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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
101 to 125 of 456 Research Studies DisplayedSinger SJ, Kerrissey M, Friedberg M
A comprehensive theory of integration.
Efforts to transform health care delivery to improve care have increasingly focused on care integration. However, variation in how integration is defined has complicated efforts to design, synthesize, and compare studies of integration in health care. Drawing on previous work, in this study the investigators presented a comprehensive theoretical model of relationships between types of integration and proposed how to measure them.
AHRQ-funded; HS024067.
Citation: Singer SJ, Kerrissey M, Friedberg M .
A comprehensive theory of integration.
Med Care Res Rev 2020 Apr;77(2):196-207. doi: 10.1177/1077558718767000..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Quality of Care
Richardson JE, Middleton B, Platt JE
Building and maintaining trust in clinical decision support: recommendations from the Patient-Centered CDS Learning Network.
Knowledge artifacts in digital repositories for clinical decision support (CDS) can promote the use of CDS in clinical practice. However, stakeholders will benefit from knowing which they can trust before adopting artifacts from knowledge repositories. In this paper, the investigators discuss their investigation into trust for knowledge artifacts and repositories by the Patient-Centered CDS Learning Network's Trust Framework Working Group (TFWG).
AHRQ-funded; HS024849.
Citation: Richardson JE, Middleton B, Platt JE .
Building and maintaining trust in clinical decision support: recommendations from the Patient-Centered CDS Learning Network.
Learn Health Syst 2020 Apr;4(2):e10208. doi: 10.1002/lrh2.10208.
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Keywords: Clinical Decision Support (CDS), Decision Making, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Hernandez-Boussard T, Blayney DW, Brooks JD
Leveraging digital data to inform and improve quality cancer care.
Efficient capture of routine clinical care and patient outcomes is needed at a population-level, as is evidence on important treatment-related side effects and their effect on well-being and clinical outcomes. The increasing availability of electronic health records (EHR) offers new opportunities to generate population-level patient-centered evidence on oncologic care that can better guide treatment decisions and patient-valued care. This study discussed how to leverage digital data to inform and improve quality cancer care.
AHRQ-funded; R01 HS024096.
Citation: Hernandez-Boussard T, Blayney DW, Brooks JD .
Leveraging digital data to inform and improve quality cancer care.
Cancer Epidemiol Biomarkers Prev 2020 Apr;29(4):816-22. doi: 10.1158/1055-9965.Epi-19-0873..
Keywords: Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Quality Improvement, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Evidence-Based Practice
Popejoy LL, Wakefield BJ, Vogelsmeier AA
Reengineering skilled nursing facility discharge: analysis of reengineered discharge implementation.
There is a need to adopt evidence-based approaches to discharge planning in the skilled nursing facility (SNF) short stay population. This article describes implementation of the Reengineered Discharge (RED) process in SNFs and makes recommendations for its future implementation. The investigators concluded that their research revealed that discharge processes are similar across settings and that evidence-based programs such as RED can be adapted to the SNF setting.
AHRQ-funded; HS022140.
Citation: Popejoy LL, Wakefield BJ, Vogelsmeier AA .
Reengineering skilled nursing facility discharge: analysis of reengineered discharge implementation.
J Nurs Care Qual 2020 Apr/Jun;35(2):158-64. doi: 10.1097/ncq.0000000000000413..
Keywords: Nursing Homes, Evidence-Based Practice, Patient-Centered Healthcare
Marcial LH, Blumenfeld B, Harle C
Barriers, facilitators, and potential solutions to advancing interoperable clinical decision support: multi-stakeholder consensus recommendations for the opioid use case.
These proceedings report on the AHRQ-sponsored Patient-Centered CDS Learning Network (PCCDS LN) Technical Framework Working Group (TechFWG), which was convened to identify barriers, facilitators, and potential solutions for interoperable clinical decision support, with a specific focus on addressing the opioid epidemic. The key insights were extrapolated to CDS-facilitated care improvement outside of the specific opioid use case. If applied broadly, the recommendations should help advance the availability and impact of interoperable CDS delivered at scale.
AHRQ-funded; HS024849.
Citation: Marcial LH, Blumenfeld B, Harle C .
Barriers, facilitators, and potential solutions to advancing interoperable clinical decision support: multi-stakeholder consensus recommendations for the opioid use case.
AMIA Annu Symp Proc 2020 Mar 4;2019:637-46..
Keywords: Clinical Decision Support (CDS), Decision Making, Opioids, Medication, Pain, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Popejoy LL, Vogelsmeier AA, Wakefield BJ
Adapting Project RED to skilled nursing facilities.
