National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Autism (1)
- Behavioral Health (2)
- Cardiovascular Conditions (2)
- Care Coordination (1)
- Caregiving (1)
- Care Management (1)
- Children/Adolescents (4)
- (-) Chronic Conditions (22)
- Clinician-Patient Communication (5)
- Communication (2)
- Decision Making (3)
- Diabetes (5)
- Diagnostic Safety and Quality (1)
- Education: Patient and Caregiver (2)
- Elderly (1)
- Electronic Health Records (EHRs) (2)
- Evidence-Based Practice (2)
- Family Health and History (1)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (5)
- Hospital Readmissions (1)
- Kidney Disease and Health (1)
- Low-Income (1)
- Nutrition (1)
- Patient-Centered Healthcare (8)
- Patient-Centered Outcomes Research (3)
- (-) Patient and Family Engagement (22)
- Patient Self-Management (5)
- Primary Care (2)
- Quality Improvement (1)
- Racial and Ethnic Minorities (1)
- Web-Based (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 22 of 22 Research Studies DisplayedMiller-Rosales C, Brewster AL, Shortell SM
Multilevel influences on patient engagement and chronic care management.
This study used data collected from the National Survey of Healthcare Organizations and Systems to examine health system- and physician practice-level capabilities associated with adoption of (1) patient engagement strategies and (2) chronic care management processes for adult patients with diabetes and/or cardiovascular disease. A total of 796 physician practices and 247 health systems were analyzed from 2017 to 2018. Health systems with processes to assess clinical evidence and with more advanced health information technology (HIT) functionality adopted more practice-level chronic care management processes, but not patient engagement strategies, compared with systems lacking these capabilities. More patient engagement strategies and chronic care management processes were adopted by physician practices with cultures oriented to innovation, more advanced HIT functionality, and with a process to assess clinical evidence than those without those characteristics.
AHRQ-funded; HS024075.
Citation: Miller-Rosales C, Brewster AL, Shortell SM .
Multilevel influences on patient engagement and chronic care management.
Am J Manag Care 2023 Apr; 29(4):196-202. doi: 10.37765/ajmc.2023.89348..
Keywords: Patient and Family Engagement, Chronic Conditions, Patient-Centered Healthcare
Bell SK, Dong ZJ, Desroches CM
Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool.
Involving patients and their families in the diagnostic process is crucial, but there is a lack of methods for consistent engagement. The implementation of policies providing patients with access to electronic health records offers new possibilities. The researchers evaluated a novel online tool ("OurDX"), co-created with patients and families, to examine the nature and frequency of potential safety issues identified by patients and their families with chronic health conditions and whether these insights were incorporated into visit notes. At two US healthcare facilities, patients and their families were encouraged to participate via an online pre-visit questionnaire, which covered: (1) visit priorities, (2) recent medical history and symptoms, and (3) potential diagnostic concerns. Two physicians assessed patient-reported diagnostic issues to validate and classify diagnostic safety opportunities (DSOs). The researchers performed a chart review to determine if patient inputs were integrated into the visit note. Descriptive statistics were employed to report implementation outcomes, DSO verification, and chart review findings. The study found that OurDX reports were completed in 7075 of 18,129 (39%) eligible pediatric subspecialty visits (site 1) and 460 of 706 (65%) eligible adult primary care visits (site 2). Of the patients expressing diagnostic concerns, 63% were confirmed as probable DSOs. Overall, 7.5% of pediatric and adult patients and their families with chronic health conditions identified probable DSOs. The most frequent DSO types included patients and families feeling unheard; issues or delays in tests or referrals; and complications or delays in clarification or subsequent steps. The chart review revealed that most clinician notes incorporated all or some of the patient or family priorities and patient-reported histories.
AHRQ-funded; HS027367
Citation: Bell SK, Dong ZJ, Desroches CM .
Partnering with patients and families living with chronic conditions to coproduce diagnostic safety through OurDX: a previsit online engagement tool.
J Am Med Inform Assoc 2023 Mar 16;30(4):692-702. doi: 10.1093/jamia/ocad003.
Keywords: Chronic Conditions, Diagnostic Safety and Quality, Health Information Technology (HIT), Patient and Family Engagement, Healthcare Delivery
Hinesley JLG, Brooks EM, O'Loughlin K
Feasibility of patient navigation for care planning in primary care.
