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Search All Research Studies
Topics
- Antibiotics (2)
- Asthma (1)
- Blood Clots (1)
- Brain Injury (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (1)
- (-) Clinical Decision Support (CDS) (15)
- COVID-19 (2)
- Decision Making (6)
- Diagnostic Safety and Quality (4)
- Elderly (2)
- Electronic Health Records (EHRs) (3)
- (-) Emergency Department (15)
- Evidence-Based Practice (1)
- Falls (2)
- Guidelines (1)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (11)
- Heart Disease and Health (1)
- Hospitalization (1)
- Imaging (2)
- Implementation (2)
- Medication (2)
- Outcomes (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (1)
- Pneumonia (1)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (3)
- Risk (1)
- Sepsis (1)
- Workflow (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 15 of 15 Research Studies DisplayedHekman DJ, Cochran AL, Maru AP
Effectiveness of an emergency department-based machine learning clinical decision support tool to prevent outpatient falls among older adults: protocol for a quasi-experimental study.
This article described a research protocol for evaluating the effectiveness of an automated screening and referral intervention tool for patients receiving falls risk intervention. The study will attempt to quantify the impact of a machine learning (ML) clinical decision support intervention on patient behavior and outcomes. The primary analysis will obtain referral completion rates from different emergency departments. The findings will inform ongoing discussion on the use of ML and artificial intelligence to augment medical decision-making.
AHRQ-funded; HS027735.
Citation: Hekman DJ, Cochran AL, Maru AP .
Effectiveness of an emergency department-based machine learning clinical decision support tool to prevent outpatient falls among older adults: protocol for a quasi-experimental study.
JMIR Res Protoc 2023 Aug 3; 12:e48128. doi: 10.2196/48128..
Keywords: Clinical Decision Support (CDS), Emergency Department, Health Information Technology (HIT), Elderly, Falls
Krishnan JA, Margellos-Anast H, Kumar R
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
The purpose of this clinical trial was to compare an emergency-department- (ED) only intervention and home visits by community health workers for 6 months (ED-plus-home) and enhanced usual care (UC). The study enrolled children aged 5 to 11 years with uncontrolled asthma. The primary outcomes were change over 6 months in the Patient-Reported Outcomes Measurement Information System Asthma Impact Scale score in children and Satisfaction with Participation in Social Roles score in caregivers. The secondary outcomes included guideline-recommended ED discharge care and self-management. The study found that of the 373 children recruited, only 63% completed the 6-month follow-up visit. Differences in Asthma Impact Scores or caregivers' Satisfaction with Participation in Social Roles scores were not significant. However, in the intervention groups guideline-recommended ED discharge care improved significantly versus in the UC group, and self-management behaviors were significantly improved in the ED-plus-home group versus in the ED-only and UC groups.
AHRQ-funded; HS027804.
Citation: Krishnan JA, Margellos-Anast H, Kumar R .
Coordinated Health Care Interventions for Childhood Asthma Gaps in Outcomes (CHICAGO) plan.
J Allergy Clin Immunol Glob 2023 Aug; 2(3). doi: 10.1016/j.jacig.2023.100100..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT), Racial and Ethnic Minorities
Lee AH, McEvoy DS, Stump T
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
This study analyzed the influence of clinical decision support (CDS) to prevent delays in second doses of broad-spectrum antibiotics in the emergency department (ED). The authors allocated adult patients who received cefepime or piperacillin/tazobactam in 9 EDs within an integrated health care system to an electronic alert that reminded ED clinicians to reorder antibiotics at the appropriate interval vs usual care. Primary outcome was a median delay in antibiotic administration, and secondary outcomes were rates of intensive care unit (ICU) admission, hospital mortality, and hospital length of stay. A total of 1,113 ED patients treated with cefepime or piperacillin/tazobactam were enrolled in the study, of whom 420 remained under ED care when their second dose was due. The electronic alert system was associated with reduced antibiotic delays, but there were no differences in ICU transfers, inpatient mortality, or hospital length of stay.