This article described the investigator recommendations for adapting hospital-based RED (Reengineered Discharge) processes to skilled nursing facilities (SNFs). Using focus groups, the SNFs' discharge processes were assessed twice additionally, research staff then recorded field notes documenting discussions about facility discharge processes as they related to RED processes. Data were systematically analyzed using thematic analysis to identify recommendations for adapting RED to the SNF setting.
AHRQ-funded; HS022140.
Citation: Popejoy LL, Vogelsmeier AA, Wakefield BJ .
Adapting Project RED to skilled nursing facilities.
Clin Nurs Res 2020 Mar;29(3):149-56. doi: 10.1177/1054773818819261..
Keywords: Nursing Homes, Elderly, Transitions of Care, Patient-Centered Healthcare
Nguyen AM, Cuthel A, Padgett DK
How practice facilitation strategies differ by practice context.
The purpose of this study was to identify contextual factors that drive facilitators' strategies to meet practice improvement goals, and how these strategies are tailored to practice context. This study was conducted as part of a larger study, HealthyHearts New York City, which evaluated the impact of practice facilitation on adoption of cardiovascular disease prevention and treatment guidelines.
AHRQ-funded; HS023922.
Citation: Nguyen AM, Cuthel A, Padgett DK .
How practice facilitation strategies differ by practice context.
J Gen Intern Med 2020 Mar;35(3):824-31. doi: 10.1007/s11606-019-05350-7..
Keywords: Quality Improvement, Evidence-Based Practice, Heart Disease and Health, Cardiovascular Conditions, Primary Care, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care: Models of Care
Tung EL, Abramsohn EM, Boyd K
Impact of a low-intensity resource referral intervention on patients' knowledge, beliefs, and use of community resources: results from the CommunityRx trial.
Connecting patients to community-based resources is now a cornerstone of modern healthcare that supports self-management of health. The mechanisms that link resource information to behavior change, however, remain poorly understood. The objective of this study was to evaluate the impact of CommunityRx, an automated, low-intensity resource referral intervention, on patients' knowledge, beliefs, and use of community resources.
AHRQ-funded; HS023007.
Citation: Tung EL, Abramsohn EM, Boyd K .
Impact of a low-intensity resource referral intervention on patients' knowledge, beliefs, and use of community resources: results from the CommunityRx trial.
J Gen Intern Med 2020 Mar;35(3):815-23. doi: 10.1007/s11606-019-05530-5..
Keywords: Patient Self-Management, Medication, Patient-Centered Healthcare, Patient Self-Management
McAlearney AS, Gaughan A, MacEwan SR
Improving acceptance of inpatient portals: patients' and care team members' perspectives.
Inpatient portals are gaining interest as a means to increase patient-centered care during hospitalization. However, acceptance of a new technology such as the inpatient portal relies on perceptions of both its usefulness and ease of use. These factors have not been studied in the context of inpatient portal implementation. In this study, the investigators interviewed patients and care team members about their experiences using an inpatient portal that had been implemented across a large, academic medical center.
AHRQ-funded; HS024379; HS024091.
Citation: McAlearney AS, Gaughan A, MacEwan SR .
Improving acceptance of inpatient portals: patients' and care team members' perspectives.
Telemed J E Health 2020 Mar;26(3):310-26. doi: 10.1089/tmj.2019.0026..
Keywords: Health Information Technology (HIT), Patient-Centered Healthcare, Teams
Keller SC, Cosgrove SE, Arbaje AI
It's complicated: patient and informal caregiver performance of outpatient parenteral antimicrobial therapy-related tasks.
This study’s objective was to perform a patient-centered goal-directed task analysis to identify what is required for successful completion of outpatient parenteral antimicrobial therapy (OPAT) by patients and caregivers. The authors conducted 40 semi-structured patient interviews and also 20 observations of patients and caregivers performing OPAT. Six goals were identified. The authors concluded that patients and caregivers should use teach-back, take formal classes, and other forms of instruction to ensure safety and good outcomes for the patients.
AHRQ-funded; HS025782.
Citation: Keller SC, Cosgrove SE, Arbaje AI .
It's complicated: patient and informal caregiver performance of outpatient parenteral antimicrobial therapy-related tasks.
Am J Med Qual 2020 Mar/Apr;35(2):133-46. doi: 10.1177/1062860619853345..