The purpose of this study was to help better control chronic conditions by connecting patients with a navigator for support creating a personal care goal. Twenty-four clinicians in 12 practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) participated in a care planning intervention under a structured process that guided 87 patients with uncontrolled chronic conditions, trained navigators, and adapted the navigation process to meet the needs of each practice. Findings indicated that patient navigation to address care plans should be feasible, with a minimal time commitment and non-intensive training. However, given the burden and competing demands in primary care, this help cannot be offered without additional resources.
AHRQ-funded; HS026223.
Citation: Hinesley JLG, Brooks EM, O'Loughlin K .
Feasibility of patient navigation for care planning in primary care.
J Prim Care Community Health 2022 Jan-Dec;13:21501319221134754. doi: 10.1177/21501319221134754..
Keywords: Primary Care, Chronic Conditions, Patient and Family Engagement
Schuttner L, Hockett Sherlock S, Simons CE
My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity.
This study’s goal was to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. The authors conducted semi-structured telephone interviews from April to July 2020 with 23 physicians across 20 clinical sites, with most being female (61%). Facilitators included: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care.
AHRQ-funded; HS026369.
Citation: Schuttner L, Hockett Sherlock S, Simons CE .
My goals are not their goals: barriers and facilitators to delivery of patient-centered care for patients with multimorbidity.
J Gen Intern Med 2022 Dec;37(16):4189-96. doi: 10.1007/s11606-022-07533-1..
Keywords: Patient-Centered Healthcare, Healthcare Delivery, Chronic Conditions, Clinician-Patient Communication, Communication, Patient and Family Engagement
Aboumatar H, Pitts S, Sharma R
Patient engagement strategies for adults with chronic conditions: an evidence map.
Existing research indicates that patient and family engagement (PFE) in health care is necessary for improving outcomes. The purpose of this study was to explore the evidence on PFE strategies for adults with chronic conditions and identify the areas where additional research is needed. The authors searched existing databases, including CINAHL, Cochrane, EMBASE, and PubMed, for data between January 2015 and September 2021, to identify systematic reviews on strategies for engaging patients with chronic conditions. The study also included their caregivers. Strategies were categorized into the following levels: direct patient care, health system, and community-policy. The authors discovered 131 reviews of direct patient care strategies, 5 reviews of health system strategies, and no reviews of community-policy strategies. The study concluded that there is much more available evidence on the effects of direct patient care strategies on PFE than on the effects of the health system or community policy strategies. In addition, the evidence map created by the researchers focused on reviews which did not provide details of individual chronic disease interventions. The authors concluded that the evidence map created provides awareness of the research gaps related to efforts to improve patient and family engagement for patients with chronic conditions.
AHRQ-funded; 290201500006I.
Citation: Aboumatar H, Pitts S, Sharma R .
Patient engagement strategies for adults with chronic conditions: an evidence map.
Syst Rev 2022 Mar 5;11(1):39. doi: 10.1186/s13643-021-01873-5..
Keywords: Patient and Family Engagement, Chronic Conditions, Evidence-Based Practice
Fuji KT, Abbott AA, Galt KA
A mixed-methods evaluation of standalone personal health record use by patients with type 2 diabetes.
The purpose of this study was to compare use of a standalone personal health records (PHRs) by patients with Type 2 diabetes to usual care through assessment of self-care behaviors, and short-term impact on social cognitive outcomes and hemoglobin A1c (HbA1c). Five themes emerged from the qualitative analysis describing participants' experiences with the PHR and identifying reasons for lack of engagement. Study findings revealed low PHR uptake and minimal impact on study outcomes, including lack of communication and information-sharing between patients and providers.
AHRQ-funded; HS018625.
Citation: Fuji KT, Abbott AA, Galt KA .
A mixed-methods evaluation of standalone personal health record use by patients with type 2 diabetes.
Perspect Health Inf Manag 2021 Fall;18(4):1e..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diabetes, Patient Self-Management, Chronic Conditions, Patient and Family Engagement
Smith BM, Sharma R, Das A
Patient and family engagement strategies for children and adolescents with chronic diseases: a review of systematic reviews.
Patient and family engagement is important for family-centered care, particularly for children and adolescents with chronic disease. In this study the investigators aimed to 1) identify available evidence from systematic reviews on engagement strategies used to help children, adolescents, and their caregivers manage chronic conditions, and 2) identify gaps in the literature. They searched PubMed and CINAHL from January 2015 to January 2020 for systematic reviews on patient and family engagement strategies in the pediatrics population (<18 years).
AHRQ-funded; 290201500006I.
Citation: Smith BM, Sharma R, Das A .
