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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
526 to 550 of 583 Research Studies DisplayedFeatherstone RM, Dryden DM, Foisy M
Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews.
This paper summarizes results, conclusions, and recommendations from published review articles examining rapid reviews (RRs). RR definitions, methods, and applications vary substantially. Published review articles suggest that RRs should not be viewed as a substitute for a standard review, although they have unique value for decision-makers. Recommendations for RR producers include transparency of methods used and the development of reporting standards.
AHRQ-funded; 290201200004C; 290201200010I; 290201200011I; 290201200013I; 290201200015I.
Citation: Featherstone RM, Dryden DM, Foisy M .
Advancing knowledge of rapid reviews: an analysis of results, conclusions and recommendations from published review articles examining rapid reviews.
Syst Rev 2015 Apr 17;4:50. doi: 10.1186/s13643-015-0040-4.
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Keywords: Research Methodologies, Evidence-Based Practice, Decision Making
Kerlin MP, Harhay MO, Kahn JM
Nighttime intensivist staffing, mortality, and limits on life support: a retrospective cohort study.
This study assesses whether the relationships between nighttime staffing models and clinical outcomes are mediated by differences in end-of-life decision-making. It found little evidence that nighttime physician staffing models affect patient outcomes. ICUs without physicians at night may exhibit reduced hospital mortality that is possibly attributable to differences in end-of-life care practices.
AHRQ-funded; HS018406.
Citation: Kerlin MP, Harhay MO, Kahn JM .
Nighttime intensivist staffing, mortality, and limits on life support: a retrospective cohort study.
Chest 2015 Apr;147(4):951-8. doi: 10.1378/chest.14-0501..
Keywords: Decision Making, Mortality, Outcomes, Workforce
Fiks AG, Mayne SL, Karavite DJ
Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT.
This study evaluated the feasibility, acceptability, and impact of MyAsthma, an EHR-linked patient portal supporting shared decision-making for pediatric asthma. It found that parents of children with moderate to severe persistent asthma used the portal more than others; 92 percent were satisfied with MyAsthma. Parents reported that use improved their communication with the office, ability to manage asthma, and awareness of the importance of ongoing attention to treatment.
AHRQ-funded; HS021645.
Citation: Fiks AG, Mayne SL, Karavite DJ .
Parent-reported outcomes of a shared decision-making portal in asthma: a practice-based RCT.
Pediatrics 2015 Apr;135(4):e965-73. doi: 10.1542/peds.2014-3167..
Keywords: Asthma, Children/Adolescents, Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kerr EA, Chen J, Sussman JB
Stress testing before low-risk surgery: so many recommendations, so little overuse.
The researchers sought to determine the prevalence of cardiac stress testing before low-risk surgeries, prior to commencement of a campaign to reduce routine stress testing, in order to estimate the potential effect of the campaign on future use of resources. Their study of VA and Medicare patients found that the use of routine preoperative stress testing before low-risk surgeries was very low, suggesting that interventions to further decrease testing would minimally improve quality.
AHRQ-funded; HS018781
Citation: Kerr EA, Chen J, Sussman JB .
Stress testing before low-risk surgery: so many recommendations, so little overuse.
JAMA Intern Med. 2015 Apr;175(4):645-7. doi: 10.1001/jamainternmed.2014.7877..
Keywords: Decision Making, Guidelines, Quality of Care, Healthcare Utilization, Surgery
Friedant AJ, Gouse BM, Boehme AK
A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke.
The authors sought to develop a simple scoring system for any hospital-acquired infection (HAI). Ranging from 0 to 7, the overall infection score consists of age 70 years or more, history of diabetes, and National Institutes of Health Stroke Scale score. Patients with an infection score of 4 or more were at 5 times greater odds of developing an infection. They concluded that, if validated in other populations, this score could assist providers in predicting infections after ischemic stroke.
AHRQ-funded; HS013852.
Citation: Friedant AJ, Gouse BM, Boehme AK .
A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke.
