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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 123 Research Studies Displayed
Cheetham MS, Zhao J, McCullough K
International peritoneal dialysis training practices and the risk of peritonitis.
In peritoneal dialysis (PD), the impact of training on patient outcomes is not well understood, with a lack of evidence to inform best practices in training. The purpose of this study was to compare international PD training practices and evaluate their association with peritonitis. In this prospective study, a cohort of 1,376 adult patients from 120 facilities across 7 counties were included, all of whom were participating in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) and were on PD for greater than 3 months. Training characteristics were reported at patient and facility levels and included duration, location, and modality of training, use of individual/ group training, use of written/ oral competency assessments, training of family members, and nurse affiliation. The study found that training was most typically conducted in a one-on-one setting (79%) by facility-affiliated nurses (87%) at the facility (81%). In 5 of 14 United Kingdom facilities, receiving training from both facility and external, third-party nurses was associated with a reduced risk of peritonitis. However, no other training characteristics were significantly associated with risk of peritonitis. The study concluded that in this study, there was no evidence that risk of peritonitis was associate with the assessed characteristics of PD patient training.
Citation: Cheetham MS, Zhao J, McCullough K . International peritoneal dialysis training practices and the risk of peritonitis. Nephrol Dial Transplant 2022 Apr 25;37(5):937-49. doi: 10.1093/ndt/gfab298..
Keywords: Kidney Disease and Health, Adverse Events, Training
Heiderscheit EA, Schlick CJR, Ellis RJ
Experiences of LGBTQ+ residents in US general surgery training programs.
The purpose of this study was to determine the national prevalence of mistreatment and poor well-being for lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) surgery residents compared with their non-LGBTQ+ peers. A voluntary, anonymous survey was conducted for clinically active general surgery residents training in accredited general surgery programs following their American Board of Surgery In-Training Examination. Findings showed that mistreatment was a common experience for LGBTQ+ surgery residents, with attending surgeons being the most common overall source. Increased suicidality among LGBTQ+ surgery residents was associated with this mistreatment. Recommendations included multifaceted interventions to develop safer and more inclusive learning environments.
Citation: Heiderscheit EA, Schlick CJR, Ellis RJ . Experiences of LGBTQ+ residents in US general surgery training programs. JAMA Surg 2022 Jan;157(1):23-32. doi: 10.1001/jamasurg.2021.5246..
Keywords: Provider: Physician, Surgery, Training, Education: Continuing Medical Education
Zittleman L, Curcija K, Nease DE
Increasing capacity for treatment of opioid use disorder in rural primary care practices.
Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation described the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.
Citation: Zittleman L, Curcija K, Nease DE . Increasing capacity for treatment of opioid use disorder in rural primary care practices. Ann Fam Med 2022 Jan-Feb;20(1):18-23. doi: 10.1370/afm.2757..
Keywords: Opioids, Rural Health, Primary Care, Substance Abuse, Behavioral Health, Training, Implementation, Medication
Feldman AG, Squires JE, Hsu EX
The current state of pediatric transplant hepatology fellowships: a survey of recent graduates.
This study’s goal was to describe the clinical, didactic, procedural, and research experiences of recent pediatric transplant hepatology (PTH) fellowship graduates. Findings showed that there is variability in the didactic, clinical, and procedural training among PTH fellowship programs. Although uniformly viewed as a beneficial fellowship year, there is an opportunity to collaborate to create a more standardized training experience.
Citation: Feldman AG, Squires JE, Hsu EX . The current state of pediatric transplant hepatology fellowships: a survey of recent graduates. Pediatr Transplant 2021 Nov;25(7):e14065. doi: 10.1111/petr.14065..
Keywords: Children/Adolescents, Provider: Physician, Education: Continuing Medical Education, Training
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
Parish MB, Gonzalez A, Hilty D
Asynchronous telepsychiatry interviewer training recommendations: a model for interdisciplinary, integrated behavioral health care.
Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlined the development of a training model for ATP clinician skills. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians. The authors suggested that more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed.
