National Healthcare Quality and Disparities Report
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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
101 to 125 of 547 Research Studies DisplayedAnderson KE, Shugarman LR, Davenport K
Regulation of provider networks in response to COVID-19.
The authors anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery. They suggested that telehealth will have a larger role in care delivery than in the pre-pandemic period, and that regulators will need to adapt network standards to accommodate in-person and virtual care delivery.
AHRQ-funded; HS000029.
Citation: Anderson KE, Shugarman LR, Davenport K .
Regulation of provider networks in response to COVID-19.
Am J Manag Care 2021 Apr;27(4):e101-e04. doi: 10.37765/ajmc.2021.88614..
Keywords: Health Insurance, Policy, Access to Care, Healthcare Delivery, COVID-19
Larsen EP, Haskins Lisle A, Law B
Identification of design criteria to improve patient care in electronic health record downtime.
Researchers identified design criteria specifications for continuing safe and efficient patient care activities during downtime by examining interview transcripts from medical personnel who had experience with downtime incidents, using phenomenological analysis. They found that workload distribution and communication were significant issues in patient care during downtime. There may not be an equal work distribution, leading to an increased workload for some personnel during downtime. Some criteria were identified as potential guidelines for the development of better downtime contingency plans.
AHRQ-funded; HS024350.
Citation: Larsen EP, Haskins Lisle A, Law B .
Identification of design criteria to improve patient care in electronic health record downtime.
J Patient Saf 2021 Mar 1;17(2):90-94. doi: 10.1097/pts.0000000000000580..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Care Management
Jurewicz KA, Neyens DM, Catchpole K
Observational study of anaesthesia workflow to evaluate physical workspace design and layout.
The objective of this study was to observe the relationship between task switching and physical layout, and then use the data collected to design and assess different anesthesia workspace layouts. Six videos of anesthesia providers from a single medical center in the United States were analyzed. Findings showed that current operating theater layouts do not fit work demands. The authors reported a simple method that facilitates a quick layout design assessment and showed that the anesthesia workspace can be improved to better suit workflow and patient care. They suggested that this arrangement could reduce anesthesia workload while improving task flow efficiency and potentially the safety of care.
AHRQ-funded; HS024380.
Citation: Jurewicz KA, Neyens DM, Catchpole K .
Observational study of anaesthesia workflow to evaluate physical workspace design and layout.
Br J Anaesth 2021 Mar;126(3):633-41. doi: 10.1016/j.bja.2020.08.063..
Keywords: Workflow, Healthcare Delivery, Surgery
Desai SM, Shambhu S, Mehrotra A
Online advertising increased New Hampshire residents' use of provider price tool but not use of lower-price providers.
This study looked at the results of an online advertising campaign to increase consumers’ awareness about insurer-specific negotiated price information available on New Hampshire’s public price transparency website. The campaign led to a more than 600% increase in visits to the website, but it did not translate to increased use of lower-price providers. The authors concluded that the findings imply that the limited success is driven by structural factors that limit consumers’ ability to use health care price information as opposed to only a lack of awareness about price transparency tools.
AHRQ-funded; HS026980.
Citation: Desai SM, Shambhu S, Mehrotra A .
Online advertising increased New Hampshire residents' use of provider price tool but not use of lower-price providers.
Health Aff 2021 Mar;40(3):521-28. doi: 10.1377/hlthaff.2020.01039..
Keywords: Healthcare Costs, Healthcare Delivery
Bhargava R, Gayre G, Huang J
Patient e-visit use and outcomes for common symptoms in an integrated health care delivery system.
The authors evaluated patients’ adoption and success of primary care e-visits by monitoring the 7-day follow-up care needed within an integrated health care delivery system. They found that e-visits offered quick, safe patient access to virtual health care for specific conditions without needing a scheduled visit, transportation, or time off of work. Their results suggested that a predominance of e-visits delivered clinical care successfully without follow-up visits or messages.
AHRQ-funded; HS25189.
Citation: Bhargava R, Gayre G, Huang J .
Patient e-visit use and outcomes for common symptoms in an integrated health care delivery system.
JAMA Netw Open 2021 Mar;4(3):e212174. doi: 10.1001/jamanetworkopen.2021.2174..
Keywords: Telehealth, Health Information Technology (HIT), Primary Care, Healthcare Delivery
Olmos-Ochoa TT, Miake-Lye IM, Glenn BA
Sustaining successful clinical-community partnerships in medically underserved urban areas: a qualitative case study.
