National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Ambulatory Care and Surgery (3)
- Asthma (1)
- Blood Pressure (1)
- Cardiovascular Conditions (1)
- Care Management (1)
- Children/Adolescents (4)
- Chronic Conditions (3)
- (-) Clinician-Patient Communication (22)
- Communication (7)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Decision Making (1)
- Diabetes (1)
- Disparities (1)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (1)
- Electronic Health Records (EHRs) (6)
- Evidence-Based Practice (1)
- Health Information Technology (HIT) (8)
- Health Literacy (2)
- Medication (3)
- Nursing (1)
- Obesity (1)
- Opioids (2)
- Pain (2)
- Patient-Centered Healthcare (5)
- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (2)
- Patient Experience (3)
- Patient Safety (1)
- Patient Self-Management (1)
- Practice Patterns (1)
- (-) Primary Care (22)
- Primary Care: Models of Care (2)
- Provider (2)
- Provider: Physician (1)
- Provider Performance (1)
- Quality Improvement (3)
- Quality of Care (2)
- Risk (1)
- Telehealth (2)
- Tools & Toolkits (1)
- Vulnerable Populations (1)
- Women (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 DisplayedQuigley DD, Elliott MN, Slaughter ME
Follow-up shadow coaching improves primary care provider-patient interactions and maintains improvements when conducted regularly: a spline model analysis.
The purpose of this study was to explore whether a second shadow coaching session (re-coaching) improves the patient experience and maintains it over time. The researchers observed a statistically significant increase of 3.7 points among re-coached providers after re-coaching on overall provider rating (OPR) and 3.5 points on provider communication (PC) (differences of 1, 3, and 5 points or more are considered small, medium, and large, respectively). Improvements from the re-coaching endured for 12 months for OPR and 8 months for PC.
AHRQ-funded; HS025920.
Citation: Quigley DD, Elliott MN, Slaughter ME .
Follow-up shadow coaching improves primary care provider-patient interactions and maintains improvements when conducted regularly: a spline model analysis.
J Gen Intern Med 2023 Jan; 38(1):221-27. doi: 10.1007/s11606-022-07881-y..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Primary Care, Clinician-Patient Communication, Patient Experience, Provider Performance
Hood-Medland EA, White AEC, Kravitz RL
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
This study looked at primary care visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience with patients taking opioids for chronic pain. The study analyzed 83 video-recorded US primary care visits at a single academic medical center in California. A total of 49 family medicine and internal resident physicians and 83 patients were filmed. The authors developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discusses. They identified 2 visit opening styles with agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda opening styles (open-ended question, patient launch, physician launch). Only 11% of visits included agenda setting and was associated with fewer surprise patient topics than visits without agenda setting.
AHRQ-funded; HS022236.
Citation: Hood-Medland EA, White AEC, Kravitz RL .
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
BMC Fam Pract 2021 Jan 4;22(1):4. doi: 10.1186/s12875-020-01317-4..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Clinician-Patient Communication, Communication, Ambulatory Care and Surgery
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
Luk JW, Parker EO, Richardson LP
Sexual attraction and experiences in the primary care setting: examining disparities in satisfaction with provider and health self-efficacy.
This study examines whether sexual minority adolescents report lower satisfaction with primary care providers and lower health self-efficacy compared to heterosexual males and females. Data from 535 adolescents who participated in one of two randomized clinical trials were analyzed. Both sets of adolescents reported high satisfaction with providers. Relative to heterosexual males, sexual minority males reported lower self-efficacy in reaching health goals. Sexual minority females reported lower confidence in positively impacting their own health and lower self-efficacy in setting health goals compared to heterosexual females.
AHRQ-funded; HS023383.
Citation: Luk JW, Parker EO, Richardson LP .
Sexual attraction and experiences in the primary care setting: examining disparities in satisfaction with provider and health self-efficacy.
J Adolesc 2020 Jun;81:96-100. doi: 10.1016/j.adolescence.2020.04.009..