Citation: Parish MB, Gonzalez A, Hilty D . Asynchronous telepsychiatry interviewer training recommendations: a model for interdisciplinary, integrated behavioral health care. Telemed J E Health 2021 Sep;27(9):982-88. doi: 10.1089/tmj.2020.0076..
Keywords: Telehealth, Health Information Technology (HIT), Behavioral Health, Primary Care, Patient-Centered Healthcare, Training
Schondelmeyer AC, Bettencourt AP, Xiao R
Evaluation of an educational outreach and audit and feedback program to reduce continuous pulse oximetry use in hospitalized infants with stable bronchiolitis: a nonrandomized clinical trial.
National guidelines recommend against continuous pulse oximetry use for hospitalized children with bronchiolitis who are not receiving supplemental oxygen, yet guideline-discordant use remains high. The objective of this study was to evaluate deimplementation outcomes of educational outreach and audit and feedback strategies aiming to reduce guideline-discordant continuous pulse oximetry use in children hospitalized with bronchiolitis who are not receiving supplemental oxygen.
Citation: Schondelmeyer AC, Bettencourt AP, Xiao R . Evaluation of an educational outreach and audit and feedback program to reduce continuous pulse oximetry use in hospitalized infants with stable bronchiolitis: a nonrandomized clinical trial. JAMA Netw Open 2021 Sep;4(9):e2122826. doi: 10.1001/jamanetworkopen.2021.22826..
Keywords: Newborns/Infants, Hospitalization, Guidelines, Practice Patterns, Training, Respiratory Conditions
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
Burgdorf JG, Arbaje AI, Stuart EA
Unmet family caregiver training needs associated with acute care utilization during home health care.
This study estimated the proportion of family caregivers assisting Medicare home health patients who have unmet training needs and its’ potential impact on older adults’ risk of acute care utilization. Linked data from the National Health and Aging Trends Study, Outcome and Assessment Information Set (OASIS), Medicare Provider of Services file, and Medicare claims data from 2011 to 2016 were used. Rates of unmet training needs varied from 8.2% of family caregivers assisting with household chores and 16% assisting with self-care tasks. After controlling for older adult and home health provider characteristics, older adults with family caregivers who had unmet training needs were twice as likely to incur acute care utilization during their home health episode.
Citation: Burgdorf JG, Arbaje AI, Stuart EA . Unmet family caregiver training needs associated with acute care utilization during home health care. J Am Geriatr Soc 2021 Jul;69(7):1887-95. doi: 10.1111/jgs.17138..
Keywords: Caregiving, Home Healthcare, Elderly, Healthcare Utilization, Training
Sinz E, Banerjee A, Steadman R
Reliability of simulation-based assessment for practicing physicians: performance is context-specific.
Even physicians who routinely work in complex, dynamic practices may be unprepared to optimally manage challenging critical events. High-fidelity simulation can realistically mimic critical clinically relevant events, however the reliability and validity of simulation-based assessment scores for practicing physicians has not been established. In this study, standardised complex simulation scenarios were developed and administered to board-certified, practicing anesthesiologists who volunteered to participate in an assessment study during formative maintenance of certification activities.
Citation: Sinz E, Banerjee A, Steadman R . Reliability of simulation-based assessment for practicing physicians: performance is context-specific. BMC Med Educ 2021 Apr 12;21(1):207. doi: 10.1186/s12909-021-02617-8..
Keywords: Simulation, Education: Continuing Medical Education, Training, Provider Performance
Burgdorf JG, Stuart EA, Arbaje AI
Family caregiver training needs and Medicare home health visit utilization.
This study looked at family caregiver training needs and Medicare home health visit utilization. Medicare home health providers are now required to give family caregiver training, but service intensity is not known. This observational study linked National Health and Aging Trends Study (NHATS), Outcomes and Assessment Information (OASIS), and Medicare claims data to evaluate the relationship between caregivers’ training needs and number/type of home health visits. A total of 1217 NHATS participants receiving Medicare-funded home health between 2011 and 2016 were included. Nurse visits were more likely when family caregivers had medication management or household chore training needs. Therapy visits were more likely when caregivers had self-care training needs. Aide visits were more likely when caregivers had household chore or self-care training needs. Medication management training needs resulted in an additional 1.06 nursing visits, and household chore training an additional 3.24 total and a subset of 1.32 aide visits.
