National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Back Health and Pain (1)
- Behavioral Health (1)
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- (-) Clinician-Patient Communication (10)
- Communication (8)
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- Health Information Technology (HIT) (2)
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- Patient Experience (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 DisplayedDoty AM, Rising KL, Hsiao T
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
This study’s objective was to describe how emergency medicine resident physicians discuss diagnostic uncertainty during a simulated emergency department (ED) discharge discussion. Most residents in the simulation explained the evaluation revealed no cause for symptoms, noted concerning diagnoses that were excluded, and acknowledged both symptoms and patients’ feelings. However, 28% of residents did not discuss diagnostic uncertainty in any form. All residents were reassuring. Those who did discuss diagnostic uncertainty used explicit and implicit language with similar frequency.
AHRQ-funded; HS025651.
Citation: Doty AM, Rising KL, Hsiao T .
"Unfortunately, I don't have an answer for you": how resident physicians communicate diagnostic uncertainty to patients during emergency department discharge.
Patient Educ Couns 2022 Jul;105(7):2053-57. doi: 10.1016/j.pec.2021.12.002..
Keywords: Clinician-Patient Communication, Emergency Department, Communication, Diagnostic Safety and Quality
McCarthy DM, Formella KT, Ou EZ
There's an app for that: teaching residents to communicate diagnostic uncertainty through a mobile gaming application.
The purpose of this study was to improve doctor-patient communication by assessing the utilization of a mobile application (app) for teaching physician communication skills about diagnostic uncertainty, obtaining feedback on app utilization, and evaluating the association between app use and mastery of skills. Emergency medicine resident physicians were randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty which included a web-based interactive model and an app. Only 31.2% of the 109 participants used the app, with senior residents more likely to use the app than junior residents. Researchers report that of those who used the app, reviews were positive, with 76% indicating the app facilitated their learning. The study found that in the trial there was no significant correlation between the utilization of the app and mastery of the communication skill. The researchers concluded that without mandated use and evidence of effectiveness, apps should not be offered to physicians as an educational option and training opportunity for improving communication skills.
AHRQ-funded; HS025651.
Citation: McCarthy DM, Formella KT, Ou EZ .
There's an app for that: teaching residents to communicate diagnostic uncertainty through a mobile gaming application.
Patient Educ Couns 2022 Jun;105(6):1463-69. doi: 10.1016/j.pec.2021.09.038..
Keywords: Diagnostic Safety and Quality, Clinician-Patient Communication, Communication, Education: Continuing Medical Education, Health Information Technology (HIT)
Meyer AND, Giardina TD, Khawaja L
Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions,.
The purpose of this study was to provide a comprehensive overview of the current literature on diagnosis-related uncertainty in patients and clinicians. The researchers describe 1) where patients and clinicians encounter uncertainty within the diagnostic process, 2) how uncertainty affects the diagnostic process, 3) origins of uncertainty related to probability/risk, ambiguity, or complexity, and 4) strategies for managing uncertainty. The study found that every step in the diagnostic process involves uncertainty. The researchers’ recommendations of strategies for general management included: acknowledging uncertainty, obtaining more information from patients, creating diagnostic safety nets such as educating patients about observing red flags, utilizing worst/ best case scenario planning, and communicating diagnostic uncertainty to patients, families, and colleagues. The study also delineated possible strategies specific to various aspects of diagnostic uncertainty.
AHRQ-funded; HS025474.
Citation: Meyer AND, Giardina TD, Khawaja L .
Patient and clinician experiences of uncertainty in the diagnostic process: current understanding and future directions,.
Patient Educ Couns 2021 Nov;104(11):2606-15. doi: 10.1016/j.pec.2021.07.028..
Keywords: Diagnostic Safety and Quality, Clinician-Patient Communication, Communication
Fenton JJ, Jerant A, Franks P
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
This paper describes the protocol that will be used for an upcoming randomized control trial to determine the effectiveness of teaching clinicians how to advise watchful waiting when patients request low-value spinal imaging for acute low back pain. The authors will recruit 8-10 primary care and urgent care clinics in Sacramento, California. The study will last 3-6 months and during this time clinicians in the intervention group with receive 3 visits with standardized patient instructors (SPIs) portraying patients with acute back pain. The SPIs will instruct clinicians in a 3-step model emphasizing trust, empathic communication, and negotiation of a watchful waiting approach. The primary outcome looked for will a decreased post-intervention rate of spinal imaging among actual patients with acute back pain compared to the rate of imaging during the baseline period. Secondary outcomes will include use of targeted communication techniques during a follow-up visit with an SP.
AHRQ-funded; HS026415.
Citation: Fenton JJ, Jerant A, Franks P .
Watchful waiting as a strategy to reduce low-value spinal imaging: study protocol for a randomized trial.
Trials 2021 Feb 27;22(1):167. doi: 10.1186/s13063-021-05106-x..
