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 79 Research Studies DisplayedIbemere SO, Tanabe P, Bonnabeau E
Awareness and use of the sickle cell disease toolbox by primary care providers in North Carolina.
The authors developed a decision support tool for sickle cell disease (SCD) for SCD management (SCD Toolbox) based on the National Heart, Lung, and Blood Institute's SCD guidelines. Using data from primary care providers (PCPs) in North Carolina, they found that PCPs rarely co-managed with a specialist, had low awareness and use of the SCD Toolbox, and requested multiple formats for the toolbox.
AHRQ-funded; HS024501.
Citation: Ibemere SO, Tanabe P, Bonnabeau E .
Awareness and use of the sickle cell disease toolbox by primary care providers in North Carolina.
J Prim Care Community Health 2021 Jan-Dec;12:21501327211049050. doi: 10.1177/21501327211049050..
Keywords: Sickle Cell Disease, Primary Care, Chronic Conditions, Decision Making, Evidence-Based Practice
Boyd R, Carter E, Moise N
Awareness, knowledge, and attitudes toward screening and treatment of masked hypertension in primary care.
The purpose of this qualitative study was to explore primary care provider (PCP) awareness, knowledge, and attitudes toward masked hypertension (MHT.) The researchers conducted 3 focus groups which included 30 PCPs from 3 medical centers in New York. The analysis and thematic content analysis found that there was low knowledge about the prevalence and impact of MHT, awareness of MHT among the participants varied, and only 2 providers had diagnosed MHT. While some PCPs were receptive to MHT screening after learning about its significance, others perceived the current evidence as insufficient to change practice. There was broad consensus for lifestyle changes for MHT but concerns about a lack of randomized trial evidence for antihypertensive medication, and the possibility of harmful side effects. The researchers concluded that limited PCP knowledge about MHT, insufficient evidence, already overburdened PCPs, and concerns about the accuracy and accessibility of screening tests were key barriers to screening and treatment for MHT.
AHRQ-funded; HS024262.
Citation: Boyd R, Carter E, Moise N .
Awareness, knowledge, and attitudes toward screening and treatment of masked hypertension in primary care.
Am J Hypertens 2021 Dec;34(12):1322-27. doi: 10.1093/ajh/hpab115..
Keywords: Blood Pressure, Screening, Primary Care
Heller CG, Rehm CD, Parsons AH
The association between social needs and chronic conditions in a large, urban primary care population.
This study sought to understand the association between social needs and chronic health conditions using a screening tool and clinical data from Electronic Health Records. From April 2018 to December 2019, 33,550 adult patients completed a 10-item social needs screening tool during primary visits in Bronx and Westchester Counties, NY. A positive, cumulative association between social needs and each of the eight outcomes asked about was found. The relationship was strongest for elevated PHQ-2 (depression screening), alcohol/drug use disorder, and smoking. Those with 3 or greater social needs were 3.9 times more likely to have an elevated PHQ-2 than those without needs. Healthcare transportation challenges was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. Examples included those with an alcohol/drug use disorder (84% more likely), and smokers (41% more likely).
AHRQ-funded; HS026396.
Citation: Heller CG, Rehm CD, Parsons AH .
The association between social needs and chronic conditions in a large, urban primary care population.
Prev Med 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752..
Keywords: Chronic Conditions, Urban Health, Primary Care, Low-Income, Social Determinants of Health, Screening
Neprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
AHRQ-funded; HS024455.
Citation: Neprash HT, Zink A, Sheridan B .
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
J Health Econ 2021 Dec;80:102541. doi: 10.1016/j.jhealeco.2021.102541..
Keywords: Medicare, Healthcare Utilization, Primary Care, Workforce, Health Insurance
McClure JB, Lapham G
Tobacco quitline engagement and outcomes among primary care patients reporting use of tobacco or dual tobacco and cannabis: an observational study.
Researchers examined dual users of tobacco and cannabis and how this use impacts individuals' interest in or ability to stop smoking. They found that, although dual use of tobacco and cannabis is common among smokers seen in primary care and those enrolling in quitline care, it may not undermine tobacco quitline engagement or smoking cessation. They concluded that tobacco quitline care was equally engaging and effective among tobacco users and dual users of tobacco and cannabis.
AHRQ-funded; HS026369.
Citation: McClure JB, Lapham G .
Tobacco quitline engagement and outcomes among primary care patients reporting use of tobacco or dual tobacco and cannabis: an observational study.
