National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
76 to 100 of 104 Research Studies DisplayedLee BY, Wedlock PT, Mitgang EA
How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India.
Researchers developed a computational simulation model of Bihar, India's routine immunization supply chain where coping occurs to evaluate the broader impact of coping. They conclude that their results show how coping can hide major system design deficiencies and how restricting coping can improve problem diagnosis and potentially lead to enhanced system design.
AHRQ-funded; HS023317.
Citation: Lee BY, Wedlock PT, Mitgang EA .
How coping can hide larger systems problems: the routine immunisation supply chain in Bihar, India.
BMJ Glob Health 2019 Sep 5;4(5):e001609. doi: 10.1136/bmjgh-2019-001609..
Keywords: Vaccination, System Design, Health Systems, Healthcare Delivery
Rangachari P, Dellsperger KC, Rethemeyer RK
A health system's pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
Similar to issues faced in health systems across USA, AU Health, based in Augusta, Georgia, faced a scenario of low physician engagement in, and limited-use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which translated to high rates of medication discrepancies and low accuracy of the patient's active medication list, during transitions of care. This paper describes AU Health’s pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P, Dellsperger KC, Rethemeyer RK .
A health system's pilot experience with using Social Knowledge Networking (SKN) technology to enable meaningful use of EHR medication reconciliation technology.
J Hosp Manag Health Policy 2019 Sep;3(22). doi: 10.21037/jhmhp.2019.08.01..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Health Systems
DeCamp M, Dukhanin V, Hebert LC
Patients' views about patient engagement and representation in healthcare governance.
Researchers used surveys to assess the importance of patient representation. Their analysis of free-text responses illuminated why patient representatives are important, keys to successful engagement, and reasons behind the skepticism. They conclude that most patients believe representation in health system governance is important, and that realizing its potential requires engagement activities that improve general patients' awareness of, and interaction with, their representatives.
AHRQ-funded; HS023684.
Citation: DeCamp M, Dukhanin V, Hebert LC .
Patients' views about patient engagement and representation in healthcare governance.
J Healthc Manag 2019 Sep-Oct;64(5):332-46. doi: 10.1097/jhm-d-18-00152..
Keywords: Patient and Family Engagement, Health Systems, Healthcare Delivery
Adler-Milstein J, Nong P, Friedman CP
AHRQ Author: Adler-Milstein J
Preparing healthcare delivery organizations for managing computable knowledge.
This article describes results of an AHRQ-funded conference where a group of experts from a range of fields examined the current state of knowledge management in healthcare delivery organizations. Conference presentations and discussions were recorded and analyzed by the authors in order to identify foundational concepts. The concepts identified are: the current state of knowledge management in healthcare delivery organizations is reliant upon an outdated biomedical library model, and only a small number of organizations have developed management approaches to push knowledge in computable form to frontline decisions; Learning Health Systems create a need for scalable computable knowledge management approaches; the ability to represent data science discoveries in computable form that are findable, accessible, interoperable, and reusable is fundamental to spreading knowledge at scale.
AHRQ-funded; HS025316.
Citation: Adler-Milstein J, Nong P, Friedman CP .
Preparing healthcare delivery organizations for managing computable knowledge.
Learn Health Syst 2019 Apr;3(2):e10070. doi: 10.1002/lrh2.10070..
Keywords: Healthcare Delivery, Learning Health Systems, Organizational Change, Health Systems
Misra-Hebert AD, Rose S, Clayton C
Implementation of patient and family advisory councils in primary care practices in a large, integrated health system.
This paper was presented as part of a poster presentation at the Comprehensive Primary Care Plus national meeting in Baltimore, MD on May 8, 2018. It describes the formation of patient and family advisory councils (PFAC) at the Cleveland Clinic Health System (CCHS). A steering committee was first created and then staff and patients were recruited. Patients were recruited through a survey and provider nominations. No monetary incentives were provided. Forty PFAC meetings were conducted between July and December 2017. A total of 151 patients were included, but there was only 35% retention of patient advisors in both quarters. Most meetings were held at the practice sites, although they were first offered at hub sites. The CFACs included a volunteer clinic lead and a group facilitator. Topics discussed varied by site but included communication with the office between visits, team-based care, access to care, financial issues, and clinical decisions such as antibiotic use. The authors concluded that these meetings were successful and they will continue to hold quarter meetings. Work will be done to improve patient recruitment and retention along with better representation of patient populations.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Rose S, Clayton C .