J Stroke Cerebrovasc Dis 2015 Mar;24(3):680-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.11.014.
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Keywords: Decision Making, Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Risk, Stroke
Burgess JF, Jones EA, Morgan JR
Capsule commentary on Tannenbaum et al., nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.
Users of computerized provider order entry (CPOE)s employ a variety of “shortcuts” to increase efficiency and reduce search costs. The authors comment on a study suggesting that new ordering could be a shortcut for signaling which choices are “common or appropriate”. They argue that future research on inappropriate use should grapple directly with when and why providers employ shortcuts.
AHRQ-funded; HS022242.
Citation: Burgess JF, Jones EA, Morgan JR .
Capsule commentary on Tannenbaum et al., nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.
J Gen Intern Med 2015 Mar;30(3):343. doi: 10.1007/s11606-014-3095-3..
Keywords: Health Information Technology (HIT), Decision Making, Medication
Gross CP, Fried TR, Tinetti ME
Decision-making and cancer screening: a qualitative study of older adults with multiple chronic conditions.
The researchers sought to understand how older persons with multiple chronic conditions (MCC) approach decisions about cancer screenings. They found that some older persons with MCC employ heuristics which circumvent the traditional quantitative comparison of risks and benefits, providing an important challenge to informed decision making.
AHRQ-funded; HS018598.
Citation: Gross CP, Fried TR, Tinetti ME .
Decision-making and cancer screening: a qualitative study of older adults with multiple chronic conditions.
J Geriatr Oncol 2015 Mar;6(2):93-100. doi: 10.1016/j.jgo.2014.12.001..
Keywords: Cancer, Chronic Conditions, Decision Making, Elderly, Screening
Samwald M, Minarro Gimenez JA, Boyce RD
Pharmacogenomic knowledge representation, reasoning and genome-based clinical decision support based on OWL 2 DL ontologies.
The authors developed Web Ontology Language (OWL) ontologies and automated reasoning methodologies to meet various goals such as providing a simple and concise formalism for representing pharmacogenomic knowledge. Their ontology-based framework can be used to represent, organize and reason over the growing wealth of pharmacogenomic knowledge, as well as to identify errors, inconsistencies and insufficient definitions in source data sets or individual patient data.
AHRQ-funded; HS019461.
Citation: Samwald M, Minarro Gimenez JA, Boyce RD .
Pharmacogenomic knowledge representation, reasoning and genome-based clinical decision support based on OWL 2 DL ontologies.
BMC Med Inform Decis Mak 2015 Feb 22;15:12. doi: 10.1186/s12911-015-0130-1..
Keywords: Comparative Effectiveness, Health Information Technology (HIT), Decision Making, Medication, Genetics
Patel MB, Humble SS, Cullinane DC
Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma.
The authors’ aims were to perform a systematic review and to develop evidence-based recommendations that might be used to direct decision making in the removal of a cervical collar from adult obtunded blunt trauma patients. In conclusion, they conditionally recommended cervical collar removal after a negative high-quality C-spine CT scan result alone.
AHRQ-funded; HS017952.
Citation: Patel MB, Humble SS, Cullinane DC .
Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma.
J Trauma Acute Care Surg 2015 Feb;78(2):430-41. doi: 10.1097/ta.0000000000000503..
Keywords: Comparative Effectiveness, Evidence-Based Practice, Guidelines, Trauma, Decision Making
Wang G, Gold M, Siegel J
AHRQ Author: Siegel J
Deliberation: obtaining informed input from a diverse public.
The Deliberative Methods Demonstration was a randomized controlled experiment comparing four deliberation methods and a reading materials control group. After surveying 907 participants before and after deliberation, the researchers found that changes in knowledge about using medical evidence in decisionmaking were not associated with race, ethnicity, or education.
AHRQ-authored.
Citation: Wang G, Gold M, Siegel J .
Deliberation: obtaining informed input from a diverse public.
J Health Care Poor Underserved. 2015 Feb;26(1):223-42. doi: 10.1353/hpu.2015.0021..