Keywords: Children/Adolescents, Patient Experience, Primary Care, Clinician-Patient Communication, Vulnerable Populations, Disparities
Chan B, Lyles C, Kaplan C
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
In this study, the authors investigated differences in overall and patterns of portal use for patients with resident and attending primary care providers (PCPs). They concluded that given the lower patient-portal use among residents' patients, residency programs should develop curricula to bolster trainee competence in using the patient-portal for communication and to enhance the patient-physician relationship.
AHRQ-funded; HS022981; HS022408.
Citation: Chan B, Lyles C, Kaplan C .
A comparison of electronic patient-portal use among patients with resident and attending primary care providers.
J Gen Intern Med 2018 Dec;33(12):2085-91. doi: 10.1007/s11606-018-4637-x..
Keywords: Clinician-Patient Communication, Education: Continuing Medical Education, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider, Provider: Physician
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
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
Hall TL, Knierim KE, Nease DE
Primary care practices' implementation of patient-team partnership: findings from EvidenceNOW Southwest.
The authors reported on practice characteristics associated with greater patient-team partnership scores. Using EvidenceNOW Southwest data, they found that practices can improve efforts to partner with patients to assess social needs, gather meaningful input on practice improvement and patient experience, and offer resource connections. These findings supplement recent evidence that patient registries and evidence-based guidelines may effectively prevent and manage cardiovascular disease.
AHRQ-funded; HS023904.
Citation: Hall TL, Knierim KE, Nease DE .
Primary care practices' implementation of patient-team partnership: findings from EvidenceNOW Southwest.
J Am Board Fam Med 2019 Jul-Aug;32(4):490-504. doi: 10.3122/jabfm.2019.04.180361..
Keywords: Cardiovascular Conditions, Clinician-Patient Communication, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient and Family Engagement, Primary Care, Quality of Care, Quality Improvement
Tai-Seale M, Olson CW, Li J
Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine.
The researchers used data on physicians' time allocation patterns captured by over thirty-one million EHR transactions in the period 2011-14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients' EHRs. Their results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day.
AHRQ-funded; HS019167.
Citation: Tai-Seale M, Olson CW, Li J .
Electronic health record logs indicate that physicians split time evenly between seeing patients and desktop medicine.
Health Aff 2017 Apr;36(4):655-62. doi: 10.1377/hlthaff.2016.0811.
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Keywords: Clinician-Patient Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Federman AD, Sanchez-Munoz A, Jandorf L
Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design.
The researchers explored patients' and clinicians' perspectives on electronic health record (EHR)-generated outpatient after-visit summaries (AVSs) to inform efforts to maximize the document's utility. They learned that core themes included the use and purpose of the AVS, content modification and prioritization, formatting improvements, customization, privacy and accuracy concerns, and clinician workflow concerns.
AHRQ-funded; HS023844.
Citation: Federman AD, Sanchez-Munoz A, Jandorf L .
Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design.
J Am Med Inform Assoc 2017 Apr;24(e1):e61-e68. doi: 10.1093/jamia/ocw106.
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Keywords: Electronic Health Records (EHRs), Ambulatory Care and Surgery, Primary Care, Clinician-Patient Communication, Education: Patient and Caregiver
Haas JS, Baer HJ, Eibensteiner K
A cluster randomized trial of a personalized multi-condition risk assessment in primary care.
This study evaluated whether collection of risk factors to generate electronic health record (EHR)-linked health risk appraisal (HRA) for coronary heart disease, diabetes, breast cancer, and colorectal cancer was associated with improved patient-provider communication, risk assessment, and plans for breast cancer screening. It concluded that patient-reported risk factors and EHR-linked multi-condition HRAs in primary care can modestly improve communication and promote accuracy of self-perceived risk.
AHRQ-funded; HS018644.
Citation: Haas JS, Baer HJ, Eibensteiner K .