Implementation of patient and family advisory councils in primary care practices in a large, integrated health system.
J Gen Intern Med 2019 Feb;34(2):190-91. doi: 10.1007/s11606-018-4660-y..
Keywords: Health Systems, Patient-Centered Healthcare, Patient and Family Engagement, Primary Care
Norton PT, Rodriguez HP, Shortell SM
Organizational influences on healthcare system adoption and use of advanced health information technology capabilities.
The purpose of this study was to identify characteristics that may drive the variability of adopting of advanced health IT capabilities, such as predictive analytic functions and patient access to records, among health systems. Responses from the 2017/2018 National Survey of Healthcare Organizations and Systems were used to assess the extent to which healthcare system organizational structure, electronic health record standardization, and resource allocation practices were associated with the use of advanced health IT capabilities. Measures of adoption, organizational structure, and resource allocation were developed based on survey responses. Results suggest that health systems that standardize their electronic health records and that own and manage hospitals and medical groups have higher rates of advanced health IT adoption and use.
AHRQ-funded; HS024075.
Citation: Norton PT, Rodriguez HP, Shortell SM .
Organizational influences on healthcare system adoption and use of advanced health information technology capabilities.
Am J Manag Care 2019 Jan;25(1):e21-e25..
Keywords: Health Systems, Health Information Technology (HIT), Healthcare Delivery
Misra-Hebert AD, Perzynski A, Rothberg MB
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
This mixed-methods comparative case study examined the implementation of team-based primary care models in a large integrated health system. Field observations of 9 practices were conducted along with 75 interviews and provider and staff surveys. The 9 practices were categorized into 3 groups: high, partial, and low update of the new models. Ability of the practices to implement the new team-based model depended on their ability to adapt to change and to adapt team roles in workflow.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Perzynski A, Rothberg MB .
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
J Gen Intern Med 2018 Nov;33(11):1928-36. doi: 10.1007/s11606-018-4611-7..
Keywords: Case Study, Health Systems, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Harrison MI, Grantham S
AHRQ Author: Harrison MI
Learning from implementation setbacks: identifying and responding to contextual challenges.
The authors addressed organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. They found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics; however, team redesign was leading to improvements in chronic care and prevention and eased provider burden. Redesign and system leaders engaged in more thorough organizational learning. Their responses to challenges helped to strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health.
AHRQ-authored; AHRQ-funded; 2902010000341.
Citation: Harrison MI, Grantham S .
Learning from implementation setbacks: identifying and responding to contextual challenges.
Learn Health Syst 2018 Oct;2(4):e10068. doi: 10.1002/lrh2.10068..
Keywords: Organizational Change, Learning Health Systems, Health Systems, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Implementation
Vest JR, Simon K
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
This study examined hospitals’ adoption of interoperability of health information technology (HIT). The relationship between hospitals’ intra- (within the same organization) and inter-system information exchange capabilities was explored using data from the 2010-2014 American Hospital Association’s Annual Health Information Technology Survey. As expected, there was more intra-system information exchange than inter-system but as time went on inter-system information exchange has increased. During the study period, hospitals were sharing 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange.
AHRQ-funded; HS024717.
Citation: Vest JR, Simon K .
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
J Am Med Inform Assoc 2018 Sep;25(9):1189-96. doi: 10.1093/jamia/ocy058..
Keywords: Health Information Exchange (HIE), Health Systems, Health Information Technology (HIT), Hospitals
Poon BY, Shortell S, Rodriguez HP
Physician practice transitions to system ownership do not result in diminished practice responsiveness to patients.