Keywords: Caregiving, Patient-Centered Healthcare, Antimicrobial Stewardship, Medication, Education: Patient and Caregiver, Patient Safety
Poon BY, Shortell SM, Rodriguez HP
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
Shared decision-making (SDM) is widely recognized as a core strategy to improve patient-centered care. However, the implementation of SDM in routine care settings has been slow and its impact mixed. In this study, the investigators examined the temporal association of patient activation and patients' experience with the SDM process to assess the dominant directionality of this relationship.
AHRQ-funded; HS022241.
Citation: Poon BY, Shortell SM, Rodriguez HP .
Patient activation as a pathway to shared decision-making for adults with diabetes or cardiovascular disease.
J Gen Intern Med 2020 Mar;35(3):732-42. doi: 10.1007/s11606-019-05351-6.
Keywords: Decision Making, Diabetes, Cardiovascular Conditions, Chronic Conditions, Patient-Centered Healthcare, Patient and Family Engagement
Byham-Gray LD, Peters EN, Rothpletz-Puglia P
Patient-centered model for protein-energy wasting: stakeholder deliberative panels.
Integrating the patient's voice into research prioritization is essential for solving problems that patients care the most about in terms of health, symptom management, and survival. In this study, the investigators used deliberative processes for adapting the existing model of protein-energy wasting (PEW) to one that included stakeholder priorities, addressing gaps from the initial concept.
AHRQ-funded; HS023434.
Citation: Byham-Gray LD, Peters EN, Rothpletz-Puglia P .
Patient-centered model for protein-energy wasting: stakeholder deliberative panels.
J Ren Nutr 2020 Mar;30(2):137-44. doi: 10.1053/j.jrn.2019.06.001..
Keywords: Patient-Centered Healthcare, Patient-Centered Outcomes Research, Evidence-Based Practice, Patient and Family Engagement, Research Methodologies
Kamal AH, Bausewein C, Casarett DJ
Standards, guidelines, and quality measures for successful specialty palliative care integration into oncology: current approaches and future directions.
This review paper discusses the need to integrate specialty palliative care into oncology and that there is robust evidence that it improves patient and health system outcomes. Three of the most cited standards/guidelines are discussed as well as quality measures related to integrated palliative and oncology care. They also recommend changes to the quality measurement framework for palliative care and a new way to match palliative care services to patients with advanced cancer.
AHRQ-funded; HS023681.
Citation: Kamal AH, Bausewein C, Casarett DJ .
Standards, guidelines, and quality measures for successful specialty palliative care integration into oncology: current approaches and future directions.
J Clin Oncol 2020 Mar 20;38(9):987-94. doi: 10.1200/jco.18.02440..
Keywords: Palliative Care, Cancer, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Evidence-Based Practice
Nembhard IM, Buta E, Lee YSH
A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers.
The authors assessed effects of adding care coordination formally to nurses’ roles on care experiences of high-risk patients and clinician teamwork during the first 6 months of use. They conducted a quasi-experimental study in which changes in staff and patient experiences at six community health center practice locations that introduced the added-role approach for high-risk patients were compared to changes in six locations without the program in the same health system. They found that there were some positive effects of adding care coordination to nurses' role within 6 months of implementation, suggesting value in this improvement strategy. They concluded that addressing compatibility between coordination and other job demands is important when implementing this approach to coordination.
AHRQ-funded; HS016978.
Citation: Nembhard IM, Buta E, Lee YSH .
A quasi-experiment assessing the six-months effects of a nurse care coordination program on patient care experiences and clinician teamwork in community health centers.
BMC Health Serv Res 2020 Feb 24;20(1):137. doi: 10.1186/s12913-020-4986-0..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Care Coordination, Nursing, Patient Experience, Community-Based Practice, Patient-Centered Healthcare, Ambulatory Care and Surgery, Teams
Kelly Costa D, Liu H, Boltey EM
The structure of critical care nursing teams and patient outcomes: a network analysis.
This examined the connectiveness of critical nursing teams and patient outcomes. The study measured “coreness” (the degree to which a network is represented by a densely integrated core) and “betweenness” (whether a nurse lies on the path of others not directly connected). The researchers used ICU data from a medical center during 2011 and looked at nurses who worked in surgical ICU (SICU) or neurosurgical ICU (NICU) during that same time period. The sample included 598 adult patients and 281 nurses. The researchers found that the greater the coreness of the team, and the more betweenness there was with ICU nurses the less likely patients were to die.
AHRQ-funded; HS024552.
Citation: Kelly Costa D, Liu H, Boltey EM .