AHRQ-funded; HS027170.
Citation: Lee AH, McEvoy DS, Stump T .
Implementation of an electronic alert to improve timeliness of second dose antibiotics for patients with suspected serious infections in the emergency department: a quasi-randomized controlled trial.
Ann Emerg Med 2023 Apr;81(4):485-91. doi: 10.1016/j.annemergmed.2022.10.022.
Keywords: Antibiotics, Medication, Emergency Department, Clinical Decision Support (CDS), Health Information Technology (HIT)
Dutta S, McEvoy DS, Rubins DM
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
This paper discusses the outcomes of using a clinical decision support (CDS) tool that was implemented in emergency departments (EDs) for sepsis patients to remind healthcare staff to take blood cultures before administration of intravenous (IV) antibiotics. The study compared timely blood culture collection outcomes prior to IV antibiotics for 54,538 adult ED patients 1 year before and after a CDS intervention implementation in the electronic health record. The baseline phase found that 46.1% had blood cultures prior to IV antibiotics, compared to 58.8% after the intervention. The CDS improved blood culture collection rates without increasing overutilization.
AHRQ-funded; HS02717.
Citation: Dutta S, McEvoy DS, Rubins DM .
Clinical decision support improves blood culture collection before intravenous antibiotic administration in the emergency department.
J Am Med Inform Assoc 2022 Sep 12;29(10):1705-14. doi: 10.1093/jamia/ocac115..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Antibiotics, Emergency Department, Medication, Sepsis
Hinson JS, Klein E, Smith A
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
This study’s objective was to develop, implement, and evaluate an electronic health record (EHR) embedded clinical decision support (CDS) system that leveraged machine learning (ML) to estimate short-term risk for clinical deterioration in patients with or under investigation for COVID-19. The system translates model-generated risk for critical care needs within 24 hours and inpatient care needs within 72 hours into rapidly interpretable COVID-19 Deterioration Risk Levels made viewable within ED clinician workflow. A retrospective cohort of 21,452 ED patients who visited one of five ED study sites was used to derive ML models and were prospectively validated in 15,670 ED visits that occurred before (n = 4322) or after (n = 11,348) CDS implementation. Model performance and numerous patient-oriented outcomes including in-hospital mortality were measured across study periods. ML model performance was excellent under all conditions. AUC ranged from 0.85 to 0.91 for prediction of critical care needs and 0.80-0.90 for inpatient care needs. Total mortality was unchanged across study periods but was reduced among high-risk patients after the implementation.
AHRQ-funded; HS026640.
Citation: Hinson JS, Klein E, Smith A .
Multisite implementation of a workflow-integrated machine learning system to optimize COVID-19 hospital admission decisions.
NPJ Digit Med 2022 Jul 16;5(1):94. doi: 10.1038/s41746-022-00646-1..
Keywords: COVID-19, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation, Electronic Health Records (EHRs), Emergency Department, Decision Making
Jacobsohn GC, Leaf M, Liao F
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
The authors used a collaborative and iterative approach to design and implement an automated clinical decision support system (CDS) for Emergency Department (ED) providers to identify and refer older adult ED patients at high risk of future falls. The system was developed using collaborative input from an interdisciplinary design team and integrated seamlessly into existing ED workflows. A key feature of development was the unique combination of patient experience strategies, human-centered design, and implementation science, which allowed for the CDS tool and intervention implementation strategies to be designed simultaneously. Challenges included: usability problems, data inaccessibility, time constraints, low appointment availability, high volume of patients, and others. The study concluded that using the collaborative, iterative approach was successful in achieving all project goals, and could be applied to other cases.
AHRQ-funded; HS024558.
Citation: Jacobsohn GC, Leaf M, Liao F .
Collaborative design and implementation of a clinical decision support system for automated fall-risk identification and referrals in emergency departments.
Healthc 2022 Mar;10(1):100598. doi: 10.1016/j.hjdsi.2021.100598..