The purpose of this study was to examine the extent to which physician-to-system ownership transitions were associated with declines in practice-reported patient responsiveness (PRPR). Data were collected from three nationally representative surveys of physician organizations - the National Survey of Large Physician Organizations/National Survey of Small- and Medium-Sized Physician Organizations and the National Survey of All-Size Physician Organizations - consisting of 40-minute interviews with medical directors, presidents, or chief executive officers. Multivariable regression estimated the effect of ownership on changes in PRPR, controlled for practice size, specialty composition, and market characteristics. The study results showed that practices that switched to system ownership did not have significantly lower PRPR at baseline, when compared to practices that were continuously physician-owned, but continuously system-owned practices did. Transitions to system ownership were associated with increased PRPR when compared to continuously physician ownership. Increased practice size and changes in specialty composition were associated with diminished PRPR.
AHRQ-funded; HS024075.
Citation: Poon BY, Shortell S, Rodriguez HP .
Physician practice transitions to system ownership do not result in diminished practice responsiveness to patients.
Health Serv Res 2018 Aug;53(4):2268-84. doi: 10.1111/1475-6773.12804.
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Keywords: Healthcare Delivery, Health Systems, Patient Experience
Funk RJ, Owen-Smith J, Kaufman SA
Association of informal clinical integration of physicians with cardiac surgery payments.
This study examined how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. It found that when beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0 percent) and postacute care services (5.8 percent).
AHRQ-funded; HS024728.
Citation: Funk RJ, Owen-Smith J, Kaufman SA .
Association of informal clinical integration of physicians with cardiac surgery payments.
JAMA Surg 2018 May;153(5):446-53. doi: 10.1001/jamasurg.2017.5150.
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Keywords: Healthcare Costs, Payment, Health Systems, Surgery
Henke RM, Karaca Z, Moore B
AHRQ Author: Karaca Z, Wong HS
Impact of health system affiliation on hospital resource use intensity and quality of care.
This study assessed the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality. It found that hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge.
AHRQ-authored.
Citation: Henke RM, Karaca Z, Moore B .
Impact of health system affiliation on hospital resource use intensity and quality of care.
Health Serv Res 2018 Feb;53(1):63-86. doi: 10.1111/1475-6773.12631..
Keywords: Healthcare Costs, Quality of Care, Health Systems, Healthcare Cost and Utilization Project (HCUP), Hospitals
Rangachari P
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in health care organizations (HCOs). It summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
Innov Entrep Health 2018;5:1-14. doi: 10.2147/ieh.s151040.
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Keywords: Evidence-Based Practice, Health Systems, Health Information Technology (HIT), Implementation, Quality Improvement, Hospitals, Quality of Care
Nix M, McNamara P, Genevro J
AHRQ Author: Nix M, McNamara P, Genevro J, Vargas N, Mistry K, Fournier A, Shofer M, Lomotan E, Miller T, Ricciardi R, Bierman AS
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
The authors examined AHRQ's experience with learning collaboratives to characterize their attributes, identify factors that might contribute to their success or failure, and assess the challenges they encountered. Building on the literature and insights from AHRQ's experience, they propose a taxonomy that can offer guidance to decision makers and funders about the factors they should consider in developing collaboratives.
AHRQ-authored.
Citation: Nix M, McNamara P, Genevro J .
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
Health Aff 2018 Feb;37(2):205-12. doi: 10.1377/hlthaff.2017.1144.
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Keywords: Learning Health Systems, Health Systems, Quality Improvement, Quality of Care, Healthcare Delivery
Mistry KB, Forrest CB
AHRQ Author: Mistry KB
Applying evidence from clinical trials: need for pediatric learning health system research.
The authors argue that to fill the many gaps in the understanding of major depressive disorder management (and more generally, the pediatric knowledge base), a new approach for augmenting the conventional randomized controlled trial is needed. They believe that the emerging field of learning health system research addresses this need.
AHRQ-authored.
Citation: Mistry KB, Forrest CB .
Applying evidence from clinical trials: need for pediatric learning health system research.
Pediatrics 2017 Dec;140(6). doi: 10.1542/peds.2017-3098.
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Keywords: Depression, Evidence-Based Practice, Health Systems, Children/Adolescents
Brach C
AHRQ Author: Brach C
The journey to become a health literate organization: a snapshot of health system improvement.