The structure of critical care nursing teams and patient outcomes: a network analysis.
Am J Respir Crit Care Med 2020 Feb 15;201(4):483-85. doi: 10.1164/rccm.201903-0543LE..
Keywords: Intensive Care Unit (ICU), Critical Care, Nursing, Teams, Outcomes, Healthcare Delivery, Patient-Centered Outcomes Research, Patient-Centered Healthcare
Businger AC, Fuller TE, Schnipper JL
Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.
This paper describes the challenges, recommendations and lessons learned while developing and implementing a Patient Safety Learning Laboratory (PSLL) project, which is comprised of a suite of HIT tools integrated with a newly implemented Electronic Health Record (EHR) vendor system in the acute care setting of a large academic medical center. The PSLL Administrative Core engaged stakeholders and study personnel throughout all phases of the project. Challenges to implementation included stakeholder engagement, project scope and complexity, technology and governance, and team structure. Some changes were implemented during the trial and others were labeled as lessons learned for future iterative interventions. A willingness to think outside of current workflows and processes to change health system culture around adverse event prevention was one of the keys to success.
AHRQ-funded; HS023535.
Citation: Businger AC, Fuller TE, Schnipper JL .
Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.
J Am Med Inform Assoc 2020 Feb;27(2):301-07. doi: 10.1093/jamia/ocz193.
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Keywords: Patient Safety, Implementation, Health Information Technology (HIT), Quality Improvement, Quality of Care, Patient-Centered Healthcare, Electronic Health Records (EHRs), Evidence-Based Practice
Neu M, Klawetter S, Greenfield JC
Mothers' experiences in the NICU before family-centered care and in NICUs where it is the standard of care.
Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown. The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago.
AHRQ-funded; HS026370.
Citation: Neu M, Klawetter S, Greenfield JC .
Mothers' experiences in the NICU before family-centered care and in NICUs where it is the standard of care.
Adv Neonatal Care 2020 Feb;20(1):68-79. doi: 10.1097/anc.0000000000000671.
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Keywords: Newborns/Infants, Patient-Centered Healthcare, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), Caregiving, Decision Making, Patient Experience, Patient and Family Engagement
McCoy RG, Lipska KJ, Van Houten HK
Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes.
Researchers examined contemporary patterns of glycemic control and use of medications known to cause hypoglycemia among adults with diabetes across age and multimorbidity. They found that the proportion of patients achieving low HbA1c levels was highest among older and multimorbid patients. Older patients and patients with higher comorbidity burden were more likely to be treated with insulin to achieve these HbA1c levels despite the potential for hypoglycemia and uncertain long-term benefit.
AHRQ-funded; HS024075.
Citation: McCoy RG, Lipska KJ, Van Houten HK .
Paradox of glycemic management: multimorbidity, glycemic control, and high-risk medication use among adults with diabetes.
BMJ Open Diabetes Res Care 2020 Feb;8(1). doi: 10.1136/bmjdrc-2019-001007..
Keywords: Diabetes, Medication, Patient-Centered Outcomes Research, Patient-Centered Healthcare, Evidence-Based Practice, Risk, Chronic Conditions
Dukhanin V, Feeser S, Berkowitz SA
Who represents me? A patient-derived model of patient engagement via patient and family advisory councils (PFACs).
This study examined what expectations would be from patients who are not patient and family advisory council (PFAC) members of PFACs. Patients and caregivers from the Johns Hopkins Medical Alliance for Patients, LLC were recruited in 2014. This Medicare accountable care organization has an established PFAC, the Beneficiary Advisory Council. Five focus groups with 42 patients and caregivers participated. Most participants were not aware of PFACs and wanted to know more about representation, what they could do and expected that patients could communicate with PFACs if desired.
AHRQ-funded; HS023684.
Citation: Dukhanin V, Feeser S, Berkowitz SA .
Who represents me? A patient-derived model of patient engagement via patient and family advisory councils (PFACs).
Health Expect 2020 Feb;23(1):148-58. doi: 10.1111/hex.12983..
Keywords: Patient and Family Engagement, Patient-Centered Outcomes Research, Patient-Centered Healthcare, Healthcare Delivery, Health Systems
Barry-Menkhaus SA, Wagner DV, Riley AR
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
In this article, the authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions among youth with type 1 diabetes.
AHRQ-funded; HS022981.
Citation: Barry-Menkhaus SA, Wagner DV, Riley AR .
Small interventions for big change: brief strategies for distress and self-management amongst youth with type 1 diabetes.