A cluster randomized trial of a personalized multi-condition risk assessment in primary care.
Am J Prev Med 2017 Jan;52(1):100-05. doi: 10.1016/j.amepre.2016.07.013.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Clinician-Patient Communication, Risk
Lee JL, Beach MC, Berger ZD
A qualitative exploration of favorite patients in primary care.
This study ascertained whether physicians have favorite patients, their experiences with such patients, and how such relationships may influence patients and physicians. It found that most participants (22/25) reported having favorite patients. For many physicians, favorite patients were not necessarily the most compliant patients, or those most similar to them. Instead, favorite patients were often very sick patients and/or those who have known their physicians for a long time.
AHRQ-funded; HS000029.
Citation: Lee JL, Beach MC, Berger ZD .
A qualitative exploration of favorite patients in primary care.
Patient Educ Couns 2016 Nov;99(11):1888-93. doi: 10.1016/j.pec.2016.06.023.
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Keywords: Patient Experience, Patient and Family Engagement, Primary Care, Clinician-Patient Communication
Toomey SL, Elliott MN, Schwebel DC
Relationship between adolescent report of patient-centered care and of quality of primary care.
This study investigated whether adolescent self-report of patient-centered care (PCC) varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality. It found that adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. The study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality.
AHRQ-funded; HS020513.
Citation: Toomey SL, Elliott MN, Schwebel DC .
Relationship between adolescent report of patient-centered care and of quality of primary care.
Acad Pediatr 2016 Nov - Dec;16(8):770-76. doi: 10.1016/j.acap.2016.01.006.
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Keywords: Children/Adolescents, Primary Care, Clinician-Patient Communication, Quality of Care, Access to Care
Mabachi NM, Cifuentes M, Barnard J
AHRQ Author: Brach C
Demonstration of the Health Literacy Universal Precautions Toolkit: lessons for quality improvement.
AHRQ’s Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support.
AHRQ-authored.
Citation: Mabachi NM, Cifuentes M, Barnard J .
Demonstration of the Health Literacy Universal Precautions Toolkit: lessons for quality improvement.
J Ambul Care Manage 2016 Jul-Sep;39(3):199-208. doi: 10.1097/jac.0000000000000102..
Keywords: Health Literacy, Quality Improvement, Tools & Toolkits, Primary Care, Clinician-Patient Communication
Robinson JD, Tate A, Heritage J
Agenda-setting revisited: when and how do primary-care physicians solicit patients' additional concerns?
The authors assessed the distribution, content, and effectiveness of physicians' post-chief-complaint, agenda-setting questions. They found that physicians' questions designed to solicit concerns additional to chief concerns occurred in only 32% of visits. Further, those that were formatted so as to allow for 'concerns' were significantly more likely to generate some type of agenda item.
AHRQ-funded; HS010922; HS013343.
Citation: Robinson JD, Tate A, Heritage J .
Agenda-setting revisited: when and how do primary-care physicians solicit patients' additional concerns?
Patient Educ Couns 2016 May;99(5):718-23. doi: 10.1016/j.pec.2015.12.009.
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Keywords: Communication, Primary Care, Patient-Centered Healthcare, Patient Safety, Clinician-Patient Communication
Bae J, Encinosa WE
AHRQ Author: Encinosa WE
National estimates of the impact of electronic health records on the workload of primary care physicians.
This study examines whether electronic health records (EHR) is associated with increases in face time with the patient per visit and increases in the physician's patient volume per week. It found that among young physicians, EHR use is associated with a decline in weekly patient volume, while EHR use among older physicians is associated with an increase in volume, regardless of initial practice size.
AHRQ-authored.
Citation: Bae J, Encinosa WE .
National estimates of the impact of electronic health records on the workload of primary care physicians.
BMC Health Serv Res 2016 May 10;16(1):172. doi: 10.1186/s12913-016-1422-6.
