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
151 to 175 of 237 Research Studies DisplayedHu YY, Ellis RJ, Hewitt DB
Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training.
A cross-sectional national survey of general surgery residents, administered with the 2018 American Board of Surgery In-Training Examination, assessed mistreatment, burnout, and suicidal thoughts during the past year. The authors assessed the association of mistreatment with burnout and suicidal thoughts; they found that mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.
AHRQ-funded; HS000078.
Citation: Hu YY, Ellis RJ, Hewitt DB .
Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training.
N Engl J Med 2019 Oct 31;381(18):1741-52. doi: 10.1056/NEJMsa1903759..
Keywords: Education: Continuing Medical Education, Burnout, Stress, Surgery, Provider: Physician, Provider, Training
Hansen M, Schoonover A, Skarica B
Implicit gender bias among US resident physicians.
The purpose of this study was to characterize implicit gender bias among residents in US Emergency Medicine and OB/GYN residencies. The investigators found that gender bias was present among US residents favoring men in leadership positions, this bias differed between male and female residents, and was associated with discipline. Implicit bias did not differ across training years, and was associated with explicit bias.
AHRQ-funded; HS023457.
Citation: Hansen M, Schoonover A, Skarica B .
Implicit gender bias among US resident physicians.
BMC Med Educ 2019 Oct 29;19(1):396. doi: 10.1186/s12909-019-1818-1..
Keywords: Provider, Provider: Physician, Sex Factors
Ganguli I, Simpkin AL, Lupo C
Cascades of care after incidental findings in a US national survey of physicians.
The objective of this study was to estimate the national frequency and consequences of cascades of care after incidental findings using a national survey of US physicians. 991 practicing U.S. internists in a research panel representative of American College of Physicians national membership participated in the survey. Survey findings indicated that almost all respondents had experienced cascades after incidental findings that did not lead to clinically meaningful outcomes yet caused harm to patients and themselves. Recommendations included encouraging policy makers and health care leaders to address cascades after incidental findings as part of efforts to improve health care value and reduce physician burnout.
AHRQ-funded; HS023812.
Citation: Ganguli I, Simpkin AL, Lupo C .
Cascades of care after incidental findings in a US national survey of physicians.
JAMA Netw Open 2019 Oct 2;2(10):e1913325. doi: 10.1001/jamanetworkopen.2019.13325..
Keywords: Chronic Conditions, Provider: Physician, Provider
Childers CP, Hofer IS, Cheng DS
Evaluating surgeons on intraoperative disposable supply costs: details matter.
Cost report cards have demonstrated variation in intraoperative supply costs and may allow comparisons between surgeons. However, cost data are complex and, if not properly vetted, may be inaccurate. In this study, a retrospective assessment of intraoperative supply costs for consecutive laparoscopic cholecystectomies (2013-2017) at a 4-facility academic center was performed. The investigators concluded that evaluating surgeons based on intraoperative supply costs was sensitive to analytic methods.
AHRQ-funded; HS025079.
Citation: Childers CP, Hofer IS, Cheng DS .
Evaluating surgeons on intraoperative disposable supply costs: details matter.
J Gastrointest Surg 2019 Oct;23(10):2054-62. doi: 10.1007/s11605-018-3889-4..
Keywords: Healthcare Costs, Provider, Provider: Physician, Surgery
Everson J, Richards MR, Buntin MB
Horizontal and vertical integration's role in meaningful use attestation over time.
This study examined rates of attestation and attrition from the meaningful use (MU) program by independent, horizontally integrated, and vertically integrated physicians. The goal was to determine if MU created pressure for independent physicians to join integrated organizations. They compared attestation rates using secondary data from SK&A and Medicare MU Files from 2011-2016 with office-based physicians. The sample size was 291,234 physicians. Forty-nine percent of physicians that remained independent during the period attested to MU at least once during the program, compared with 70% that remained horizontally or vertically integrated. There was also significantly more attrition among independent physicians than those physicians who were integrated.
AHRQ-funded; HS026395.
