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
76 to 100 of 1425 Research Studies DisplayedApathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW
Documentation dynamics: note composition, burden, and physician efficiency.
This study’s objective was to analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. This cross-sectional study examined EHR metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. The authors calculated physician-level averages for four measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. They found that physicians in the top decile of note length demonstrated greater burden and lower efficiency than physicians in the median decile level, spending 39% more time in the EHR after hours and closing 5.6 percentage points fewer visits on the same day. Copy/paste use demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day and spending more time in the EHR after hours and on days off. Templated text such as Epic’s SmartTools demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
AHRQ-funded; HS026116.
Citation: Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW .
Documentation dynamics: note composition, burden, and physician efficiency.
Health Serv Res 2023 Jun; 58(3):674-85. doi: 10.1111/1475-6773.14097..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Anderson NW, Halfon N, Eisenberg D
Mixed signals in child and adolescent mental health and well-being indicators in the United States: a call for improvements to population health monitoring.
The authors of this paper suggest that policies targeting social indicators of youth status may not have improved overall mental health and well-being. They contend this absence of impact is evidenced by the divergence between social indicators which are improving, such as high school graduation, food insecurity, and smoking, and those which are worsening, such as mental health and well-being. The researchers report that available data indicates that one or more common exposures may be to blame, including those inadequately captured by existing social indicators.
AHRQ-funded; HS000046.
Citation: Anderson NW, Halfon N, Eisenberg D .
Mixed signals in child and adolescent mental health and well-being indicators in the United States: a call for improvements to population health monitoring.
Milbank Q 2023 Jun; 101(2):259-86. doi: 10.1111/1468-0009.12634..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Ambulatory Care and Surgery, Cardiovascular Conditions
Blecker S, Gannon M, De Leon S
Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial.
This paper describes a protocol for a study that will be conducted to compare the effect of hypertension-focused clinical decision support (CDS) plus practice facilitation on blood pressure (BP) control, as compared to CDS alone. The investigators will conduct a cluster randomized control trial that will include initial training on the CDS and a review of current guidelines along with follow-up for coaching and integration support. They will randomize 46 small primary care practices in New York City who use the same electronic health record vendor to intervention or control. They will also assess implementation of CDS in all practices and practice facilitation in the intervention group.
AHRQ-funded; HS027120.
Citation: Blecker S, Gannon M, De Leon S .
Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial.
Contemp Clin Trials 2023 Jun; 129:107177. doi: 10.1016/j.cct.2023.107177..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Blood Pressure, Cardiovascular Conditions
Khor S, Heagerty PJ, Basu A
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
This study examined whether the accuracy of a proxy for colorectal cancer (CRC) recurrence differed by race/ethnicity and the possible mechanisms that drove the differences. Using data from a large integrated health care system, the authors identified a stratified random sample of 282 Black/African American (AA), Hispanic, and non-Hispanic White (NHW) patients with CRC who received primary treatment. The recurrence proxy was found to have excellent overall accuracy (positive predictive value [PPV] 89.4%; negative predictive value 96.5%; mean difference in timing 1.96 months); however, accuracy varied by race/ethnicity. Compared with NHW patients, PPV was 14.9% lower among Hispanic patients and 4.3% lower among Black/AA patients. The proxy disproportionately inflated the 5-year recurrence incidence for Hispanic patients by 10.6%. Compared with NHW patients, proxy recurrences for Hispanic patients were almost three times as likely to have been misclassified as positive (adjusted risk ratio 2.91). The authors theorize that higher false positives among racial/ethnic minorities may be related to higher prevalence of noncancerous lung-related problems and substantial delays in primary treatment because of insufficient patient-provider communication and abnormal treatment patterns.
AHRQ-funded; HS013853.
Citation: Khor S, Heagerty PJ, Basu A .
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
JCO Clin Cancer Inform 2023 Jun; 7:e2300004. doi: 10.1200/cci.23.00004..
Keywords: Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Disparities
Cho Y, Yang R, Gong Y
Use of electronic communication with clinicians among cancer survivors: Health Information National Trend Survey in 2019 and 2020.