Patient and family engagement strategies for children and adolescents with chronic diseases: a review of systematic reviews.
Patient Educ Couns 2021 Sep;104(9):2213-23. doi: 10.1016/j.pec.2021.02.026..
Keywords: Children/Adolescents, Patient and Family Engagement, Chronic Conditions, Patient-Centered Healthcare, Evidence-Based Practice, Patient Self-Management
Feinberg E, Kuhn J, Eilenberg JS
Improving family navigation for children with autism: a comparison of two pilot randomized controlled trials.
This study looked at impacts of a modification to a pilot program called Family Navigation to help low-income, minority children needing autism-related diagnostic services receive those services. An advisory group recommended modifications to recruitment criteria and study conditions. 40 parent-child dyad participants were randomized between the two pilots to receive usual care (UC) or modified FN. Participant enrollment, satisfaction with clinical care, and timely completion of the diagnostic assessment were compared. Recruitment improved significantly with the modified protocol (4.8% vs. 19.5%) and no participants were excluded from study enrollment compared to the first pilot (43.6%). Families in the second pilot were more likely to complete diagnostic assessment and report greater satisfaction with clinical care.
AHRQ-funded; HS022155; HS022242.
Citation: Feinberg E, Kuhn J, Eilenberg JS .
Improving family navigation for children with autism: a comparison of two pilot randomized controlled trials.
Acad Pediatr 2021 Mar;21(2):265-71. doi: 10.1016/j.acap.2020.04.007..
Keywords: Children/Adolescents, Autism, Patient-Centered Healthcare, Care Coordination, Racial and Ethnic Minorities, Low-Income, Patient and Family Engagement, Chronic Conditions
Pantalone KM, Misra-Hebert AD, Hobbs TM
The probability of a1c goal attainment in patients with uncontrolled type 2 diabetes in a large integrated delivery system: a prediction model.
Researchers assessed patient characteristics and treatment factors associated with uncontrolled type 2 diabetes and the probability of hemoglobin A(1c) (A1C) goal attainment. Using electronic health record data at Cleveland Clinic, they found that a minority of patients with an A1C >9% achieved an A1C <8% at 1 year. While most identified predictive factors are nonmodifiable by the clinician, pursuit of frequent patient engagement and tailored drug regimens may help to improve A1C goal attainment.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Misra-Hebert AD, Hobbs TM .
The probability of a1c goal attainment in patients with uncontrolled type 2 diabetes in a large integrated delivery system: a prediction model.
Diabetes Care 2020 Aug;43(8):1910-19. doi: 10.2337/dc19-0968..
Keywords: Diabetes, Patient-Centered Healthcare, Patient and Family Engagement, Chronic Conditions
Nahm ES, Son H, Yoon JM
Older adults' use of patient portals: experiences, challenges, and suggestions shared through discussion board forums.
The goal of this study was to explore older adults' experiences with using patient portals (PPs), perceived impact of PPs on their health, and suggestions for improvement through analysis of discussion posts. The research team had previously developed an older-adult-friendly Theory-based PP eLearning Program (T-PeP), and tested its impact on older adults with chronic conditions. Findings from 10 major themes explained older adults' experiences with PPs and offered suggestions for vendors and healthcare organizations.
AHRQ-funded; HS024739.
Citation: Nahm ES, Son H, Yoon JM .
Older adults' use of patient portals: experiences, challenges, and suggestions shared through discussion board forums.
Geriatr Nurs 2020 Jul-Aug;41(4):387-93. doi: 10.1016/j.gerinurse.2019.12.001..
Keywords: Elderly, Health Information Technology (HIT), Chronic Conditions, Care Management, Patient and Family Engagement, Education: Patient and Caregiver
Poon BY, Shortell SM, Rodriguez HP
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
Shared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed. In this study, the investigators examined the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship.
AHRQ-funded; HS022241.
Citation: Poon BY, Shortell SM, Rodriguez HP .
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
J Gen Intern Med 2020 Mar;35(3):732-42. doi: 10.1007/s11606-019-05351-6.
Keywords: Decision Making, Diabetes, Cardiovascular Conditions, Chronic Conditions, Patient-Centered Healthcare, Patient and Family Engagement
Pavlo AJ, O'Connell M, Olsen S
Missing ingredients in shared decision-making?
This article discusses the practice of shared decision making (SDM) for clinicians when making decisions in health care. This widespread practice is considered the best approach for person-centered care, but for individuals diagnosed with serious mental illness there are still many barriers to effective collaboration. The authors suggest that more emphasis needs to be placed on the doctor-patient relationship itself conducting SDM.