This chapter explores the journey that a growing number of organizations are taking to become health literate. A part of the chapter highlights the experiences of three organizations that have explicitly set a goal to become health literate: Carolinas Healthcare System (CHS), Intermountain Healthcare, and Northwell Health. The chapter ends with lessons learned from the experiences of health literacy pioneers that may be useful to organizations embarking on the journey.
AHRQ-authored.
Citation: Brach C .
The journey to become a health literate organization: a snapshot of health system improvement.
Stud Health Technol Inform 2017;240:203-37.
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Keywords: Health Literacy, Health Systems, Quality Improvement
Pantalone KM, Hobbs TM, Chagin KM
Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system.
The purpose of the study was to determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity. This cross-sectional summary from a large US integrated health system found that three out of every four patients had overweight or obesity based on BMI. Less than half of patients who were identified as having obesity according to BMI received a formal diagnosis via ICD-9 documentation.
AHRQ-funded; HS024128.
Citation: Pantalone KM, Hobbs TM, Chagin KM .
Prevalence and recognition of obesity and its associated comorbidities: cross-sectional analysis of electronic health record data from a large US integrated health system.
BMJ Open 2017 Nov 16;7(11):e017583. doi: 10.1136/bmjopen-2017-017583..
Keywords: Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Systems, Obesity, Patient-Centered Outcomes Research
Franklin P, Chenok K, Lavalee D
Framework to guide the collection and use of patient-reported outcome measures in the learning healthcare system.
Web-based collection of patient-reported outcome measures (PROMs) in clinical practice is expanding rapidly as electronic health records include web portals for patients to report standardized assessments of their symptoms. As the value of PROMs in patient care expands, a framework to guide the implementation planning, collection, and use of PROs to serve multiple goals and stakeholders is needed. In this study, researchers identified diverse clinical, quality, and research settings where PROMs have been successfully integrated into care and routinely collected and analyzed drivers of successful implementation.
AHRQ-funded; HS022789.
Citation: Franklin P, Chenok K, Lavalee D .
Framework to guide the collection and use of patient-reported outcome measures in the learning healthcare system.
eGEMS 2017 Sep 4;5(1):17. doi: 10.5334/egems.227..
Keywords: Learning Health Systems, Health Systems, Electronic Health Records (EHRs), Health Information Technology (HIT), Web-Based, Patient-Centered Healthcare
Fowler AC, Grabowski DC, Gambrel RJ
Corporate investors increased common ownership in hospitals and the postacute care and hospice sectors.
The researchers used data from the Provider Enrollment, Chain, and Ownership System of the Centers for Medicare and Medicaid Services to identify common investor ownership linkages across the acute care, postacute care, and hospice sectors within the same geographic markets. To our knowledge, this study provides the first description of common investor ownership trends in these sectors.
AHRQ-funded; HS024072.
Citation: Fowler AC, Grabowski DC, Gambrel RJ .
Corporate investors increased common ownership in hospitals and the postacute care and hospice sectors.
Health Aff 2017 Sep;36(9):1547-55. doi: 10.1377/hlthaff.2017.0591.
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Keywords: Hospitals, Health Systems
Blumenthal KG, Lai KH, Huang M
Adverse and hypersensitivity reactions to prescription nonsteroidal anti-inflammatory agents in a large health care system.
The researchers aimed to use electronic health record data to determine the incidence and predictors of hypersentivity reaction (HSR) to prescription nonsteroidal anti-inflammatory drugs (NSAIDs). They concluded that NSAID therapeutic use can be limited by adverse drug reactions (ADRs); about 1 in 5 NSAID ADRs is an hypersentivity reaction.
AHRQ-funded; HS022728.
Citation: Blumenthal KG, Lai KH, Huang M .
Adverse and hypersensitivity reactions to prescription nonsteroidal anti-inflammatory agents in a large health care system.
J Allergy Clin Immunol Pract 2017 May-Jun;5(3):737-43. doi: 10.1016/j.jaip.2016.12.006.