Keywords: Elderly, Clinical Decision Support (CDS), Decision Making, Falls, Risk, Emergency Department, Health Information Technology (HIT)
Salwei ME, Carayon P, Hoonakker PLT
Workflow integration analysis of a human factors-based clinical decision support in the emergency department.
Numerous challenges with the implementation, acceptance, and use of health IT are related to poor usability and a lack of integration of the technologies into clinical workflow, and have, therefore, limited the potential of these technologies to improve patient safety. In this paper, the investigators propose a definition and conceptual model of health IT workflow integration. Using interviews of 12 emergency department (ED) physicians, they identified 134 excerpts of barriers and facilitators to workflow integration of a human factors (HF)-based clinical decision support (CDS) implemented in the ED.
AHRQ-funded; HS022086.
Citation: Salwei ME, Carayon P, Hoonakker PLT .
Workflow integration analysis of a human factors-based clinical decision support in the emergency department.
Appl Ergon 2021 Nov;97:103498. doi: 10.1016/j.apergo.2021.103498..
Keywords: Emergency Department, Workflow, Clinical Decision Support (CDS), Health Information Technology (HIT), Implementation
Soares WE, Knee A, Gemme SR
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
The HEART score is a risk stratification aid that may safely reduce chest pain admissions for emergency department patients. However, differences in interpretation of subjective components potentially alters the performance of the score. In this study, the investigators compared agreement between HEART scores determined during clinical practice with research-generated scores and estimated their accuracy in predicting 30-day major adverse cardiac events.
AHRQ-funded; HS024815.
Citation: Soares WE, Knee A, Gemme SR .
SC, et al. A prospective evaluation of Clinical HEART score agreement, accuracy, and adherence in emergency department chest pain patients.
Ann Emerg Med 2021 Aug;78(2):231-41. doi: 10.1016/j.annemergmed.2021.03.024..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Emergency Department, Diagnostic Safety and Quality, Clinical Decision Support (CDS), Health Information Technology (HIT)
Joshi RP, Pejaver V, Hammarlund NE
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
This retrospective case-control study investigated whether the use of a prediction tool based on complete blood count results and patient sex can better allocate testing for SARS-CoV-2 PCR testing in hospital emergency departments. Participants were emergency department patients who had concurrent complete blood counts and SARS-CoV-2 PCR testing in Northern California, Seattle, Washington, Chicago Illinois, and South Korea. A hypothetical scenario of 1000 patients requiring testing was developed, but in this scenario testing resources are limited to 60% of patients. This tool would allow a 33% increase in properly allocated resources.
AHRQ-funded; HS026385.
Citation: Joshi RP, Pejaver V, Hammarlund NE .
A predictive tool for identification of SARS-CoV-2 PCR-negative emergency department patients using routine test results.
J Clin Virol 2020 Aug;129:104502. doi: 10.1016/j.jcv.2020.104502..
Keywords: Emergency Department, COVID-19, Pneumonia, Respiratory Conditions, Diagnostic Safety and Quality, Clinical Decision Support (CDS)
Carayon P, Hoonakker P, Hundt AS
Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study.
This study used a scenario-based simulation to compare a human factor (HF)-based clinician decision support (CDS) with a web-based CDS (MDCalc) for clinicians to diagnose pulmonary embolism (PE) in the emergency department. A total of 32 emergency physicians participated using both CDS types. Emergency physicians made more appropriate diagnoses decisions with the PE-Dx CDS (94%) than with the web-based CDS (84%). Experimental tasks were also performed faster (average 96 seconds per scenario versus 117 seconds). They also reported lower workload and higher satisfaction with the HF-based CDS.
AHRQ-funded; HS024342; HS024558; HS022086.
Citation: Carayon P, Hoonakker P, Hundt AS .
Application of human factors to improve usability of clinical decision support for diagnostic decision-making: a scenario-based simulation study.
BMJ Qual Saf 2020 Apr;29(4):329-40. doi: 10.1136/bmjqs-2019-009857..
