National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (2)
- Behavioral Health (3)
- Burnout (1)
- Cancer (2)
- Cancer: Colorectal Cancer (2)
- Care Coordination (1)
- Caregiving (1)
- Care Management (1)
- Children/Adolescents (4)
- Chronic Conditions (4)
- Clinician-Patient Communication (2)
- Colonoscopy (1)
- Communication (2)
- Decision Making (1)
- Depression (1)
- Diagnostic Safety and Quality (1)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
- Healthcare Costs (1)
- Healthcare Delivery (5)
- Health Information Technology (HIT) (2)
- Health Services Research (HSR) (1)
- Hospital Readmissions (1)
- Hospitals (1)
- Human Immunodeficiency Virus (HIV) (1)
- Implementation (1)
- Medicare (1)
- Medication (2)
- Obesity (1)
- Obesity: Weight Management (1)
- Opioids (2)
- Pain (2)
- Patient-Centered Healthcare (10)
- Patient-Centered Outcomes Research (2)
- Practice Patterns (1)
- Prevention (1)
- Primary Care (17)
- (-) Primary Care: Models of Care (18)
- Provider (2)
- Provider: Clinician (1)
- Quality Improvement (4)
- Quality Indicators (QIs) (1)
- Quality of Care (4)
- Racial and Ethnic Minorities (3)
- Research Methodologies (1)
- Screening (3)
- Stress (1)
- Teams (4)
- Tobacco Use (1)
- Tobacco Use: Smoking Cessation (1)
- Transitions of Care (1)
- Vulnerable Populations (2)
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 18 of 18 Research Studies DisplayedSaluja S, Hochman M, Bourgoin A
Primary care: the new frontier for reducing readmissions.
To date, efforts to reduce hospital readmissions have centered largely on hospitals. In a recently published environmental scan, the investigators examined the literature focusing on primary care-based efforts to reduce readmissions. They found that multi-component care transitions programs that are initiated early in the hospitalization and are part of broader primary care practice transformation appear most promising.
AHRQ-funded; 233201500019I.
Citation: Saluja S, Hochman M, Bourgoin A .
Primary care: the new frontier for reducing readmissions.
J Gen Intern Med 2019 Dec;34(12):2894-97. doi: 10.1007/s11606-019-05428-2.
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Keywords: Primary Care, Hospital Readmissions, Hospitals, Transitions of Care, Primary Care: Models of Care, Healthcare Delivery
Schuttner L, Wong ES, Rosland AM
Association of the patient-centered medical home implementation with chronic disease quality in patients with multimorbidity.
The purpose of this retrospective cohort study was to examine the association of Patient-Aligned Care Team (PACT) implementation, the Veterans Health Administration (VA) PCMH model, and care quality for multimorbid patients enrolled in VA primary care from 2012 to 2014. The investigators found that for one-third of metrics (5/15), greater implementation of PACT in 2012 was associated with higher predicted probability of meeting the quality metric in 2013-2014. This association persisted for only two metrics among patients with > 5 chronic diseases.
AHRQ-funded; HS026369.
Citation: Schuttner L, Wong ES, Rosland AM .
Association of the patient-centered medical home implementation with chronic disease quality in patients with multimorbidity.
J Gen Intern Med 2020 Oct;35(10):2932-38. doi: 10.1007/s11606-020-06076-7..
Keywords: Patient-Centered Healthcare, Implementation, Chronic Conditions, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care
Chan B, Hulen E, Edwards S
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
AHRQ-funded; HS022981.
Citation: Chan B, Hulen E, Edwards S .
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
Ann Fam Med 2019 Nov;17(6):495-501. doi: 10.1370/afm.2464..
Keywords: Primary Care, Primary Care: Models of Care, Ambulatory Care and Surgery, Vulnerable Populations, Patient-Centered Healthcare, Healthcare Delivery
Kuo YF, Raji MA, Lin YL
Use of Medicare data to identify team-based primary care: is it possible?
This study’s goal was to determine if Medicare data can be used to identify type and degree of collaboration between primary care providers (PCPs), nurse practitioners, and physician assistants in a team care model. Researchers surveyed 63 primary care practices in Texas and linked the survey results to 2015 100% Medicare data. They measured sensitivity, specificity and positive predictive value (PPV) of dyad teams in Medicare data. They found a higher PPV between MD-nurse practitioner/physician assistant pairs than for MD-MD pairs. There was low sensitivity over all (27.8%), but specificity was 91.7% and PPV 72.2%.