Keywords: Disparities, Quality of Care, Decision Making, Racial and Ethnic Minorities, Social Determinants of Health
Crosby LE, Shook LM, Ware RE
Shared decision making for hydroxyurea treatment initiation in children with sickle cell anemia.
While decision aids and tools are being developed, the authors recommended six strategies providers can use to facilitate discussions concerning the NHLBI clinical guidelines to recommend hydroxyurea for young patients with sickle cell anemia.
AHRQ-funded; HS021114.
Citation: Crosby LE, Shook LM, Ware RE .
Shared decision making for hydroxyurea treatment initiation in children with sickle cell anemia.
Pediatr Blood Cancer 2015 Feb;62(2):184-85. doi: 10.1002/pbc.25124.
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Keywords: Children/Adolescents, Decision Making, Education: Patient and Caregiver, Patient and Family Engagement, Sickle Cell Disease
Gold JA, Tutsch AS, Gorsuch A
Integrating the electronic health record into high-fidelity interprofessional intensive care unit simulations.
The authors described the impact of integrating the electronic health record (EHR) into high-fidelity, interprofessional intensive care unit (ICU) simulations, and the errors induced. They found a number of safety issues directly related to the EHR, and they now have an infrastructure to focus educational initiative and deploy informatics solutions to mitigate these safety issues.
AHRQ-funded; HS021637.
Citation: Gold JA, Tutsch AS, Gorsuch A .
Integrating the electronic health record into high-fidelity interprofessional intensive care unit simulations.
J Interprof Care 2015;29(6):562-3. doi: 10.3109/13561820.2015.1063482.
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Keywords: Decision Making, Electronic Health Records (EHRs), Intensive Care Unit (ICU), Patient Safety, Training
Butler KA, Mercer E, Bahrami A
Model checking for verification of interactive health IT systems.
The authors proposed to formalize the relationship between HIT and the conceptual work that increasingly typifies modern care. They demonstrated the method on a patient contact system to show that model checking is effective for interactive systems and that much of it can be automated.
AHRQ-funded; HS021233.
Citation: Butler KA, Mercer E, Bahrami A .
Model checking for verification of interactive health IT systems.
AMIA Annu Symp Proc 2015;2015:349-58.
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Keywords: Decision Making, Health Information Technology (HIT), Health Information Technology (HIT), Patient Safety, Workflow
George AJ, Boehme AK, Dunn CR
Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients.
The authors questioned the utility of routine 24-h computed tomography imaging and looked at the National Institutes of Health Stroke Scale as a possible clinical screen for selecting candidates for 24-h imaging. They found that routine 24-h computed tomography scan in patients without 24-h National Institutes of Health Stroke Scale worsening was less likely to yield information that results in a deviation from standard acute stroke care, and that no patient without worsening had parenchymal hematoma on 24-h computed tomography. They concluded that application of this Stroke Scale to distinguish patients who should have 24-h follow-up imaging from those who will not benefit is a potential avenue for improving utilization of resources and warrants further study.
AHRQ-funded; HS013852.
Citation: George AJ, Boehme AK, Dunn CR .
Trimming the fat in acute ischemic stroke: an assessment of 24-h CT scans in tPA patients.
Int J Stroke 2015 Jan;10(1):37-41. doi: 10.1111/ijs.12293.
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Keywords: Decision Making, Imaging, Stroke
McCullagh LJ, Sofianou A, Kannry J
User centered clinical decision support tools: adoption across clinician training level.
This study examined the differences in adoption of CDS tools across providers’ training level. It found that the completion rates of the CDS calculator and medication order sets were higher among first year residents compared to all other training levels. Attending physicians were the less likely to accept the initial step of the CDS tool (29.3 percent) or complete the medication order sets (22.4 percent) that guided their prescription decisions.
AHRQ-funded; HS018491.
Citation: McCullagh LJ, Sofianou A, Kannry J .
User centered clinical decision support tools: adoption across clinician training level.
Appl Clin Inform 2014 Dec 17;5(4):1015-25. doi: 10.4338/aci-2014-05-ra-0048.