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Diagnostic Safety and Quality, Emergency Department
Cochran AL, Rathouz PJ, Kocher KE
A latent variable approach to potential outcomes for emergency department admission decisions.
The authors sought to provide a general framework to evaluate admission decisions from electronic healthcare records. They estimated that while admitting a patient with higher latent needs reduced the 30-day risk of revisiting the emergency department or later being admitted through the emergency department by over 79%, admitting a patient with lower latent needs actually increased these 30-day risks by 3.0% and 7.6%, respectively.
AHRQ-funded; HS024160.
Citation: Cochran AL, Rathouz PJ, Kocher KE .
A latent variable approach to potential outcomes for emergency department admission decisions.
Stat Med 2019 Sep 10;38(20):3911-35. doi: 10.1002/sim.8210..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Clinical Decision Support (CDS), Decision Making, Hospitalization
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Patterson BW, Pulia MS, Ravi S
Scope and influence of electronic health record-integrated clinical decision support in the emergency department: a systematic review.
This systematic review examined the scope and influence of electronic health record-integrated clinical decision support (CDS) technologies implemented in hospital emergency departments. A literature search was conducted using 4 databases from the inception of these CDS systems through January 2018. Out of 2,558 potential studies identified, 42 met inclusion criteria. Common uses for CDS technologies included medication and radiology ordering practices, and more comprehensive systems supporting diagnosis and treatment for specific diseases. The majority of studies (83%) reported positive effects on outcomes, with most studies using a pre-post experimental design (76%). The authors concluded that although most studies show positive effects of CDS technologies, many of the studies were small and poorly controlled.
AHRQ-funded; HS024342; HS024558; HS022086.
Citation: Patterson BW, Pulia MS, Ravi S .
Scope and influence of electronic health record-integrated clinical decision support in the emergency department: a systematic review.
Ann Emerg Med 2019 Aug;74(2):285-96. doi: 10.1016/j.annemergmed.2018.10.034..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department
Sharp AL, Huang BZ, Tang T
Implementation of the Canadian CT Head Rule and Its association with use of computed tomography among patients with head injury.
The researchers evaluated the association of implementation of the Canadian CT Head Rule on head computed tomography (CT) imaging in community emergency departments (EDs). They found that a multicomponent implementation of the Canadian CT Head Rule was associated with a modest reduction in CT use and an increased diagnostic yield of head CTs for adult trauma encounters in community EDs.
AHRQ-funded; HS021271.
Citation: Sharp AL, Huang BZ, Tang T .
Implementation of the Canadian CT Head Rule and Its association with use of computed tomography among patients with head injury.
Ann Emerg Med 2018 Jan;71(1):54-63.e2. doi: 10.1016/j.annemergmed.2017.06.022.
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Keywords: Brain Injury, Clinical Decision Support (CDS), Decision Making, Emergency Department, Guidelines, Healthcare Utilization, Imaging
Moore CL, Daniels B, Singh D
Ureteral stones: implementation of a reduced-dose CT protocol in patients in the emergency department with moderate to high likelihood of calculi on the basis of STONE score.
The purpose of this paper was to determine if a reduced-dose computed tomography (CT) protocol could effectively help to identify patients in the emergency department (ED) with moderate to high likelihood of calculi who would require urologic intervention within 90 days. The authors found that a CT protocol with over 85% dose reduction can be used in patients with moderate to high likelihood of ureteral stone to safely and effectively identify patients in the ED who will require urologic intervention.
AHRQ-funded; HS018322.
Citation: Moore CL, Daniels B, Singh D .
Ureteral stones: implementation of a reduced-dose CT protocol in patients in the emergency department with moderate to high likelihood of calculi on the basis of STONE score.
Radiology 2016 Sep;280(3):743-51. doi: 10.1148/radiol.2016151691.
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Keywords: Clinical Decision Support (CDS), Emergency Department, Imaging, Patient Safety