National Healthcare Quality and Disparities Report
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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 94 Research Studies DisplayedDe Oliveira GS, Errea M, Bialek J
The impact of health literacy on shared decision making before elective surgery: a propensity matched case control analysis.
The primary aim of this study was to evaluate a possible association between health literacy and decision conflict in surgical patients. Patients undergoing a diverse number of elective surgeries were enrolled in the study. Health literacy was measured using the Newest Vital Sign instrument and decision conflict using the low literacy version of the Decision Conflict Scale. The investigators found that poor health literacy is associated with greater decision conflict in patients undergoing elective surgical procedures.
AHRQ-funded; HS024158.
Citation: De Oliveira GS, Errea M, Bialek J .
The impact of health literacy on shared decision making before elective surgery: a propensity matched case control analysis.
BMC Health Serv Res 2018 Dec 12;18(1):958. doi: 10.1186/s12913-018-3755-9..
Keywords: Decision Making, Education: Patient and Caregiver, Health Literacy, Surgery
Yang Y, Bass EJ, Sockolow PS
Knowledge elicitation of homecare admission decision making processes via focus group, member checking and data visualization.
Researchers elicit knowledge related to expert decision-making processes to inform information technology design and related interventions. In this study, the investigators examine knowledge elicitation of homecare admission decision making processes via focus group, member checking and data visualization. The investigators concluded that the data collection and validation methodology showed promise for knowledge elicitation in time-constrained situations.
AHRQ-funded; HS024537.
Citation: Yang Y, Bass EJ, Sockolow PS .
Knowledge elicitation of homecare admission decision making processes via focus group, member checking and data visualization.
AMIA Annu Symp Proc 2018 Dec 5;2018:1127-36..
Keywords: Home Healthcare, Decision Making, Health Information Technology (HIT), Data
Li SA, Alexander PE, Reljic T
Evidence to decision framework provides a structured "roadmap" for making GRADE guidelines recommendations.
It is unclear how guidelines panelists discuss and consider factors (criteria) that are formally and not formally included in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. To describe the use of decision criteria, the investigators explored how panelists adhered to GRADE criteria and sought to identify any emerging non-GRADE criteria when the panelists used the Evidence to Decision (EtD) framework as part of GRADE application.
AHRQ-funded; HS024917.
Citation: Li SA, Alexander PE, Reljic T .
Evidence to decision framework provides a structured "roadmap" for making GRADE guidelines recommendations.
J Clin Epidemiol 2018 Dec;104:103-12. doi: 10.1016/j.jclinepi.2018.09.007..
Keywords: Evidence-Based Practice, Guidelines, Decision Making
Breathett K, Jones J, Lum HD
Factors related to physician clinical decision-making for African-American and Hispanic patients: a qualitative meta-synthesis.
The purpose of this study was to synthesize qualitative studies that explore various aspects of how patients’ African-American race or Hispanic ethnicity may factor into physician clinical decision-making. Researchers derived six fundamental themes that detail the role of patient race and ethnicity on physician decision-making. They found that a non-hierarchical system of intertwining themes influenced clinical decision-making among racial and ethnic minority patients and recommended paths for future study.
AHRQ-funded; HS024569.
Citation: Breathett K, Jones J, Lum HD .
Factors related to physician clinical decision-making for African-American and Hispanic patients: a qualitative meta-synthesis.
J Racial Ethn Health Disparities 2018 Dec;5(6):1215-29. doi: 10.1007/s40615-018-0468-z..
Keywords: Racial and Ethnic Minorities, Decision Making, Disparities
Morrow AS, Whiteside SP, Sim LA
Developing tools to enhance the use of systematic reviews for clinical care in health systems.
The researchers’ goal was to develop tools to facilitate the uptake of evidence as summarized in systematic reviews by clinical decisionmakers in health systems. After they conducted a systematic review on the management of anxiety in children, the researchers interviewed health system representatives, clinicians and patients to gain additional information about decisionmaking. Two decision-aid tools - one for the health system and the other for the clinical encounter - were then developed using stakeholders' feedback and literature searches. The health system decision aid provided information on patients who were candidates for treatment, values and preferences, costs and resources, acceptability, impact on health equity, feasibility, drug dosing, alternative therapies, remission rates, and prognosis. The encounter decision aid was produced as a set of cards that contained information on the issues that drive treatment decisions. Health system stakeholders found the first decision aid useful, and patients, parents, and clinicians found the second to be helpful.