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Keywords: Clinical Decision Support (CDS), Decision Making, Practice Patterns
Concannon TW, Fuster M, Saunders T
A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research.
This study reviewed 70 articles on methods of stakeholder engagement in comparative effectiveness research and patient-centered outcomes research. The authors found frequent engagement with patients, modestly frequent engagement with clinicians, and infrequent engagement with other stakeholders.The roles and activities of stakeholders were highly variable across research and program reports.
AHRQ-funded; HS017726
Citation: Concannon TW, Fuster M, Saunders T .
A systematic review of stakeholder engagement in comparative effectiveness and patient-centered outcomes research.
J Gen Intern Med. 2014 Dec;29(12):1692-701. doi: 10.1007/s11606-014-2878-x..
Keywords: Comparative Effectiveness, Clinician-Patient Communication, Decision Making
Kuntz JL, Safford MM, Singh JA
Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings.
This review reports the current state of scientific research around interventions to improve medication management through four patient-centered domains. Out of 60 studies, the authors found the following types of intervention: patient education, augmented pharmacy services, decision aids, shared decision-making, and clinical review of patient adherence. They were unable to determine whether these interventions were more effective than traditional medication adherence interventions.
AHRQ-funded; HS021107.
Citation: Kuntz JL, Safford MM, Singh JA .
Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings.
Patient Educ Couns 2014 Dec;97(3):310-26. doi: 10.1016/j.pec.2014.08.021.
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Keywords: Education: Patient and Caregiver, Decision Making, Medication, Patient Adherence/Compliance, Patient-Centered Healthcare
Heisler M, Choi H, Palmisano G
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
This study compared outcomes between community health worker (CHW) use of a tailored, interactive, Web-based, tablet computer-delivered tool specifically developed for the study and use of printed educational materials. In a population of low-income Latino and African American adults with diabetes and relatively low levels of formal education, participants in both CHW-led interventions reported mostly similar improvements in outcomes over 3 months.
AHRQ-funded; HS019256
Citation: Heisler M, Choi H, Palmisano G .
Comparison of community health worker-led diabetes medication decision-making support for low-income Latino and African American adults with diabetes using e-health tools versus print materials: a randomized, controlled trial.
Ann Intern Med. 2014 Nov 18;161(10 Suppl):S13-22. doi: 10.7326/m13-3012..
Keywords: Health Information Technology (HIT), Diabetes, Decision Making, Outcomes, Social Determinants of Health
Einbinder J, Hebel E, Wright A
The number needed to remind: a measure for assessing CDS effectiveness.
The purpose of this paper is to provide a better understanding of population based clinical decision support (CDS) performance measurement, to identify best practices for designing and implementing CDS, and to introduce two new quality measures, titled Reminder Performance (RP) and the Number Needed to Remind (NNR) for evaluating the effectiveness of clinical reminders in the context of the CDS Dashboards.
AHRQ-funded; 290200810010.
Citation: Einbinder J, Hebel E, Wright A .
The number needed to remind: a measure for assessing CDS effectiveness.
AMIA Annu Symp Proc 2014 Nov 14;2014:506-15..
Keywords: Decision Making, Clinical Decision Support (CDS), Quality Measures, Quality of Care
Kruger JF, Chen AH, Rybkin A
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
The authors examined outpatient clinician attitudes towards considering radiation exposure when ordering CT scans and clinician reactions to displaying radiation exposure information for CT scans at clinician electronic order entry. They found that displaying clinically relevant radiation exposure information at order entry may improve clinician knowledge and inform patient-clinician discussions regarding risks and benefits of imaging.
AHRQ-funded; HS018090.
Citation: Kruger JF, Chen AH, Rybkin A .
Clinician perspectives on considering radiation exposure to patients when ordering imaging tests: a qualitative study.
BMJ Qual Saf 2014 Nov;23(11):893-901. doi: 10.1136/bmjqs-2013-002773.