Subst Abus 2021;42(4):417-22. doi: 10.1080/08897077.2020.1846665..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Primary Care
Abraham CM, Zheng K, Norful AA
Use of multifunctional electronic health records and burnout among primary care nurse practitioners.
This study investigated whether there is an association with the use of multifunctional electronic health records (EHRs) with nurse practitioner (NP) burnout in primary care practices. The study used cross-sectional survey data secondary analysis collected from NPs in Pennsylvania and New Jersey. The NPs completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Of 396 NPs included, 25.3% reported burnout, but the use of multifunctional EHRs did not increase primary care NP burnout.
AHRQ-funded; HS027290.
Citation: Abraham CM, Zheng K, Norful AA .
Use of multifunctional electronic health records and burnout among primary care nurse practitioners.
J Am Assoc Nurse Pract 2021 Dec;33(12):1182-89. doi: 10.1097/jxx.0000000000000533..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Nurse, Primary Care
Tobin JN, Cassells A, Weiss E
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
AHRQ-funded; HS021667.
Citation: Tobin JN, Cassells A, Weiss E .
Integrating cancer screening and mental health services in primary care: protocol and baseline results of a patient-centered outcomes intervention study.
J Health Care Poor Underserved 2021;32(4):1907-34. doi: 10.1353/hpu.2021.0173..
Keywords: Patient-Centered Healthcare, Cancer, Behavioral Health, Primary Care, Depression, Women, Screening
Jonas DE, Barclay C, Grammer D
The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care.
This paper describes a randomized, controlled trial to evaluate the effect of primary care practice facilitation and telehealth services on evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use in primary care practices in North Carolina with 10 or fewer providers. The study will produce important evidence about the effect of practice facilitation on uptake of evidence-based screening, counseling, and pharmacotherapy for unhealthy alcohol use when delivered on a large scale to small and medium-sized practices. The results of this rigorously conducted evaluation are expected to have a positive impact by accelerating the dissemination and implementation of evidence related to unhealthy alcohol use into primary care practices.
AHRQ-funded; HS027078.
Citation: Jonas DE, Barclay C, Grammer D .
The STUN (STop UNhealthy) Alcohol Use Now trial: study protocol for an adaptive randomized trial on dissemination and implementation of screening and management of unhealthy alcohol use in primary care.
Trials 2021 Nov 16;22(1):810. doi: 10.1186/s13063-021-05641-7..
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Screening, Implementation
Oberlander T, Scholle SH, Marsteller J
Implementation of patient safety structures and processes in the patient-centered medical home.
This study's objectives were to identify patient-centered medical home (PCMH) standards relevant to patient safety, to construct a measure of patient safety activity implementation, and to examine differences in adoptions of these activities by practice and community characteristics. Findings showed that implementation of patient safety activities varied; the few military practices studied had the highest, and community clinics the lowest, patient safety score, both overall and across specific domains, while other practice and community characteristics were not associated with the patient safety score.
AHRQ-funded; HS024859.
Citation: Oberlander T, Scholle SH, Marsteller J .
Implementation of patient safety structures and processes in the patient-centered medical home.
J Healthc Qual 2021 Nov-Dec;43(6):324-39. doi: 10.1097/jhq.0000000000000312..
Keywords: Patient-Centered Healthcare, Patient Safety, Implementation, Primary Care
Ganguli I, Morden NE, Yang CW
Low-value care at the actionable level of individual health systems.
This study measured and reported low-value care use across and within individual health systems and to identify system characteristics associated with higher use using Medicare administrative data. This retrospective cohort study was conducted using 11,637,763 Medicare beneficiaries in 556 health systems in the AHRQ Compendium of US Health Systems. These Medicare beneficiaries were enrolled in Medicare Parts A and B for at least 12 months in 2016 or 2017. The most common low-value services include preoperative laboratory testing, prostate-specific antigen testing in men older than 70 years, and use of antipsychotic medications in patients with dementia. Forty-one low-value services were measured based on the Milliman MedInsight Health Waste Calculator. In multivariable analysis, the health system characteristics associated with higher use of low-value care were a smaller proportion of primary care physicians for systems with less than the median percentage of primary care physicians vs -0.16 for those with more than the median percentage of primary care physicians; no major teaching hospital without a teaching hospital vs -0.18 with a teaching hospital; larger proportion of non-White patients for systems with >20% of non-White beneficiaries vs -0.06 for systems with ≤20% of non-White beneficiaries; headquartered in the South or West for the South and 0.22 for the West compared with -0.09 for the Northeast and -0.44 for the Midwest;, and serving areas with more health care spending for areas above the median level of spending vs -0.24 for areas below the median level of spending.
