National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (15)
- Adverse Drug Events (ADE) (54)
- Adverse Events (87)
- Alcohol Use (6)
- Ambulatory Care and Surgery (34)
- Antibiotics (7)
- Antimicrobial Stewardship (4)
- Anxiety (4)
- Arthritis (12)
- Asthma (15)
- Autism (4)
- Back Health and Pain (1)
- Behavioral Health (41)
- Blood Clots (2)
- Blood Pressure (22)
- Blood Thinners (8)
- Brain Injury (7)
- Breast Feeding (3)
- Burnout (11)
- Cancer (56)
- Cancer: Breast Cancer (8)
- Cancer: Colorectal Cancer (2)
- Cancer: Lung Cancer (6)
- Cancer: Prostate Cancer (3)
- Cardiovascular Conditions (50)
- Care Coordination (24)
- Caregiving (45)
- Care Management (31)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Centers for Education and Research on Therapeutics (CERTs) (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (108)
- Chronic Conditions (88)
- Clinical Decision Support (CDS) (128)
- Clinician-Patient Communication (61)
- Clostridium difficile Infections (1)
- Colonoscopy (1)
- Communication (95)
- Community-Acquired Infections (1)
- Community-Based Practice (19)
- Community Partnerships (1)
- Comparative Effectiveness (26)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (4)
- COVID-19 (46)
- Critical Care (15)
- Cultural Competence (5)
- Data (43)
- Decision Making (85)
- Dementia (10)
- Dental and Oral Health (1)
- Depression (14)
- Diabetes (50)
- Diagnostic Safety and Quality (71)
- Digestive Disease and Health (10)
- Disabilities (5)
- Disparities (19)
- Domestic Violence (3)
- Ear Infections (1)
- Education: Continuing Medical Education (9)
- Education: Patient and Caregiver (54)
- Elderly (76)
- Electronic Health Records (EHRs) (597)
- Electronic Prescribing (E-Prescribing) (20)
- Emergency Department (74)
- Emergency Medical Services (EMS) (20)
- Emergency Preparedness (2)
- Evidence-Based Practice (50)
- Eye Disease and Health (1)
- Falls (11)
- Family Health and History (1)
- Genetics (8)
- Guidelines (9)
- Healthcare-Associated Infections (HAIs) (18)
- Healthcare Cost and Utilization Project (HCUP) (5)
- Healthcare Costs (13)
- Healthcare Delivery (77)
- Healthcare Utilization (19)
- Health Information Exchange (HIE) (41)
- (-) Health Information Technology (HIT) (1425)
- Health Insurance (5)
- Health Literacy (28)
- Health Promotion (8)
- Health Services Research (HSR) (24)
- Health Status (5)
- Health Systems (14)
- Heart Disease and Health (26)
- Hepatitis (1)
- Home Healthcare (22)
- Hospital Discharge (16)
- Hospitalization (28)
- Hospital Readmissions (15)
- Hospitals (77)
- Human Immunodeficiency Virus (HIV) (14)
- Imaging (27)
- Implementation (22)
- Infectious Diseases (8)
- Influenza (4)
- Injuries and Wounds (14)
- Inpatient Care (28)
- Intensive Care Unit (ICU) (20)
- Kidney Disease and Health (6)
- Labor and Delivery (1)
- Learning Health Systems (5)
- Lifestyle Changes (16)
- Long-Term Care (18)
- Low-Income (9)
- Maternal Care (10)
- Medicaid (3)
- Medical Devices (3)
- Medical Errors (55)
- Medical Expenditure Panel Survey (MEPS) (2)
- Medicare (4)
- Medication (147)
- Medication: Safety (45)
- Men's Health (2)
- Mortality (9)
- Neonatal Intensive Care Unit (NICU) (2)
- Neurological Disorders (20)
- Newborns/Infants (10)
- Nursing (18)
- Nursing Homes (26)
- Nutrition (8)
- Obesity (15)
- Obesity: Weight Management (8)
- Opioids (11)
- Organizational Change (2)
- Orthopedics (6)
- Osteoporosis (2)
- Outcomes (42)
- Pain (9)
- Palliative Care (4)
- Patient-Centered Healthcare (55)
- Patient-Centered Outcomes Research (66)
- Patient Adherence/Compliance (29)
- Patient and Family Engagement (64)
- Patient Experience (31)
- Patient Safety (195)
- Patient Self-Management (48)
- Payment (7)
- Pneumonia (2)
- Policy (14)
- Practice-Based Research Network (PBRN) (1)
- Practice Patterns (18)
- Pregnancy (17)
- Pressure Ulcers (6)
- Prevention (38)
- Primary Care (100)
- Primary Care: Models of Care (6)
- Provider (49)
- Provider: Clinician (12)
- Provider: Health Personnel (7)
- Provider: Nurse (18)
- Provider: Pharmacist (14)
- Provider: Physician (28)
- Provider Performance (11)
- Public Health (14)
- Public Reporting (3)
- Quality Improvement (57)
- Quality Indicators (QIs) (10)
- Quality Measures (21)
- Quality of Care (91)
- Quality of Life (10)
- Racial and Ethnic Minorities (38)
- Registries (18)
- Rehabilitation (3)
- Research Methodologies (30)
- Respiratory Conditions (15)
- Risk (40)
- Rural/Inner-City Residents (3)
- Rural Health (20)
- Screening (26)
- Sepsis (13)
- Sex Factors (1)
- Sexual Health (6)
- Sickle Cell Disease (8)
- Simulation (6)
- Social Determinants of Health (20)
- Social Media (11)
- Stress (3)
- Stroke (12)
- Substance Abuse (15)
- Surgery (49)
- Surveys on Patient Safety Culture (1)
- System Design (8)
- Teams (13)
- Telehealth (217)
- Tobacco Use (6)
- Tobacco Use: Smoking Cessation (3)
- Tools & Toolkits (8)
- Training (10)
- Transitions of Care (18)
- Transplantation (9)
- Trauma (8)
- Treatments (3)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Urban Health (3)
- Urinary Tract Infection (UTI) (2)
- Vaccination (12)
- Vitamins and Supplements (1)
- Vulnerable Populations (15)
- Web-Based (42)
- Women (29)
- Workflow (20)
- Workforce (5)
- Young Adults (9)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
201 to 225 of 1425 Research Studies DisplayedReese T, Wright A, Liu S
Improving the specificity of drug-drug interaction alerts: can it be done?
A lack of accuracy and specificity of medication alerts have an impact on alert fatigue, high rates of override, and harm to the patient. The drugs that activate alerts are frequently grouped inconsistently into value sets, and alerts for drug-drug interactions (DDI) often do not account for the factors that could decrease risk. The purpose of this proof-of-concept study was to identify and bring attention to the inconsistency of drug value sets for activating alerts, as well as provide a method of classifying factors that can be utilized to alter the risk of harm from a DDI. The researchers included 15 well-known DDIs, and utilized 3 drug interaction references to isolate 2 drug value sets as well as order- and patient-related factors for each DDI. The study reported 30 value sets, with 56% of value sets (17) having nonsignificant agreement, with average moderate agreement among the remaining 13 value sets. Thirty-three factors were identified that could decrease risk in 93% (14) of the 15 DDIs. The researchers concluded that the study shows the value of improving the consistency of DDI-alerting drug value sets, and ways in which alert usefulness and specificity can be improved.
AHRQ-funded; HS025984; HS023826.
Citation: Reese T, Wright A, Liu S .
Improving the specificity of drug-drug interaction alerts: can it be done?
Am J Health Syst Pharm 2022 Jun 23;79(13):1086-95. doi: 10.1093/ajhp/zxac045..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Clinical Decision Support (CDS), Health Information Technology (HIT)
Dullabh P, Sandberg SF, Heaney-Huls K
AHRQ Author: Berliner E, Dymek C, Harrison MI, Swiger J
Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.
This AHRQ-authored horizon scan identified challenges and opportunities for advancing patient-centered clinical decision support (PC CDS) and future directions for PC CDS. The authors engaged a technical expert panel, conducted a scoping literature review, and interviewed key informants. They quantitatively analyzed literature and interview transcripts and mapped the findings to the 4 phases translating evidence into PC CDS interventions (Prioritizing, Authoring, Implementing, and Measuring) and to external factors. Twelve challenges were identified for PC CDS development with lack of patient input identified as a critical challenge. Lack of patient-centered terminology standards was viewed as a challenge in authoring PC CDS. They also found a dearth of CDS studies that measured clinical outcomes, creating significant gaps in the understanding of PC CDS’ impact.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dullabh P, Sandberg SF, Heaney-Huls K .
Challenges and opportunities for advancing patient-centered clinical decision support: findings from a horizon scan.
J Am Med Inform Assoc 2022 Jun 14;29(7):1233-43. doi: 10.1093/jamia/ocac059.
.
.
Keywords: Clinical Decision Support (CDS), Patient-Centered Healthcare, Health Information Technology (HIT), Decision Making, Patient-Centered Outcomes Research, Evidence-Based Practice
Fang Y, Idnay B, Sun Y
Combining human and machine intelligence for clinical trial eligibility querying.
This study’s objective was to combine machine efficiency and human intelligence for converting complex clinical trial eligibility criteria text into cohort queries. The machine interactive tool Criteria2Query (C2Q) 2.0 was developed to enable real-time user intervention for criteria selection and simplification, parsing error correction, and concept mapping. This tool had been previously evaluated using a curated gold standard – the annotated eligibility criteria of 1010 COVID-19 clinical trials. The usability and usefulness were evaluated by 10 research coordinators using 5 Alzheimer’s disease trials with data collected by user interaction logging, a demographic questionnaire, the Health Information Technology Usability Evaluation Scale (Health-ITUES), and a feature-specific questionnaire. C2Q 2.0 achieved a moderate usability score (3.84/5) and a high learnability score (4.54/5). Experienced researchers made more modifications to the tool than novice researchers. The most frequent modification was deletion.
AHRQ-funded; HS028752.
Citation: Fang Y, Idnay B, Sun Y .
Combining human and machine intelligence for clinical trial eligibility querying.
J Am Med Inform Assoc 2022 Jun 14;29(7):1161-71. doi: 10.1093/jamia/ocac051..
Keywords: Health Information Technology (HIT)
Norton JM, Ip A, Ruggiano N
AHRQ Author: Camara DS, Hsiao CJ, Bierman AS
Assessing progress toward the vision of a comprehensive, shared electronic care plan: scoping review.
People with multiple chronic conditions often receive care from a broad array of clinicians across multiple health care settings, making it difficult to share care plans between those facilities and providers. One method for possibly improving care for those individuals is through the development and use of comprehensive, shared, electronic care (e-care) plans. The purpose of the study was to review existing e-care plans and related initiatives that could be utilized to develop a comprehensive, shared e-care plan, and facilitate the National Institutes of Health and Agency for Healthcare Research and Quality joint initiative’s creation of e-care planning tools for people with multiple chronic conditions. The researchers conducted a review of literature from 2015-2020, as well as interviews of expert informants to identify information missing from the literature search. The study identified 7 different interventions for e-care plans and 3 different projects for health care data standards, all of which included elements which could be utilized to further the goals of developing a comprehensive, shared e-care plan. The study concluded that while none of the existing interventions met all the optimal e-care plan criteria for people with multiple chronic conditions, each plan included the infrastructure necessary to progress toward that goal. The researchers reported that gaps must first be addressed, but that a comprehensive, shared e-care plan can improve care coordination across multiple care settings and clinicians.
AHRQ-authored.
Citation: Norton JM, Ip A, Ruggiano N .
Assessing progress toward the vision of a comprehensive, shared electronic care plan: scoping review.
J Med Internet Res 2022 Jun 10;24(6):e36569. doi: 10.2196/36569..
Keywords: Chronic Conditions, Care Coordination, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Health Information Exchange (HIE)
Gallo T, Heise CW, Woosley RL
Clinician responses to a clinical decision support advisory for high risk of Torsades de pointes.
The purpose of this study was to assess provider actions taken in response to a Clinical decision support (CDS) advisory for Torsade de pointes (TdP) that uses a modified Tisdale QT risk score and presents single click management options. The researchers implemented an inpatient TdP risk advisory across a large, 30 hospital health care system. The CDS advisory was programmed to appear when prescribers attempted to order medications with a known risk of TdP in a patient. The CDS advisory displayed patient-specific information and offered related management options including canceling the requested medication and ordering relevant protocols. The study found that 7794 TdP risk advisories were issued during an 8-month period. The most frequent advisory trigger was antibiotics (33.1%.) The most frequent action taken as a result of the advisory was ordering an ECG (20.3%). Incoming medication orders were canceled in 10.2% of the advisories. The researchers concluded that a single-click, modified Tisdale QT risk score-based CDS resulted in a high action/response rate.
AHRQ-funded; HS026662.
Citation: Gallo T, Heise CW, Woosley RL .
Clinician responses to a clinical decision support advisory for high risk of Torsades de pointes.
J Am Heart Assoc 2022 Jun 7;11(11):e024338. doi: 10.1161/jaha.122.024338..
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Heart Disease and Health, Cardiovascular Conditions
Vallamkonda S, Ortega CA, Lo YC
Identifying and reconciling patients' allergy information within the electronic health record.
The authors examined the prevalence of incompleteness, inaccuracy, and redundancy of allergy information within the electronic health record (EHR) for patients with a clinical encounter at any Mass General Brigham facility between January 1 and December 31, 2018. They identified 4 key places in the EHR containing reconcilable allergy information and determined that 45.2% of the patients had an active allergy entry, with 37.1% indicating a need for reconciliation.
AHRQ-funded; HS025375.
Citation: Vallamkonda S, Ortega CA, Lo YC .
Identifying and reconciling patients' allergy information within the electronic health record.
Stud Health Technol Inform 2022 Jun 6;290:120-24. doi: 10.3233/shti220044..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Adverse Drug Events (ADE), Adverse Events
Cuellar A, Pomeroy JML, Burla S
Outpatient care among users and nonusers of direct-to-patient telehealth: observational study.
The purpose of this study was to explore whether telehealth services users depend more on other forms of outpatient care vs. nonusers, and to estimate differences in payment rates between the two groups. The researchers evaluated claims data from 2017, analyzing patients with visits for 3 common diagnoses (N=660,546) and calculating the total number of visits per patient. The study reported that users of telehealth visits had .44 fewer visits to primary care, .11 fewer visits to emergency departments, and .17 fewer visits to retail and urgent care than nonusers. In addition, the average payment rates for telehealth visits were less than all other outpatient care settings. The study concluded that instead of adding to in-person care, telehealth visits may provide a less expensive alternative by substituting for some types of in-person care.
AHRQ-funded; HS025163.
Citation: Cuellar A, Pomeroy JML, Burla S .
Outpatient care among users and nonusers of direct-to-patient telehealth: observational study.
J Med Internet Res 2022 Jun 6;24(6):e37574. doi: 10.2196/37574..
Keywords: Telehealth, Health Information Technology (HIT), Ambulatory Care and Surgery
Villa Zapata L, Subbian V, Boyce RD
Overriding drug-drug interaction alerts in clinical decision support systems: a scoping review.
The authors reviewed published data on the rate of Drug-Drug Interactions (DDI) alert overrides and medications involved in the overrides. Among 34 eligible studies, they found that the override rate of DDI alerts ranged from 55% to 98%, with more than half of the studies reporting the most common drug pairs or medications involved in acceptance or overriding of alerts. They recommended decision support systems that take user, drug, and institutional factors into consideration, as well as actionable metrics to better characterize harm associated with overrides.
AHRQ-funded; HS025984; HS023826.
Citation: Villa Zapata L, Subbian V, Boyce RD .
Overriding drug-drug interaction alerts in clinical decision support systems: a scoping review.
Stud Health Technol Inform 2022 Jun 6;290:380-84. doi: 10.3233/shti220101..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Medication
Dullabh P, Heaney-Huls K, Hovey L
The technology landscape of patient-centered clinical decision support - where are we and what is needed?
This paper explores the technology landscape for patient-centered clinical decision support (PC CDS) and what has come out of Patient Centered Outcomes Research (PCOR) and health care delivery system transformation efforts. The authors explore what is needed to make it more shareable, standards-based, and publicly available with the goal of improving patient care and clinical outcomes. Three sources of information were used: (1) a 22-member technical expert panel; (2) a literature review of peer-reviewed and grey literature; and (3) key informant interviews with PC CDS stakeholders. Ten salient technical considerations that span all phases of PC CDS development were identified. Although significant progress has been made, challenges remain.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls K, Hovey L .
The technology landscape of patient-centered clinical decision support - where are we and what is needed?
Stud Health Technol Inform 2022 Jun 6;290:350-53. doi: 10.3233/shti220094..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Patient-Centered Outcomes Research, Decision Making
Villa Zapata L, Boyce RD, Chou E
QTc prolongation with the use of hydroxychloroquine and concomitant arrhythmogenic medications: a retrospective study using electronic health records data.
The purpose of this AHRQ-funded retrospective study of electronic health records was to assess changes in the QTc interval in patients taking hydroxychloroquine (with or without concomitant QT-prolonging medications.) Patients were placed into one of 6 cohorts, depending upon their monotherapy with one of 3 different medications: hydroxychloroquine, methotrexate, or sulfasalazine, or, based on their exposure to any combination of those drugs with any other drug known to increase the QT interval. The study concluded that compared to sulfasalazine or methotrexate, hydroxychloroquine was related with an increase in the QTc interval.
AHRQ-funded; HS025984.
Citation: Villa Zapata L, Boyce RD, Chou E .
QTc prolongation with the use of hydroxychloroquine and concomitant arrhythmogenic medications: a retrospective study using electronic health records data.
Drugs Real World Outcomes 2022 Jun 5:1-9. doi: 10.1007/s40801-022-00307-5..
Keywords: Medication, Cardiovascular Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Lieu TA, Warton EM, Levan C
Association of medical assistant-supported virtual rooming with successful video visit connections.
The purpose of this study was to systematically evaluate medical assistant-supported virtual rooming for physician video visits to address the digital divide which exists in physician video visit availability and accessibility for patients who have lower socioeconomic status (SES), low English proficiency, or are African American or Black or Latino. The study found that of the 114,214 video visits with successful connections, 14.2% had low neighborhood SES, 3.6% needed interpreters, 20.1% were Latino, and 7.9% were African American or Black. African American or Black race, Latino ethnicity, needing an interpreter, and living in a low SES neighborhood were associated with a lower likelihood of connecting. The researchers concluded that medical assistant–supported virtual rooming was associated with successful video visit connections in this diverse population. High medical assistant supported rooming rates were associated with larger connection improvements for patients at higher risk of not connecting, including those with lower SES, of Latino ethnicity or African American or Black race, or needing interpreters.
AHRQ-funded; HS025189.
Citation: Lieu TA, Warton EM, Levan C .
Association of medical assistant-supported virtual rooming with successful video visit connections.
JAMA Intern Med 2022 Jun;182(6):680-82. doi: 10.1001/jamainternmed.2022.1032..
Keywords: Quality Improvement, Quality of Care, Telehealth, Health Information Technology (HIT), Clinician-Patient Communication, Communication, Healthcare Delivery
Bardach NS, Stotts JR, Fiore DM
Family Input for Quality and Safety (FIQS): using mobile technology for in-hospital reporting from families and patients.
This study’s goal was to test a real-time mobile-responsive website called Family Input for Quality and Safety (FIQS) for inpatient reporting from families and patients. The tool was piloted from June 2017 to April 2018 on the medical-surgical unit of a children’s hospital. The authors enrolled 253 patients aged 13 and older and patient family members. This resulted in 8.15 safety reports/100 patient-days, most frequently regarding medications (29% of reports) and communication (20% of reports). Fifty-one reports met incident reporting (IR) criteria with only 1 having been reported via the IR system. White participants submitted more observations than Latinx participants.
AHRQ-funded; HS028477; HS024553.
Citation: Bardach NS, Stotts JR, Fiore DM .
Family Input for Quality and Safety (FIQS): using mobile technology for in-hospital reporting from families and patients.
J Hosp Med 2022 Jun;17(6):456-65. doi: 10.1002/jhm.2777..
Keywords: Quality of Care, Patient Safety, Health Information Technology (HIT), Patient and Family Engagement
Andino JJ, Zhu Z, Surapaneni M
Interstate telehealth use by Medicare beneficiaries before and after COVID-19 licensure waivers, 2017-20.
This study analyzed trends in interstate telehealth use by Medicaid beneficiaries during 2017-2020, which covers the period both directly before and during the first year of the pandemic. Although the volume of interstate telehealth use increased in 2020, out-of-state telehealth only made up 0.8% of all outpatient visits, and 5% of all telehealth visits overall. For individual states, out-of-state telehealth made up between 0.2-9.3% of all outpatient visits. Most out-of-state telehealth visits were used for established patient care, and a higher percentage of out-of-state telehealth users lived in rural areas compared with beneficiaries who stayed with in-state care (28% versus 23%).
AHRQ-funded; HS027632.
Citation: Andino JJ, Zhu Z, Surapaneni M .
Interstate telehealth use by Medicare beneficiaries before and after COVID-19 licensure waivers, 2017-20.
Health Aff 2022 Jun;41(6):838-45. doi: 10.1377/hlthaff.2021.01825.
AHRQ-funded; HS027632..
AHRQ-funded; HS027632..
Keywords: Telehealth, COVID-19, Health Information Technology (HIT), Medicare, Healthcare Delivery
McCarthy DM, Formella KT, Ou EZ
There's an app for that: teaching residents to communicate diagnostic uncertainty through a mobile gaming application.
The purpose of this study was to improve doctor-patient communication by assessing the utilization of a mobile application (app) for teaching physician communication skills about diagnostic uncertainty, obtaining feedback on app utilization, and evaluating the association between app use and mastery of skills. Emergency medicine resident physicians were randomized to receive immediate or delayed access to an educational curriculum focused on diagnostic uncertainty which included a web-based interactive model and an app. Only 31.2% of the 109 participants used the app, with senior residents more likely to use the app than junior residents. Researchers report that of those who used the app, reviews were positive, with 76% indicating the app facilitated their learning. The study found that in the trial there was no significant correlation between the utilization of the app and mastery of the communication skill. The researchers concluded that without mandated use and evidence of effectiveness, apps should not be offered to physicians as an educational option and training opportunity for improving communication skills.
AHRQ-funded; HS025651.
Citation: McCarthy DM, Formella KT, Ou EZ .
There's an app for that: teaching residents to communicate diagnostic uncertainty through a mobile gaming application.
Patient Educ Couns 2022 Jun;105(6):1463-69. doi: 10.1016/j.pec.2021.09.038..
Keywords: Diagnostic Safety and Quality, Clinician-Patient Communication, Communication, Education: Continuing Medical Education, Health Information Technology (HIT)
Yerneni S, Shah S, Blackley SV
Heterogeneity of drug allergies and reaction lists in two U.S. healthcare systems' electronic health records.
This study compared adverse drug reaction (ADRs) picklists for clinicians in the electronic health record (EHR) allergy list for two different healthcare institutions. The authors used data from the EHRs of patients who visited the emergency department or outpatient clinics at Brigham and Women's Hospital (BWH) and University of Colorado Hospital (UCH) from 2013-2018. They investigated the reactions on each picklist and compared the top 40 reactions at each institution, as well as the top 10 reactions within each drug class. Out of 2,160,116 patients sampled, 30% reported active drug allergies. The most commonly reported drug class allergens were similar between the two institutions, however BWH’s picklist had 48 reactions while UCH’s had 160. Twenty-nine reactions were shared by both picklists. There was a lot more granularity with UCH’s picklist so that body locality, swelling and edema were described in much greater detail than for BWH. These picklists may partially explain variations in reported ADRs across healthcare systems.
AHRQ-funded; HS025375.
Citation: Yerneni S, Shah S, Blackley SV .
Heterogeneity of drug allergies and reaction lists in two U.S. healthcare systems' electronic health records.
Appl Clin Inform 2022 May 26;13(3):741-51. doi: 10.1055/a-1862-9425..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Patient Safety
Giardina TD, Choi DT, Upadhyay DK
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
This study’s objective was to test if patients can identify concerns about their diagnosis through structured evaluation of their online visit notes in an electronic health record (EHR) system. Patients aged 18-85 years in a large integrated health system who actively used the patient portal were invited to respond to an online questionnaire if an EHR algorithm detected any recent visit following an initial primary care consultation. The authors developed and tested an instrument (Safer Dx Patient Instrument) to help patients identify concerns related to the diagnostic process based on notes review and recall of recent “at-risk” visits. The algorithm identified 1282 eligible patients, of whom 486 responded. Of the 418 patients included in the analysis, 51 patients (12.2%) identified a diagnostic concern. Patients were more likely to report a concern if they disagreed with statements "The care plan the provider developed for me addressed all my medical concerns", "I trust the provider that I saw during my visit" and agreed with the statement "I did not have a good feeling about my visit".
AHRQ-funded; HS027363; HS025474.
Citation: Giardina TD, Choi DT, Upadhyay DK .
Inviting patients to identify diagnostic concerns through structured evaluation of their online visit notes.
J Am Med Inform Assoc 2022 May 11;29(6):1091-100. doi: 10.1093/jamia/ocac036..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Experience, Patient Safety
Dullabh P, Heaney-Huls K, Lobach DF
AHRQ Author: Lomotan E, Swiger J, Harrison MI, Dymek C
The technical landscape for patient-centered CDS: progress, gaps, and challenges.
The purpose of this study was to evaluate the technical landscape for patient-centered clinical decision support (PC CDS) methods to assess the gaps in making PC CDS more standard-based, publicly available, and with greater shareability. The researchers utilized qualitative data from a literature review, a panel of technical experts, and interviews with 18 CDS stakeholders to identify 7 technical considerations that span 5 phases of the development of PC CDS. The authors concluded that while there has been progress in the technical landscape, the field of CDS must focus on improving a number of CDS methods and processes, including standards for translating clinical guidelines into patient-centered clinical decision support, procedures to collect, standardize, and incorporate health data generated by patients, and other CDS processes.
AHRQ-authored; AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls K, Lobach DF .
The technical landscape for patient-centered CDS: progress, gaps, and challenges.
J Am Med Inform Assoc 2022 May 11;29(6):1101-05. doi: 10.1093/jamia/ocac029..
Keywords: Clinical Decision Support (CDS), Decision Making, Patient-Centered Healthcare, Health Information Technology (HIT)
Garcia SF, Smith JD, Kallen M
Protocol for a type 2 hybrid effectiveness-implementation study expanding, implementing and evaluating electronic health record-integrated patient-reported symptom monitoring in a multisite cancer centre.
This paper describes a protocol for a type 2 hybrid effectiveness-implementation study expanding, implementing, and evaluating electronic health record-integrated patient-reported symptom monitoring in a multisite cancer center. The authors previously developed and piloted an electronic patient-reported symptom and need assessment ('cPRO' for cancer patient-reported outcomes) within the electronic health record (EHR). They will track implementation strategies using the Longitudinal Implementation Strategy Tracking System. A formal evaluation will be conducted with a stepped wedge trial with a type 2 hybrid effectiveness-implementation design. Aim 1 will comprise of a mixed method evaluation of cPRO implementation and Aim 2 will evaluate cPRO’s impact on patient and system outcomes over 12 months via (a) a quality improvement study (n=4000 cases) and (b) a human subjects substudy (n=1000 patients). Aim 2a will evaluate EHR-documented healthcare usage and patient satisfaction; and in Aim 2b, participating patients will complete patient-reported healthcare utilization and quality, symptoms and health-related quality of life measures at baseline, 6 and 12 months. Aim 3 will identify cPRO implementation facilitators and barriers via mixed methods research gathering feedback from stakeholders with 50 patients (n=50) participating in focus groups or interviews. Implementation will be evaluated with 40 clinicians and administrators.
AHRQ-funded; HS026170.
Citation: Garcia SF, Smith JD, Kallen M .
Protocol for a type 2 hybrid effectiveness-implementation study expanding, implementing and evaluating electronic health record-integrated patient-reported symptom monitoring in a multisite cancer centre.
BMJ Open 2022 May 3;12(5):e059563. doi: 10.1136/bmjopen-2021-059563..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Cancer
Fraze TK, Beidler LB, De Marchis EH
"Beyond just a supplement": administrators' visions for the future of virtual primary care services.
The purpose of this study was to examine what health care organization administrators think about the future of virtual primary care services post-pandemic. In March-April 2021, the administrators of 17 health care organizations participated in semistructured qualitative phone interviews. The researchers explored how the administrators thought their organizations would offer virtual services after the pandemic. The study found that all the participants anticipated that their organization’s virtual primary care services would exist after the pandemic, with the main goals of 1) optimizing medical services; 2) enhancing the patient experience; and 3) increasing loyalty among patients, and the primary motivation being to remain competitive and financial solvency. The researchers concluded that administrators of health care organizations are examining how virtual services can continue after the pandemic, and what roles they will play in the delivery of services.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, De Marchis EH .
"Beyond just a supplement": administrators' visions for the future of virtual primary care services.
J Am Board Fam Med 2022 May-Jun;35(3):527-36. doi: 10.3122/jabfm.2022.03.210479..
Keywords: Primary Care, Telehealth, Health Information Technology (HIT), Healthcare Delivery, COVID-19
Wong J, Prieto-Alhambra D, Rijnbeek PR
Applying machine learning in distributed data networks for pharmacoepidemiologic and pharmacovigilance studies: opportunities, challenges, and considerations.
In this paper, investigators discussed opportunities, challenges, and considerations for applying machine learning (ML) in distributed data networks (DDNs) for pharmacoepidemiologic and pharmacovigilance studies. They started with major types of activities performed by DDNs and how ML may be used, followed by practical data-related factors influencing how DDNs work in practice. Then they combined these discussions and considered how opportunities for ML are affected by practical data-related factors for DDNs. They concluded by presenting different approaches for addressing these challenges and highlighting efforts that real-world DDNs have taken or are currently taking to help mitigate them.
AHRQ-funded; HS026214.
Citation: Wong J, Prieto-Alhambra D, Rijnbeek PR .
Applying machine learning in distributed data networks for pharmacoepidemiologic and pharmacovigilance studies: opportunities, challenges, and considerations.
Drug Saf 2022 May;45(5):493-510. doi: 10.1007/s40264-022-01158-3..
Keywords: Health Information Technology (HIT)
Rice H, Garabedian PM, Shear K
Clinical decision support for fall prevention: defining end-user needs.
The purpose of this study was to identify patient and primary care staff needs for development of a tool that will generate clinical decision support (CDS) to prevent falls and injuries in older adults. Community-dwelling patients aged 60 and over and primary care clinic staff were eligible to participate in the study; all were affiliated with the University of Florida Health Archer Family Health Care primary care clinic and the Brigham & Women's Hospital-affiliated primary care clinics. Through qualitative interviews with patients (n=18) and primary care clinic staff (n=24) user needs were identified and then categorized into the following themes: evidence-based safe exercises; expert guidance; individualized resources; in-person assessment of patient condition; motivational tools; patient understanding of fall risk; personal support networks; systematic communication and workload burden. The study concluded that personalized, actionable, and evidence-based clinical decision support may be able to address some of the many gaps that exist in fall prevention management in older adults.
AHRQ-funded; HS027557.
Citation: Rice H, Garabedian PM, Shear K .
Clinical decision support for fall prevention: defining end-user needs.
Appl Clin Inform 2022 May;13(3):647-55. doi: 10.1055/s-0042-1750360..
Keywords: Elderly, Falls, Prevention, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT)
Jeffery AD
Data science for nurses.
This “Practice Matters” article discusses how nurses can apply data science methods to improve nurses’ insight into care delivery. Data science in nursing is defined and the data science process is described in five steps: capture, maintain, process, analyze, and communicate. A table is included which highlights several recently published studies that leveraged data science methods in nursing-relevant projects. The article ends with a call to action.
AHRQ-funded; HS026395.
Citation: Jeffery AD .
Data science for nurses.
Am Nurse 2022 May; 17(5)..
Keywords: Provider: Nurse, Electronic Health Records (EHRs), Health Information Technology (HIT)
Allen KS, Danielson EC, Downs SM
Evaluating a prototype clinical decision support tool for chronic pain treatment in primary care.
This study evaluates a prototype decision support tool to aid primary care clinicians when caring for patients with chronic noncancer pain called The Chronic Pain Treatment Tracker (Tx Tracker). The authors conducted 12 semi-structured interviews with primary care clinicians from four Indiana health systems. The interviews were conducted in two waves, with the last 6 interviews prototype and interview guide revisions. The interviews explored the Tx Tracker using a think-aloud approach and a clinical scenario. Evaluation questions were also asked. The researchers identified several themes: the need for clinicians to be presented with a comprehensive patient history, the usefulness of Tx Tracker in patient discussions about treatment planning, potential usefulness of Tx Tracker for patients with high uncertainty or risk, potential usefulness of Tx Tracker in aggregating scattered information, variability in expectations about workflows, skepticism about underlying electronic health record data quality, interest in using Tx Tracker to annotate or update information, interest in using Tx Tracker to translate information to clinical action, desire for interface with visual cues for risks, warnings, or treatment options, and desire for interactive functionality.
AHRQ-funded; HS023306.
Citation: Allen KS, Danielson EC, Downs SM .
Evaluating a prototype clinical decision support tool for chronic pain treatment in primary care.
Appl Clin Inform 2022 May;13(3):602-11. doi: 10.1055/s-0042-1749332..
Keywords: Clinical Decision Support (CDS), Primary Care, Chronic Conditions, Health Information Technology (HIT)
Di Tosto G, Walker DM, Sieck CJ
Examining the relationship between health literacy, health numeracy, and patient portal use.
The purpose of this randomized controlled trial study across the inpatient population of a U.S.-based academic medical center was to examine the association between health literacy and numeracy (HLN) and patient portal use. The researchers assessed the association between patients’ perceptions of health literacy and their skills, interpreting medical information with measurements of interaction with patient portals. The study reported that levels of HLN for the 654 patients in the study sample were not significantly associated with use of the inpatient portal. Six-month use of the outpatient portal after hospital discharge was also not related with HLN. There was a significant increase in self-reported levels of health literacy. The researchers concluded that although prior research suggested that low HLN can serve as a barrier to inpatient portal use and could limit interaction with outpatient portals, this study did not find the same associations. Instead, this study indicates that the inpatient setting might be effective in encouraging acceptance of technology such as hospital-provided tablets.
AHRQ-funded; HS024091; HS024349; HS024379.
Citation: Di Tosto G, Walker DM, Sieck CJ .
Examining the relationship between health literacy, health numeracy, and patient portal use.
Appl Clin Inform 2022 May;13(3):692-99. doi: 10.1055/s-0042-1751239..
Keywords: Health Literacy, Health Information Technology (HIT), Electronic Health Records (EHRs)
Ferucci ED, Arnold RI, Holck P
Factors associated with telemedicine use for chronic disease specialty care in the Alaska Tribal Health System, 2015-2019.
The purpose of this study was to explore and describe factors associated with telemedicine use in the setting of usual care in the Alaskan Tribal Health System (ATHS) prior to the COVID-19 pandemic. The researchers collected electronic health records (EHR) data from 2015 through 2019 for 3,075 patients with chronic diseases requiring specialty care from 4 regions in the ATHS to identify ever users (799) and never users (2,276) of telemedicine. The study found that the factors of male gender, age, geographic region, rate of outpatient visits per year, and having had at least one cardiology clinic visit were all associated with telemedicine use.
AHRQ-funded; HS026208.
Citation: Ferucci ED, Arnold RI, Holck P .
Factors associated with telemedicine use for chronic disease specialty care in the Alaska Tribal Health System, 2015-2019.
Telemed J E Health 2022 May;28(5):682-89. doi: 10.1089/tmj.2021.0131..
Keywords: Telehealth, Chronic Conditions, Racial and Ethnic Minorities, Health Information Technology (HIT)