This qualitative case study examines the Faith Community Health Partnership, which is a collaboration between faith-community nurses and community organizations sustained over 25 years. Factors supporting partnership sustainability were identified through semi-structured interviews with 18 FHCP partners. Factors include maintaining partners’ commitment over time; strategic resource-sharing; facilitating engagement; and preserving partnership flexibility.
AHRQ-funded; HS000046.
Citation: Olmos-Ochoa TT, Miake-Lye IM, Glenn BA .
Sustaining successful clinical-community partnerships in medically underserved urban areas: a qualitative case study.
J Community Health Nurs 2021 Jan-Mar;38(1):1-12. doi: 10.1080/07370016.2021.1869423.
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Keywords: Community Partnerships, Vulnerable Populations, Urban Health, Case Study, Access to Care, Healthcare Delivery
Han B, Chen PG, Yu H
Access to after-hours primary care: a key determinant of children's medical home status.
Researchers sought to identify individual survey items or domains that best predict medical home (MH) status for children and use them to develop brief markers of MH status. Using MEPS data, they found that accessibility, especially the ability to access health care after regular office hours, appeared to be the major predictor of having a MH among children. They recommended that the ongoing efforts to promote the MH model target improving accessibility of health care after regular hours for children overall and especially for Latino children.
AHRQ-funded; HS023336.
Citation: Han B, Chen PG, Yu H .
Access to after-hours primary care: a key determinant of children's medical home status.
BMC Health Serv Res 2021 Feb 27;21(1):185. doi: 10.1186/s12913-021-06192-y..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Access to Care, Healthcare Delivery, Disparities, Racial and Ethnic Minorities
Li J, Carayon P
Health Care 4.0: a vision for smart and connected health care.
The authors discuss the historical evolution of Health Care 1.0 to 4.0, described the characteristics of smart and connected care in Health Care 4.0, identified multiple research challenges and opportunities of Health Care 4.0 in terms of data, model, dynamics, and integration, and outlined the implications of people, process, system and health outcomes.
AHRQ-funded; HS026624.
Citation: Li J, Carayon P .
Health Care 4.0: a vision for smart and connected health care.
ISE Trans Healthc Syst Eng 2021;11(3):171-80. doi: 10.1080/24725579.2021.1884627..
Keywords: Health Information Technology (HIT), Healthcare Delivery
Lee YSH, Cleary PD, Nembhard IM
Effects of leader tactics on the creativity, implementation, and evolution of ideas to improve healthcare delivery.
Researchers examined the association between leader tactics and the creativity, implementation outcome, and evolution of quality improvement ideas from clinicians and staff. They found that two identified tactics, brainstorming and reflection, were helpful depending on goals. They suggested that brainstorming may aide leaders seeking disruptive change via more creative, rapidly implemented ideas, while reflection on team process may aide leaders seeking high-engagement ideas that may be implemented slowly. They concluded that both tactics may help leaders cultivate dynamics that increase implementation of ideas that improve healthcare.
AHRQ-funded; HS016978.
Citation: Lee YSH, Cleary PD, Nembhard IM .
Effects of leader tactics on the creativity, implementation, and evolution of ideas to improve healthcare delivery.
J Gen Intern Med 2021 Feb;36(2):341-48. doi: 10.1007/s11606-020-06139-9..
Keywords: Organizational Change, Healthcare Delivery, Quality Improvement, Quality of Care, Implementation
Fernandes-Taylor S, Yang DY, Schumacher J
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
This study looked at the factors contributing to transfer of emergency general surgery (EGS) patients to another hospital. Data from the AHRQ Nationwide Emergency Department Sample (NEDS) from 2010-2014 was analyzed. The transfer rate during that time was 1.9%. Patients with Medicare or other insurance had higher odds of transfer compared to patients with private health insurance. Odds of transfer increased with a greater number of comorbid conditions as well as resuscitation, intestinal obstruction, and conditions of the upper gastrointestinal tract. Transfers were more likely to originate from rural hospitals or Level I or II trauma centers.
AHRQ-funded; HS025224.
Citation: Fernandes-Taylor S, Yang DY, Schumacher J .
Factors associated with Interhospital transfers of emergency general surgery patients from emergency departments.