AHRQ-funded; HS024075.
Citation: Ganguli I, Morden NE, Yang CW .
Low-value care at the actionable level of individual health systems.
JAMA Intern Med 2021 Nov;181(11):1490-500. doi: 10.1001/jamainternmed.2021.5531..
Keywords: Health Systems, Primary Care
Lasser EC, Heughan JA, Lai AY
Patient perceptions of safety in primary care: a qualitative study to inform care.
The authors sought to understand the patient perspective on patient safety in patient-centered medical homes (PCMHs). Using focus groups/interviews, they found overarching themes focused on (1) clear and timely communication with and between clinicians and (2) trust in the care team, including being heard, respected, and treated as a whole person. Other themes included sharing of and access to information, patient education and patient-centered medication reconciliation process, clear documentation for the diagnostic process, patient-centered comprehensive visits, and timeliness of care.
AHRQ-funded; HS024859.
Citation: Lasser EC, Heughan JA, Lai AY .
Patient perceptions of safety in primary care: a qualitative study to inform care.
Curr Med Res Opin 2021 Nov;37(11):1991-99. doi: 10.1080/03007995.2021.1976736..
Keywords: Patient Safety, Patient Experience, Primary Care, Patient-Centered Healthcare
Fraze TK, Beidler LB, Fichtenberg C
Resource brokering: efforts to assist patients with housing, transportation, and economic needs in primary care settings.
This study reviewed how 29 diverse health care organizations assisted patients with housing, transportation, and economic needs in primary care settings. Semistructured interviews were conducted with leaders and frontline staff. Organizations used case management programs to assist patients with social needs through referrals to community-based organizations (CBOs) and regular follow-up. About one-half incorporated care into established case management programs, and the remaining described standalone programs. While all organizations referred patients to CBOs, some also provided more intense services such as assistance in completing patients’ applications for services or conducting home visits. Challenges described by the organizations include: 1) effectively engaging CBOs; 2) obtaining buy-in from clinical staff; 3) considering patients' perspectives; and 4) ensuring program sustainability.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Fichtenberg C .
Resource brokering: efforts to assist patients with housing, transportation, and economic needs in primary care settings.
Ann Fam Med 2021 Nov-Dec;19(6):507-14. doi: 10.1370/afm.2739..
Keywords: Social Determinants of Health, Primary Care, Care Management
Quigley DD, Elliott MN, Slaughter ME
Shadow coaching improves patient experience with care, but gains erode later.
Health care organizations strive to improve patient care experiences. Some use one-on-one provider counseling (shadow coaching) to identify and target modifiable provider behaviors. In this study, the investigators examined whether shadow coaching improved patient experience across 44 primary care practices in a large urban Federally Qualified Health Center. The investigators concluded that shadow coaching improved providers' overall performance and communication immediately after being coached.
AHRQ-funded; HS025920.
Citation: Quigley DD, Elliott MN, Slaughter ME .
Shadow coaching improves patient experience with care, but gains erode later.
Med Care 2021 Nov;59(11):950-60. doi: 10.1097/mlr.0000000000001629..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Provider Performance, Quality Improvement, Quality of Care, Primary Care
Nehls N, Yap TS, Salant T
Systems engineering analysis of diagnostic referral closed-loop processes.
This systems engineering (SE) analysis of diagnostic referral closed-loop processes examines process logic, variation, reliability, and failures for completing diagnostic referrals originating in two primary care practices serving different demographics, using dermatology as an illustrating use case. Research has shown that there is a 65-73% failure rate in completing diagnostic referrals, which is a significant patient safety problem. An interdisciplinary team collaborated to understand processes of initiating and completing diagnostic referrals. Cross-functional process maps were developed through iterative group interviews with an urban community-based health center and a teaching practice within a large academic medical center. Results were used to conduct an engineering process analysis, assess variation between and within practices, and identify common failure modes and potential solutions.
AHRQ-funded; HS027282.
Citation: Nehls N, Yap TS, Salant T .
Systems engineering analysis of diagnostic referral closed-loop processes.