AHRQ-funded; 290201500013I; 29032001T.
Citation: Morrow AS, Whiteside SP, Sim LA .
Developing tools to enhance the use of systematic reviews for clinical care in health systems.
BMJ Evid Based Med 2018 Dec;23(6):206-09. doi: 10.1136/bmjebm-2018-110995..
Keywords: Children/Adolescents, Decision Making, Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
Medford-Davis LN, Singh H, Mahajan P
Diagnostic decision-making in the emergency department.
Emergency providers must often diagnose from undifferentiated symptoms, without previous knowledge of the patient. Failure to provide an accurate assessment of the problem or to communicate the problem to the patient is diagnostic error. This article considers methods to monitor diagnostic error in emergency departments.
AHRQ-funded; HS024953.
Citation: Medford-Davis LN, Singh H, Mahajan P .
Diagnostic decision-making in the emergency department.
Pediatr Clin North Am 2018 Dec;65(6):1097-105. doi: 10.1016/j.pcl.2018.07.003..
Keywords: Emergency Department, Diagnostic Safety and Quality, Decision Making, Medical Errors, Patient Safety
Fisher KA, Tan ASL, Matlock DD
Keeping the patient in the center: common challenges in the practice of shared decision making.
This study examines the practice of shared-decision making (SDM) to achieve patient-centered decisions. It was determined that not all circumstances make it possible for that to happen and there have to be some basic elements present. Those elements include the patients’ health literacy, their emotional state, their relationship with the clinician and the nature of the decision.
AHRQ-funded; HS024596.
Citation: Fisher KA, Tan ASL, Matlock DD .
Keeping the patient in the center: common challenges in the practice of shared decision making.
Patient Educ Couns 2018 Dec;101(12):2195-201. doi: 10.1016/j.pec.2018.08.007..
Keywords: Clinician-Patient Communication, Decision Making, Health Literacy, Patient-Centered Healthcare, Patient and Family Engagement
Neal JL, Lowe NK, Phillippi JC
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
The goals of this study were: Determine the proportions of women admitted to the hospital before or in active labor per the leading National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) guidelines; Compare associations of labor status at admission with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. Active labor diagnostic guidelines were applied retrospectively to cervical examination data. The authors conclude that many parous women with spontaneous labor onset are admitted to the hospital before active labor, and these women are more likely to receive oxytocin augmentation during labor and to have a cesarean birth. Implications for practice are discussed.
AHRQ-funded; HS024733.
Citation: Neal JL, Lowe NK, Phillippi JC .
Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines.
Midwifery 2018 Dec;67:64-69. doi: 10.1016/j.midw.2018.09.007..
Keywords: Decision Making, Guidelines, Hospitalization, Labor and Delivery, Pregnancy, Women
Kim K, Heinze K, Xu J
Theories of health care decision making at the end of life: a meta-ethnography.
The aim of this meta-ethnography was to appraise the types and uses of theories relative to end-of-life decision making and to develop a conceptual framework to describe end-of-life decisionmaking among patients with advanced cancers, heart failure, and amyotrophic lateral sclerosis (ALS), and their caregivers or providers. A conceptual framework was developed using themes including context of decision making, communication and negotiation of decisionmaking, characteristics of decision makers, goals of decision making, options and alternatives, and outcomes.
AHRQ-funded; HS022140.
Citation: Kim K, Heinze K, Xu J .
Theories of health care decision making at the end of life: a meta-ethnography.
West J Nurs Res 2018 Dec;40(12):1861-84. doi: 10.1177/0193945917723010..
Keywords: Caregiving, Communication, Decision Making, Palliative Care
Quintana Y, Crotty B, Fahy D
Information sharing across generations and environments (InfoSAGE): study design and methodology protocol.
This open prospective cohort study aimed to assess a novel, Internet based, family-centric communication and collaboration platform created to address the information needs of elders and their informal caregivers in a community setting. It used a mixed methods approach, utilizing qualitative survey data along with website usage analytic data.
AHRQ-funded; HS021495.
Citation: Quintana Y, Crotty B, Fahy D .
Information sharing across generations and environments (InfoSAGE): study design and methodology protocol.
BMC Med Inform Decis Mak 2018 Nov 20;18(1):105. doi: 10.1186/s12911-018-0697-4.
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BMC Med Inform Decis Mak 2018 Nov 20;18(1):105. doi: 10.1186/s12911-018-0697-4.
