National Healthcare Quality and Disparities Report
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Topics
- Access to Care (2)
- Ambulatory Care and Surgery (1)
- Behavioral Health (3)
- Blood Pressure (1)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Clinician-Patient Communication (2)
- Communication (2)
- COVID-19 (5)
- Dementia (1)
- Diabetes (4)
- Disparities (1)
- Education: Patient and Caregiver (2)
- Elderly (2)
- Healthcare Delivery (5)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (18)
- Implementation (1)
- Long-Term Care (1)
- Medication (1)
- Neurological Disorders (1)
- Nursing (1)
- Nursing Homes (1)
- Obesity (1)
- Opioids (1)
- Patient-Centered Healthcare (2)
- Patient Experience (1)
- Patient Self-Management (2)
- (-) Primary Care (22)
- Primary Care: Models of Care (1)
- Provider: Nurse (1)
- Racial and Ethnic Minorities (2)
- Risk (1)
- Rural Health (3)
- Substance Abuse (1)
- (-) Telehealth (22)
- Training (1)
- Treatments (1)
- Urban Health (1)
- Vulnerable Populations (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 22 of 22 Research Studies DisplayedReed M, Huang J, Somers M
Telemedicine versus in-person primary care: treatment and follow-up visits.
The objective of this study was to compare treatment and follow-up visits between primary care video or telephone telemedicine and in-person office visits. The study examined an insured population during the late COVID-19 pandemic period. Data was taken from administrative and electronic health records (EHRs) from a large, integrated health care delivery system; telemedicine was fully integrated with ongoing EHRs and with clinicians in this study setting. In-person return visits were found to be slightly higher after telemedicine compared with in-person primary care visits, but results varied by specific clinical condition.
AHRQ-funded; HS025189.
Citation: Reed M, Huang J, Somers M .
Telemedicine versus in-person primary care: treatment and follow-up visits.
Ann Intern Med 2023 Oct; 176(10):1349-57. doi: 10.7326/m23-1335..
Keywords: Telehealth, Primary Care, Health Information Technology (HIT)
Hua Y, Temkin-Greener H, Cai S
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
The purpose of this study was to explore primary care telemedicine use among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) who resided in Assisted Living Facilities (Als) during the early stage of the COVID-19 pandemic, with a focus on possible racial and socioeconomic differences. The study found that at the start of the pandemic in quarter 2 of 2020, Black residents were less likely to have telemedicine visits than their White counterparts. In the following two quarters, Black residents were more likely to receive primary care via telemedicine than White residents; a similar difference was observed between Hispanic and White residents, but with smaller effect sizes. Compared with nondual residents, dual residents were more likely to receive primary care via telemedicine in Q3. In addition, residents in AL communities with a higher proportion of dual residents, compared with those in low-dual ALs, were less likely to receive primary care via telemedicine throughout the study period. However, the difference in telemedicine use between higher vs lower dual ALs narrowed over time.
AHRQ-funded; HS026893.
Citation: Hua Y, Temkin-Greener H, Cai S .
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
J Am Med Dir Assoc 2023 Aug; 24(8):1157-58.e3. doi: 10.1016/j.jamda.2023.05.005..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Racial and Ethnic Minorities, Elderly
Barton AJ, Amura CR, Willems EL
Patient and provider perceptions of COVID-19-driven telehealth use from nurse-led care models in rural, frontier, and urban Colorado communities.
The aim of this study was to describe the patient and provider encounter in the unexpected telehealth application that took place with the onset of the COVID-19 pandemic. Patients and providers from 3 nurse-led models of care (federally qualified health centers, nurse midwifery practices, and the Nurse-Family partnership program) in Colorado were surveyed. Data from the Patient Attitude toward Telehealth survey and Provider Perceptions about Telehealth were collected. Patients who resided in urban areas utilized telehealth with greater frequency than in rural or frontier areas. Across each of the 5 domains assessed, rural/frontier patients had significantly lower attitude scores than urban patients. The mode of Telehealth employed differed across location, with video calls utilized more frequently by urban providers, and phone calls utilized by rural/frontier providers.
AHRQ-funded; HS028085.
Citation: Barton AJ, Amura CR, Willems EL .
Patient and provider perceptions of COVID-19-driven telehealth use from nurse-led care models in rural, frontier, and urban Colorado communities.