This study’s objective was to describe cancer survivors' use of electronic communication (e-communication) with clinicians and identify factors associated with their use, including the COVID-19 pandemic. The authors conducted a secondary analysis of cancer survivors (N = 1,482) from the combined Health Information National Trends Survey HINTS 5 Cycle 3 and Cycle 4. Survivors' use of e-communication was defined by at least one of four e-communication use behaviors in the previous 12 months. Cancer survivors had a 64% prevalence of e-communication use, with older adults (≥65 years old) were less likely to use e-communication. Survivors who were white, living in a metro area, diagnosed with breast cancer, seeking cancer-related information previously, or having a regular health care provider were more likely to use e-communication. The start of the COVID-19 pandemic was marginally associated with the increased e-communication use when other variables were controlled.
AHRQ-funded; HS027846.
Citation: Cho Y, Yang R, Gong Y .
Use of electronic communication with clinicians among cancer survivors: Health Information National Trend Survey in 2019 and 2020.
Telemed J E Health 2023 Jun; 29(6):866-74. doi: 10.1089/tmj.2022.0203..
Keywords: Clinician-Patient Communication, Communication, Cancer, Telehealth, Health Information Technology (HIT)
Huo T, Glueck DH, Shenkman EA
Stratified split sampling of electronic health records
Data extracted from electronic health records may require very different approaches for model building and analysis than data from clinical research. Because electronic health record data is designed for clinical use, researchers need to engage in the iterative process of defining and provide clear definitions of outcome and predictor variables and assessing associations. This process can increase Type I error rates and decrease the chance of replicability. Failure to consider subgroups may mask heterogeneous relationships between predictor and outcome by subgroups, thus decreasing the generalizability of the findings. To improve the likelihood of both replicability and generalizability, the researchers recommended utilizing a stratified split sample approach for studies using electronic health records. The researchers illustrate the approach through an electronic health record study of the relationships between socio-demographic factors and uptake of hepatic cancer screening, and potential heterogeneity of association in subgroups defined by gender, self-identified race and ethnicity, census-tract level poverty and insurance type.
AHRQ-funded; HS028283.
Citation: Huo T, Glueck DH, Shenkman EA .
Stratified split sampling of electronic health records
BMC Med Res Methodol 2023 May 25; 23(1):128. doi: 10.1186/s12874-023-01938-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, Health Services Research (HSR)
Burstin H, Curry S, Ranney ML
AHRQ Author: Jain A
Identifying credible sources of health information in social media: phase 2-considerations for non-accredited nonprofit organizations, for-profit entities, and individual sources.
This paper (which included an AHRQ author) objective was to develop principles and attitudes to guide social media and other digital platforms to rigorously identify credible sources of health information. This paper was partially funded by YouTube. Phase 1 of this study was completed in 2021 by an expert advisory group convened by the National Academy of Medicine (NAM) which yielded foundational principles and attributes for determining credibility of health information sources, but only for US sources. This paper describes Phase 2, which was carried out by a multidisciplinary, independent advisory committee convened by the Council of Medical Specialty Societies (CMSS) in collaboration with NAM and WHO and expanded from Phase 1 to include global sources. The Phase 2 advisory committee examined and deliberated on the three principles established during Phase 1 and their defining attributes in individual breakout groups. The focus was on one of three potential sources of credible health information: for-profit organizations, non-accredited nonprofit organizations, and individuals. A draft of the proposed new attributes, a related questionnaire and a preliminary draft of this paper was posted for public comment from September 9 to 19, 2022. A final virtual meeting was convened so the entire committee could discuss and incorporate feedback from the public comments. The principles of diversity, equity, and inclusion (DEI) was identified as of sufficient importance to elevate it as a new principle. A table showing the four principles and the attributes for each of the sources is included.
AHRQ-authored.
Citation: Burstin H, Curry S, Ranney ML .
Identifying credible sources of health information in social media: phase 2-considerations for non-accredited nonprofit organizations, for-profit entities, and individual sources.
NAM Perspect 2023 May 23; 2023. doi: 10.31478/202305b..