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Keywords: Caregiving, Communication, Decision Making, Elderly, Health Information Technology (HIT), Patient-Centered Healthcare, Clinician-Patient Communication, Web-Based
Gianfrancesco MA, Tamang S, Yazdany J
Potential biases in machine learning algorithms using electronic health record data.
This Special Communication outlines the potential biases that may be introduced into machine learning-based clinical decision support tools that use electronic health record data and proposes potential solutions to the problems of overreliance on automation, algorithms based on biased data, and algorithms that do not provide information that is clinically meaningful.
AHRQ-funded; HS024412.
Citation: Gianfrancesco MA, Tamang S, Yazdany J .
Potential biases in machine learning algorithms using electronic health record data.
JAMA Intern Med 2018 Nov;178(11):1544-47. doi: 10.1001/jamainternmed.2018.3763..
Keywords: Electronic Health Records (EHRs), Clinical Decision Support (CDS), Health Information Technology (HIT), Decision Making
Leeds IL, Rosenblum AJ, Wise PE
Eye of the beholder: risk calculators and barriers to adoption in surgical trainees.
This study examined barriers to surgical trainees in using risk calculator tools before surgery. A total of 124 surgical residents responded to a survey and most still favored more traditional methods for risk calculation including direct verbal communication, sketch diagrams, and brochures. Only about half or less were familiar with more contemporary tools such as best-worst case scenario framing, case-specific risk calculators, and all-procedure calculators.
AHRQ-funded; HS024736.
Citation: Leeds IL, Rosenblum AJ, Wise PE .
Eye of the beholder: risk calculators and barriers to adoption in surgical trainees.
Surgery 2018 Nov;164(5):1117-23. doi: 10.1016/j.surg.2018.07.002..
Keywords: Clinical Decision Support (CDS), Decision Making, Education: Continuing Medical Education, Risk, Surgery
Cornelius T, Moise N, Birk JL
The presence of companions during emergency department evaluation and its impact on perceptions of clinician-patient communication.
Investigators studies whether having a companion present during an emergency department visit improves clinician-patient communication. An observation cohort of patients with suspected acute coronary syndrome were recruited at an academic medical center from 2013-2016. There was no observational difference except when the patient had a high school education or less.
AHRQ-funded; HS025198.
Citation: Cornelius T, Moise N, Birk JL .
The presence of companions during emergency department evaluation and its impact on perceptions of clinician-patient communication.
Emerg Med J 2018 Nov;35(11):701-03. doi: 10.1136/emermed-2018-207735..
Keywords: Clinician-Patient Communication, Decision Making, Emergency Department, Patient and Family Engagement
Militello LG, Anders S, Downs SM
Understanding how primary care clinicians make sense of chronic pain.
This research explored how primary care clinicians manage their patients with chronic noncancer pain. They conducted Critical Decision Method interviews with 10 clinicians about 30 individual patients. Findings suggested that clinicians should focus on supporting sensemaking in the content of clinical evidence rather than trying to provide them with rules.
AHRQ-funded; HS023306.
Citation: Militello LG, Anders S, Downs SM .
Understanding how primary care clinicians make sense of chronic pain.
Cogn Technol Work 2018 Nov;20(4):575-84. doi: 10.1007/s10111-018-0491-1..
Keywords: Pain, Chronic Conditions, Opioids, Medication, Decision Making, Primary Care, Care Management
Scherer AM, Witteman HO, Solomon J
Improving the understanding of test results by substituting (not adding) goal ranges: web-based between-subjects experiment.
Most displays of laboratory test results include a standard reference range. For some patients (eg, those with chronic conditions), however, getting a result within the standard range may be unachievable, inappropriate, or even harmful. The purpose of this study was to test the impact of including clinically appropriate goal ranges outside the standard range in the visual displays of laboratory test results.
AHRQ-funded; HS021681.
Citation: Scherer AM, Witteman HO, Solomon J .
Improving the understanding of test results by substituting (not adding) goal ranges: web-based between-subjects experiment.
J Med Internet Res 2018 Oct 19;20(10):e11027. doi: 10.2196/11027..
Keywords: Decision Making, Education: Patient and Caregiver
Peltier WL, Gani F, Blissitt J
Initial experience with "Honoring Choices Wisconsin": implementation of an advance care planning pilot in a tertiary care setting.