Citation: Everson J, Richards MR, Buntin MB .
Horizontal and vertical integration's role in meaningful use attestation over time.
Health Serv Res 2019 Oct;54(5):1075-83. doi: 10.1111/1475-6773.13193..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workforce, Provider: Physician, Provider, Medicare
Zikmund-Fisher BJ, Solomon JB, Scherer AM
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
Patient portals of electronic health record systems currently present patients with tables of laboratory test results, but visual displays can increase patient understanding and sensitivity to result variations. In this study, the investigators sought to assess physician preferences and concerns about visual display designs as potential motivators or barriers to their implementation.
Citation: Zikmund-Fisher BJ, Solomon JB, Scherer AM .
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
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Keywords: Primary Care, Electronic Health Records (EHRs), Education: Patient and Caregiver, Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Vemulakonda VM, Hamer MK, Kempe A
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
Although there are significant demographic and clinical variations in treatment decisions for infants with high-grade hydronephrosis concerning for ureteropelvic junction obstruction (UPJO), there has been little research on the roles of parents and surgeons in the surgical decision-making (DM) process. The purpose of this study was to understand parents' and surgeons' perceived roles in the surgical DM process for infants with high-grade hydronephrosis.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM, Hamer MK, Kempe A .
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
J Pediatr Urol 2019 Oct;15(5):469.e1-69.e9. doi: 10.1016/j.jpurol.2019.05.027..
Keywords: Newborns/Infants, Decision Making, Surgery, Kidney Disease and Health, Caregiving, Provider: Physician, Provider, Patient and Family Engagement
Oslock WM, Paredes AZ, Baselice HE
Women surgeons and the emergence of acute care surgery programs.
The authors sought to examine predictors of women surgeons in emergency general surgery (EGS) generally, and in acute care surgery (ACS) particularly. They found that 50.4% of hospitals studied had zero women surgeons. Women were more likely to be among EGS surgeons at hospitals with ACS models. They concluded that their study highlighted the dearth of women representation within EGS hospitals nationally and illuminated some of the underlying characteristics of ACS that may draw women: urban, academic, and staffed by more recently trained surgeons.
AHRQ-funded; HS022694.
Citation: Oslock WM, Paredes AZ, Baselice HE .
Women surgeons and the emergence of acute care surgery programs.
Am J Surg 2019 Oct;218(4):803-08. doi: 10.1016/j.amjsurg.2019.07.008..
Keywords: Surgery, Provider: Physician, Provider, Emergency Department
Manojlovich M, Ameling JM, Forman J
Contextual barriers to communication between physicians and nurses about appropriate catheter use.
This study identified contextual barriers to communication between physicians and nurses that contribute to inappropriate use of catheters and increased risk of health care-associated infections. The researchers conducted individual and small-group semistructured interviewed with physicians and nurses in a progressive care unit of an academic hospital. Common barriers included workflow misalignment between clinicians, issues with electronic medical records and pagers, and strained relationships between clinicians.
AHRQ-funded; HS024385.
Citation: Manojlovich M, Ameling JM, Forman J .
Contextual barriers to communication between physicians and nurses about appropriate catheter use.
Am J Crit Care 2019 Jul;28(4):290-98. doi: 10.4037/ajcc2019372..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Communication, Healthcare-Associated Infections (HAIs), Patient Safety, Provider, Provider: Nurse, Provider: Physician, Urinary Tract Infection (UTI), Workflow
Bernstein A, Rogers KM, Possin KL
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
The prevalence of dementia, a neurocognitive disorder (NCD), is expected to triple in the next 30 years. In this study, the investigators surveyed a national sample of primary care physicians to characterize their attitudes and practices with respect to the evaluation and management of NCDs.
AHRQ-funded; HS022241.
Citation: Bernstein A, Rogers KM, Possin KL .
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
J Gen Intern Med 2019 Sep;34(9):1691-92. doi: 10.1007/s11606-019-05013-7..
Keywords: Dementia, Neurological Disorders, Provider: Physician, Provider: Clinician, Provider, Primary Care
Hultman GM, Marquard JL, Kandaswamy S
Electronic progress note reading patterns: an eye tracking analysis.