Keywords: Social Media, Education: Patient and Caregiver, Health Information Technology (HIT)
Ahmad FA, Chan P, McGovern C
Adapting an electronic STI risk assessment program for use in pediatric primary care.
This study’s goal was to evaluate the usability of an electronic risk assessment tool to support sexually transmitted disease (STI) testing in the authors’ pediatric emergency department that they had previously designed and implemented. They conducted qualitative interviews of pediatricians, clinic staff, and adolescents from 4 pediatric practices as part of a study whose goal is to ultimately implement STI screening in pediatric primary care. The goal of the interviews was (1) to understand contextual factors related to STI screening in primary care, which they reported previously, and (2) to obtain feedback on their electronic platform, the questionnaire content, and their perspective on implementing it in primary care settings. They received quantitative feedback using the System Usability Scale (SUS). The SUS is a validated, reliable tool to measure the usability of hardware, software, websites, and applications, with a score of 68 (range 0-100) being average usability. They recruited 14 physicians, 9 clinic staff, and 12 adolescents. Participants rated the tool with a median score of 92.5, which shows a high level of usability.
AHRQ-funded; HS026704.
Citation: Ahmad FA, Chan P, McGovern C .
Adapting an electronic STI risk assessment program for use in pediatric primary care.
J Prim Care Community Health 2023 Jan-Dec; 14:21501319231172900. doi: 10.1177/21501319231172900..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Health Information Technology (HIT), Screening, Prevention
Chu CD, Lenoir KM, Rai NK
Concordance between clinical outcomes in the systolic blood pressure intervention trial and in the electronic health record.
This study examined the role that electronic health records (EHRs) can play in follow-up for concordance with trial-ascertained outcomes. The authors linked EHR and trial data for participants in the Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial comparing intensive and standard blood pressure targets. Among participants with available EHR data concurrent to trial-ascertained outcomes, they calculated sensitivity, specificity, positive predictive value, and negative predictive value for EHR-recorded cardiovascular disease (CVD) events, using the gold standard of SPRINT-adjudicated outcomes (myocardial infarction (MI)/acute coronary syndrome (ACS), heart failure, stroke, and composite CVD events). They additionally compared the incidence of non-CVD adverse events (hyponatremia, hypernatremia, hypokalemia, hyperkalemia, bradycardia, and hypotension) in trial versus EHR data. Of the 2468 SPRINT participants included, EHR data demonstrated ≥80% sensitivity and specificity, and ≥99% negative predictive value for MI/ACS, heart failure, stroke, and composite CVD events. Positive predictive value ranged from 26% for heart failure to 52% for MI/ACS. Conclusions were that EHR data uniformly identified more non-CVD adverse events and higher incidence rates compared with trial ascertainment.
AHRQ-funded; HS026383.
Citation: Chu CD, Lenoir KM, Rai NK .
Concordance between clinical outcomes in the systolic blood pressure intervention trial and in the electronic health record.
Contemp Clin Trials 2023 May; 128:107172. doi: 10.1016/j.cct.2023.107172..
Keywords: Blood Pressure, Electronic Health Records (EHRs), Health Information Technology (HIT), Cardiovascular Conditions
Hewner S, Smith E, Sullivan SS
Identifying high-need primary care patients using nursing knowledge and machine learning methods.
This study examined how patient cohorts generated by machine learning can be enhanced with clinical knowledge to increase translational value and provide a practical approach to patient segmentation based on a mix of medical, behavioral, and social factors. The authors used a primary care practice dataset (N=3438) of high need patients defined by practice criteria and parsed it to a subset population of patients with diabetes (n=1233). Three expert nurses selected variables for k-means cluster analysis using knowledge of critical factors for care coordination, and their knowledge was again applied to describe the psychosocial phenotypes in four prominent clusters, aligned with social and medical care plans. Four distinct clusters were used to create four cohorts including: (1) A large cluster of racially diverse female, non-English speakers with low medical complexity, and history of childhood illness; (2) A large cluster of English speakers with significant comorbidities (obesity and respiratory disease); (3) A small cluster of males with substance use disorder and significant comorbidities (mental health, liver and cardiovascular disease) who frequently visit the hospital; and (4) A moderate cluster of older, racially diverse patients with renal failure.