The purpose of this study was to evaluate the impact of a pilot program using the "Honoring Choices Wisconsin" (HCW) model for advance care planning (ACP) in a tertiary care setting, and to understand barriers to system-wide implementation. The study concluded that implementation of a facilitator-based ACP care model was associated with fewer ICU admissions, and a higher use of hospice care.
AHRQ-funded; HS024736.
Citation: Peltier WL, Gani F, Blissitt J .
Initial experience with "Honoring Choices Wisconsin": implementation of an advance care planning pilot in a tertiary care setting.
J Palliat Med 2017 Sep;20(9):998-1003. doi: 10.1089/jpm.2016.0530..
Keywords: Decision Making
Harris VC, Links AR, Walsh J
A systematic review of race/ethnicity and parental treatment decision-making.
Researchers examined patient race/ethnicity as it affects health care utilization, provider trust, and treatment choice in pediatric care. Pooled results from their systematic review showed (1) racial/ethnic minorities tended to prefer more aggressive end-of-life care; (2) familial tradition of neonatal circumcision influenced the decision to circumcise; and (3) non-Hispanic Whites were less likely to pursue human papillomavirus vaccination but more likely to complete the vaccine series if initiated. They recommended further investigation.
AHRQ-funded; HS022932.
Citation: Harris VC, Links AR, Walsh J .
A systematic review of race/ethnicity and parental treatment decision-making.
Clin Pediatr 2018 Oct;57(12):1453-64. doi: 10.1177/0009922818788307..
Keywords: Children/Adolescents, Decision Making, Caregiving, Racial and Ethnic Minorities, Healthcare Utilization
Admon AJ, Gupta A, Williams M
Appraising the evidence supporting Choosing Wisely(R) recommendations.
This study’s objective was to appraise the evidence supporting the Choosing Wisely® campaign initiated by the American Board of Internal Medicine (ABIM) Foundation to advance dialogue on prevention of unnecessary medical tests, treatments, and procedures. The authors extracted all 320 recommendations that were published through August 2014. The recommendations were then categorized by evidence strength and then a sample of referenced clinical practice guidelines (CPGs) using the validated Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Overall, 70.3% of recommendations cited CPGs, whereas 22.2% cited primary research as their highest evidence level. Hospital medicine recommendations cited CPGs 90% of the time. However, the median overall score using AGREE II was 54.2% and even for hospital medicine-referenced CPGs was 58.3%.
AHRQ-funded; HS020672.
Citation: Admon AJ, Gupta A, Williams M .
Appraising the evidence supporting Choosing Wisely(R) recommendations.
J Hosp Med 2018 Oct;13(10):688-91. doi: 10.12788/jhm.2964..
Keywords: Decision Making, Evidence-Based Practice, Guidelines, Prevention, Quality of Care, Quality Improvement
Murray DJ, Boyle WA, Beyatte MB
Decision-making skills improve with critical care training: using simulation to measure progress.
Health care professionals are expected to acquire decision-making skills during their training, but few methods are available to assess progress in acquiring these essential skills. The purpose of this study was to determine whether a simulation methodology could be used to assess whether decision-making skills improve during critical care training. The investigators indicate that their findings provide evidence to support the validity of a simulation-based method to assess progress in decision-making skills.
AHRQ-funded; HS022265.
Citation: Murray DJ, Boyle WA, Beyatte MB .
Decision-making skills improve with critical care training: using simulation to measure progress.
J Crit Care 2018 Oct;47:133-38. doi: 10.1016/j.jcrc.2018.06.021..
Keywords: Critical Care, Education: Continuing Medical Education, Decision Making, Simulation, Teams, Training
Panattoni L, Chan A, Yang Y
Nudging physicians and patients with autopend clinical decision support to improve diabetes management.
This study’s objective was to determine the impact on routine glycalated hemoglobin (A1C) laboratory test completion of incorporating an autopend laboratory order functionality into clinical decision support. The clinical decision support includes 1) routing provider alerts to a separate electronic folder, 2) automatically populating preauthorization forms, and 3) linking the timing and content of electronic patient health maintenance topic (HMT) reminders to the provider authorization. The likelihood of A1C laboratory test completion increased after autopend by between 21% to 33.9%.
AHRQ-funded; HS019167.
Citation: Panattoni L, Chan A, Yang Y .
Nudging physicians and patients with autopend clinical decision support to improve diabetes management.
Am J Manag Care 2018 Oct;24(10):479-83..
