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
101 to 125 of 126 Research Studies DisplayedMirsky 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
Tieu L, Sarkar U, Schillinger D
Barriers and facilitators to online portal use among patients and caregivers in a safety net health care system: a qualitative study.
The researchers explored patient and caregiver perspectives on online patient portal use before its implementation at San Francisco General Hospital. Despite concerns about security, difficulty understanding medical information, and satisfaction with current communication processes, respondents generally expressed enthusiasm about portal use. Their findings suggest a strong need for training and support to assist vulnerable patients with portal registration and use, particularly those with limited health literacy.
AHRQ-funded; HS022561; HS022047; HS022408.
Citation: Tieu L, Sarkar U, Schillinger D .
Barriers and facilitators to online portal use among patients and caregivers in a safety net health care system: a qualitative study.
J Med Internet Res 2015 Dec 03;17(12):e275. doi: 10.2196/jmir.4847.
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Keywords: Web-Based, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Literacy
Petkovic J, Epstein J, Buchbinder R
Toward ensuring health equity: Readability and cultural equivalence of OMERACT patient-reported outcome measures.
The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM.
AHRQ-funded; HS021110.
Citation: Petkovic J, Epstein J, Buchbinder R .
Toward ensuring health equity: Readability and cultural equivalence of OMERACT patient-reported outcome measures.
J Rheumatol 2015 Dec;42(12):2448-59. doi: 10.3899/jrheum.141168.
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Keywords: Patient-Centered Outcomes Research, Outcomes, Health Literacy
Hahn EA, Burns JL, Jacobs EA
Health literacy and patient-reported outcomes: a cross-sectional study of underserved English- and Spanish-speaking patients with type 2 diabetes.
The investigators examined associations between patient characteristics, health behaviors, and health outcomes and explored the role of health literacy as a potential mediator of outcomes. They found that health literacy was not associated with diabetes self-care, health status, or satisfaction with communication, and it did not mediate the effects of other factors on these outcomes. Diabetes self-efficacy was significantly associated with health behaviors and outcomes. The association between Spanish language preference and poorer health was not mediated by this group's lower health literacy.
AHRQ-funded; HS019335.
Citation: Hahn EA, Burns JL, Jacobs EA .
Health literacy and patient-reported outcomes: a cross-sectional study of underserved English- and Spanish-speaking patients with type 2 diabetes.
J Health Commun 2015;20 Suppl 2:4-15. doi: 10.1080/10810730.2015.1061071.
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Keywords: Communication, Diabetes, Health Literacy, Patient-Centered Outcomes Research, Racial and Ethnic Minorities
Brega AG, Freedman MA, LeBlanc WG
AHRQ Author: Brach C
Using the Health Literacy Universal Precautions Toolkit to improve the quality of patient materials.
The researchers conducted interviews to learn about practices’ implementation activities and assessed the readability, understandability, and actionability of patient education materials collected during pre- and postimplementation site visits. They found that many of the revised and newly developed documents had reading levels appropriate for most patients and better readability than the original materials.
AHRQ-authored.
Citation: Brega AG, Freedman MA, LeBlanc WG .
Using the Health Literacy Universal Precautions Toolkit to improve the quality of patient materials.
J Health Commun 2015 Oct;20 Suppl 2:69-76. doi: 10.1080/10810730.2015.1081997..
Keywords: Health Literacy, Education: Patient and Caregiver, Quality of Care
Goodman MS, Griffey RT, Carpenter CR
Do subjective measures improve the ability to identify limited health literacy in a clinical setting?
The researchers assessed whether the addition of Single-Item Literacy Screener (SILS) items or the Brief Health Literacy Screen (BHLS) to patient demographics readily available in ambulatory clinical settings reaching underserved patients improves the ability to identify limited health literacy. Their findings suggest that the BHLS and SILS items improve the ability to identify patients with limited health literacy compared with demographic predictors alone.
AHRQ-funded; HS020309.
Citation: Goodman MS, Griffey RT, Carpenter CR .
Do subjective measures improve the ability to identify limited health literacy in a clinical setting?
J Am Board Fam Med 2015 Sep-Oct;28(5):584-94. doi: 10.3122/jabfm.2015.05.150037..
Keywords: Health Literacy, Vulnerable Populations
Fink A, Beck JC
Developing and evaluating a website to guide older adults in their health information searches: a mixed-methods approach.
This mixed-methods study developed and evaluated an online program to improve older adults’ skills in identifying high-quality web-based health information. It found that experimental participants assigned significantly higher ratings of usability and learning to the new site than controls did to their tutorial although no differences were found in self-efficacy or knowledge.
AHRQ-funded; HS019745.