AHRQ-funded; HS028000.
Citation: Hewner S, Smith E, Sullivan SS .
Identifying high-need primary care patients using nursing knowledge and machine learning methods.
Appl Clin Inform 2023 May; 14(3):408-17. doi: 10.1055/a-2048-7343..
Keywords: Primary Care, Health Information Technology (HIT), Nursing
Dhopeshwarkar RV, Freij M, Callaham M
AHRQ Author: Harrison MI, Swiger J, Lomotan EA, Dymek C
Lessons learned from a national initiative promoting publicly available standards-based clinical decision support.
The purpose of this study was to discuss lessons learned from a national program promoting publicly available, standards-based Clinical decision support (CDS) resources, describe the challenges encountered with their use, and make suggestions for areas of improvement. The source of the findings was an evaluation of the Agency for Healthcare Research and Quality (AHRQ) Patient-Centered Outcomes Research CDS Initiative, the purpose of which was to advance evidence into practice through standards-based and publicly available CDS. The researchers utilized a review of literature and program materials, conducted key informant interviews, and administered a web-based survey about a public repository of CDS archives and tools for writing standards-based CDS. The review identified key lessons for developing and implementing standards-based CDS through publicly available repositories such as CDS Connect. The researchers identified trust as a key factor in uptake, which can be strengthened by transparent information on underlying evidence, collaboration with experts, and feedback loops between users and developers to support continuous quality improvement. In addition, lower-resourced health systems will need more support to ensure effective implementation and utilization. Finally, the study found that health systems want more information about patient-centered, clinical, and cost-related outcomes to facilitate justifying the investment required to implement publicly available, standards-based CDS.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dhopeshwarkar RV, Freij M, Callaham M .
Lessons learned from a national initiative promoting publicly available standards-based clinical decision support.
Appl Clin Inform 2023 May; 14(3):566-74. doi: 10.1055/s-0043-1769911..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Patient-Centered Outcomes Research
Kimchi A, Aronow HU, Ni YM
Postdischarge noninvasive telemonitoring and nurse telephone coaching improve outcomes in heart failure patients with high burden of comorbidity.
The purpose of this study was to explore how comorbidity burden modulates the effectiveness of Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) and identify patients with HF who may benefit from postdischarge NTM-NTC based on their burden of comorbidity. METHODS AND RESULTS: In the Better Effectiveness After Transition - Heart Failure trial, patients hospitalized for acute decompensated HF were randomized to postdischarge NTM-NTC or usual care. In this secondary analysis of 1313 patients with complete data, comorbidity burden was assessed by scoring complication and coexisting diagnoses from index admissions. Clinical outcomes included 30-day and 180-day readmissions, mortality, days alive, and combined days alive and out of the hospital. Patients had a mean of 5.7 comorbidities and were stratified into low (0-2), moderate (3-8), and high comorbidity (≥9) subgroups. Increased comorbidity burden was associated with worse outcomes. NTM-NTC was not associated with readmission rates in any comorbidity subgroup. Among high comorbidity patients, NTM-NTC was associated with significantly lower mortality at 30 days (hazard ratio 0.25, 95% confidence interval 0.07-0.90) and 180 days (hazard ratio 0.51, 95% confidence interval 0.27-0.98), as well as more days alive (160.1 vs 140.3, P = .029) and days alive out of the hospital (152.0 vs 133.2, P = .044) compared with usual care. CONCLUSIONS: Postdischarge NTM-NTC improved survival among patients with HF with a high comorbidity burden. Comorbidity burden may be useful for identifying patients likely to benefit from this management strategy.
AHRQ-funded; HS019311.
Citation: Kimchi A, Aronow HU, Ni YM .
Postdischarge noninvasive telemonitoring and nurse telephone coaching improve outcomes in heart failure patients with high burden of comorbidity.