AHRQ-funded; HS023000.
Citation: Pavlo AJ, O'Connell M, Olsen S .
Missing ingredients in shared decision-making?
Psychiatr Q 2019 Jun;90(2):333-38. doi: 10.1007/s11126-019-9624-9..
Keywords: Chronic Conditions, Clinician-Patient Communication, Communication, Decision Making, Behavioral Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Patient and Family Engagement
Ivey SL, Shortell SM, Rodriguez HP
Patient engagement in ACO practices and patient-reported outcomes among adults with co-occurring chronic disease and mental health conditions.
The purpose of this study was to assess the extent to which practices with patient-centered cultures, greater shared decision-making strategies, and better coordination among team members have better patient-reported outcomes for patients with diabetes and/or cardiovascular and comorbid mental health diagnoses. The study concluded that Accountable Care Organization patients with comorbid physical and mental health diagnoses report better physical functioning when practices have patient-centered cultures.
AHRQ-funded; HS024075.
Citation: Ivey SL, Shortell SM, Rodriguez HP .
Patient engagement in ACO practices and patient-reported outcomes among adults with co-occurring chronic disease and mental health conditions.
Med Care 2018 Jul;56(7):551-56. doi: 10.1097/mlr.0000000000000927..
Keywords: Chronic Conditions, Behavioral Health, Patient and Family Engagement, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Churchill SS, Kieckhefer GM
One year follow-up of outcomes from the randomized clinical trial of the building on family strengths program.
This study tested the 12-month efficacy of an inclusive non-diagnosis-specific, parent education program with seven in-person sessions. The outcome measures were self-efficacy, parent and child shared management of chronic condition, coping skills, parental depressive symptoms and quality of life. All of the outcomes improved within the intervention group over 12 months.
AHRQ-funded; HS013384.
Citation: Churchill SS, Kieckhefer GM .
One year follow-up of outcomes from the randomized clinical trial of the building on family strengths program.
Matern Child Health J 2018 Jun;22(6):913-21. doi: 10.1007/s10995-018-2467-4.
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Keywords: Children/Adolescents, Chronic Conditions, Education: Patient and Caregiver, Family Health and History, Patient and Family Engagement
Sequist TD, Holliday AM, Orav EJ
Physician and patient tools to improve chronic kidney disease care.
This study sought to determine if electronic health record (EHR) tools and patient engagement can improve the quality of chronic kidney disease (CKD) care. It found that, among high-risk patients, those in the intervention arm were significantly more likely to have an office visit with a nephrologist compared with those in the control arm.
AHRQ-funded; HS018226.
Citation: Sequist TD, Holliday AM, Orav EJ .
Physician and patient tools to improve chronic kidney disease care.
Am J Manag Care 2018 Apr;24(4):e107-e14.
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Keywords: Chronic Conditions, Electronic Health Records (EHRs), Kidney Disease and Health, Patient and Family Engagement, Quality Improvement
Egan M, Greenhawt M
Common questions in food allergy avoidance.
Allergists must be able to provide avoidance advice while suggesting age and nutritionally appropriate substitutions. This review therefore focuses on providing an understanding of identifying potential myths that may surround certain aspects of food allergy management, with a focus on redirecting misconceptions, and enhancing communications that can improve how patients live life with disease.
AHRQ-funded; HS024599.
Citation: Egan M, Greenhawt M .
Common questions in food allergy avoidance.
Ann Allergy Asthma Immunol 2018 Mar;120(3):263-71. doi: 10.1016/j.anai.2017.09.078.
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Keywords: Chronic Conditions, Nutrition, Patient and Family Engagement, Clinician-Patient Communication, Patient Self-Management
Ganapathy D, Acharya C, Lachar J
The patient buddy app can potentially prevent hepatic encephalopathy-related readmissions.
The researchers aimed to define the feasibility of using the Patient Buddy App and its impact on 30-day readmissions by engaging and educating cirrhotic inpatients and caregivers in a pilot study. In their proof-of-concept trial, the use of Patient Buddy is feasible in recently discharged patients with cirrhosis and their caregivers. Eight hepatic encephalopathy-related readmissions were potentially avoided after the use of the App.
AHRQ-funded; HS024004.
Citation: Ganapathy D, Acharya C, Lachar J .
The patient buddy app can potentially prevent hepatic encephalopathy-related readmissions.
