National Healthcare Quality and Disparities Report
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Search All Research Studies
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- Cancer (1)
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- (-) Decision Making (8)
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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 8 of 8 Research Studies DisplayedHinson 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
Reese TJ, Schlechter CR, Kramer H
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
This study explored the implementation of lung cancer screening with low-dose computed tomography (CT) in primary care. The study’s two goals included exploring the implementation of lung cancer screening primary care in the context of integrating a decision aid into the electronic health record and a designing of implementation strategies that target hypothesized mechanics of change and context-specific barriers. The two phases included a Qualitative Analysis phase including semi-structured interviews with primary care physicians to elicit key task behaviors, and an Implementation Strategy Design phase consisting of defining implementation strategies and hypothesizing causal pathways to improve screening with a decision aid. Fourteen interviews were conducted and out of that 3 key task behaviors and four behavioral determinants emerged. Strategies included increasing provider self-efficacy toward performing shared decision making and using the decision aid, improving provider performance expectancy, increasing social influence, and addressing key facilitators to using the decision aid.
AHRQ-funded; HS026198.
Citation: Reese TJ, Schlechter CR, Kramer H .
Implementing lung cancer screening in primary care: needs assessment and implementation strategy design.
Transl Behav Med 2022 Feb 16;12(2):187-97. doi: 10.1093/tbm/ibab115..
Keywords: Cancer: Lung Cancer, Cancer, Primary Care, Screening, Implementation, Decision Making
Panattoni L, Stults CD, Chan AS
The human resource costs of implementing autopend clinical decision support to improve health maintenance.
This study estimated the costs of developing and implementing the Sutter Health autopend functionality within an existing electronic health maintenance (HM) reminder system. Findings showed that developing and implementing autopend took more than 3 years, involved 6 managers and 3 Epic programmers, and cost $201,500 and 2670 total hours, excluding the costs of implementing the initial HM reminder system. The autopend clinical decision support might be similarly costly for other organizations to implement if their managers need to complete comparable activities. However, electronic health record vendors could include autopend as a standard package to reduce development costs and improve the uptake of this promising clinical decision support tool.
AHRQ-funded; HS022631.
Citation: Panattoni L, Stults CD, Chan AS .
The human resource costs of implementing autopend clinical decision support to improve health maintenance.
Am J Manag Care 2020 Jul;26(7):e232-e36. doi: 10.37765/ajmc.2020.43766..
Keywords: Clinical Decision Support (CDS), Decision Making, Implementation
Ray-Barruel G, Cooke M, Chopra V
The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation.
This study assessed the I-DECIDED clinical decision-making tool for peripheral intravenous catheter (PIVC) assessment and safe removal. A clinimetric validation process was designed and conducted in three distinct phases. Content validity testing was conducted via online survey with vascular access experts and clinicians from Australia, the UK, Canada, and the US. Then inter-rater reliability was conducted between 34 pairs of assessors for a total of 68 PIVC assessments. The tool demonstrated strong content validity among international vascular access experts and clinicians and high inter-rater reliability in seven adult medical-surgical wards of three Australian hospitals. Overall, inter-rater reliability was 87.13%. Time to complete assessments averaged 2 minutes, and nurse-reported acceptability was also high.
AHRQ-funded; HS025891.
Citation: Ray-Barruel G, Cooke M, Chopra V .
The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation.
BMJ Open 2020 Jan 21;10(1):e035239. doi: 10.1136/bmjopen-2019-035239..
Keywords: Decision Making, Patient Safety, Tools & Toolkits, Implementation
Guise JM, Reid E, Fiordalisi CV
AHRQ Author: Borsky A, Chang S
AHRQ series on improving translation of evidence: progress and promise in supporting learning health systems.
The authors discuss the articles in the AHRQ EPC series published in this journal over the past six months. They state that satisfaction, care, and costs would all improve if health care delivery were as efficient and effective as possible given current knowledge. They conclude that millions of health decisions must be made by clinicians, patients, and health care systems, and they believe better decisions will be made with evidence.
AHRQ-authored; AHRQ-funded; 290201700003C.
Citation: Guise JM, Reid E, Fiordalisi CV .
AHRQ series on improving translation of evidence: progress and promise in supporting learning health systems.
Jt Comm J Qual Patient Saf 2020 Jan;46(1):51-52. doi: 10.1016/j.jcjq.2019.10.008..
Keywords: Implementation, Evidence-Based Practice, Learning Health Systems, Health Systems, Healthcare Delivery, Decision Making
Morrow AS, Whiteside SP, Sim LA
Developing tools to enhance the use of systematic reviews for clinical care in health systems.
The researchers’ goal was to develop tools to facilitate the uptake of evidence as summarized in systematic reviews by clinical decisionmakers in health systems. After they conducted a systematic review on the management of anxiety in children, the researchers interviewed health system representatives, clinicians and patients to gain additional information about decisionmaking. Two decision-aid tools - one for the health system and the other for the clinical encounter - were then developed using stakeholders' feedback and literature searches. The health system decision aid provided information on patients who were candidates for treatment, values and preferences, costs and resources, acceptability, impact on health equity, feasibility, drug dosing, alternative therapies, remission rates, and prognosis. The encounter decision aid was produced as a set of cards that contained information on the issues that drive treatment decisions. Health system stakeholders found the first decision aid useful, and patients, parents, and clinicians found the second to be helpful.
AHRQ-funded; 290201500013I; 29032001T.
Citation: Morrow AS, Whiteside SP, Sim LA .
Developing tools to enhance the use of systematic reviews for clinical care in health systems.
BMJ Evid Based Med 2018 Dec;23(6):206-09. doi: 10.1136/bmjebm-2018-110995..
Keywords: Children/Adolescents, Decision Making, Evidence-Based Practice, Patient-Centered Outcomes Research, Implementation
Armstrong MJ, Gronseth GS
Approach to assessing and using clinical practice guidelines.
Knowing when to use guidelines in clinical practice requires neurologists to assess the rigor of published guidelines. This review briefly describes guideline definitions and the American Academy of Neurology process for guideline development, outlines key elements for assessing guideline quality, and details a practical approach for incorporating guideline recommendations when partnering with patients in shared decision-making.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS .
Approach to assessing and using clinical practice guidelines.
Neurol Clin Pract 2018 Feb;8(1):58-61. doi: 10.1212/cpj.0000000000000417.
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Keywords: Decision Making, Evidence-Based Practice, Guidelines, Patient and Family Engagement, Implementation
Randhawa G
AHRQ Author: Randhawa G
Moving to a user-driven research paradigm.
The combination of changes in research practice and in health care delivery, growing complexity in decision-making, increasing use of electronic health records, and growing resource constraints necessitate a shift to a user-driven research paradigm to generate new knowledge. This article's conceptual framework was created to clarify the perspective of the decision makers as well as the range of factors and the variability in thresholds used to make decisions. It may help researchers in creating actionable information to meet the needs of decision makers, which is needed for the transition to a user-driven research paradigm.
AHRQ-authored.
Citation: Randhawa G .
Moving to a user-driven research paradigm.
EGEMS 2013 Oct;1(2):1017. doi: 10.13063/2327-9214.1017.
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Keywords: Decision Making, Electronic Health Records (EHRs), Evidence-Based Practice, Healthcare Delivery, Implementation