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Keywords: Electronic Health Records (EHRs), Medication, Risk, Health Systems, Adverse Drug Events (ADE)
Bishai D, Sherry M, Pereira CC
Development and usefulness of a district health systems tool for performance improvement in essential public health functions in Botswana and Mozambique.
This study describes the development of a self-audit tool for public health and the associated methodology for implementing a district health system self-audit tool that can provide quantitative data on how district governments perceive their performance of the essential public health functions. It found that instant feedback from the audit was a feature that 100 percent of pilot respondents found most useful.
AHRQ-funded; HS000029.
Citation: Bishai D, Sherry M, Pereira CC .
Development and usefulness of a district health systems tool for performance improvement in essential public health functions in Botswana and Mozambique.
J Public Health Manag Pract 2016 Nov-Dec;22(6):586-96. doi: 10.1097/phh.0000000000000407.
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Keywords: Health Systems, Public Health, Quality Improvement
Peiris D, Phipps-Taylor MC, Stachowski CA
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
The researchers examined differences between commercial accountable care organizations (ACOs) and noncommercial ACOs. They found that among all ACOs, there was low uptake of quality and efficiency activities; commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods; and about two-thirds of the ACOs had established processes for distributing any savings accrued. They concluded that ACO delivery systems remain at a nascent stage.
AHRQ-funded; HS024075.
Citation: Peiris D, Phipps-Taylor MC, Stachowski CA .
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
Health Aff 2016 Oct;35(10):1849-56. doi: 10.1377/hlthaff.2016.0387.
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Keywords: Healthcare Costs, Payment, Health Systems, Medicaid, Medicare
Simianu VV, Fichera A, Bastawrous AL
Number of diverticulitis episodes before resection and factors associated with earlier interventions.
The authors described patterns of episodes of diverticulitis before surgery and factors associated with earlier interventions using inpatient, outpatient, and antibiotic prescription claims. They found that 56.3% of elective resections for uncomplicated diverticulitis occurred after fewer than 3 episodes. Further, they determined that earlier surgery was not explained by younger age, laparoscopy, time between the last 2 episodes preceding surgery, or financial risk-bearing for patients.
AHRQ-funded; HS020025.
Citation: Simianu VV, Fichera A, Bastawrous AL .
Number of diverticulitis episodes before resection and factors associated with earlier interventions.
JAMA Surg 2016 Jul;151(7):604-10. doi: 10.1001/jamasurg.2015.5478.
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Keywords: Shared Decision Making, Digestive Disease and Health, Health Systems, Healthcare Utilization, Surgery
Rangachari P
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
In this paper, Rangachari 1) conducted a narrative review of the literature on "technology use," to understand how technologies-in-practice may be transformed from limited use to meaningful use; 2) conducted a narrative review of the literature on "organizational change implementation," to understand how changes in technology use could be successfully implemented and sustained in a healthcare organizational context; and 3) applied lessons learned from the narrative literature reviews to identify strategies for the meaningful use and successful implementation of EHR Medication Reconciliation technology.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Role of social knowledge networking technology in facilitating meaningful use of electronic health record medication reconciliation.
J Hosp Adm 2016 Jun;5(3):98-106. doi: 10.5430/jha.v5n3p98.
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Keywords: Health Systems, Medication, Hospitals, Organizational Change, Electronic Health Records (EHRs)
Fisher ES, Shortell SM, Savitz LA
Implementation science: A potential catalyst for delivery system reform.
Understanding which of the multitude of technological, policy, and organizational changes under way are most effective at improving care is a critical challenge. This article describes 3 ideas that could be helpful: application of a well-grounded conceptual framework; distinguishing 3 distinct types of innovations that health systems are using to improve care; and a focus on building the information systems needed to accelerate timely learning.
AHRQ-funded; HS024075.
Citation: Fisher ES, Shortell SM, Savitz LA .
Implementation science: A potential catalyst for delivery system reform.
JAMA 2016 Jan 26;315(4):339-40. doi: 10.1001/jama.2015.17949..
Keywords: Healthcare Delivery, Implementation, Quality Improvement, Quality of Care, Health Systems