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Keywords: Primary Care, Electronic Health Records (EHRs), Clinician-Patient Communication, Health Information Technology (HIT)
Flieger SP
Implementing the patient-centered medical home in complex adaptive systems: becoming a relationship-centered patient-centered medical home.
The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the patient-centered medical homes (PCMH) model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. It found that becoming a relationship-centered PCMH requires attention to reflection, sensemaking, learning, and collaboration.
AHRQ-funded; HS021385.
Citation: Flieger SP .
Implementing the patient-centered medical home in complex adaptive systems: becoming a relationship-centered patient-centered medical home.
Health Care Manage Rev 2016 Apr/Jun;42(2):112-21. doi: 10.1097/hmr.0000000000000100.
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Keywords: Patient-Centered Healthcare, Primary Care, Clinician-Patient Communication
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
Mirsky JB, Tieu L, Lyles C
Readability assessment of patient-provider electronic messages in a primary care setting.
The purpose of this study was to generate hypotheses about the readability of patient and provider electronic messages. It found that patients used more words in their initial e-mails compared to providers, but the Flesch-Kincaid Grade Levels (FKGLs) were similar, and 68 percent of provider messages were written below an FKGL = 8.
AHRQ-funded; HS023558; HS022408.
Citation: Mirsky JB, Tieu L, Lyles C .
Readability assessment of patient-provider electronic messages in a primary care setting.
J Am Med Inform Assoc 2016 Jan;23(1):202-6. doi: 10.1093/jamia/ocv087.
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Keywords: Communication, Health Information Technology (HIT), Health Literacy, Primary Care, Clinician-Patient Communication
Schussler-Fiorenza Rose SM, Gangnon RE, Chewning B
Increasing discussion rates of incontinence in primary care: a randomized controlled trial.
The study’s aim was to evaluate whether the use of an electronic pelvic floor assessment questionnaire (ePAQ-PF) improves communication about incontinence in primary care. It found that use of the ePAQ-PF prior to clinic visits increases discussion of urinary and fecal incontinence, particularly clinician-initiated discussion.
AHRQ-funded; HS017028.
Citation: Schussler-Fiorenza Rose SM, Gangnon RE, Chewning B .
Increasing discussion rates of incontinence in primary care: a randomized controlled trial.
J Womens Health 2015 Nov;24(11):940-9. doi: 10.1089/jwh.2015.5230..
Keywords: Clinician-Patient Communication, Communication, Primary Care, Women
Baer HJ, Wee CC, DeVito K
Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.
The researchers described the design of a trial to examine the effectiveness of electronic health record-based tools for the assessment and management of overweight and obesity among adult primary care patients, as well as the challenges encountered. New features included reminders to measure height and weight, and an alert asking providers to add overweight or obesity to the problem list.
AHRQ-funded; HS019789.
Citation: Baer HJ, Wee CC, DeVito K .
Design of a cluster-randomized trial of electronic health record-based tools to address overweight and obesity in primary care.
Clin Trials 2015 Aug;12(4):374-83. doi: 10.1177/1740774515578132..
Keywords: Health Information Technology (HIT), Primary Care, Obesity, Electronic Health Records (EHRs), Clinician-Patient Communication
Gillette C, Blalock SJ, Rao JK
Provider-caregiver-child discussions about risks associated with asthma control medications: content and prevalence.
The objectives of the study were to: (1) describe the extent to which primary care pediatric providers discuss risks associated with asthma control medications with families and (2) examine the relationship between child, caregiver, provider, and clinic visit characteristics and discussions about risks associated with asthma control medications. It found that providers discussed asthma control medication risks during 23% of visits.
AHRQ-funded; HS020534.
Citation: Gillette C, Blalock SJ, Rao JK .
Provider-caregiver-child discussions about risks associated with asthma control medications: content and prevalence.
Pediatr Pulmonol 2014 Aug;49(8):727-33. doi: 10.1002/ppul.22892..
Keywords: Medication, Asthma, Children/Adolescents, Clinician-Patient Communication, Primary Care