Citation: Fink A, Beck JC .
Developing and evaluating a website to guide older adults in their health information searches: a mixed-methods approach.
J Appl Gerontol 2015 Aug;34(5):633-51. doi: 10.1177/0733464813486961..
Keywords: Elderly, Web-Based, Health Information Technology (HIT), Health Literacy
Mueller SK, Giannelli K, Boxer R
Readability of patient discharge instructions with and without the use of electronically available disease-specific templates.
The investigators examined the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. They concluded that the use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion.
AHRQ-funded; HS023331.
Citation: Mueller SK, Giannelli K, Boxer R .
Readability of patient discharge instructions with and without the use of electronically available disease-specific templates.
J Am Med Inform Assoc 2015 Jul;22(4):857-63. doi: 10.1093/jamia/ocv005.
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Keywords: Education: Patient and Caregiver, Health Literacy, Hospital Discharge, Patient Safety
Slota C, Sayner R, Vitko M
Glaucoma patient expression of medication problems and nonadherence.
The purpose of this article was to evaluate what patient characteristics led patients to express (1) medication problems, including difficulty with side effects and eye drop administration, and (2) problems with nonadherence to glaucoma medications. It found that patients with lower health literacy are less likely to express medication-related problems and patients who express medication problems often express nonadherence.
AHRQ-funded; HS023054.
Citation: Slota C, Sayner R, Vitko M .
Glaucoma patient expression of medication problems and nonadherence.
Optom Vis Sci 2015 May;92(5):537-43. doi: 10.1097/opx.0000000000000574..
Keywords: Eye Disease and Health, Patient Adherence/Compliance, Medication, Health Literacy
Kestenbaum LA, Feemster KA
Identifying and addressing vaccine hesitancy.
Despite, and perhaps because of, their public health impact, an increasing number of parents and patients are choosing to delay or refuse vaccines. These individuals are described as “vaccine hesitant.” This review explores the history of vaccine hesitancy, its causes, and suggests approaches for reducing hesitancy and strengthening vaccine acceptance.
AHRQ-funded; HS020939.
Citation: Kestenbaum LA, Feemster KA .
Identifying and addressing vaccine hesitancy.
Pediatr Ann 2015 Apr;44(4):e71-5. doi: 10.3928/00904481-20150410-07..
Keywords: Vaccination, Health Literacy, Patient Adherence/Compliance
Heerman WJ, White RO, Barkin SL
Advancing informed consent for vulnerable populations.
The authors suggest an innovative approach that uses low health-literacy communication strategies and visual aids to augment and potentially replace the traditional approach to informed consent. This approach involves: (1) the use of effective health communication and low-literacy techniques, (2) the use of visual aids and graphics to promote understanding and guide the reader toward key study concepts, and (3) careful attention to child dissenting behaviors.
AHRQ-funded; HS022990.
Citation: Heerman WJ, White RO, Barkin SL .
Advancing informed consent for vulnerable populations.
Pediatrics 2015 Mar;135(3):e562-4. doi: 10.1542/peds.2014-3041..
Keywords: Children/Adolescents, Communication, Health Literacy, Obesity, Research Methodologies
Lyles CR, Sarkar U
Health literacy, vulnerable patients, and health information technology use: where do we go from here?
The authors comment on an article in the same issue that found only 32 percent of older adults used the Internet to get health information and only 10 percent of older adults with limited health literacy did so. They discuss its implications for the related issues of access, training, and perhaps most importantly, the usability of websites and other technology platforms.
AHRQ-funded; HS023558; HS022047.
Citation: Lyles CR, Sarkar U .
Health literacy, vulnerable patients, and health information technology use: where do we go from here?
J Gen Intern Med 2015 Mar;30(3):271-2. doi: 10.1007/s11606-014-3166-5..
Keywords: Health Literacy, Education: Patient and Caregiver, Elderly, Health Information Technology (HIT)
Smith W, Brach C, Horowitz AM
AHRQ Author: Brach C
Poor oral health literacy: why nobody understands you.
The authors examined the mistaken interpretation of the word “individuals” to be limited almost exclusively to citizens and patients. They identified gaps in knowledge, understanding, and practices regarding caries prevention among the public and all provider groups.
AHRQ-authored.
Citation: Smith W, Brach C, Horowitz AM .
Poor oral health literacy: why nobody understands you.
J Dent Hyg 2015 Feb;89 Suppl 1:36-8.
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Keywords: Dental and Oral Health, Health Literacy, Prevention
Dorn SD, Palsson OS, Woldeghebriel M
Development and pilot testing of an integrated, web-based self-management program for irritable bowel syndrome (IBS).