This study used eye-tracking to understand how the order of note sections influences the way physicians read electronic progress notes. Results showed no relationship between time spent reading a section and section origin of verbal summaries.
AHRQ-funded; HS022085.
Citation: Hultman GM, Marquard JL, Kandaswamy S .
Electronic progress note reading patterns: an eye tracking analysis.
Stud Health Technol Inform 2019 Aug 21;264:1684-85. doi: 10.3233/shti190596..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider, Provider: Physician
Rogers ES, Cuthel AM, Berry CA
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
This study examined the effectiveness of practice facilitation to improve cardiovascular disease in 257 small independent primary care practices (SIPs) enrolled in the AHRQ-funded EvidenceNOW initiative called HealthyHearts. These SIPs were enrolled in HealthyHearts NYC in New York City. Interviews were conducted with SIPs with 3 or fewer office staff and their answers were compared with interviews with practices with more than 3 office staff. Three facilitation benefits were found to the most important, including 1. Creating awareness of quality gaps; 2. Connecting practices to information, resources, and strategies, and; 3. Optimizing the HER for QI goals.
AHRQ-funded; HS023922.
Citation: Rogers ES, Cuthel AM, Berry CA .
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S17-s23. doi: 10.1370/afm.2427..
Keywords: Primary Care, Provider: Clinician, Provider: Physician, Provider, Quality Improvement, Quality of Care, Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Kroth PJ, Morioka-Douglas N, Veres S
Association of electronic health record design and use factors with clinician stress and burnout.
The authors sought to determine which electronic health record (EHR) design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. Surveying ambulatory primary care and subspecialty clinicians from 3 institutions, they found that, although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.
AHRQ-funded; HS022065.
Citation: Kroth PJ, Morioka-Douglas N, Veres S .
Association of electronic health record design and use factors with clinician stress and burnout.
JAMA Netw Open 2019 Aug 2;2(8):e199609. doi: 10.1001/jamanetworkopen.2019.9609..
Keywords: Burnout, Stress, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider: Clinician, Provider: Physician, Provider: Nurse
Brunsberg KA, Landrigan CP, Garcia BM
Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services.
The objective of this paper was to determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians. Results of this prospective cohort study showed that resident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors, indicating the importance of determining what interventions might mitigate the patient safety risk.
AHRQ-funded; HS019456.
Citation: Brunsberg KA, Landrigan CP, Garcia BM .
Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services.
Acad Med 2019 Aug;94(8):1150-56. doi: 10.1097/acm.0000000000002778..
Keywords: Children/Adolescents, Provider: Physician, Provider, Medical Errors, Adverse Events, Burnout, Patient Safety, Depression, Behavioral Health
Barbash IJ, Pilewski JM, McVerry BJ
Closing the loop: engaging leaders and front-line physicians to promote physician wellness.
The authors describe their experience with linking buy-in from organizational leaders with a process of engaging frontline physicians to identify and drive changes designed to improve physician wellness in an academic pulmonary and critical care medicine division. They conclude that, with support from local leaders, empowered physicians can improve their work environments in ways that allow them to focus on the essential missions of academic medicine—discovery, teaching, and patient care.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Pilewski JM, McVerry BJ .
Closing the loop: engaging leaders and front-line physicians to promote physician wellness.
Ann Am Thorac Soc 2019 Aug;16(8):970-73. doi: 10.1513/AnnalsATS.201812-866PS.
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Keywords: Burnout, Provider: Physician, Provider
Armstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Gupta K, Lisker S, Rivadeneira NA
Decisions and repercussions of second victim experiences for mothers in medicine (SAVE DR MoM).
Researchers characterized events contributing to the second-victim effect among a diverse sample of physician mothers, described the impact on both provider and patient, and sought to determine the association between experiencing a mistake and burnout. They found that physician mothers involved in errors experience negative outcomes and may be at increased risk for burnout. They recommended additional research focusing on strategies to mitigate burnout associated with the second victim effect, particularly among women physicians and those with family responsibilities.