AHRQ-funded; HS020642.
Citation: Kuo YF, Raji MA, Lin YL .
Use of Medicare data to identify team-based primary care: is it possible?
Med Care 2019 Nov;57(11):905-12. doi: 10.1097/mlr.0000000000001201..
Keywords: Medicare, Primary Care, Teams, Primary Care: Models of Care, Healthcare Delivery
Kim LY, Giannitrapani KF, Huynh AK
What makes team communication effective: a qualitative analysis of interprofessional primary care team members' perspectives.
This paper describes the elements of effective communication as perceived by members of interprofessional patient-centered medical home primary care teams and identified elements of effective communication that have persisted over time. Nine elements of effective communication emerged: shared knowledge, situation/goal awareness, problem-solving, mutual respect, transparency, timeliness, frequency, consistency, and parsimony. Recommendations included comprehensive quality improvement efforts incorporating a variety of strategies to facilitate communication of pertinent patient information in a brief and concise manner.
AHRQ-funded; HS000046.
Citation: Kim LY, Giannitrapani KF, Huynh AK .
What makes team communication effective: a qualitative analysis of interprofessional primary care team members' perspectives.
J Interprof Care 2019 Nov-Dec;33(6):836-38. doi: 10.1080/13561820.2019.1577809..
Keywords: Teams, Communication, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare
Drouin O, Sharifi M, Gerber M
Parents' willingness to pay for pediatric weight management programs.
This study examined parents’ interested in continuing and willingness to pay (WTP) for 2 pediatric weight management programs after their childrens’ participation. Participants were parents of 2- to 12-year-old children with a body mass index equal to or greater than the 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other group EPC plus individualized coaching (EPC+C). After 1 year, they assessed parents’ self-reported WTP for a similar program and the maximum amount they would pay. Of 638 parents polled, 85% were interested in continuing and 38% of them were willing to pay. The median amount they were willing to pay was $25/month. Parents of Hispanic/Latino children versus white ethnicity and those reporting a higher satisfaction with the program more most likely to endorse WTP. Parents of children getting EPC+C were also more willing to pay.
AHRQ-funded; HS024332; HS022986.
Citation: Drouin O, Sharifi M, Gerber M .
Parents' willingness to pay for pediatric weight management programs.
Acad Pediatr 2019 Sep - Oct;19(7):764-72. doi: 10.1016/j.acap.2019.05.124..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Healthcare Costs, Caregiving, Primary Care, Primary Care: Models of Care
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Davis MM, Gunn R, Pham R
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
This study focused on ways that Medicaid Accountable Care Organizations (ACOs) are implementing interventions with primary care clinics to improve colorectal cancer screening. The researchers conducted a comparative case study of 14 Medicaid ACOs in Oregon and their contracted primary care clinics. They focused on interventions that reduced structural barriers (12 ACOs), delivered provider assessment and feedback (11 ACOs), and provided patient reminders (7 ACOs). There was an unintended consequence of potential exclusion of smaller clinics and metric focus and fatigue.
AHRQ-funded; HS022981.
Citation: Davis MM, Gunn R, Pham R .
Key collaborative factors when Medicaid Accountable Care Organizations work with primary care clinics to improve colorectal cancer screening: relationships, data, and quality improvement infrastructure.
Prev Chronic Dis 2019 Aug 15;16:E107. doi: 10.5888/pcd16.180395..
Keywords: Primary Care: Models of Care, Primary Care, Screening, Colonoscopy, Cancer: Colorectal Cancer, Cancer, Quality Improvement, Quality of Care, Care Coordination, Patient-Centered Healthcare
Ronis SD, Kleinman LC, Stange KC
A learning loop model of collaborative decision-making in chronic illness.
In this article, the authors discuss their learning loop model, which posits the relationship between pediatric patients, their parents, and their clinicians as central to the collaborative decision-making process in the setting of chronic illness. The model incorporates the evolution of both context and developmental capacity over time. It suggests that "meta-learning" from the experience of and outcomes from iterative decision is a key factor that may influence relationships and thus continued engagement in collaboration by patients, their parents, and their clinicians.
AHRQ-funded; HS024433.
Citation: Ronis SD, Kleinman LC, Stange KC .
A learning loop model of collaborative decision-making in chronic illness.
Acad Pediatr 2019 Jul;19(5):497-503. doi: 10.1016/j.acap.2019.04.006..