Am J Emerg Med 2021 Feb;40:83-88. doi: 10.1016/j.ajem.2020.12.012..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Emergency Department, Transitions of Care, Hospitals, Healthcare Delivery
Zimmerman S, Guo W, Mao Y, S, Guo W, Mao Y
Health care needs in assisted living: survey data may underestimate chronic conditions.
In this paper, the authors caution that survey data may underestimate chronic conditions when examining healthcare needs in assisted living. Research using electronic and administrative databases has become increasingly common in post-acute and long-term cared. However, data accuracy in some areas has been challenged. Thus, research based on administrative databases must be cautiously interpreted.
AHRQ-funded; HS026893.
Citation: Zimmerman S, Guo W, Mao Y, S, Guo W, Mao Y .
Health care needs in assisted living: survey data may underestimate chronic conditions.
J Am Med Dir Assoc 2021 Feb;22(2):471-73. doi: 10.1016/j.jamda.2020.11.036..
Keywords: Elderly, Chronic Conditions, Long-Term Care, Healthcare Delivery
Post B, Norton EC, Hollenbeck B
Hospital-physician integration and Medicare's site-based outpatient payments.
AHRQ-funded; HS027044.
Citation: Post B, Norton EC, Hollenbeck B .
Hospital-physician integration and Medicare's site-based outpatient payments.
Health Serv Res 2021 Feb;56(1):7-15. doi: 10.1111/1475-6773.13613..
Keywords: Hospitals, Payment, Medicare, Ambulatory Care and Surgery, Healthcare Delivery
Kuo YF, Lin YL, D Jupiter, et al.
How to identify team-based primary care in the United States using Medicare data.
The authors assessed whether analyses using different sets of Medicare data can produce results similar to those from analyses using 100% data from an entire state in identifying primary care teams through social network analysis. They found that, depending on specific study purposes, researchers could use either 100% data from Medicare beneficiaries in randomly selected primary care services areas or data from a 20% national sample of Medicare beneficiaries to study team-based primary care in the United States.
AHRQ-funded; HS020642.
Citation: Kuo YF, Lin YL, D Jupiter, et al..
How to identify team-based primary care in the United States using Medicare data.
Med Care 2021 Feb;59(2):118-22. doi: 10.1097/mlr.0000000000001478.
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Keywords: Teams, Primary Care: Models of Care, Primary Care, Medicare, Health Services Research (HSR), Healthcare Delivery
Hung DY, Truong QA, Liang SY
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
Investigators examined 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. They found that Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks, thus supporting the use of Lean techniques to engage teams in routine aspects of patient care. They recommended more research to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.
AHRQ-funded; HS024529.
Citation: Hung DY, Truong QA, Liang SY .
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
J Gen Intern Med 2021 Feb;36(2):274-79. doi: 10.1007/s11606-020-06317-9..
Keywords: Primary Care, Quality Improvement, Quality of Care, Primary Care: Models of Care, Primary Care, Implementation, Workflow, Teams, Healthcare Delivery
Kohn R, Harhay MO, Bayes B
Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study.
The objective of this cohort study was to assess the association of bedspacing with patient-centered outcomes among United States patients admitted to general medicine services. The study compared internal medicine, family medicine and geriatric service patients who were bedspaced versus cohorted for the entirety of their hospital stay within three large, urban hospitals. Findings showed that bedspacing was associated with adverse patient-centered outcomes. Recommendations for future work included a need to confirm these findings, to understand mechanisms contributing to adverse outcomes, and to identify factors that mitigate these adverse effects in order to provide high-value, patient-centered care to hospitalized patients.
AHRQ-funded; HS026372.
Citation: Kohn R, Harhay MO, Bayes B .
Influence of bedspacing on outcomes of hospitalised medicine service patients: a retrospective cohort study.
BMJ Qual Saf 2021 Feb;30(2):116-22. doi: 10.1136/bmjqs-2019-010675..
Keywords: Patient-Centered Outcomes Research, Outcomes, Inpatient Care, Hospitals, Healthcare Delivery, Care Management, Adverse Events
Huguet N, Schmidt T, Larson A
Prevalence of pre-existing conditions among community health center patients with COVID-19: implications for the Patient Protection and Affordable Care Act.
Researchers described the prevalence of pre-existing conditions among community health center patients overall and those with COVID-19 by race/ethnicity. Electronic health record data from OCHIN, a network of 396 community health centers across 14 states, was used. They concluded that since the future of the Patient Protection and Affordable Care Act is uncertain, and since the long-term health effects of COVID-19 are largely unknown, ensuring that people with pre-existing conditions can acquire health insurance is essential to achieving health equity.