BMJ Open Qual 2021 Nov;10(4). doi: 10.1136/bmjoq-2021-001603..
Keywords: Diagnostic Safety and Quality, Primary Care, Patient Safety
Reed M, Huang J, Graetz I
Treatment and follow-up care associated with patient-scheduled primary care telemedicine and in-person visits in a large integrated health system.
Telemedicine visits can offer patients convenient access to a clinician, but it is unclear whether treatment differs from that with in-person visits or how often patients require in-person follow-up. The objectives of this study was to examine whether physician prescribing and orders differed between telemedicine and office visits, whether physicians conducting telemedicine visits were more likely to require in-person follow-up, and whether telemedicine visits were associated with more health events.
AHRQ-funded; HS25189.
Citation: Reed M, Huang J, Graetz I .
Treatment and follow-up care associated with patient-scheduled primary care telemedicine and in-person visits in a large integrated health system.
JAMA Netw Open 2021 Nov;4(11):e2132793. doi: 10.1001/jamanetworkopen.2021.32793..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care
Sussman AL, Crawford JN, Brakey HR
Use of a benchmark tracking assessment to support expansion of buprenorphine for treatment of opioid use disorder in primary care.
Barriers to the expansion of opioid use disorder (OUD) treatment in primary care using buprenorphine are well documented. Providers require support along a continuum. A systematic tracking framework to enhance provider progress along this continuum is lacking. The investigators developed a benchmark tracking assessment (BTA) as part of data collection in a 5-year study to examine the impact of provider participation in an online intervention to support expansion of buprenorphine treatment for OUD in rural primary care.
AHRQ-funded; HS025345.
Citation: Sussman AL, Crawford JN, Brakey HR .
Use of a benchmark tracking assessment to support expansion of buprenorphine for treatment of opioid use disorder in primary care.
J Am Board Fam Med 2021 Nov-Dec;34(6):1216-20. doi: 10.3122/jabfm.2021.06.210111..
Keywords: Opioids, Primary Care, Medication, Substance Abuse, Behavioral Health
Davidson KW, Krist AH, Tseng CW
AHRQ Author: Mills J, Borsky A
Incorporation of social risk in US Preventive Services Task Force Recommendations and identification of key challenges for primary care.
The authors assessed how social risks have been considered in USPSTF recommendation statements and identified current gaps in evidence needed to expand the systematic inclusion of social risks in future recommendations. They concluded that their report serves as a benchmark and foundation for ongoing work to advance the goal of ensuring that health equity and social risks are incorporated into USPSTF methods and recommendations.
AHRQ-authored.
Citation: Davidson KW, Krist AH, Tseng CW .
Incorporation of social risk in US Preventive Services Task Force Recommendations and identification of key challenges for primary care.
JAMA 2021 Oct 12;326(14):1410-15. doi: 10.1001/jama.2021.12833..
Keywords: U.S. Preventive Services Task Force (USPSTF), Primary Care, Social Determinants of Health, Risk, Evidence-Based Practice, Research Methodologies, Guidelines
Rudin RA, Perez S, Rodriguez JA
User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care.
The objective of this study was to determine user and electronic health records (EHR) integration requirements for a scalable remote symptom monitoring intervention for asthma patients and their providers. Using the NASSS framework to guide their user-centered design process, the investigators identified patient and provider requirements for scaling an EHR-integrated remote symptom monitoring intervention in primary care.
AHRQ-funded; HS026432.
Citation: Rudin RA, Perez S, Rodriguez JA .
User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care.
J Am Med Inform Assoc 2021 Oct 12;28(11):2433-44. doi: 10.1093/jamia/ocab157..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Asthma, Respiratory Conditions, Primary Care
Savitz LA, Bayliss EA
Emerging models of care for individuals with multiple chronic conditions.
The objective of this study was to characterize emerging and current practice models to more effectively treat and support patients with multiple chronic conditions (MCC). The investigators concluded that integrating care for MCC patient populations requires processes for determining different subpopulation needs in various settings and lived experiences. Innovation should be anchored at the nexus of payment systems, social risks, medical needs, and community-based resources.
AHRQ-funded; 290201600001B.
Citation: Savitz LA, Bayliss EA .
Emerging models of care for individuals with multiple chronic conditions.
Health Serv Res 2021 Oct;56(Suppl 1):980-89. doi: 10.1111/1475-6773.13774..