J Patient Exp 2023 Jan 25; 10:23743735231151546. doi: 10.1177/23743735231151546..
Keywords: COVID-19, Telehealth, Primary Care, Patient Experience, Rural Health, Urban Health, Vulnerable Populations, Provider: Nurse
Juergens N, Huang J, Gopalan A
The association between video or telephone telemedicine visit type and orders in primary care.
The purpose of this study was to examine the impact of telemedicine visit type on clinical ordering behavior. The researchers compared proportions of patient-scheduled video versus telephone visits for each of eight diagnosis groups and compared physician orders for medications, antibiotics, lab, and imaging studies by visit type within each diagnosis group. They observed statistically significant differences in clinician orders by visit type during telemedicine encounters for common primary care conditions. Their findings suggested that, for certain conditions, visual information conveyed during video visits may promote clinical work-up and treatment.
AHRQ-funded; HS025189.
Citation: Juergens N, Huang J, Gopalan A .
The association between video or telephone telemedicine visit type and orders in primary care.
BMC Med Inform Decis Mak 2022 Nov 19;22(1):302. doi: 10.1186/s12911-022-02040-z..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care
Dixit RA, Ratwani RM, Bishop JA
The impact of expanded telehealth availability on primary care utilization.
This study examined the impact of telehealth availability due to the COVID-19 pandemic and whether it may result in an unnecessary increase in utilization. The authors analyzed 4,114,651 primary care encounters from three healthcare systems between 2019 and 2021 and found little change in telehealth utilization as it became widely available.
AHRQ-funded; HS028255.
Citation: Dixit RA, Ratwani RM, Bishop JA .
The impact of expanded telehealth availability on primary care utilization.
NPJ Digit Med 2022 Sep 9;5(1):141. doi: 10.1038/s41746-022-00685-8..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care, Healthcare Utilization
Grauer A, Duran AT, Liyanage-Don NA
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
The purpose of this retrospective cohort study was to explore whether there is a relationship between telemedicine use in primary care and risk factor assessment and control for patients with diabetes mellitus. The study included patients with diabetes mellitus ages 18-75 with a telemedicine visit in a primary care network between February 2020 and December 2020. Researchers evaluated whether low-density lipoprotein cholesterol (LDL-C), blood pressure (BP), and hemoglobin A1c (HbA1c) and were assessed for each patient. The study identified 1,824 patients with diabetes during the study period and found that telemedicine use was associated with a lower proportion of patients with all three risk factors assessed. The researchers concluded that telemedicine use was related with gaps in risk factor assessment for patients with diabetes during the COVID-19 pandemic.
AHRQ-funded; HS026121; HS024262.
Citation: Grauer A, Duran AT, Liyanage-Don NA .
Association between telemedicine use and diabetes risk factor assessment and control in a primary care network.
J Endocrinol Invest 2022 Sep;45(9):1749-56. doi: 10.1007/s40618-022-01814-6..
Keywords: Diabetes, Chronic Conditions, Telehealth, Health Information Technology (HIT), Primary Care, Risk
Fraze TK, Beidler LB, De Marchis EH
"Beyond just a supplement": administrators' visions for the future of virtual primary care services.
The purpose of this study was to examine what health care organization administrators think about the future of virtual primary care services post-pandemic. In March-April 2021, the administrators of 17 health care organizations participated in semistructured qualitative phone interviews. The researchers explored how the administrators thought their organizations would offer virtual services after the pandemic. The study found that all the participants anticipated that their organization’s virtual primary care services would exist after the pandemic, with the main goals of 1) optimizing medical services; 2) enhancing the patient experience; and 3) increasing loyalty among patients, and the primary motivation being to remain competitive and financial solvency. The researchers concluded that administrators of health care organizations are examining how virtual services can continue after the pandemic, and what roles they will play in the delivery of services.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, De Marchis EH .
"Beyond just a supplement": administrators' visions for the future of virtual primary care services.
J Am Board Fam Med 2022 May-Jun;35(3):527-36. doi: 10.3122/jabfm.2022.03.210479..
Keywords: Primary Care, Telehealth, Health Information Technology (HIT), Healthcare Delivery, COVID-19
Huang J, Graetz I, Millman A
Primary care telemedicine during the COVID-19 pandemic: patient's choice of video versus telephone visit.