AHRQ-funded; HS025962.
Citation: Huguet N, Schmidt T, Larson A .
Prevalence of pre-existing conditions among community health center patients with COVID-19: implications for the Patient Protection and Affordable Care Act.
J Am Board Fam Med 2021 Feb;34(Suppl):S247-s49. doi: 10.3122/jabfm.2021.S1.200571..
Keywords: Electronic Health Records (EHRs), COVID-19, Racial and Ethnic Minorities, Policy, Healthcare Delivery
Mohr NM, Harland KK, Okoro UE
TELEmedicine as an Intervention for Sepsis in Emergency Departments: a multicenter, comparative effectiveness study (TELEvISED Study).
Sepsis is a life-threatening infection that affects over 1.7 million Americans annually. Low-volume rural hospitals have worse sepsis outcomes, and emergency department (ED)-based telemedicine (tele-ED) has been one promising strategy for improving rural sepsis care. The objective of this study was to evaluate the impact of tele-ED consultation on sepsis care and outcomes in rural ED patients.
AHRQ-funded; HS025753.
Citation: Mohr NM, Harland KK, Okoro UE .
TELEmedicine as an Intervention for Sepsis in Emergency Departments: a multicenter, comparative effectiveness study (TELEvISED Study).
J Comp Eff Res 2021 Feb;10(2):77-91. doi: 10.2217/cer-2020-0141..
Keywords: Sepsis, Telehealth, Health Information Technology (HIT), Emergency Department, Comparative Effectiveness, Evidence-Based Practice, Rural Health, Healthcare Delivery
Shehadeh KS, Cohn AEM, Jiang R
Using stochastic programming to solve an outpatient appointment scheduling problem with random service and arrival times.
The investigators studied a stochastic outpatient appointment scheduling problem (SOASP) in which they needed to design a schedule and an adaptive rescheduling (i.e., resequencing or declining) policy for a set of patients. Each patient had a known type and associated probability distributions of random service duration and random arrival time. Finding a provably optimal solution to this problem required solving a multistage stochastic mixed-integer program (MSMIP) with a schedule optimization problem solved at each stage, determining the optimal rescheduling policy over the various random service durations and arrival times.
AHRQ-funded; HS024385.
Citation: Shehadeh KS, Cohn AEM, Jiang R .
Using stochastic programming to solve an outpatient appointment scheduling problem with random service and arrival times.
Nav Res Logistics 2021 Feb;68(1):89-111. doi: 10.1002/nav.21933..
Keywords: Healthcare Delivery
Solberg LI, Kuzel A, Parchman ML
A taxonomy for external support for practice transformation.
There is no commonly accepted comprehensive framework for describing the practical specifics of external support for practice change. In this study, the researchers’goal was to develop a taxonomy that could be used by both external groups or researchers and health care leaders. The leaders of 8 grants from Agency for Research and Quality for the EvidenceNOW study of improving cardiovascular preventive services in over 1500 primary care practices nationwide worked collaboratively over 18 months to develop descriptions of key domains that might comprehensively characterize any external support intervention.
AHRQ-funded; HS023940.
Citation: Solberg LI, Kuzel A, Parchman ML .
A taxonomy for external support for practice transformation.
J Am Board Fam Med 2021 Jan-Feb;34(1):32-39. doi: 10.3122/jabfm.2021.01.200225..
Keywords: Primary Care, Healthcare Delivery, Cardiovascular Conditions, Evidence-Based Practice, Prevention, Quality Improvement, Practice Improvement, Quality of Care
Pestka DL, Paterson NL, Benedict KA
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
As part of a population health-focused primary care transformation, in 2019 a health system in Minnesota developed a primary care team to exclusively care for high-cost high-need patients. Through its development and implementation, the team has discovered several key lessons in delivering care to complex patients. In this paper, the authors discuss lessons learned from their research.
AHRQ-funded; HS026379.
Citation: Pestka DL, Paterson NL, Benedict KA .
Delivering care to high-cost high-need patients: lessons learned in the development of a complex care primary care team.
J Prim Care Community Health 2021 Jan-Dec;12:21501327211023888. doi: 10.1177/21501327211023888..