Keywords: Back Health and Pain, Pain, Chronic Conditions, Imaging, Diagnostic Safety and Quality, Clinician-Patient Communication, Communication
Rogith D, Satterly T, Singh H
Application of human factors methods to understand missed follow-up of abnormal test results.
This study demonstrated application of human factors methods for understanding causes for lack of timely follow-up of abnormal test results ("missed results") in outpatient settings. The investigators identified 30 cases of missed test results by querying electronic health record data, developed a critical decision method based interview guide to understand decision-making processes, and interviewed physicians who ordered these tests. They analyzed transcribed responses, developed a CI-based flow model, and conducted a fault tree analysis to identify hierarchical relationships between factors that delayed action.
AHRQ-funded; HS022087; HS022901.
Citation: Rogith D, Satterly T, Singh H .
Application of human factors methods to understand missed follow-up of abnormal test results.
Appl Clin Inform 2020 Oct;11(5):692-98. doi: 10.1055/s-0040-1716537..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Decision Making, Diagnostic Safety and Quality, Communication, Clinician-Patient Communication
Bardach NS, Burkhart Q, Richardson LP
Hospital-based quality measures for pediatric mental health care.
The objective of this study was to develop and test medical record-based measures used to assess quality of pediatric mental health care in the emergency department (ED) and inpatient settings. The investigators drafted an evidence-based set of pediatric mental health care quality measures for the ED and inpatient settings and used them to identify sex and race disparities and substantial hospital variation.
AHRQ-funded; HS020506.
Citation: Bardach NS, Burkhart Q, Richardson LP .
Hospital-based quality measures for pediatric mental health care.
Pediatrics 2018 Jun;141(6). doi: 10.1542/peds.2017-3554..
Keywords: Cancer, Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Decision Making, Diagnostic Safety and Quality, Patient Experience, Patient and Family Engagement
Sulzer SH, Muenchow E, Potvin A
Improving patient-centered communication of the borderline personality disorder diagnosis.
This study aimed to understand how clinicians communicate the diagnosis of borderline personality disorder (BPD) with patients, and compare these practices with patient communication preferences. It found that the majority of clinicians sampled did not actively share the BPD diagnosis with their patients, while the majority of patients wanted to be told that they had the disorder, as well as have their providers discuss the stigma they would face.
AHRQ-funded; HS000032.
Citation: Sulzer SH, Muenchow E, Potvin A .
Improving patient-centered communication of the borderline personality disorder diagnosis.
J Ment Health 2016;25(1):5-9. doi: 10.3109/09638237.2015.1022253.
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Keywords: Communication, Diagnostic Safety and Quality, Behavioral Health, Clinician-Patient Communication, Social Stigma
Kantor R, Thyssen JP, Paller AS
Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'.
The authors sought to determine the most commonly-used terms for atopic dermatitis. They found that atopic dermatitis was the most commonly-used term in studies across almost all publication types, languages, and journals and appears to be increasing in popularity. They concluded by suggesting the use of the term atopic dermatitis in publications, healthcare clinician training, and patient education.
AHRQ-funded; HS023011.
Citation: Kantor R, Thyssen JP, Paller AS .
Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of 'atopic dermatitis'.
Allergy 2016 Oct;71(10):1480-5. doi: 10.1111/all.12982.
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Keywords: Education: Patient and Caregiver, Diagnostic Safety and Quality, Patient-Centered Healthcare, Clinician-Patient Communication, Skin Conditions
Medford-Davis L, Park E, Shlamovitz G
Diagnostic errors related to acute abdominal pain in the emergency department.
This study reviewed a selected high-risk cohort of patients presenting to the ED with abdominal pain to evaluate for possible diagnostic errors and associated process breakdowns. Diagnostic errors occurred in 35 of 100 high-risk cases. Over two-thirds had breakdowns involving the patient-provider encounter (most commonly history-taking or ordering additional tests) and/or follow-up and tracking of diagnostic information (most commonly follow-up of abnormal test results).
AHRQ-funded; HS022087.
Citation: Medford-Davis L, Park E, Shlamovitz G .
Diagnostic errors related to acute abdominal pain in the emergency department.
Emerg Med J 2016 Apr;33(4):253-9. doi: 10.1136/emermed-2015-204754.
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Keywords: Pain, Emergency Department, Diagnostic Safety and Quality, Medical Errors, Clinician-Patient Communication
Al-Mutairi A, Meyer AN, Chang P
Lack of timely follow-up of abnormal imaging results and radiologists' recommendations.
This study tested the association between information contained in radiologists’ reports and follow-up outcomes. It found that abnormal imaging results with recommendations for further imaging are more vulnerable to lack of timely follow-up. Expression of “doubt” in the radiology reports did not affect follow-up actions.
AHRQ-funded; HS022087.
Citation: Al-Mutairi A, Meyer AN, Chang P .
Lack of timely follow-up of abnormal imaging results and radiologists' recommendations.
J Am Coll Radiol 2015 Apr;12(4):385-9. doi: 10.1016/j.jacr.2014.09.031..
Keywords: Communication, Diagnostic Safety and Quality, Imaging, Clinician-Patient Communication