The goal of this study was to examine the association between patient characteristics and primary care telemedicine choice among integrated delivery system patients self-scheduling visits during the COVID-19 pandemic. Findings showed that patients of Black or Hispanic race/ethnicity, or living in low socioeconomic status or low internet access neighborhoods were less likely to schedule video visits. Also, patients 65 years or older, with prior video visit experience or mobile portal access, or visiting their own personal provider were more likely to schedule video visits. While video adoption was substantial in all patient groups examined, differences in telemedicine choice suggested the persistence of a digital divide.
AHRQ-funded; HS025189.
Citation: Huang J, Graetz I, Millman A .
Primary care telemedicine during the COVID-19 pandemic: patient's choice of video versus telephone visit.
JAMIA Open 2022 Apr;5(1):ooac002. doi: 10.1093/jamiaopen/ooac002..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Access to Care
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
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
Misra-Hebert AD, Hu B, Pantalone KM
Primary care health care use for patients with type 2 diabetes during the COVID-19 pandemic.
This study sought to examine factors associated with total and virtual primary care use for patients with type 2 diabetes (T2D) during the COVID-19 pandemic. This study used electronic medical records in the Cleveland Clinic Health System comparing prepandemic use from August 2019 to March 2020 (baseline period 0) to two pandemic periods: March to June 2020 (period 1) when in-person visits were converted to virtual; and July to November 2020 when in-person visits resumed (period 2). Demographic characteristics were obtained including age, sex, race, insurance type, median income estimated by zip code and baseline HbA1C. The study included 76,015 patients with T2D who completed a primary care visit in baseline period 0. Cohort median age was 66.2 years, 50.7% women, 21.7% Black, 71.0% White and 7.4 Other. Insurance distribution was 43.2% private, 46.5% Medicare, and 9.5% Medicaid. Median income was estimated at $59,000 and baseline HbA1C was ≤ 7% for 59.6% of patients. There were higher odds of Black patients, those with uncontrolled T2D, and those with Medicare and Medicare using virtual visits during the 2 postpandemic periods suggesting that virtual visits may be a preference for those groups. Older and male patients had lower odds of visit completion.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Pantalone KM .
Primary care health care use for patients with type 2 diabetes during the COVID-19 pandemic.
Diabetes Care 2021 Sep;44(9):e173-e74. doi: 10.2337/dc21-0853..
Keywords: COVID-19, Diabetes, Primary Care, Telehealth, Health Information Technology (HIT), Healthcare Delivery, Access to Care, Chronic Conditions
Bhargava R, Gayre G, Huang J
Patient e-visit use and outcomes for common symptoms in an integrated health care delivery system.
The authors evaluated patients’ adoption and success of primary care e-visits by monitoring the 7-day follow-up care needed within an integrated health care delivery system. They found that e-visits offered quick, safe patient access to virtual health care for specific conditions without needing a scheduled visit, transportation, or time off of work. Their results suggested that a predominance of e-visits delivered clinical care successfully without follow-up visits or messages.
AHRQ-funded; HS25189.
Citation: Bhargava R, Gayre G, Huang J .
Patient e-visit use and outcomes for common symptoms in an integrated health care delivery system.
JAMA Netw Open 2021 Mar;4(3):e212174. doi: 10.1001/jamanetworkopen.2021.2174..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care, Healthcare Delivery
Howland C, Despins L, Sindt J
Primary care clinic nurse activities with a telehealth monitoring system.
The purpose of this study was to evaluate differences in the types of nursing activities and communication processes reported in a primary care clinic between patients using a home-based monitoring system to electronically communicate self-monitored blood glucose and blood pressure values and those assuming usual care. Significant differences were identified for the direct care nursing activities of providing lifestyle and health education, medication adjustments, and patient follow-up, providing evidence of greater nursing activity reported in a primary care clinic in patients who utilized a home-based monitoring system.
AHRQ-funded; HS017035.
Citation: Howland C, Despins L, Sindt J .
Primary care clinic nurse activities with a telehealth monitoring system.
West J Nurs Res 2021 Jan;43(1):5-12. doi: 10.1177/0193945920923082..