Liver Int 2017 Dec;37(12):1843-51. doi: 10.1111/liv.13494.
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Keywords: Caregiving, Chronic Conditions, Health Information Technology (HIT), Patient and Family Engagement, Hospital Readmissions
Shortell SM, Poon BY, Ramsay PP
A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of accountable care organizations.
For adult primary care practices seeing patients with diabetes and/or cardiovascular disease, researchers examined the relationship between selected practice characteristics, patient engagement, and patient-reported outcomes of care. They found that having a patient-centered culture was positively associated with fewer depression symptoms and better physical function scores. Patient activation was positively associated with fewer depression symptoms.
AHRQ-funded; HS024075.
Citation: Shortell SM, Poon BY, Ramsay PP .
A multilevel analysis of patient engagement and patient-reported outcomes in primary care practices of accountable care organizations.
J Gen Intern Med 2017 Jun;32(6):640-47. doi: 10.1007/s11606-016-3980-z.
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Keywords: Patient and Family Engagement, Patient-Centered Outcomes Research, Primary Care, Chronic Conditions, Diabetes, Cardiovascular Conditions
Berry ABL, Lim C, Hartzler AL
Creating conditions for patients' values to emerge in clinical conversations: perspectives of health care team members.
The researchers sought to inform the design of interventions to support conversations about patient values between patients with multiple chronic conditions and their health care providers. Their paper contributes a practice-based account of ways in which providers engage with patient values, and discusses how future work in interactive systems design might extend and enrich these engagements.
AHRQ-funded; HS022364.
Citation: Berry ABL, Lim C, Hartzler AL .
Creating conditions for patients' values to emerge in clinical conversations: perspectives of health care team members.
DIS (Des Interact Syst Conf) 2017 Jun;2017:1165-74. doi: 10.1145/3064663.3064669.
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Keywords: Chronic Conditions, Clinician-Patient Communication, Patient Self-Management, Patient and Family Engagement
Smith MA, Bednarz L, Nordby PA
Increasing consumer engagement by tailoring a public reporting website on the quality of diabetes care: a qualitative study.
The goal of this study was to determine if tailoring quality reports to persons with diabetes mellitus and co-occurring chronic conditions would increase user engagement with a website that publicly reports the quality of diabetes care. It concluded that tailoring can be used to improve public reporting sites for individuals with chronic conditions, ultimately allowing consumers to make more informed health care decisions.
AHRQ-funded; HS021899.
Citation: Smith MA, Bednarz L, Nordby PA .
Increasing consumer engagement by tailoring a public reporting website on the quality of diabetes care: a qualitative study.
J Med Internet Res 2016 Dec 21;18(12):e332. doi: 10.2196/jmir.6555.
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Keywords: Chronic Conditions, Decision Making, Diabetes, Patient and Family Engagement, Web-Based
Hong MK, Wilcox L, Machado D
Care partnerships: toward technology to support teens' participation in their health care.
The authors conducted 38 in-depth interviews along with nine non-participant observations of clinical consultations to better understand common challenges and needs that could be supported through design. They drew their findings to propose design goals for sociotechnical systems to support teens in partnering in their care, highlighting the need for design to support gradually evolving partnerships in care.
AHRQ-funded; HS021393.
Citation: Hong MK, Wilcox L, Machado D .
Care partnerships: toward technology to support teens' participation in their health care.
Proc SIGCHI Conf Hum Factor Comput Syst 2016 May 7;2016:5337-49. doi: 10.1145/2858036.2858508.
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Keywords: Children/Adolescents, Chronic Conditions, Patient and Family Engagement, Patient Self-Management
O'Leary K, Vizer L, Eschler J
Understanding patients' health and technology attitudes for tailoring self-management interventions.
The researchers elicited attitudes toward technology use and participation in care of 40 participants in a maximum variation sample. They found three participant clusters-"Proactive Techies," "Indie Self-Managers," and "Remind Me! Non-Techies"-that represent varying attitudes toward health behaviors and technologies that were independent of race, education level, and age. Their approach provides insight into how people prioritize important values related to health participation and technology.
AHRQ-funded; HS021590.
Citation: O'Leary K, Vizer L, Eschler J .
Understanding patients' health and technology attitudes for tailoring self-management interventions.
AMIA Annu Symp Proc 2015 Nov 5;2015:991-1000.
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Keywords: Chronic Conditions, Health Information Technology (HIT), Patient and Family Engagement, Clinician-Patient Communication