J Card Fail 2023 May; 29(5):774-83. doi: 10.1016/j.cardfail.2022.11.012..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Telehealth, Health Information Technology (HIT), Hospital Discharge
Cantor AG, Nelson HD, Pappas M
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
This comparative effectiveness review was conducted on the effectiveness and harms of telehealth interventions for women's reproductive health and intimate partner violence (IPV) services. A literature search was conducted for randomized controlled trials (RCTs) and observational studies of telehealth strategies for women's reproductive health and IPV versus usual care for the period July 2016 to May 2022. Eight RCTs, 1 nonrandomized trial, and 7 observational studies were included (7 studies of contraceptive care and 9 of IPV services). Telehealth services demonstrated similar care as usual care for contraceptive use, sexually transmitted infections, and pregnancy (low strength of evidence [SOE]). Evidence on abortion was insufficient. Outcomes were also similar between telehealth and usual care interventions to replace or supplement IPV services and comparators for repeat IPV, depression, posttraumatic stress disorder, fear of partner, coercive control, self-efficacy, and safety behaviors (low SOE). Telehealth barriers identified included limited internet access, digital literacy, technical challenges, and confidentiality concerns. Safety strategies increased telehealth use for IPV services. Evidence lacked on access, health equity, or harms.
AHRQ-funded; 75Q80120D00006.
Citation: Cantor AG, Nelson HD, Pappas M .
Telehealth for women's preventive services for reproductive health and intimate partner violence: a comparative effectiveness review.
J Gen Intern Med 2023 May; 38(7):1735-43. doi: 10.1007/s11606-023-08033-6..
Keywords: Telehealth, Health Information Technology (HIT), Women, Prevention, Domestic Violence, Evidence-Based Practice, Maternal Care, Sexual Health, Patient-Centered Outcomes Research, Comparative Effectiveness
Zhang J, Kummerfield E, Hultman G
Application of causal discovery algorithms in studying the nephrotoxicity of remdesivir using longitudinal data from the EHR.
Researchers analyzed the role of remdesivir in the mechanism and optimal treatment of the development of acute kidney injury (AKI) in the setting of COVID. Applying causal discovery machine learning techniques, they built multifactorial causal models of COVID-AKI; risk factors and renal function measures were represented in a temporal sequence using longitudinal data from Electronic Health Records. Their results indicated a need for assessment of renal function on second- and third-day use of remdesivir, and also showed that remdesivir may pose less risk to AKI than existing conditions of chronic kidney disease.
AHRQ-funded; HS024532.
Citation: Zhang J, Kummerfield E, Hultman G .
Application of causal discovery algorithms in studying the nephrotoxicity of remdesivir using longitudinal data from the EHR.
AMIA Annu Symp Proc 2023 Apr 29; 2022:1227-36..
Keywords: COVID-19, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Adverse Drug Events (ADE), Adverse Events
Hobensack M, Song J, Chae S
Capturing concerns about patient deterioration in narrative documentation in home healthcare.
This study aimed to build machine learning algorithms to identify “concerning” narrative notes of home healthcare (HHC) patients and identify emergency themes to support early identification of patients at risk for deterioration. Six algorithms were applied to 4000 narrative notes from a HHC agency to classify notes as either "concerning" or "not concerning." Emerging themes were identified using Latent Dirichlet Allocation bag of words topic modeling. Emerging themes of concern included patient-clinician communication, HHC services provided, gait challenges, mobility concerns, wounds, and caregivers. Most of these themes had already been identified in previous literature as increasing risk for adverse events.
AHRQ-funded; HS027742.
Citation: Hobensack M, Song J, Chae S .
Capturing concerns about patient deterioration in narrative documentation in home healthcare.
AMIA Annu Symp Proc 2023 Apr 29; 2022:552-59..
Keywords: Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT)
Moy AJ, Cato KD, Withall J
Using time series clustering to segment and infer emergency department nursing shifts from electronic health record log files.
