean years in practice, 19.2% palliative care board-certified). While goals of surgery are commonly discussed, there is low consistency of documenting these goals. There were conflicting views about the relevance of care preferences to preoperative conversations and surrogate decision-maker documentation by the surgeon and questioned the direct connection between documentation of quality standards and higher value patient care. Key themes in adopting quality standards of documentation included organizational culture, workflow, and multidisciplinary collaboration.
AHRQ-funded; HS024736.
Citation: Hu FY, Tabata-Kelly M, Johnston FM .
Surgeon-reported factors influencing adoption of quality standards for goal-concordant care in patients with advanced cancer: a qualitative study.
Ann Surg 2023 May; 277(5):e1000-e05. doi: 10.1097/sla.0000000000005441..
Keywords: Surgery, Provider: Physician, Cancer
Casalino LP, Jung HY, Bodenheimer T
The association of teamlets and teams with physician burnout and patient outcomes.
This cross-sectional observational study’s goal was to determine the prevalence and performance of primary care teamlets and teams. Survey participants included 688 general internists and family physicians. Physicians were assigned to one of four teamlet/team categories (e.g., teamlet/no team) and, in secondary analyses, to one of eight teamlet/team categories that classified teamlets into high, medium, and low collaboration as perceived by the physician (e.g., teamlet perceived-high collaboration/no team) based on their responses. The majority of physicians (77.4%) practiced in teamlets; 36.7% in teams. The four categories were divided as follows: 49.1% practiced in the teamlet/no team category; 28.3% in the teamlet/team category; 8.4% in no teamlet/team; 14.1% in no teamlet/no team. Results showed that 15.7%, 47.4%, and 14.4% of physicians practiced in perceived high-, medium-, and low-collaboration teamlets. Physicians who did not practice in a teamlet or team had significantly lower rate of burnout compared to the three teamlet/team categories. There were no significant differences in outcomes or Medicare spending by teamlet/team or teamlet perceived-collaboration/team categories compared to no teamlet/no team, for Medicare beneficiaries in general, or for dual-eligible beneficiaries.
AHRQ-funded; HS025716.
Citation: Casalino LP, Jung HY, Bodenheimer T .
The association of teamlets and teams with physician burnout and patient outcomes.
J Gen Intern Med 2023 May; 38(6):1384-92. doi: 10.1007/s11606-022-07894-7..
Keywords: Teams, Burnout, Primary Care, Provider: Physician
Barger LK, Weaver MD, Sullivan JP
Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study.
The purpose of this study was to determine if long weekly work hours and shifts of extended duration are associated with adverse patient and physician safety outcomes. The criteria included work hours and shifts (≥24 hours) and for senior resident physicians (postgraduate year 2 and above; PGY2+). This study was conducted in the U.S. and spanned eight academic years. The analysis concluded that working 48 hours per week or longer, and extended shifts endanger even experienced (ie, PGY2+) resident physicians and their patients. It recommends lowering weekly work hour limits, as the European Union has done, and eliminating shifts of extended duration to protect the more than 150 000 physicians training in the US and their patients.
AHRQ-funded; HS012032.
Citation: Barger LK, Weaver MD, Sullivan JP .
Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study.
BMJ Med 2023; 2(1):e000320. doi: 10.1136/bmjmed-2022-000320..
Keywords: Provider: Physician, Burnout, Patient Safety
Bamdad MC, Vitous CA, Rivard SJ
"You remember those days"-a qualitative study of resident surgeon responses to complications and deaths.
This qualitative study examined the impact of complications and deaths on surgery residents to facilitate development of improved support systems. Twenty-eight mid-level and senior residents (PGY3 and above) from 14 different training programs across the US were given semi-structured interviews. The interviewees described an initial emotional response of sadness, frustration, or grief. Simultaneously or soon after went through an examination period where they looked at how and why the outcome occurred with the goal of learning from it. The last phase was having a feeling of ownership, which was strengthened by involved in patient care and length of rotation.
AHRQ-funded; HS026772.
Citation: Bamdad MC, Vitous CA, Rivard SJ .
"You remember those days"-a qualitative study of resident surgeon responses to complications and deaths.
J Surg Educ 2022 Mar-Apr; 79(2):452-62. doi: 10.1016/j.jsurg.2021.09.011..
Keywords: Surgery, Provider: Physician, Adverse Events, Mortality
Jetty A, Jabbarpour Y, Eden AR
AHRQ Author: Eden AR
Female family physicians are more racially diverse than their male counterparts in federal sites.
The objective of this study was to compare the racial/ethnic composition of Federal family physicians to the entire cohort of family physicians in the US and to stratify by gender. Results showed that female family physicians who served at Federal sites were more racially/ethnically diverse than the overall population of female family physicians as well as their male Federal counterparts. The researchers concluded that this gendered trend among Federal physicians should be explored further.
AHRQ-authored.
Citation: Jetty A, Jabbarpour Y, Eden AR .
Female family physicians are more racially diverse than their male counterparts in federal sites.
J Am Board Fam Med 2023 Feb 8; 36(1):188-89. doi: 10.3122/jabfm.2022.220178R1..
Keywords: Provider: Physician, Racial and Ethnic Minorities
Zhou RA, McIntosh N, Rajan R
Association between use of clinician performance information and patient experience.