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Keywords: Decision Making, Provider: Health Personnel, Imaging, Patient Safety, Practice Patterns
Ghomrawi HM, Alexiades M, Pavlov H
Evaluation of two appropriateness criteria for total knee replacement.
The researchers evaluated the performance of 2 sets of non-U.S. appropriateness criteria (one from Spain and the other from Canada) for total knee replacement (TKR) in a group of 508 TKR patients. Although only 4.7 percent were classified as inappropriate by both sets of criteria, there was little agreement between the two.
AHRQ-funded; HS016075
Citation: Ghomrawi HM, Alexiades M, Pavlov H .
Evaluation of two appropriateness criteria for total knee replacement.
Arthritis Care Res. 2014 Nov;66(11):1749-53. doi: 10.1002/acr.22390..
Keywords: Surgery, Arthritis, Decision Making
Lacson R, Prevedello LM, Andriole KP
Four-year impact of an alert notification system on closed-loop communication of critical test results.
The authors evaluated the impact of an alert notification system on policy adherence for communicating critical imaging test results to referring providers and assessed system adoption over the first 4 years after implementation. They concluded that an automated alert notification system for communicating critical imaging results was successfully adopted and was associated with increased adherence to institutional policy for communicating critical test results and with reduced workflow interruptions.
AHRQ-funded; HS019635.
Citation: Lacson R, Prevedello LM, Andriole KP .
Four-year impact of an alert notification system on closed-loop communication of critical test results.
AJR Am J Roentgenol 2014 Nov;203(5):933-8. doi: 10.2214/ajr.14.13064.
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Keywords: Communication, Decision Making, Guidelines, Health Information Technology (HIT), Imaging
Schlesinger M, Kanouse DE, Martino SC
Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior.
The authors identified four pathways through which complexity may impair consumer choice. They examined these pathways using data from an experiment in which consumers hypothetically selected a primary care physician. They found that some of the loss of decision quality accompanying more complex choice sets can be explained by consumers' skills and decision-making style, but even after accounting for these factors, complexity undermines the quality of decision making in ways that cannot be fully explained. They concluded by discussing implications for report designers, sponsors, and policy makers aspiring to promote consumer empowerment and health care quality.
AHRQ-funded; HS016978; HS016980.
Citation: Schlesinger M, Kanouse DE, Martino SC .
Complexity, public reporting, and choice of doctors: a look inside the blackest box of consumer behavior.
Med Care Res Rev 2014 Oct;71(5 Suppl):38s-64s. doi: 10.1177/1077558713496321.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Decision Making, Quality of Care, Primary Care, Public Reporting
Damberg CL, McNamara P
AHRQ Author: McNamara P
Postscript: research agenda to guide the next generation of public reports for consumers.
The authors identified five areas for additional public reporting tools research that, if addressed, could foster better design and delivery of quality and cost information to consumers.
AHRQ-authored.
Citation: Damberg CL, McNamara P .
Postscript: research agenda to guide the next generation of public reports for consumers.
Med Care Res Rev 2014 Oct;71(5 Suppl):97s-107s. doi: 10.1177/1077558714535982.
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Keywords: Education: Patient and Caregiver, Decision Making, Quality of Care, Health Services Research (HSR), Public Reporting
Welch BM, Eilbeck K, Del Fiol G
Technical desiderata for the integration of genomic data with clinical decision support.
The objective of this study is to develop and validate a guiding set of technical desiderata for supporting the clinical use of the whole genome sequence (WGS) through clinical decision support (CDS). A panel of domain experts in genomics and CDS developed a proposed set of seven additional requirements. These additional desiderata provide important guiding principles for the technical development of CDS capabilities for the clinical use of WGS information.
AHRQ-funded; HS018352.
Citation: Welch BM, Eilbeck K, Del Fiol G .
Technical desiderata for the integration of genomic data with clinical decision support.
J Biomed Inform 2014 Oct;51:3-7. doi: 10.1016/j.jbi.2014.05.014..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Genetics, Electronic Health Records (EHRs), Decision Making