National Healthcare Quality and Disparities Report
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- Burnout (1)
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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 10 of 10 Research Studies DisplayedVu K, Zhou J, Everhart A
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
Variation in de-adoption of ineffective or unsafe treatments is not well-understood. In this study the investigators examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA's revision of its safety warning. The investigators found that physician specialty had a dominant role in prescribing decision, and specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.
AHRQ-funded; HS025164.
Citation: Vu K, Zhou J, Everhart A .
Uptake of evidence by physicians: de-adoption of erythropoiesis-stimulating agents after the TREAT trial.
BMC Nephrol 2021 Aug 21;22(1):284. doi: 10.1186/s12882-021-02491-y..
Keywords: Evidence-Based Practice, Medication: Safety, Medication, Patient Safety, Practice Patterns, Provider: Physician
Dymek C, Kim B, Melton GB
AHRQ Author: Dymek C, Hsiao CJ
Building the evidence-base to reduce electronic health record-related clinician burden.
This paper looks at the evidence-base to reduce electronic health record-related (EHR-related) clinician burden. Evidence-based informatics approaches, pragmatic next steps, and future research directions are presented to improve three of the highest contributors to EHR burden: documentation, chart review, and inbox tasks. Perspectives are also offered on how EHR vendors, healthcare system leaders, and policymakers can play an integral role to make EHR easier to use.
AHRQ-authored; AHRQ-funded; HS027363.
Citation: Dymek C, Kim B, Melton GB .
Building the evidence-base to reduce electronic health record-related clinician burden.
J Am Med Inform Assoc 2021 Apr 23;28(5):1057-61. doi: 10.1093/jamia/ocaa238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Evidence-Based Practice, Provider: Clinician, Provider: Physician, Provider
Ehlers AP, Vitous CA, Sales A
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
Investigators explored factors associated with surgeon choice of approach (minimally invasive vs open) in inguinal hernia repair as a tool to gain an understanding of guideline-discordant care. They found that decision-making for the approach to inguinal hernia repair was largely influenced by surgeon preference and access to resources rather than patient factors. Although a one-size-fits-all approach is not recommended, the operative approach should ideally be informed by patient factors, including hernia characteristics. They recommended addressing surgeon preference and available resources with a clinician-facing decision aid to provide an opportunity to optimize care for patients undergoing inguinal hernia repair.
AHRQ-funded; HS025778.
Citation: Ehlers AP, Vitous CA, Sales A .
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
JAMA Netw Open 2020 Nov 2;3(11):e2023684. doi: 10.1001/jamanetworkopen.2020.23684..
Keywords: Surgery, Guidelines, Provider: Physician, Provider, Decision Making, Evidence-Based Practice
Kapoor N, Lacson R, Hammer M
Physician agreement with recommendations contained in a national guideline for the management of incidental pulmonary nodules: a case study.
This survey of physicians was used to determine agreement with recommendations in the national guideline for the management of incidental pulmonary nodules from the 2017 Fleischner Society Guidelines for Management of Incident Pulmonary Nodules (FSG). The FSG contains 18 unique recommendations which were codified into a clinical evidence logic statement (CELS) for this study. The FSG also included ratings for strength of evidence based on the American Society of Chest Physicians grading system. In order to internally grade the strength of evidence behind each recommendation, two medical librarians from the Harvard Library of Evidence analyzed each CELS independently and graded the recommendations based on the supporting clinical studies using the Oxford Centre for Evidence-Based levels of evidence and the US Preventive Service Task Force I-scores. Nine physicians from a single large academic institution were then surveyed via SurveyMonkey to assess agreement with each of the 18 CELS. Agreement on each recommendation ranged from 0 to 100%. This study was meant to be exploratory and to test the hypothesis that guideline nonadherence may be partly affected by lack of physician agreement with guideline component recommendations.
AHRQ-funded; HS024722.
Citation: Kapoor N, Lacson R, Hammer M .
Physician agreement with recommendations contained in a national guideline for the management of incidental pulmonary nodules: a case study.
J Am Coll Radiol 2020 Nov;17(11):1437-42. doi: 10.1016/j.jacr.2020.07.020..
Keywords: U.S. Preventive Services Task Force (USPSTF), Guidelines, Evidence-Based Practice, Respiratory Conditions, Practice Patterns, Provider: Physician, Provider
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
AHRQ-funded; HS025701.
Citation: Westafer LM, Kunz A, Bugajska P .
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Rogers ES, Cuthel AM, Berry CA
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
This study examined the effectiveness of practice facilitation to improve cardiovascular disease in 257 small independent primary care practices (SIPs) enrolled in the AHRQ-funded EvidenceNOW initiative called HealthyHearts. These SIPs were enrolled in HealthyHearts NYC in New York City. Interviews were conducted with SIPs with 3 or fewer office staff and their answers were compared with interviews with practices with more than 3 office staff. Three facilitation benefits were found to the most important, including 1. Creating awareness of quality gaps; 2. Connecting practices to information, resources, and strategies, and; 3. Optimizing the HER for QI goals.
AHRQ-funded; HS023922.
Citation: Rogers ES, Cuthel AM, Berry CA .
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S17-s23. doi: 10.1370/afm.2427..
Keywords: Primary Care, Provider: Clinician, Provider: Physician, Provider, Quality Improvement, Quality of Care, Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Armstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
McCreedy EM, Kane RL, Gollust SE
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explored how patient characteristics associated with a high risk-to-benefit ratio with hypoglycemia medications affected decision making by primary care clinicians. The investigators found that primary care clinicians often chose to intensify glycemic control despite individual patient factors that warranted higher glycemic targets based on existing guidelines.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Kane RL, Gollust SE .
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
J Am Board Fam Med 2018 Mar-Apr;31(2):192-200. doi: 10.3122/jabfm.2018.02.170141..
Keywords: Diabetes, Elderly, Patient-Centered Healthcare, Guidelines, Evidence-Based Practice, Decision Making, Medication, Primary Care, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Ganiats TG, Bierman AS
AHRQ Author: Ganiats TG, Bierman AS
AHRQ's tools for better practice: helping family physicians manage today's challenges.
AHRQ is engaged in the dissemination and widespread implementation of what works in primary care. The agency’s main point of contact with the primary care community is the National Center for Excellence in Primary Care Research (NCEPCR). The authors discuss the variety of tools and resources made available by the NCEPCR.
AHRQ-authored.
Citation: Ganiats TG, Bierman AS .
AHRQ's tools for better practice: helping family physicians manage today's challenges.
Am Fam Physician 2017 Nov 1;96(9):569-70.
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Keywords: Communication, Evidence-Based Practice, Provider: Physician, Primary Care, Tools & Toolkits
Varghese TK, Jr., Ghaferi AA
Cutting-edge efforts in surgical patient safety.
In October, 2015, the Surgical Outcomes Club convened a patient safety panel in Chicago, Illinois. The goal was to emphasize that patient safety efforts require a uniform, systematic, evidence-based approach. This article incorporates the major themes of the session—developing reliable measures of surgeon performance, real-world methods for continuous improvement and learning, and opportunities for incorporating the principles of implementation science into patient safety efforts.
AHRQ-funded; HS023621; HS024403.
Citation: Varghese TK, Jr., Ghaferi AA .
Cutting-edge efforts in surgical patient safety.
JAMA Surg 2017 Aug;152(8):719-20. doi: 10.1001/jamasurg.2017.0858.
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Keywords: Patient-Centered Outcomes Research, Surgery, Patient Safety, Evidence-Based Practice, Provider: Physician, Provider