Curr Diab Rep 2020 Jan 30;20(1):3. doi: 10.1007/s11892-020-1290-7..
Keywords: Diabetes, Patient-Centered Healthcare, Patient Self-Management, Patient Adherence/Compliance, Care Management, Patient-Centered Outcomes Research, Healthcare Delivery, Children/Adolescents
Kittelson AJ, Hoogeboom TJ, Schenkman M
Person-centered care and physical therapy: a "people-like-me" approach.
In this article the authors propose developing "people-like-me" reference charts, generated with historical outcomes data, to provide real-time information on an individual's status relative to similar people, using as an example people rehabilitating after total knee arthroplasty. The authors propose this framework as a practical mechanism to advance person-centered decisions in physical therapy according to the ideals of evidence-based practice.
AHRQ-funded; HS024316; HS025692.
Citation: Kittelson AJ, Hoogeboom TJ, Schenkman M .
Person-centered care and physical therapy: a "people-like-me" approach.
Phys Ther 2020 Jan 23;100(1):99-106. doi: 10.1093/ptj/pzz139..
Keywords: Patient-Centered Healthcare, Surgery, Orthopedics
Heeringa J, Mutti A, Furukawa MF
AHRQ Author: Furukawa MF
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
The authors conducted a narrative review of 10 years of literature to identify definitional components of key organizational structures in the United States. They found that U.S. policymakers seek to promote provider integration and coordination. They conclude that emerging evidence suggested that organizational structures, composition, and other characteristics influence cost and quality performance. They recommend future research to examine systematically the role of organizational structure in cost and quality outcomes.
AHRQ-authored; AHRQ-funded.
Citation: Heeringa J, Mutti A, Furukawa MF .
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
Int J Integr Care 2020 Jan 20;20(1):2. doi: 10.5334/ijic.4635.
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Keywords: Health Systems, Healthcare Delivery, Patient-Centered Healthcare, Care Coordination, Organizational Change, Policy
Owodunni OP, Haut ER, Shaffer DL
Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: is there a differential effect by race?
Venous thromboembolism (VTE) is a leading cause of preventable harm, and disparities observed in prevention practices. In this study, the investigators examined the impact of a patient-centered VTE education bundle on the non-administration of preventive prophylaxis by race. The investigators found that the patient education materials, developed collaboratively with a diverse group of patients, improved patient's understanding and the importance of VTE prevention through prophylaxis.
AHRQ-funded; HS024547.
Citation: Owodunni OP, Haut ER, Shaffer DL .
Using electronic health record system triggers to target delivery of a patient-centered intervention to improve venous thromboembolism prevention for hospitalized patients: is there a differential effect by race?
PLoS One 2020 Jan 16;15(1):e0227339. doi: 10.1371/journal.pone.0227339..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Healthcare, Blood Clots, Prevention, Inpatient Care, Health Literacy, Education: Patient and Caregiver
Ramsey WA, Heidelberg RE, Gilbert AM
eHealth and mHealth interventions in pediatric cancer: a systematic review of interventions across the cancer continuum.
The primary objectives of this study were to (a) identify current published research in electronic health (eHealth) and mobile health (mHealth) interventions for youth undergoing cancer treatment and child, adolescent, and young adult survivors of childhood cancer and (b) critically appraise the current scientific evidence on their effectiveness and efficacy. As an exploratory aim, the investigators identified pediatric cancer patients' and survivors' perceptions, attitudes, and concerns related to eHealth and mHealth interventions.
AHRQ-funded; HS023011.
Citation: Ramsey WA, Heidelberg RE, Gilbert AM .
eHealth and mHealth interventions in pediatric cancer: a systematic review of interventions across the cancer continuum.
Psychooncology 2020 Jan;29(1):17-37. doi: 10.1002/pon.5280..
Keywords: Children/Adolescents, Cancer, Telehealth, Health Information Technology (HIT), Healthcare Delivery, Patient-Centered Healthcare
Hao Z, Ruggiano N
Family-centeredness in dementia care: what is the evidence?
In this systematic review, the authors identified and evaluated intervention studies examining family-centered care in Alzheimer’s disease and related dementias. They discussed further implications for research and practice.
AHRQ-funded; HS026571.
Citation: Hao Z, Ruggiano N .
Family-centeredness in dementia care: what is the evidence?
Soc Work Health Care 2020 Jan;59(1):1-19. doi: 10.1080/00981389.2019.1690089..
Keywords: Dementia, Neurological Disorders, Evidence-Based Practice, Patient-Centered Healthcare, Caregiving