The researchers developed, assessed, and refined an integrated IBS self-management program (IBS Self-care) and then conducted a 12-week pilot test. They found that the IBS Self-Care program was well received by users who after 12 weeks reported improved knowledge about IBS, but no significant changes in self-efficacy or quality of life.
AHRQ-funded; HS019468.
Citation: Dorn SD, Palsson OS, Woldeghebriel M .
Development and pilot testing of an integrated, web-based self-management program for irritable bowel syndrome (IBS).
Neurogastroenterol Motil 2015 Jan;27(1):128-34. doi: 10.1111/nmo.12487..
Keywords: Patient Self-Management, Health Literacy, Education: Patient and Caregiver, Digestive Disease and Health
Halverson JL, Martinez-Donate AP, Palta M
Health literacy and health-related quality of life among a population-based sample of cancer patients.
The authors examined the relation between health literacy and health-related quality of life among cancer patients. Their cross-sectional survey found that health literacy is positively and independently associated with health-related quality of life among cancer patients. Their findings support adoption of health literacy best practices by cancer care systems.
AHRQ-funded; HS000083.
Citation: Halverson JL, Martinez-Donate AP, Palta M .
Health literacy and health-related quality of life among a population-based sample of cancer patients.
J Health Commun 2015;20(11):1320-9. doi: 10.1080/10810730.2015.1018638..
Keywords: Health Literacy, Quality of Life, Cancer
Albrecht JS, Gruber-Baldini AL, Hirshon JM
Hospital discharge instructions: comprehension and compliance among older adults.
The purpose of this prospective cohort study was to quantify the prevalence of non-comprehension and non-compliance with discharge instructions and to identify associated patient characteristics. The investigators concluded that non-comprehension of discharge instructions among older adults was prevalent, multi-factorial, and varies by domain.
AHRQ-funded; HS021068.
Citation: Albrecht JS, Gruber-Baldini AL, Hirshon JM .
Hospital discharge instructions: comprehension and compliance among older adults.
J Gen Intern Med 2014 Nov;29(11):1491-8. doi: 10.1007/s11606-014-2956-0..
Keywords: Elderly, Health Literacy, Hospital Discharge, Patient Adherence/Compliance
Griffey RT, Kennedy SK, D'Agostino McGowan L, Good RT, Kennedy SK, D'Agostino McGowan L
Is low health literacy associated with increased emergency department utilization and recidivism?
The study objective was to determine whether patients with low health literacy have higher emergency department (ED) use and higher ED recidivism than patients with adequate health literacy. It found that patients with inadequate health literacy had higher ED use compared to those with adequate health literacy.
AHRQ-funded; HS020309
Citation: Griffey RT, Kennedy SK, D'Agostino McGowan L, Good RT, Kennedy SK, D'Agostino McGowan L .
Is low health literacy associated with increased emergency department utilization and recidivism?
Acad Emerg Med. 2014 Oct;21(10):1109-15. doi: 10.1111/acem..
Keywords: Health Literacy, Emergency Department, Emergency Medical Services (EMS), Healthcare Utilization
Barton JL, Trupin L, Tonner C
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
The objective of this study was to examine patterns of perceived communication around decision making in 2 cohorts of adults with rheumatoid arthritis (RA). The investigators found that nearly one-third of subjects reported suboptimal shared decision making communication (SDM) with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts.
AHRQ-funded; HS019209.
Citation: Barton JL, Trupin L, Tonner C .
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
J Rheumatol 2014 Jul;41(7):1290-7. doi: 10.3899/jrheum.131350..
Keywords: Arthritis, Clinician-Patient Communication, Communication, Decision Making, Health Literacy, Patient and Family Engagement
Barton JL, Trupin L, Tonner C
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
The objective of this study was to examine patterns of perceived communication around decision making in 2 cohorts of adults with rheumatoid arthritis (RA). The investigators found that nearly one-third of subjects reported suboptimal shared decision making communication (SDM) with their clinicians, regardless of cohort. Lower trust in physician was independently associated with suboptimal SDM communication in both cohorts.
AHRQ-funded; HS019209.
Citation: Barton JL, Trupin L, Tonner C .
English language proficiency, health literacy, and trust in physician are associated with shared decision making in rheumatoid arthritis.
J Rheumatol 2014 Jul;41(7):1290-7. doi: 10.3899/jrheum.131350..
Keywords: Arthritis, Clinician-Patient Communication, Communication, Decision Making, Health Literacy, Patient and Family Engagement
Brach C
AHRQ Author: Brach C
A daughter's frustration with the dearth of patient- and family-centered care.