Clinical shifts are an essential unit of work recognized in clinical settings and may function as a primary unit of analysis in the study of documentation burden. The purpose of this proof- of-concept study was to investigate the feasibility of a new approach utilizing time series clustering to segment and infer clinician shifts from electronic health record (HER) log files. The researchers recorded 33,535,585 events between April-June 2021 and computationally identified 43,911 potential shifts among 2,285 emergency department nurses. On average, shifts were 10.6±3.1 hours in duration. Researchers classified the shifts based on type: day, evening, night; and length: 12-hour, 8-hour, other. The preliminary results of the study found that unsupervised clustering methods may be a feasible approach for quickly identifying clinician shifts.
AHRQ-funded; HS028454.
Citation: Moy AJ, Cato KD, Withall J .
Using time series clustering to segment and infer emergency department nursing shifts from electronic health record log files.
AMIA Annu Symp Proc 2023 Apr 29; 2022:805-14..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department, Workforce
Taft T, Rudd EA, Thraen I
"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses.
The objectives of this study were to characterize persistent hazards and inefficiencies in inpatient medication administration, to explore cognitive attributes of medication administration tasks, and to discuss strategies to reduce technology-related hazards. Researchers interviewed nurses at two urban US health systems. Persistent safety hazards and inefficiencies related to medication administration technology were organized around the perception-action cycle (PAC) cycle. The researchers concluded that errors may persist in medication administration despite successful deployment of Bar Code Medication Administration and Electronic Medication Administration Record. Opportunities to improve would require a deeper understanding of high-level reasoning in medication administration.
AHRQ-funded; HS025136.
Citation: Taft T, Rudd EA, Thraen I .
"Are we there yet?" Ten persistent hazards and inefficiencies with the use of medication administration technology from the perspective of practicing nurses.
J Am Med Inform Assoc 2023 Apr 19; 30(5):809-18. doi: 10.1093/jamia/ocad031..
Keywords: Medication, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Patient Safety, Adverse Drug Events (ADE), Medical Errors, Medication: Safety
Kneifati-Hayek JZ, Applebaum JR, Schechter CB
Effect of restricting electronic health records on clinician efficiency: substudy of a randomized clinical trial.
This substudy of a prior randomized controlled trial compared clinician efficiency between electronic health records (EHRs) where the EHR limits the clinician to opening 1 record at a time to unrestricted configuration allowing up to 4 records open concurrently. Among a total of 2556 clinicians, there was no significant difference between unrestricted and restricted groups in total active minutes per day (115.1 vs 113.3 min, respectively), overall or by clinician type and practice area.
AHRQ-funded; HS026121; HS023704.
Citation: Kneifati-Hayek JZ, Applebaum JR, Schechter CB .
Effect of restricting electronic health records on clinician efficiency: substudy of a randomized clinical trial.
J Am Med Inform Assoc 2023 Apr 19; 30(5):953-57. doi: 10.1093/jamia/ocad025..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT)
Grauer A, Rosen A, Applebaum JR
Examining medication ordering errors using AHRQ network of patient safety databases.
Research on the impact of Computerized Physician Order Entry (CPOE) systems on drug order inaccuracies has shown inconsistent results, with CPOE not reliably preventing such mistakes. The study utilized the Network of Patient Safety Databases (NPSD) from the Agency for Healthcare Research and Quality (AHRQ) to explore the frequency and degree of harm associated with reported events during the ordering stage, and to classify them by error type.
The researchers conducted a retrospective analysis of reported safety incidents provided by healthcare systems associated with patient safety organizations from June 2010 to December 2020. All errors related to medication and other substance orders reported to the NPSD using the common format v1.2 during this period were assessed. The researchers grouped and categorized the prevalence of reported medication order errors by error type, harm levels, and demographic data. The study found that during the study period, 12,830 mistakes were reported. Incorrect dosage accounted for 3,812 errors (29.7%), followed by incorrect medicine 2,086 (16.3%), and incorrect duration 765 (6.0%). Out of 5,282 incidents that affected the patient and had a known severity level, 12 resulted in fatalities, 4 led to severe harm, 45 caused moderate harm, 341 led to minor harm, and 4,880 resulted in no harm. The study concluded that the most frequently reported and damaging types of medication order errors were incorrect dose and incorrect medication orders.