Keywords: Primary Care, Primary Care: Models of Care, Healthcare Delivery, Teams, Communication, Implementation
Cottrell EK, Dambrun K, O'Malley J
Documenting new ways of delivering care under Oregon's Alternative Payment and Advanced Care Model.
This study’s objective was to describe trends in rates of traditional face-to-face office visits and “Care Services That Engage Patients” (Care STEPs) documentation among community health centers (CHCs) involved in the first 3 phases Oregon’s Alternative Payment and Advanced Care Model (APCM) pilot program. In this program, participating community health centers (CHCs) received per-member-per-month payments for empaneled Medicaid patients in lieu of standard fee-for-service Medicaid payments. Among participating CHCs, the mean rate of face-to-face visits with billable providers declined. Care STEPS documentation increased, but the difference was not statistically significant. The Care STEPs category New Visit Types were documented most frequently. There were significant increases in document of Patient Care Coordination and Integration, and a smaller but still significant increase in Reducing Barriers to Health. There was a significant decrease in documentation done by physicians and advanced practice providers with an increase by ancillary staff.
AHRQ-funded; R01 HS022651.
Citation: Cottrell EK, Dambrun K, O'Malley J .
Documenting new ways of delivering care under Oregon's Alternative Payment and Advanced Care Model.
J Am Board Fam Med 2021 Jan-Feb;34(1):78-88. doi: 10.3122/jabfm.2021.01.200027..
Keywords: Healthcare Delivery, Payment, Community-Based Practice, Medicaid
Kimmey L, Furukawa MF, Jones DJ
AHRQ Author: Furukawa MF
Geographic variation in the consolidation of physicians into health systems, 2016-18.
The authors asked the following questions: To what extent does consolidation of physicians into vertically integrated health systems vary across markets, and how did that change from 2016 to 2018? In this article, they used AHRQ data on health systems and commercial data on physician-system affiliation to describe metropolitan statistical area-level physician consolidation and to identify differences by region and metropolitan statistical area size.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Kimmey L, Furukawa MF, Jones DJ .
Geographic variation in the consolidation of physicians into health systems, 2016-18.
Health Aff 2021 Jan;40(1):165-69. doi: 10.1377/hlthaff.2020.00812..
Keywords: Health Systems, Provider: Physician, Provider, Healthcare Delivery
Patel VL, Denton CA, Soni HC
Physician workflow in two distinctive emergency departments: an observational study.
In this study, the investigators characterized physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) were explored within the context of organizational complexity for the delivery of care. The investigators concluded that 1.) the nature of the clinical practice and EHR-mediated workflow reflected the ED work practices; 2.) physicians in more complex organizations may be less efficient because of the fragmented workflow- however these effects could be mitigated by effort distribution through team communication, which affords inherent safety checks.
AHRQ-funded; HS022670.
Citation: Patel VL, Denton CA, Soni HC .
Physician workflow in two distinctive emergency departments: an observational study.
Appl Clin Inform 2021 Jan;12(1):141-52. doi: 10.1055/s-0040-1722615..
Keywords: Emergency Department, Workflow, Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT)
Fraze TK, Beidler LB, Briggs ADM
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
Researchers sought to understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs. After conducting semi-structured interviews with Medicare ACOs, they found that ACOs were using care plans for patients with complex needs, but their use of care plans did not always meet the best practices; ACOs were adapting use of care plans to better fit the needs of patients and providers.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Briggs ADM .
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
J Gen Intern Med 2021 Jan;36(1):147-53. doi: 10.1007/s11606-020-06122-4..
Keywords: Implementation, Evidence-Based Practice, Medicare, Health Insurance, Healthcare Delivery
Scanlon DP, Harvey JB, Wolf LJ
Are health systems redesigning how health care is delivered?
The purpose of this study was to explore why and how health systems are engaging in care delivery redesign (CDR)-defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim. The investigators concluded that the ability to validly and reliably measure CDR activities-particularly across varying organizational contexts and markets-was currently limited but is key to better understanding CDR's impact on intended outcomes, which is important for guiding both health system decision making and policy making.
AHRQ-funded; HS024067.
Citation: Scanlon DP, Harvey JB, Wolf LJ .
Are health systems redesigning how health care is delivered?
Health Serv Res 2020 Dec;55(Suppl 3):1129-43. doi: 10.1111/1475-6773.13585..
Keywords: Health Systems, Healthcare Delivery