The objective of this study was to examine the association between the collection and use of clinician performance information in physician practices and patient experience in primary care. Researchers conducted observational multivariant generalized linear regression at the patient level. Patient experience scores were calculated from the 2018-2019 Massachusetts Statewide Survey of Adult Patient Experience of Primary Care. The findings showed that nearly ninety percent of practices in the sample collected or used clinician performance information, which was associated with better primary care patient experience among physician practices. The authors concluded that efforts to use clinician performance information in ways that cultivate clinicians' intrinsic motivation may be especially effective for quality improvement.
AHRQ-funded; HS024075; HS024074.
Citation: Zhou RA, McIntosh N, Rajan R .
Association between use of clinician performance information and patient experience.
Am J Manag Care 2023 Feb;29(2):e51-e57. doi: 10.37765/ajmc.2023.89321.
Keywords: Provider Performance, Patient Experience, Provider: Physician
Apathy NC, Hare AJ, Fendrich S
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
The authors analyzed observed reductions in physicians’ note length and documentation time, both of which contribute to EHR burden and burnout. Their study used EHR metadata for ambulatory physician Epic users and examined changes in note composition of physicians who decreased note length and/or documentation time. Their findings showed that note length decreases were primarily attributable to reductions in copy/paste text and templated text, while note time decreases were primarily attributable to reductions in manual text. They concluded that future research should explore scalable burden-reduction initiatives that are responsive to both note bloat and documentation time.
AHRQ-funded; HS026116.
Citation: Apathy NC, Hare AJ, Fendrich S .
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
J Am Med Inform Assoc 2023 Jan18; 30(2):355-60. doi: 10.1093/jamia/ocac211..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Edwards ST, Marino M, Balasubramanian BA
Burnout among physicians, advanced practice clinicians and staff in smaller primary care practices.
The purpose of this study was to examine the association between physician-, advanced practice clinician- and staff-reported burnout and specific structural, organizational, and contextual characteristics of smaller primary care practices. Results showed that burnout is prevalent among physicians, advanced practice clinicians, and staff in smaller primary care practices. Members of solo practices less commonly report burnout, while members of health system-owned practices and Federally Qualified Health Centers more commonly report burnout, suggesting that practice level autonomy may be a critical determinant.
AHRQ-funded; HS023940.
Citation: Edwards ST, Marino M, Balasubramanian BA .
Burnout among physicians, advanced practice clinicians and staff in smaller primary care practices.
J Gen Intern Med 2018 Dec;33(12):2138-46. doi: 10.1007/s11606-018-4679-0..
Keywords: Burnout, Primary Care, Provider: Physician, Provider: Clinician, Provider
Sheetz KH, Ibrahim AM, Regenbogen SE
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
This population-based study examined whether surgeon experience with laparoscopy influenced payments for laparoscopy versus open surgery colectomies. The study used 182,852 national Medicare beneficiaries undergoing colectomies between 2010 and 2012. Surgeons with the most laparoscopic experience did experience an average payment savings of $5456 per patient in laparoscopic versus open cases. For surgeons in the lowest quartile of experience there was no difference.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Ibrahim AM, Regenbogen SE .
Surgeon experience and Medicare expenditures for laparoscopic compared to open colectomy.
Ann Surg 2018 Dec;268(6):1036-42. doi: 10.1097/sla.0000000000002312..
Keywords: Elderly, Surgery, Medicare, Healthcare Costs, Provider: Physician
Horwood CR, Moffatt-Bruce SD, Fitzgerald M
A qualitative analysis of clinical decompensation in the surgical patient: perceptions of nurses and physicians.
This study is a quantitative analysis of nurse and physician perception of clinical decompensation in postsurgical patients. The study aims to assess how nurses and physicians perceive early warning signs that predict clinical decompensation, changes in clinical acuity, and the need for escalation of care. Many areas showed strong agreement, but there were differences between nurses and physicians in primary indicators of patient stability. There were also differences in the methods and frequency used to monitor medically unstable patients.
AHRQ-funded; HS024379.
Citation: Horwood CR, Moffatt-Bruce SD, Fitzgerald M .
A qualitative analysis of clinical decompensation in the surgical patient: perceptions of nurses and physicians.
Surgery 2018 Dec;164(6):1311-15. doi: 10.1016/j.surg.2018.06.006..
Keywords: Adverse Events, Health Status, Provider: Clinician, Provider: Nurse, Provider: Physician, Surgery
Lybarger KJ, Ostendorf M, Riskin E
Asynchronous speech recognition affects physician editing of notes.
Clinician progress notes are an important record for care and communication, but there is a perception that electronic notes take too long to write and may not accurately reflect the patient encounter, threatening quality of care. Automatic speech recognition (ASR) has the potential to improve clinical documentation process; however, ASR inaccuracy and editing time are barriers to wider use. In this study, the investigators hypothesized that automatic text processing technologies could decrease editing time and improve note quality.
AHRQ-funded; HS023631.
Citation: Lybarger KJ, Ostendorf M, Riskin E .
Asynchronous speech recognition affects physician editing of notes.
Appl Clin Inform 2018 Oct;9(4):782-90. doi: 10.1055/s-0038-1673417..
Keywords: Provider: Physician, Provider, Electronic Health Records (EHRs), Health Information Technology (HIT)