This article is a first-person account of a hospitalization that describes the lack of patient and family inclusion in decision-making, failure to use plain language and other health literacy strategies, and disregard for patient and family preferences. The author concludes that if the health care system is going to shift from paternalistic to patient- and family-centered, providers must be trained in how to communicate and partner with patients and families. The author references resources to help hospitals make systematic changes to hard wire health literate and patient- and family-centered care.
AHRQ-authored.
Citation: Brach C .
A daughter's frustration with the dearth of patient- and family-centered care.
Patient Exp J 2014 Apr 1;1(1):43-47.
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Keywords: Healthcare Delivery, Decision Making, Health Literacy, Patient and Family Engagement, Patient-Centered Healthcare
Brach C, Dreyer BP, Schillinger D
AHRQ Author: Brach C
Physicians' roles in creating health literate organizations: a call to action.
Physicians are being called on to deliver patient-centered care, reduce medical errors, and generally increase health care quality and health outcomes, all while containing costs. Fully engaging patients in prevention, decision-making and self-management activities is critical to achieving these aims. The authors of this paper concluded that being health literate must be a new way of delivering care rather than an add-on. For national health literacy goals to be met, health care organizations must ingrain health literacy into their routines.
AHRQ-authored.
Citation: Brach C, Dreyer BP, Schillinger D .
Physicians' roles in creating health literate organizations: a call to action.
J Gen Intern Med 2014 Feb;29(2):273-5. doi: 10.1007/s11606-013-2619-6.
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Keywords: Healthcare Delivery, Decision Making, Health Literacy, Patient and Family Engagement, Patient-Centered Healthcare
Shoemaker SJ, Staub-DeLong L, Wasserman M
Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.
The purpose of this study is to understand the facilitators and barriers to the adoption and implementation of AHRQ’s health literacy tools, particularly a tool to assess a pharmacy’s health literacy practices. The study found facilitators including awareness of health literacy, a culture of innovation, and a change champion. It also identified barriers such as lack of leadership support and limited staff time.
AHRQ-funded; 290200600011I
Citation: Shoemaker SJ, Staub-DeLong L, Wasserman M .
Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.
Res Social Adm Pharm. 2013 Sep-Oct;9(5):553-63. doi: 10.1016/j.sapharm.2013.05.003..
Keywords: Health Literacy, Education: Patient and Caregiver, Practice Patterns, Tools & Toolkits, Medication
Baur C, Brach C
AHRQ Author: Brach C
Pharmacy research on health literacy can contribute to national goals and health care system improvements.
Three key points about health literacy underscore the articles in this special issue: 1. Effective health communication utilizes both the spoken and written word; 2. A number of health literacy tools can help pharmacists implement health literacy practices; 3. Readability assessments can be a step on a path toward more productive provider–patient communication.
AHRQ-authored.
Citation: Baur C, Brach C .
Pharmacy research on health literacy can contribute to national goals and health care system improvements.
Res Social Adm Pharm 2013 Sep-Oct;9(5):498-502. doi: 10.1016/j.sapharm.2013.06.012.
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Keywords: Healthcare Delivery, Communication, Health Literacy, Provider: Pharmacist
Robertson J, Farris KB, Schultz SK
Older adults' views about "Managing Your Medications" booklet.
The objective of the study was to evaluate the Managing Your Medications (MYM) booklet to improve medication management. Older adults reported it was comprehensible and 17 percent reported behavioral intentions to change their current actions regarding medications. Overall, 12.7 percent of respondents agreed that MYM changed their opinion of the topic. The most popular means to dis¬seminate were doctors’ offices and senior citizens’ centers.
AHRQ-funded; HS016094.
Citation: Robertson J, Farris KB, Schultz SK .
Older adults' views about "Managing Your Medications" booklet.
J Appl Gerontol 2013 Apr;32(3):370-82. doi: 10.1177/0733464811421910..
Keywords: Elderly, Education: Patient and Caregiver, Health Literacy, Medication
Koh HK, Brach C, Harris LM
AHRQ Author: Brach C
A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care.
The researchers proposed a Health Literate Care Model that would weave health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model). Their new model calls for approaching all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them, and then confirming and ensuring patients' understanding. They suggested that health literacy would then become an organizational value infused into all aspects of planning and operations. They also proposed a measurement framework to track the impact of the new Health Literate Care Model on patient outcomes and quality of care.
AHRQ-authored.
Citation: Koh HK, Brach C, Harris LM .
A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care.
Health Aff 2013 Feb;32(2):357-67. doi: 10.1377/hlthaff.2012.1205.
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Keywords: Healthcare Delivery, Decision Making, Education: Patient and Caregiver, Health Literacy, Primary Care: Models of Care, Patient and Family Engagement