Keywords: Clinical Decision Support (CDS), Decision Making, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT)
Schoenfeld EM, Kanzaria HK, Quigley DD
Patient preferences regarding shared decision making in the emergency department: findings from a multisite survey.
In this study, the investigators sought to determine patients' desired level of involvement in medical decisions and their perceptions of potential barriers and facilitators to shared decision making in the emergency department (ED). They found that the majority of ED patients wanted to be involved in medical decisions, especially in the case of a "serious" medical problem, and felt that they had the ability to do so. Nevertheless, many patients were unlikely to actively seek involvement and defaulted to allowing the physician to make decisions during the ED visit.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Kanzaria HK, Quigley DD .
Patient preferences regarding shared decision making in the emergency department: findings from a multisite survey.
Acad Emerg Med 2018 Oct;25(10):1118-28. doi: 10.1111/acem.13499..
Keywords: Clinician-Patient Communication, Decision Making, Emergency Department, Patient and Family Engagement, Patient Experience
Jolles MP, Lee PJ, Javier JR
Shared decision-making and parental experiences with health services to meet their child's special health care needs: racial and ethnic disparities.
This study investigated the relationship between shared decision-making (SDM) and parents’ frustrations in getting health needs met for their special needs child. Secondary analysis was done on data from the 2009-2010 National Survey of Children with Special Health Care Needs. More Whites than Blacks engaged in SDM, and when Blacks did engage they had a higher odds of negative experiences than Whites. Researchers weren’t sure what the cause was of that, but speculated it was due to increased awareness of service challenges.
AHRQ-funded; HS000032.
Citation: Jolles MP, Lee PJ, Javier JR .
Shared decision-making and parental experiences with health services to meet their child's special health care needs: racial and ethnic disparities.
Patient Educ Couns 2018 Oct;101(10):1753-60. doi: 10.1016/j.pec.2018.05.022..
Keywords: Access to Care, Caregiving, Children/Adolescents, Decision Making, Disabilities, Disparities, Racial and Ethnic Minorities
Bordley J, Sakata KK, Bierman J
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
The electronic health record is a primary source of information for all professional groups participating in ICU rounds. However, it is unclear how team dynamics impacts identification and verbalization of viewed data. Therefore, the investigators created an ICU rounding simulation to assess how the interprofessional team recognized and reported data and its impact on decision-making.
AHRQ-funded; HS023793.
Citation: Bordley J, Sakata KK, Bierman J .
Use of a novel, electronic health record-centered, interprofessional ICU rounding simulation to understand latent safety issues.
Crit Care Med 2018 Oct;46(10):1570-76. doi: 10.1097/ccm.0000000000003302..
Keywords: Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Teams
Hall SF, Wright NC, Wolinsky FD
The prevalence of overtreatment of osteoporosis: results from the PAADRN trial.
There is a robust body of literature addressing undertreatment in osteoporosis, but limited data addressing overtreatment. In this study, the investigators sought to understand overtreatment as this understanding is important to minimizing harm and decrease costs. The investigators found that in their sample of older adults, overuse of osteoporosis pharmacotherapy was only 8.1%. Nevertheless, they concluded, overtreatment exposed patients to possible risk with negligible chance of benefit and should be minimized.
AHRQ-funded; HS023009.
Citation: Hall SF, Wright NC, Wolinsky FD .
The prevalence of overtreatment of osteoporosis: results from the PAADRN trial.
Arch Osteoporos 2018 Sep 28;13(1):103. doi: 10.1007/s11657-018-0517-6..
Keywords: Osteoporosis, Decision Making, Medication, Elderly, Patient-Centered Healthcare, Patient and Family Engagement, Care Management
D'Agata EMC, Tran D, Bautista J
Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities: a decision analytic model.
In this study, the authors developed a decision analytic model of antimicrobial use on the clinical and economic consequences of implementing a nationwide antimicrobial stewardship program in outpatient dialysis facilities. The authors found that the model suggested that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and C. difficile, infection-related deaths, and costs.
AHRQ-funded; R18 HS021666.
Citation: D'Agata EMC, Tran D, Bautista J .
Clinical and economic benefits of antimicrobial stewardship programs in hemodialysis facilities: a decision analytic model.
Clin J Am Soc Nephrol 2018 Sep 7;13(9):1389-97. doi: 10.2215/cjn.12521117..
Keywords: Antimicrobial Stewardship, Decision Making, Antibiotics, Medication, Healthcare Costs, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs)