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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 72 Research Studies Displayed
Baughman AW, Renton M, Wehbi NK
Building community and resilience in Massachusetts nursing homes during the COVID-19 pandemic.
Researchers discuss the partnership of the Massachusetts Senior Care Association and Hebrew SeniorLife with AHRQ ECHO National Nursing Home COVID-19 Action Network (the Network). This educational program provided 16 weeks of free weekly virtual sessions to 295 eligible nursing homes. The Network weekly meetings were a source of connection, emotional support, and validation and may be a valuable mechanism to support resilience and wellbeing for nursing home staff.
Citation: Baughman AW, Renton M, Wehbi NK . Building community and resilience in Massachusetts nursing homes during the COVID-19 pandemic. J Am Geriatr Soc 2021 Oct;69(10):2716-21. doi: 10.1111/jgs.17389..
Keywords: COVID-19, Elderly, Nursing Homes, Evidence-Based Practice, Provider: Health Personnel, Education: Continuing Medical Education, Training
Adams LB, Richmond J, Watson SN
Community health worker training curricula and intervention outcomes in African American and Latinx communities: a systematic review.
This systematic review examined research on the relationship between community health worker (CHW) training curricula and intervention outcomes conducted among African American and Latinx populations. Studies included were quantitative, qualitative, and mixed methods studies employed to conduct outcome and process evaluations of CHW-led interventions. Out of 3,295 articles from the extensive literature search, only 36 met the review’s inclusion criteria. Overall, the strength of evidence linking specific CHW training curricula components to primary health interventions in conditions such as hypertension and diabetes was weak, and no studies directly linked outcomes to specific characteristics of CHW training. Studies that discussed training related to didactic sessions or classified as high intensity reported higher percentages of positive outcomes compared to other CHW training methods.
AHRQ-funded; HS000032; HS026122.
Citation: Adams LB, Richmond J, Watson SN . Community health worker training curricula and intervention outcomes in African American and Latinx communities: a systematic review. Health Educ Behav 2021 Aug;48(4):516-31. doi: 10.1177/1090198120959326..
Keywords: Community-Based Practice, Racial / Ethnic Minorities, Training, Outcomes, Provider: Health Personnel
Byhoff E, Paulus JK, Guardado R
Healthcare workers' perspectives on coronavirus testing availability: a cross sectional survey.
This article describes a survey that was conducted during the first wave of the COVID pandemic during March-August 2020 of hospital workers on their perceptions of, access to, and receipt of COVID testing. A survey was given to all hospital employees in a single academic medical center in Boston, Massachusetts. A total of 2543 employees responded to the survey. Respondents were mostly female (76%), white (55%), with the mean age being 40 years. They were nurses (27%), administrators (22%), and patient support roles (22%) of which 56% of respondents wanted COVID testing. Age, full-time status, employment tenure, changes in quality of life, changes in job duties, and worries about enough sick paid leave were associated with testing. Nurses were more likely to want testing than administrators and patient support staff.
Citation: Byhoff E, Paulus JK, Guardado R . Healthcare workers' perspectives on coronavirus testing availability: a cross sectional survey. BMC Health Serv Res 2021 Jul 21;21(1):719. doi: 10.1186/s12913-021-06741-5..
Keywords: COVID-19, Diagnosis, Provider: Health Personnel, Public Health
Measuring caregiver retention in nursing homes.
This study examined the retention of nursing home caregivers using a survey of nursing home administrators conducted in 2016 from 2,898 facilities. Survey data was matched with Nursing Home Compare and the Certification and Survey Provider Enhanced Reporting data. Four measures of retention were associated with each of three types for caregivers: nurse aids (NAs), registered nurses (RNs), and licensed practical nurses with six quality indicators. Retention rates at 5 years was shown to be low for all three of these caregiver types. Regression estimates showed some support for the theory that different measures of retention were more/less associated with quality. The 3- and 5-year retention measures had the strongest associations with quality of care.
Citation: Castle NG . Measuring caregiver retention in nursing homes. Gerontologist 2021 Jun 2;61(4):e118-e28. doi: 10.1093/geront/gnab012..
Keywords: Nursing Homes, Long-Term Care, Provider: Health Personnel, Workforce
Haidari E, Main EK, Cui X
Maternal and neonatal health care worker well-being and patient safety climate amid the COVID-19 pandemic.
The purpose of this study was to assess the perspectives of maternal and neonatal healthcare workers (HCWs) on well-being and patient safety amid the COVID-19 pandemic. Using HCW surveys, findings showed that 66% of respondents reported symptoms of burnout and 73% felt that burnout among their co-workers had significantly increased. Compared to physicians, nurses reported higher rates of unprofessional behavior and difficulty focusing on work. The authors concluded that three months into the COVID-19 pandemic, HCW well-being was substantially compromised, with negative ramifications for patient safety.
Citation: Haidari E, Main EK, Cui X . Maternal and neonatal health care worker well-being and patient safety climate amid the COVID-19 pandemic. J Perinatol 2021 May;41(5):961-69. doi: 10.1038/s41372-021-01014-9..
Keywords: COVID-19, Burnout, Patient Safety, Provider: Nurse, Provider: Health Personnel, Maternal Care
Willard-Grace R, Knox M, Huang B
Primary care clinician burnout and engagement association with clinical quality and patient experience.
Burnout and engagement are commonly conceptualized as opposite ends of a spectrum, and there is concern that high clinician burnout and lack of engagement may adversely impact patient care. In this study, the investigators matched self-reported data on burnout and engagement for 182 primary care clinicians with data on clinical quality (cancer screenings, hypertension and diabetes control) and patient experience (Clinician and Group Survey-Consumer Assessment of Healthcare Providers and Systems [CG-CAHPS] communication scores, overall rating, and likelihood to recommend the clinic).
Citation: Willard-Grace R, Knox M, Huang B . Primary care clinician burnout and engagement association with clinical quality and patient experience. J Am Board Fam Med 2021 May-Jun;34(3):542-52. doi: 10.3122/jabfm.2021.03.200515..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Burnout, Patient Experience, Patient and Family Engagement, Provider: Clinician, Provider: Physician, Quality of Care, Provider: Nurse, Provider: Health Personnel
Mazur LM, Adams R, Mosaly PR
Effect of simulation-based training and neurofeedback interventions on radiation technologists' workload, situation awareness, and performance.
The purpose of this study was to assess the effect of a combined intervention - simulation-based training supported by neurofeedback sessions - on radiation technologists' (RTs') workload, situation awareness, and performance during routine quality assurance and treatment delivery tasks. The investigators found that RTs randomized to simulation-based training followed by neurofeedback sessions demonstrated no significant changes in perceived workload or situation awareness scores but did have better performance compared with other study groups (P < .01).
Citation: Mazur LM, Adams R, Mosaly PR . Effect of simulation-based training and neurofeedback interventions on radiation technologists' workload, situation awareness, and performance. Pract Radiat Oncol 2021 Mar-Apr;11(2):e124-e33. doi: 10.1016/j.prro.2020.08.005..
Keywords: Simulation, Training, Provider Performance, Provider: Health Personnel
Misra-Hebert AD, Ji X, Nowacki AS
Impact of the COVID-19 pandemic on healthcare workers' risk of infection and outcomes in a large, integrated health system.
Researchers assessed healthcare workers (HCW) risk for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission. Participants were individuals who had tested for SARS-CoV-2 infection in a large academic healthcare system. The study found that, in a large healthcare system, HCW had similar odds for testing positive, but lower odds of hospitalization, compared to non-HCW. Patient-facing HCW had higher odds of a positive test.
Citation: Misra-Hebert AD, Ji X, Nowacki AS . Impact of the COVID-19 pandemic on healthcare workers' risk of infection and outcomes in a large, integrated health system. J Gen Intern Med 2020 Nov;35(11):3293-301. doi: 10.1007/s11606-020-06171-9..
Keywords: COVID-19, Risk, Provider: Health Personnel, Public Health, Healthcare Delivery, Infectious Diseases
Shechter A, Diaz F, Moise N
Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.
The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. In this study the authors, using a cross-sectional web survey, characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic. They concluded that NYC HCWs, especially nurses and advanced practice providers, were experiencing COVID-19-related psychological distress.
Citation: Shechter A, Diaz F, Moise N . Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry 2020 Sep-Oct;66:1-8. doi: 10.1016/j.genhosppsych.2020.06.007..
Keywords: COVID-19, Stress, Provider: Clinician, Provider: Physician, Provider: Nurse, Provider: Health Personnel, Behavioral Health
Cho HJ, Feldman LS, Keller S
Choosing Wisely in the COVID-19 era: preventing harm to healthcare workers.
This paper highlights the 5 top recommendations developed for hospitals in the COVID-19 era as part of the Choosing Wisely® campaign. This top 5 list of overuse practices in hospital medicine can lead to harm of both patients and healthcare workers. The recommendations include: 1) Do not obtain nonurgent labs in separate blood draws if they can be batched together; 2) Do not use bronchodilators unless there is active obstructive airway disease; 3) Do not use posteroanterior and lateral chest X-ray (CXR) as initial imaging, use a portable CXR instead; 4) Avoid in-person evaluations in favor of virtual communication unless necessary; and 5) Do not delay goals of care conversations for hospitalized patients who are unlikely to benefit from life-sustaining treatments.
Citation: Cho HJ, Feldman LS, Keller S . Choosing Wisely in the COVID-19 era: preventing harm to healthcare workers. J Hosp Med 2020 Jun;15(6):360-62. doi: 10.12788/jhm.3457..
Keywords: COVID-19, Infectious Diseases, Hospitals, Prevention, Public Health, Provider: Health Personnel
Baloh J, Thom KA, Perencevich E
Hand hygiene before donning nonsterile gloves: healthcareworkers' beliefs and practices.
The purpose of this study was to examine the practices and beliefs of health care workers related to the use of nonsterile gloves and associated hand hygiene (HH) before gloving. Gloving and HH practices of health care workers at three large academic hospitals were observed as they entered patient rooms, and interviews were conducted with providers, nurses, and nursing assistants to elicit their beliefs and perceptions of these hygiene practices. While interviewed health care workers reported 100% HH compliance before gloving, observed HH compliance was only 42% and observed gloving before entering contact precaution rooms was 78%. Most health care workers described glove use more often than was necessary, and generally used gloves for their own safety, and sanitized their hands before gloving for patient safety. The authors conclude that HH and glove use are intertwined in clinical practice and should be considered jointly to improve infection prevention improvement efforts.
Citation: Baloh J, Thom KA, Perencevich E . Hand hygiene before donning nonsterile gloves: healthcareworkers' beliefs and practices. Am J Infect Control 2019 May;47(5):492-97. doi: 10.1016/j.ajic.2018.11.015..
Keywords: Provider: Clinician, Provider, Provider: Health Personnel, Patient Safety, Prevention
Sterling MR, Silva AF, Leung PBK
"It's like they forget that the word 'health' is in 'home health aide'": Understanding the perspectives of home care workers who care for adults with heart failure.
Home care workers (HCWs) were interviewed about their role and perspectives in caring for community-dwelling adults with heart failure (HF) posthospitalization. Researchers conducted a total of 8 focus groups in partnership with the Home Care Industry Education Fund. A total of 46 English- and Spanish-speaking HCWs employed by 21 unique home care agencies participated. Generally they felt overworked and unappreciated but care about their clients and families and still love their job. The majority of HCWs have not received HF training, so do not feel supported when their clients’ symptoms worsened.
Citation: Sterling MR, Silva AF, Leung PBK . "It's like they forget that the word 'health' is in 'home health aide'": Understanding the perspectives of home care workers who care for adults with heart failure. J Am Heart Assoc 2018 Dec 4;7(23):e010134. doi: 10.1161/jaha.118.010134..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Home Healthcare, Provider: Health Personnel
Blanco N, Johnson JK, Sorkin JD
Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities.
The purpose of this study was to estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission. The investigators found that RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission.
Citation: Blanco N, Johnson JK, Sorkin JD . Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities. Infect Control Hosp Epidemiol 2018 Dec;39(12):1425-30. doi: 10.1017/ice.2018.247.
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Nursing Homes, Prevention, Provider, Provider: Health Personnel
Blechter B, Jiang N, Cleland C
Correlates of burnout in small independent primary care practices in an urban setting.
Little is known about the prevalence and correlates of burnout among providers who work in small independent primary care practices (< 5 providers). The authors conducted a cross-sectional analysis by using data collected from 235 providers practicing in 174 small independent primary care practices in New York City. The burnout rate was relatively low among their sample of providers compared with previous surveys that focused primarily on larger practices.
Citation: Blechter B, Jiang N, Cleland C . Correlates of burnout in small independent primary care practices in an urban setting. J Am Board Fam Med 2018 Jul-Aug;31(4):529-36. doi: 10.3122/jabfm.2018.04.170360..
Keywords: Burnout, Provider: Health Personnel, Primary Care
White VanGompel E, Main EK, Tancredi D
Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study.
The authors estimated the association between individual provider attitudes towards birth and their low-risk primary cesarean rate. Through surveys of California providers of intrapartum care in 2013, they found that provider attitudinal differences are associated with nulliparous, term, singleton, vertex cesarean rates. Those meeting the HP2020 goal hold attitudes more favorable towards vaginal birth, suggesting a modifiable target for quality improvement initiatives to decrease low risk primary cesareans.
Citation: White VanGompel E, Main EK, Tancredi D . Do provider birth attitudes influence cesarean delivery rate: a cross-sectional study. BMC Pregnancy Childbirth 2018 May 29;18(1):184. doi: 10.1186/s12884-018-1756-7.
Keywords: Provider: Health Personnel, Labor and Delivery, Pregnancy, Practice Patterns
Berridge C, Tyler DA, Miller SC
Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey.
This article examines whether staff empowerment practices common to nursing home culture change are associated with certified nursing assistant (CNA) retention. It concluded that after adjustment for covariates, a greater staff empowerment practice score was positively associated with greater retention. Compared with the low empowerment category, nursing homes with scores in the medium category had a 44 percent greater likelihood of having higher CNA retention.
Citation: Berridge C, Tyler DA, Miller SC . Staff empowerment practices and CNA retention: findings from a nationally representative nursing home culture change survey. J Appl Gerontol 2018 Apr;37(4):419-34. doi: 10.1177/0733464816665204.
Keywords: Long-Term Care, Nursing Homes, Provider, Provider: Health Personnel, Workforce
Grout RW, Cheng ER, Carroll AE
A six-year repeated evaluation of computerized clinical decision support system user acceptability.
This study examined user acceptance patterns over six years of a continuous computerized clinical decision support system (CDSS) integration and updated a long-term, repeated follow-up of user acceptability of a CDSS. It found that favorable opinions of the CDSS were more likely in frequent users, physicians and advanced practitioners, and full-time workers.
AHRQ-funded; HS017939; HS018453; HS020640.
Citation: Grout RW, Cheng ER, Carroll AE . A six-year repeated evaluation of computerized clinical decision support system user acceptability. Int J Med Inform 2018 Apr;112:74-81. doi: 10.1016/j.ijmedinf.2018.01.011.
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Provider: Health Personnel, Health Information Technology (HIT), Quality Improvement
Nowak-Wegrzyn A, Greenhawt M
The importance of food allergy to the practicing clinician.
This article introduces a theme issue on food allergy that brings an impressive lineup of state-of-the-art reviews, provocative commentaries, and innovative original research studies. It briefly summarizes the content of the various studies and commentaries included in the issue.
Citation: Nowak-Wegrzyn A, Greenhawt M . The importance of food allergy to the practicing clinician. Ann Allergy Asthma Immunol 2018 Mar;120(3):227-28. doi: 10.1016/j.anai.2018.01.024.
Keywords: Evidence-Based Practice, Provider: Health Personnel, Nutrition, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Benda N, Hettinger A, Bisantz A
Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department.
This study described the patterns and content of nurse to physician verbal conversations in three emergency departments (EDs) with electronic health records. It found that physician participants experienced significantly more communication events than nurse participants, while nurses initiated significantly more communication events than physicians. Most of the communication events occurred at the physician workstation followed by patient treatment areas.
Citation: Benda N, Hettinger A, Bisantz A . Communication in the electronic age: an analysis of face-to-fact physician-nurse communication in the emergency department. Journal of Healthcare Informatics Research 2017 Dec;1(2):218-30.
Keywords: Communications, Electronic Health Records (EHRs), Provider: Health Personnel, Emergency Department, Nursing
Rizvi RF, Marquard JL, Seywerd MA
Usability evaluation of an EHR's clinical notes interface from the perspective of attending and resident physicians: an exploratory study.
Usability of a commercial, inpatient Electronic Health Record (EHR) clinical notes documentation interface was analyzed from standpoints of two provider groups employing two standardized patient cases. The study results suggested that: (1) EHR usability and desirability is influenced by user characteristics, (2) repeated task performance improves user efficiency, and (3) user performance is correlated to their subjective system assessments.
Citation: Rizvi RF, Marquard JL, Seywerd MA . Usability evaluation of an EHR's clinical notes interface from the perspective of attending and resident physicians: an exploratory study. Stud Health Technol Inform 2017;245:1128-32.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Health Personnel
Mosaly PR, Mazur LM, Marks LB
Quantification of baseline pupillary response and task-evoked pupillary response during constant and incremental task load.
The objective of this study was to assess variability in baseline pupil size and task-evoked pupillary response (TEPR) during two basic working memory tasks: constant load of 3-letters memorization-recall (10 trials), and incremental load memorization-recall. It concluded that quantification of TEPR can be affected by shifts in baseline pupil size that are most likely affected by non-cognitive factors when other external factors are kept constant.
AHRQ-funded; HS023458; HS024062.
Citation: Mosaly PR, Mazur LM, Marks LB . Quantification of baseline pupillary response and task-evoked pupillary response during constant and incremental task load. Ergonomics 2017 Oct;60(10):1369-75. doi: 10.1080/00140139.2017.1288930.
Keywords: Health Information Technology (HIT), Provider: Health Personnel, Patient Safety
Kruse GR, Hays H, Orav EJ
Meaningful use of the Indian Health Service electronic health record.
This study sought to understand the use of electronic health record (EHR) functionalities by physicians practicing in an underserved setting. Physicians routinely used a median 7 of 10 EHR functionalities targeted by the Meaningful Use program, but only 5 percent used all 10. Most (63 percent) felt the EHR improved quality of care. Many (76 percent) reported increased documentation time and poorer quality patient-physician interactions (45 percent).
Citation: Kruse GR, Hays H, Orav EJ . Meaningful use of the Indian Health Service electronic health record. Health Serv Res 2017 Aug;52(4):1349-63. doi: 10.1111/1475-6773.12531.
Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Practice Patterns, Vulnerable Populations
Davis MM, Howk S, Spurlock M
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
Researchers conducted this study to explore what clinic and community-based users want in intervention toolkits and to identify the factors that support application in practice. They found that participants wanted toolkits targeted at the right audience and demonstrated to be effective. Well organized toolkits, often with a quick start guide, with tools that were easy to tailor and apply were desired.
Citation: Davis MM, Howk S, Spurlock M . A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.". BMC Health Serv Res 2017 Jul 18;17(1):497. doi: 10.1186/s12913-017-2413-y.
Keywords: Provider: Health Personnel, Outpatient Care, Primary Care, Tools & Toolkits, Translating Research Into Practice (TRIP)
Dyrbye LN, Shanafelt TD, Sinsky CA
AHRQ Author: Meyers D
Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care.
The high prevalence of burnout among health care professionals is cause for concern because it appears to be affecting quality, safety, and health care system performance. Efforts are needed to address this growing problem. Progress will require methodologically sound studies, adequate funding, and collaborative efforts. The authors hope that research sponsors, institutions, clinician organizations, researchers, clinicians, and patients join in supporting enhanced research efforts focused on these topics.
Citation: Dyrbye LN, Shanafelt TD, Sinsky CA . Burnout among health care professionals: a call to explore and address this underrecognized threat to safe, high-quality care. NAM Perspectives 2017 Jul 5.
Keywords: Quality of Care, Provider: Health Personnel, Patient Safety, Workforce
Bush RA, Connelly CD, Perez A
Physician perception of the role of the patient portal in pediatric health.
Little information regarding physician opinion of the patient portal is available, with almost no information gathered in the pediatric environment. Using a mixed-methods approach, physicians in a large pediatric medical facility and integrated delivery network were surveyed by online quantitative questionnaire and structured interviews. Physicians reported the portal's role in more communication efficiency for patients, parents, and providers.
Citation: Bush RA, Connelly CD, Perez A . Physician perception of the role of the patient portal in pediatric health. J Ambul Care Manage 2017 Jul/Sep;40(3):238-45. doi: 10.1097/jac.0000000000000175.
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Provider: Health Personnel, Clinician-Patient Communication, Web-Based