The researchers conducted a retrospective analysis of reported safety incidents provided by healthcare systems associated with patient safety organizations from June 2010 to December 2020. All errors related to medication and other substance orders reported to the NPSD using the common format v1.2 during this period were assessed. The researchers grouped and categorized the prevalence of reported medication order errors by error type, harm levels, and demographic data. The study found that during the study period, 12,830 mistakes were reported. Incorrect dosage accounted for 3,812 errors (29.7%), followed by incorrect medicine 2,086 (16.3%), and incorrect duration 765 (6.0%). Out of 5,282 incidents that affected the patient and had a known severity level, 12 resulted in fatalities, 4 led to severe harm, 45 caused moderate harm, 341 led to minor harm, and 4,880 resulted in no harm. The study concluded that the most frequently reported and damaging types of medication order errors were incorrect dose and incorrect medication orders.
AHRQ-funded; HS026121.
Citation: Grauer A, Rosen A, Applebaum JR .
Examining medication ordering errors using AHRQ network of patient safety databases.
J Am Med Inform Assoc 2023 Apr 19; 30(5):838-45. doi: 10.1093/jamia/ocad007..
Keywords: Medication, Adverse Drug Events (ADE), Adverse Events, Medical Errors, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Medication: Safety
Moy AJ, Hobensack M, Marshall K
Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments.
This study’s goal was to understand the perceived role of electronic health records (EHR) and workflow fragmentation on clinician documentation burden in the emergency department (ED). The authors conducted semistructured interviews with a national sample of US prescribing providers and registered nurses who actively practice in the adult ED setting and use Epic Systems' EHR. They recruited 12 prescribing providers and 12 registered nurses. Six themes were found related to EHR factors perceived to contribute to documentation burden including lack of advanced EHR capabilities, absence of EHR optimization for clinicians, poor user interface design, hindered communication, increased manual work, and added workflow blockages, and five themes associated with cognitive load. The relationship between workflow fragmentation and EHR documentation burden brought up two themes: underlying sources and adverse consequences.
AHRQ-funded; HS028454.
Citation: Moy AJ, Hobensack M, Marshall K .
Understanding the perceived role of electronic health records and workflow fragmentation on clinician documentation burden in emergency departments.
J Am Med Inform Assoc 2023 Apr 19; 30(5):797-808. doi: 10.1093/jamia/ocad038..
Keywords: Electronic Health Records (EHRs), Workflow, Health Information Technology (HIT), Emergency Department
Krevat SA, Samuel S, Boxley C
Identifying electronic health record contributions to diagnostic error in ambulatory settings through legal claims analysis.
The purpose of this study was to evaluate legal claims data to assess whether there is a relationship between problems with electronic health records and diagnostic errors. The researchers also explored specific types of errors that took place and at which point in the diagnostic process the errors occurred.
AHRQ-funded; HS027119.
Citation: Krevat SA, Samuel S, Boxley C .
Identifying electronic health record contributions to diagnostic error in ambulatory settings through legal claims analysis.
JAMA Netw Open 2023 Apr 3; 6(4):e238399. doi: 10.1001/jamanetworkopen.2023.8399..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality
Steeves-Reece AL, Davis MM, Hiebert Larson J
Patients' willingness to accept social needs navigation after in-person versus remote screening.
The authors conducted a cross-sectional study in order to assess possible adverse effects of screening patients remotely on patient engagement and interest in accepting social needs navigation. Participants were Medicare and Medicaid beneficiaries in the Oregon Accountable Health Communities (AHC) model. The results indicated that over 70% of participants were willing to accept help with social needs; neither the mode of screening nor interaction term were significantly associated with willingness to accept navigation assistance. The authors concluded remote screening may not adversely affect patient willingness to accept health care-based navigation for social needs.
AHRQ-funded; HS027707.
Citation: Steeves-Reece AL, Davis MM, Hiebert Larson J .
Patients' willingness to accept social needs navigation after in-person versus remote screening.
J Am Board Fam Med 2023 Apr 3;36(2):229-39. doi: 10.3122/jabfm.2022.220259R1.