Keywords: Chronic Conditions, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care
Lewis VA, Spivack S, Murray GF
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
Researchers assessed capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients. Data from the National Survey of Healthcare Organizations and Systems was analyzed. They found that federally qualified health centers were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities.
AHRQ-funded; HS024075.
Citation: Lewis VA, Spivack S, Murray GF .
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
J Gen Intern Med 2021 Oct;36(10):2922-28. doi: 10.1007/s11606-021-06746-0..
Keywords: Vulnerable Populations, Primary Care, Access to Care, Uninsured, Medicaid, Quality of Care
Bierman AS, Wang J, O'Malley PG
AHRQ Author: Bierman AS, Wang J, O'Malley PG, Moss DK
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
AHRQ-authored.
Citation: Bierman AS, Wang J, O'Malley PG .
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords: Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
Luo Z, Gritz M, Connelly L
A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients.
The objective of this study was to fill the gap in knowledge on systematic differences between primary care practices (PCP) that do or do not provide intensive behavioral therapy (IBT) for obese Medicare patients. The investigators concluded that although the Centers for Medicare and Medicaid Services established payment codes for PCPs to deliver IBT for obesity in 2011, very few providers submitted fee-for-service claims for these services after almost 10 years.
AHRQ-funded; HS024843.
Citation: Luo Z, Gritz M, Connelly L .
A survey of primary care practices on their use of the intensive behavioral therapy for obese Medicare patients.
J Gen Intern Med 2021 Sep;36(9):2700-08. doi: 10.1007/s11606-021-06596-w..
Keywords: Primary Care, Obesity, Behavioral Health, Medicare, Elderly
Chen H, Upadhyay N, Lyu N
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
This study’s objective was to examine whether linkage with mental health (MH) treatment differed across 3 different integrated care agreements (ICAs) following diagnosis for Attention Deficit Hyperactive Disorder (ADHD) or Major Depressive Disorder (MDD) given by primary care providers (PCPs) in the pediatric setting. The ICAs were categorized as PCPs who practiced alone (non-co-located); PCPs practiced with specialist outside the practice but co-located at the practice site; and employed specialists who were co-located. A total of 4203 incident ADHD and 298 incident MDD diagnoses were identified, of which 74% of ADHD cases and 67% of MDD cases received treatment within 90 days of diagnosis. Children with ADHD were twice as likely to receive treatment if they were diagnosed by non-co-located or co-affiliated PCPs than those diagnosed by non-co-located PCPs. Those treated children were also 2 times more likely to receive guideline recommended psychotherapy and treated at the diagnosing site versus elsewhere.
AHRQ-funded; HS025251.
Citation: Chen H, Upadhyay N, Lyu N .
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
Acad Pediatr 2021 Sep-Oct;21(7):1187-94. doi: 10.1016/j.acap.2021.05.021..
Keywords: Children/Adolescents, Behavioral Health, Patient-Centered Healthcare, Primary Care, Healthcare Delivery, Depression
Parish MB, Gonzalez A, Hilty D
Asynchronous telepsychiatry interviewer training recommendations: a model for interdisciplinary, integrated behavioral health care.
Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlined the development of a training model for ATP clinician skills. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians. The authors suggested that more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed.
AHRQ-funded; HS021477.
Citation: Parish MB, Gonzalez A, Hilty D .
Asynchronous telepsychiatry interviewer training recommendations: a model for interdisciplinary, integrated behavioral health care.
Telemed J E Health 2021 Sep;27(9):982-88. doi: 10.1089/tmj.2020.0076..
Keywords: Telehealth, Health Information Technology (HIT), Behavioral Health, Primary Care, Patient-Centered Healthcare, Training
Patel E, Kandrack R
Differences in the number of services provided by nurse practitioners and physicians during primary care visits.
Due to differential training, nurse practitioners (NPs) and physicians may provide different quantities of services to patients. The purpose of this study was to assess differences in the number of laboratory, imagining, and procedural services provided by primary care NPs and physicians. The investigators found that NPs provided fewer laboratory and imaging services than physicians during primary care visits.
AHRQ-funded; HS000032.
Citation: Patel E, Kandrack R .
Differences in the number of services provided by nurse practitioners and physicians during primary care visits.
Nurs Outlook 2021 Sep-Oct;69(5):886-91. doi: 10.1016/j.outlook.2021.04.003..
Keywords: Primary Care, Practice Patterns, Provider: Physician, Provider: Nurse