Keywords: Children/Adolescents, Chronic Conditions, Decision Making, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care, Clinician-Patient Communication, Communication
Bravo RI, Kietzman KG, Toy P
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
This paper describes the Healthy Aging Partnerships in Prevention Initiative (HAPPI) which aims to increase colorectal cancer screening and other preventive services among underserved Latinos and African-Americans in South Los Angeles who are 50 years and older. It uses an evidence-based model (SPARC) to leverage existing resources and has multi-sectoral partnerships among different agencies, community health centers (CHCs), and a university. The authors engaged five CHCs in quality improvement activities and eight non-governmental organizations in networking and programming to increase awareness of these preventive services.
AHRQ-funded; HS010858.
Citation: Bravo RI, Kietzman KG, Toy P .
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
Salud Publica Mex 2019 Jul-Aug;61(4):427-35. doi: 10.21149/9450..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Primary Care: Models of Care, Primary Care, Elderly, Racial and Ethnic Minorities, Vulnerable Populations, Patient-Centered Healthcare
Parchman ML, Penfold RB, Ike B
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
This study examined the effect of using an opioid medication management program called Six Building Blocks in primary care practices to help reduce the rate of opioid prescriptions. Six rural-serving organizations with 20 clinic locations received support for 15 months to help them implement the Six Building Blocks. This case-control study compared monthly trends in patients undergoing long-term opioid therapy (LtOT) for patients enrolled in the intervention clinics with those enrolled in a regional health plan who did not receive care at the study sites but resided in the same areas. There was a significant rate of decrease of patients on LtOT at intervention clinics compared with the control group.
AHRQ-funded; HS023750.
Citation: Parchman ML, Penfold RB, Ike B .
Team-based clinic redesign of opioid medication management in primary care: effect on opioid prescribing.
Ann Fam Med 2019 Jul;17(4):319-25. doi: 10.1370/afm.2390..
Keywords: Opioids, Primary Care: Models of Care, Primary Care, Teams, Medication, Pain, Chronic Conditions, Practice Patterns, Patient-Centered Healthcare
Sorkin DH, Rizzo S, Biegler K
AHRQ Author: Ngo-Metzger Q
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
This article describes a multicomponent health information technology screening tool designed to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder (PTSD) in the primary care setting, with an eye toward meeting the mental health needs of traumatized refugees in the US Cambodian community. In a randomized controlled trial, 18 primary care providers were randomized to receive access to the mental health screening intervention, or to a minimal intervention control group. Cambodian American patients empaneled to participating providers were assigned to the providers' randomized group. From the results, the authors conclude that this approach offers the potential for training providers to diagnose and treat traumatized patients seeking mental health care in primary care.
AHRQ-authored.
Citation: Sorkin DH, Rizzo S, Biegler K .
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S190-s96. doi: 10.1097/mlr.0000000000001036..
Keywords: Depression, Diagnostic Safety and Quality, Health Information Technology (HIT), Behavioral Health, Primary Care, Primary Care: Models of Care, Racial and Ethnic Minorities, Screening
Nocon RS, Fairchild PC, Gao Y
Provider and staff morale, job satisfaction, and burnout over a 4-year medical home intervention.
This study examined the impact of adopting the patient-centered medical home (PCMH) on clinicians and staff at primary care practices. A longitudinal study was done comparing baseline (201) and post-intervention (2013-2014) survey results. Five-hundred thirty-six providers and staff at baseline and 589 were surveyed post-intervention. Almost half of all clinics reported improved better job morale, job satisfaction, and freedom from burnout. However, there were some clinics that saw a decrease in the percentage of providers reporting high job satisfaction and freedom from burnout. Control clinics were not used in this study, so it is impossible to know if results were similar in non-PCMH primary care practices.
AHRQ-funded; HS000084.
Citation: Nocon RS, Fairchild PC, Gao Y .
Provider and staff morale, job satisfaction, and burnout over a 4-year medical home intervention.
J Gen Intern Med 2019 Jun;34(6):952-59. doi: 10.1007/s11606-019-04893-z..
Keywords: Burnout, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Provider, Provider: Clinician, Stress
Riley AR, Paternostro JK, Walker BL
The impact of behavioral health consultations on medical encounter duration in pediatric primary care: a retrospective match-controlled study.