AHRQ-funded; HS023558.
Citation: Gupta K, Lisker S, Rivadeneira NA .
Decisions and repercussions of second victim experiences for mothers in medicine (SAVE DR MoM).
BMJ Qual Saf 2019 Jul;28(7):564-73. doi: 10.1136/bmjqs-2018-008372..
Keywords: Adverse Events, Burnout, Medical Errors, Patient Safety, Provider: Physician
Johnston FM, Beckman M
Navigating difficult conversations.
In this paper, the authors discussed breaking bad news and navigating difficult conversations in surgical oncology practice. They note that mounting evidence supports a patient-centered communication approach and models of shared decisionmaking. Physician training in patient-centered cancer communication also continues to evolve.
AHRQ-funded; HS024736.
Citation: Johnston FM, Beckman M .
Navigating difficult conversations.
J Surg Oncol 2019 Jul;120(1):23-29. doi: 10.1002/jso.25472..
Keywords: Cancer, Clinician-Patient Communication, Communication, Decision Making, Patient-Centered Healthcare, Patient and Family Engagement, Provider: Physician, Surgery
Ranganathan K, Kochkodan JM, Baker MK
Variation in the desire for cleft revision surgery among children, caregivers, and surgeons.
This study examined the differences in perception between children, caregivers, and their surgeons for the need for cleft revision surgery. A sample of 100 children with cleft lip and/or cleft palate and their caregivers (n=100) were surveyed on satisfaction with appearance using the Cleft Evaluation Profile. Ten surgeons and ten control observers then rated photographs of these children using questions analogous to the Profile. The children generally reported greater satisfaction in appearance across all domains compared with surgeons. Children and caregivers had similar degrees of satisfaction in appearance of the lip and maxilla. The authors concluded that more care must be given to children’s perception before moving forward with further revision surgery.
AHRQ-funded; HS023313.
Citation: Ranganathan K, Kochkodan JM, Baker MK .
Variation in the desire for cleft revision surgery among children, caregivers, and surgeons.
Plast Reconstr Surg 2019 Jul;144(1):171-78. doi: 10.1097/prs.0000000000005722..
Keywords: Caregiving, Children/Adolescents, Surgery, Provider, Provider: Physician
Linzer M, Poplau S, Prasad K
Characteristics of health care organizations associated with clinician trust: results from the healthy work place study.
This study examined clinician trust among clinicians in private practices using retrospective cohort data from the Healthy Work Place randomized clinical trial. Thirty-four primary care practices in the Upper Midwest and East Coast were sampled. The study included 165 clinicians with most being physicians, and some advanced practice clinicians (nurse practitioners and physician assistants). Measures of clinician trust included belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need. The population surveyed were 87.7% physicians and 52.1% women. Most (63.6%) worked in family medicine and the rest in internal medicine. Greater work control was associated with higher levels of trust. Men were more likely to express loyalty and high trust. Higher trust was associated with greater work satisfaction and leads to better staff retention and lower stress levels.
AHRQ-funded.
Citation: Linzer M, Poplau S, Prasad K .
Characteristics of health care organizations associated with clinician trust: results from the healthy work place study.
JAMA Netw Open 2019 Jun 5;2(6):e196201. doi: 10.1001/jamanetworkopen.2019.6201..
Keywords: Primary Care, Provider, Provider: Clinician, Provider: Nurse, Provider: Physician
Mitchell AP, Rotter JS, Patel E
Association between reimbursement incentives and physician practice in oncology: a systematic review.
Investigators sought to evaluate whether the financial incentives presented by oncology reimbursement policies affect physician practice patterns. Following a literature search, 18 observational cohort studies were included, most with moderate risk of bias. The findings suggested that some oncologists may, in certain circumstances, alter treatment recommendations based on personal revenue considerations. The authors concluded that an implication of this finding is that value-based reimbursement policies may be a useful tool to better align physician incentives with patient need and increase the value of oncology care.
AHRQ-funded; HS000032.