Keywords: Telehealth, Health Information Technology (HIT), Blood Pressure, Primary Care, Clinician-Patient Communication, Communication, Patient Self-Management, Nursing, Patient-Centered Healthcare, Diabetes
Reed ME, Huang J, Graetz I
Patient characteristics associated with choosing a telemedicine visit vs office visit with the same primary care clinicians.
Video or telephone telemedicine can offer patients access to a clinician without arranging for transportation or spending time in a waiting room, but little is known about patient characteristics associated with choosing between telemedicine or office visits. The objective of this study was to examine patient characteristics associated with choosing a telemedicine visit versus office visit with the same primary care clinicians.
AHRQ-funded; HS25189.
Citation: Reed ME, Huang J, Graetz I .
Patient characteristics associated with choosing a telemedicine visit vs office visit with the same primary care clinicians.
JAMA Netw Open 2020 Jun;3(6):e205873. doi: 10.1001/jamanetworkopen.2020.5873..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care
Jonassaint CR, Belnap BH, Huang Y
Racial differences in the effectiveness of Internet-delivered mental health care.
The purpose of this study was to examine race differences in the impact of computerized cognitive behavioral therapy (cCBT) use on mental health outcomes among White and African American primary care patients. Participants were patients aged 18-75 who were referred by their primary care physicians and who met the eligibility criteria. Findings showed that, compared to usual care, cCBT had no effect on quality of life, depression, or anxiety for Whites. However, for African American patients, cCBT was associated with a significant 6-month decrease in depression and anxiety scores; thus, cCBT may be an efficient and scalable first step to eliminating disparities in mental health care.
AHRQ-funded; HS022989.
Citation: Jonassaint CR, Belnap BH, Huang Y .
Racial differences in the effectiveness of Internet-delivered mental health care.
J Gen Intern Med 2020 Feb;35(2):490-97. doi: 10.1007/s11606-019-05542-1..
Keywords: Behavioral Health, Telehealth, Racial and Ethnic Minorities, Disparities, Primary Care, Treatments
Golberstein E, Joseph JM, Druss BG
The use of psychiatric econsults in primary care.
This study examined the use of an electronic consultation tool (eConsult) by primary care physicians (PCPs) with psychiatrists. The authors investigated the use of psychiatric eConsults in a large integrated delivery system in Minnesota (Allina Health). The tool was introduced in 22 of its primary care clinics on August 1, 2015. Patients had no fee and psychiatrists received 0.75 work relative value units for each eConsult. Out of 95,105 encounters across 219 PCPs from August 2015 through December 2016 only 256 (0.27%) had a psychiatric eConsult order. Among 37.606 encounters with a primary mental health diagnosis only 138 (0.37%) had an eConsult order. Anxiety and depressive disorders were the most common diagnosis types for PCP visits without an eConsult order as well as bipolar disorder, but schizophrenia and psychotic disorder diagnoses were more common with eConsult orders. Over half of eConsults were for medication-related issues, 33% for a specific mental health diagnosis, and 15% for psychiatry without any details. Most PCPs (63%) never ordered an eConsult but the top ten users of eConsults accounted for 46% of the total orders.
AHRQ-funded; HS025245.
Citation: Golberstein E, Joseph JM, Druss BG .
The use of psychiatric econsults in primary care.
J Gen Intern Med 2020 Feb;35(2):616-17. doi: 10.1007/s11606-019-05048-w..
Keywords: Telehealth, Health Information Technology (HIT), Behavioral Health, Primary Care: Models of Care, Primary Care, Healthcare Delivery
Knox M, Murphy EJ, Leslie T
e-Consult implementation success: lessons from 5 county-based delivery systems.
This study evaluated organizational factors for e-consult implementation across five publicly financed, county-based health systems in California. Health system leaders whose systems received grant funding to plan and implement e-consult were interviewed to discuss platform selection, electronic health record compatibility, primary care clinician and specialist opinions, and project governance. Findings showed that three of the 5 systems successfully implemented e-consults. Existing primary care clinician-specialist relationships emerged as the strongest facilitator. E-consult-EHR technology integration was also important. These findings add to existing e-consult implementation literature that emphasizes reimbursement and leadership champions.
AHRQ-funded; HS022241.
Citation: Knox M, Murphy EJ, Leslie T .
e-Consult implementation success: lessons from 5 county-based delivery systems.