This retrospective match-controlled study examined the impact of behavioral health consultations on medical visit duration in pediatric primary care. Patient encounters involving behavioral health consultants were significantly longer (11 plus minutes) than matched controls, and had less time allowed for medical care. The authors of the study recommend that behavioral health consultants work with the clinician to improve time efficiency.
AHRQ-funded; HS022981.
Citation: Riley AR, Paternostro JK, Walker BL .
The impact of behavioral health consultations on medical encounter duration in pediatric primary care: a retrospective match-controlled study.
Fam Syst Health 2019 Jun;37(2):162-66. doi: 10.1037/fsh0000406..
Keywords: Behavioral Health, Children/Adolescents, Healthcare Delivery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Primary Care: Models of Care
Schnall R, Carcamo J, Porras T
Use of the phase-based model of smoking treatment to guide intervention development for persons living with HIV who self-identify as African American tobacco smokers.
To address the issue of developing effective tobacco cessation interventions for persons with HIV, this study conducted six focus group sessions with 45 African American smokers who are living with HIV in order to understand barriers to smoking cessation and strategies to help overcome these barriers. The participants articulated key components for incorporation into tobacco cessation intervention: personalized plans for quitting, reminders about the plan, and a support system. Participants also described barriers to use of pharmacotherapy, such as adverse side effects of nicotine gum and patch, and expressed concerns about negative health effects of some oral medications. The authors conclude that their findings provide information on the components of a tobacco cessation intervention for persons living with HIV.
AHRQ-funded; HS025071.
Citation: Schnall R, Carcamo J, Porras T .
Use of the phase-based model of smoking treatment to guide intervention development for persons living with HIV who self-identify as African American tobacco smokers.
Int J Environ Res Public Health 2019 May 15;16(10). doi: 10.3390/ijerph16101703..
Keywords: Human Immunodeficiency Virus (HIV), Primary Care: Models of Care, Racial and Ethnic Minorities, Tobacco Use, Tobacco Use: Smoking Cessation
Hysong SJ, Amspoker AB, Hughes AM
Impact of team configuration and team stability on primary care quality.
This paper discusses an upcoming study on the impact of team configurations on primary care effectiveness in clinics in the Veterans Health Administration (VHA). Recommendations are based on the Patient-Centered Medical Home (PCMH) model. Researchers plan to extract data from over 7000 primary care teams in the VHA’s Team Assignment Reports (TAR).
AHRQ-funded; HS025982.
Citation: Hysong SJ, Amspoker AB, Hughes AM .
Impact of team configuration and team stability on primary care quality.
Implement Sci 2019 Mar 6;14(1):22. doi: 10.1186/s13012-019-0864-8..
Keywords: Primary Care, Primary Care: Models of Care, Quality of Care, Teams
Riley AR, Freeman KA
Impacting pediatric primary care: opportunities and challenges for behavioral research in a shifting healthcare landscape.
This commentary discusses the role that behavioral analysts can have in partnership with pediatric medicine. There have been advances, but there has been limited impact for the daily practice of pediatrics. The authors discuss why behavioral pediatrics has failed to gain traction in primary care, describe possible opportunities for an expanded portfolio of research, and identify several examplars from the behavior analytic literature that has influenced pediatric primary care, and make further recommendations for producing influential data.
AHRQ-funded; HS022981.
Citation: Riley AR, Freeman KA .
Impacting pediatric primary care: opportunities and challenges for behavioral research in a shifting healthcare landscape.
Behav Anal 2019 Feb;19(1):23-38. doi: 10.1037/bar0000114..
Keywords: Behavioral Health, Children/Adolescents, Health Services Research (HSR), Healthcare Delivery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Primary Care: Models of Care, Research Methodologies
Shah T, Patel-Teague S, Kroupa L
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
In this study, the investigators evaluated the impact of a national, multicomponent, quality improvement (QI) programme designed to reduce low-value EHR notifications. The investigators found that, based on prior estimates on time to process notifications, this national QI programme potentially saved 1.5 hours per week per PCP to enable higher value work. The investigators also found that the number of daily notifications remained high, suggesting the need for additional multifaceted interventions and protected clinical time to help manage them.
AHRQ-funded; HS022087.
Citation: Shah T, Patel-Teague S, Kroupa L .
Impact of a national QI programme on reducing electronic health record notifications to clinicians.
BMJ Qual Saf 2019 Jan;28(1):10-14. doi: 10.1136/bmjqs-2017-007447..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Indicators (QIs), Quality Improvement, Quality of Care, Primary Care, Primary Care: Models of Care