Keywords: Telehealth, Screening, Health Information Technology (HIT), Social Determinants of Health
Su YR, Buist DSM, Lee JM
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
The authors compared the relative predictive performance of statistical and machine learning (ML) models to guide modeling strategy selection for surveillance mammography outcomes in women with a personal history of breast cancer. They cross-validated seven risk prediction models for two surveillance outcomes, using 9,447 mammograms. The results suggested that regularized regression outperformed other modeling approaches for predicting breast cancer surveillance mammography outcomes and balanced the trade-off between model flexibility and interpretability.
AHRQ-funded; HS018366.
Citation: Su YR, Buist DSM, Lee JM .
Performance of statistical and machine learning risk prediction models for surveillance benefits and failures in breast cancer survivors.
Cancer Epidemiol Biomarkers Prev 2023 Apr 3; 32(4):561-71. doi: 10.1158/1055-9965.Epi-22-0677..
Keywords: Cancer: Breast Cancer, Cancer, Health Information Technology (HIT), Imaging
Giardina TD, Woodard LD, Singh H
Advancing diagnostic equity through clinician engagement, community partnerships, and connected care.
This article explores the persistent disparities in healthcare, particularly in the diagnostic process, which have been further exposed by the COVID-19 pandemic. The authors highlight the higher rates of infection, hospitalization, and death from COVID-19 among Black, Hispanic, and Asian patients, who are also less likely to be tested for the virus. Similar disparities are noted in cardiac testing, mental health diagnoses, appendicitis diagnosis, and receipt of diagnostic imaging in the Emergency Department. The authors propose a three-pronged approach to address these disparities: clinician engagement, community partnerships, and connected care. Clinician engagement involves fostering critical consciousness among healthcare providers to recognize and address systemic inequities. Community partnerships with Community Health Workers (CHWs) can help fill gaps in the diagnostic process. Lastly, connected care through telehealth can potentially eliminate traditional barriers to care, although disparities in access to technology and digital literacy remain a challenge. The authors call for further research and initiatives to address these disparities and promote diagnostic equity.
AHRQ-funded; HSP233201500022I; HS025474
Citation: Giardina TD, Woodard LD, Singh H .
Advancing diagnostic equity through clinician engagement, community partnerships, and connected care.
J Gen Intern Med 2023 Apr; 38(5):1293-95. doi: 10.1007/s11606-022-07966-8..
Keywords: Community Partnerships, Disparities, Telehealth, Health Information Technology (HIT)
Flynn A, Taksler G, Caverly T
CBK model composition using paired web services and executable functions: A demonstration for individualizing preventive services.
The integration of Computable Biomedical Knowledge (CBK) models presents a difficult task for evolving health systems. The purpose of the study was to show that by utilizing the technical abilities of the World Wide Web (WWW), along with digital entities named Knowledge Objects, and introducing a fresh method of CBK model activation, the assembly of CBK models can be achieved in a more standardized, manageable, and beneficial manner. Using previously indicated compound digital objects known as Knowledge Objects, CBK models are packaged with metadata, API descriptions, and runtime requirements. Using open-source runtimes and a tool the researchers developed (the KGrid Activator) CBK models can be instantiated inside runtimes and made accessible via RESTful APIs by the KGrid Activator. The KGrid Activator then serves as a gateway and provides a method for interconnecting CBK model outputs and inputs, thus establishing a CBK model composition method. As a means of validating their method, the researchers created an intricate composite CBK model made up of 42 CBK submodels. The resulting model (CM-IPP), calculates life-gain estimates for individuals based on their unique characteristics. The outcome is a highly modularized CM-IPP execution that can be distributed and made operational in any usual server environment. The study found that construction of CBK models using compound digital entities and distributed computing technologies is achievable.
AHRQ-funded; HS026257.
Citation: Flynn A, Taksler G, Caverly T .
CBK model composition using paired web services and executable functions: A demonstration for individualizing preventive services.
Learn Health Syst 2023 Apr; 7(2):e10325. doi: 10.1002/lrh2.10325..
Keywords: Learning Health Systems, Health Information Technology (HIT)