Citation: Mitchell AP, Rotter JS, Patel E .
Association between reimbursement incentives and physician practice in oncology: a systematic review.
JAMA Oncol 2019 Jun;5(6):893-99. doi: 10.1001/jamaoncol.2018.6196..
Keywords: Practice Patterns, Payment, Provider: Physician, Provider
Anton NE, Mizota T, Whiteside JA
Mental skills training limits the decay in operative technical skill under stressful conditions: results of a multisite, randomized controlled study.
The authors hypothesize that surgery residents trained on mental skills would outperform controls under increased stress conditions in the simulated operating room. They find that their comprehensive mental skills curriculum implemented with surgery residents at two institutions was effective at minimizing the deterioration of resident technical performance under stressful conditions compared with controls. They conclude that their results provide further evidence for the effectiveness of mental skills training to optimize surgery trainees' technical performance during challenging clinical situations.
AHRQ-funded; R18 HS022080.
Citation: Anton NE, Mizota T, Whiteside JA .
Mental skills training limits the decay in operative technical skill under stressful conditions: results of a multisite, randomized controlled study.
Surgery 2019 Jun;165(6):1059-64. doi: 10.1016/j.surg.2019.01.011..
Keywords: Surgery, Education: Continuing Medical Education, Stress, Provider Performance, Training, Provider: Physician, Provider
Martin JR, Anton N, Timsina L
Performance variability during training on simulators is associated with skill transfer.
Researchers looked at performance variability during training on simulators for performing laparoscopic surgery. Their hypothesis was that participants (surgery residents and medical students) who had consistent scores were most likely to have the most expertise and be capable of training others. The trainees first used the Fundamentals of Laparoscopic Surgery (FLS) simulator to learn laparoscopic suturing and then were transfer tested on a live, anesthetized porcine model. Their hypothesis was proven true and those with decreased practice variability was associated with greater scores in posttests and transfer tests.
AHRQ-funded; R18 HS022080.
Citation: Martin JR, Anton N, Timsina L .
Performance variability during training on simulators is associated with skill transfer.
Surgery 2019 Jun;165(6):1065-68. doi: 10.1016/j.surg.2019.01.013..
Keywords: Simulation, Training, Surgery, Education: Continuing Medical Education, Provider Performance, Provider: Physician, Provider
Aronson PL, Schaeffer P, Fraenkel L
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
This paper discusses the reasons for wide variation in the decision to perform lumbar punctures (LPs) in febrile infants 8 weeks or less. Semi-structured interviews were conducted with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Five themes emerged from the interviews that included: age of the infant, the physician’s clinical experience, physician’s use of research findings, the physician’s values, and the role of the primary care pediatrician.
AHRQ-funded; HS026006.
Citation: Aronson PL, Schaeffer P, Fraenkel L .
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
Hosp Pediatr 2019 Jun;9(6):405-14. doi: 10.1542/hpeds.2019-0002..
Keywords: Newborns/Infants, Decision Making, Provider: Physician, Provider: Nurse, Provider: Clinician, Provider, Emergency Department, Diagnostic Safety and Quality
Mueller SK, Schnipper JL
Physician perspectives on interhospital transfers.
This study examined physician perspectives of the common problems that occur during acute care hospital interhospital transfers. The process tends to be nonstandardized which creates a number of issues. These issues include: patients sometimes, frequently, or always arriving without required specialized care (56% of the time), arriving with unrealistic expectations of care (77.2% of responses), arrived more than 24 hours after accepted transfer in 80.1% of responses, and arrived without necessary transfer records 86.9% of the time. The last issue and also time of day of arrival many physicians felt posed a risk to the transferred patients.
AHRQ-funded; HS023331.
Citation: Mueller SK, Schnipper JL .
Physician perspectives on interhospital transfers.
J Patient Saf 2019 Jun;15(2):86-89. doi: 10.1097/pts.0000000000000312..
Keywords: Healthcare Delivery, Hospitals, Patient Safety, Provider, Provider: Physician, Transitions of Care