Am J Manag Care 2020 Jan;26(1):e21-e27. doi: 10.37765/ajmc.2020.42149..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Delivery, Implementation, Primary Care, Ambulatory Care and Surgery
Salvador J, Bhatt S, Fowler R
Engagement with Project ECHO to increase medication-assisted treatment in rural primary care.
The purpose of this study was to understand the barriers and facilitators that affect engagement with Project ECHO (Extension for Community Healthcare Outcomes) to implement medication-assisted treatment (MAT) in primary care settings. This brief report identified key systematic challenges that may directly limit primary care providers' engagement in telementoring models such as Project ECHO.
AHRQ-funded; HS025345.
Citation: Salvador J, Bhatt S, Fowler R .
Engagement with Project ECHO to increase medication-assisted treatment in rural primary care.
Psychiatr Serv 2019 Dec;70(12):1157-60. doi: 10.1176/appi.ps.201900142..
Keywords: Opioids, Medication, Substance Abuse, Primary Care, Rural Health, Telehealth, Health Information Technology (HIT)
Breitenstein SM, Laurent S, Pabalan L
Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care.
The authors studied implementation of mobile delivery to deliver parent training in order to identify and address barriers and facilitators and inform sustainability efforts. They suggest that implementation fidelity may improve with additional education and training of the interdisciplinary team, clear messaging regarding the purpose and content of the program, defining roles within the care team, identifying practice champions, and use of the electronic health record. Findings from this evaluation, including data from the randomized controlled trial and literature to support intervention effectiveness and implementation, will be used to develop an implementation toolkit to include specific strategies for implementation and ideas for local adaptations.
AHRQ-funded; HS024273.
Citation: Breitenstein SM, Laurent S, Pabalan L .
Implementation findings from an effectiveness-implementation trial of tablet-based parent training in pediatric primary care.
Fam Syst Health 2019 Dec;37(4):282-90. doi: 10.1037/fsh0000447..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care, Children/Adolescents, Education: Patient and Caregiver
Batsis JA, Pletcher SN, Stahl JE
Telemedicine and primary care obesity management in rural areas - innovative approach for older adults?
The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models.
AHRQ-funded; HS021681.
Citation: Batsis JA, Pletcher SN, Stahl JE .
Telemedicine and primary care obesity management in rural areas - innovative approach for older adults?
BMC Geriatr 2017 Jan 5;17(1):6. doi: 10.1186/s12877-016-0396-x.
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Keywords: Telehealth, Primary Care, Obesity, Rural Health, Elderly
Garg SK, Lyles CR, Ackerman S
Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.
The researchers interviewed safety net health systems piloting texting initiatives to study facilitators and barriers to real-world implementation. Sites interviewed applied texting for programs related to medication adherence and monitoring, appointment reminders, care coordination, and health education and promotion. Patient privacy government regulations emerged as a crucial barrier. A technical challenge was the inablitiy to integrate texting platforms with electronic health records. The authors concluded that inadequate data management capabilities and unclear privacy and security regulations for mobile health technology slowed the initial implementation and limited the clinical use of texting in the safety net and scope of pilots.
AHRQ-funded; HS022047; HS022408.
Citation: Garg SK, Lyles CR, Ackerman S .
Qualitative analysis of programmatic initiatives to text patients with mobile devices in resource-limited health systems.
BMC Med Inform Decis Mak 2016 Feb 6;16:16. doi: 10.1186/s12911-016-0258-7.
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Keywords: Communication, Primary Care, Telehealth, Health Information Technology (HIT), Clinician-Patient Communication
Cherrington AL, Agne AA, Lampkin Y
Diabetes Connect: developing a mobile health intervention to link diabetes community health workers with primary care.
The authors tested a model for the integration of a community health worker-delivered mobile health technology intervention to improve diabetes self-management. They found that the integration of mobile health technology into community health worker programs was successfully achieved and readily accepted.
AHRQ-funded; HS019465.
Citation: Cherrington AL, Agne AA, Lampkin Y .
Diabetes Connect: developing a mobile health intervention to link diabetes community health workers with primary care.
J Ambul Care Manage 2015 Oct-Dec;38(4):333-45. doi: 10.1097/jac.0000000000000110.
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Keywords: Education: Patient and Caregiver, Diabetes, Primary Care, Patient Self-Management, Telehealth