Citation: Burgdorf JG, Stuart EA, Arbaje AI . Family caregiver training needs and Medicare home health visit utilization. Med Care 2021 Apr;59(4):341-47. doi: 10.1097/mlr.0000000000001487..
Keywords: Caregiving, Elderly, Home Healthcare, Medicare, Training, Healthcare Utilization
Volerman A, Kan K, Carpenter D
Strategies for improving inhalation technique in children: a narrative review.
Inhaled medicines are commonly utilized by children for various respiratory conditions and must be used effectively for the medication to reach the airways. Poor inhaler technique contributes to poorly controlled asthma with significant associated morbidity. In this paper the authors provide a narrative review of strategies for improving inhalation technique in children.
Citation: Volerman A, Kan K, Carpenter D . Strategies for improving inhalation technique in children: a narrative review. Patient Prefer Adherence 2021 Mar 29;15:665-75. doi: 10.2147/ppa.S267053..
Keywords: Children/Adolescents, Respiratory Conditions, Training
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
Balikai SC, Badheka A, Casey A
Simulation to train pediatric ICU teams in endotracheal intubation of patients with COVID-19.
This paper describes the outcomes of pediatric intensive care unit (PICU) simulation training to safely perform endotracheal intubations in children with suspected or confirmed COVID-19. Confidence levels before and after training was measured using the Simulation Effectiveness Tool-Modified (SET-M, Likert scale 0-2). Fifty unique PICU staff members participated in 9 simulation sessions and mean confidences scores increased from 0.9 to 2.
Citation: Balikai SC, Badheka A, Casey A . Simulation to train pediatric ICU teams in endotracheal intubation of patients with COVID-19. Pediatr Qual Saf 2021 Jan-Feb;6(1):e373. doi: 10.1097/pq9.0000000000000373..
Keywords: Children/Adolescents, COVID-19, Intensive Care Unit (ICU), Critical Care, Simulation, Training, Public Health, Infectious Diseases
Branca A, Tellez D, Berkenbosch J
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Researchers evaluated the effect of the timing of the PICU fellow academic cycle on tracheal intubation-associated events in a retrospective cohort study of 37 PICUs participating in the National Emergency Airway Registry for Children.. They found that the New Trainee Effect in tracheal intubation safety outcomes was not observed in various types of PICUs. There was a significant improvement in pediatric critical care medicine fellows' first attempt success and a significant decline in tracheal intubation-associated event rates, indicating substantial skills acquisition throughout pediatric critical care medicine fellowship.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Branca A, Tellez D, Berkenbosch J . The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children. Pediatr Crit Care Med 2020 Dec;21(12):1042-50. doi: 10.1097/pcc.0000000000002480..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Patient Safety, Registries, Education: Continuing Medical Education, Training
Burgdorf JG, Arbaje AI, Wolff JL
Training needs among family caregivers assisting during home health, as identified by home health clinicians.
This study’s objective was to estimate the proportion of family caregivers assisting older adults during Medicare home health who have an identified need for activity-specific training and identify characteristics associated with caregiver training needs. This nationally representative retrospective cohort study included 1758 Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011 and 2016. More than 1 in 3 family caregivers assisting older adults during Medicare home health had an identified training need with at least 1 caregiving activity. Training needs varied widely, from 8.6% among caregiving helping with advocacy to 48.2% among caregivers helping with medical procedures. Weighted analyses adjusted for older adults’ health and function showed family caregivers were less likely to have identified training needs when assisting older adults with ongoing disability or who received caregiver assistance before home health admission.
Citation: Burgdorf JG, Arbaje AI, Wolff JL . Training needs among family caregivers assisting during home health, as identified by home health clinicians. J Am Med Dir Assoc 2020 Dec;21(12):1914-19. doi: 10.1016/j.jamda.2020.05.032..
Keywords: Caregiving, Home Healthcare, Education: Patient and Caregiver, Training
Brady AK, Brown W, Denson JL
Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship.
This study looked at outcomes of participation of fellows for Pulmonary and Critical Medicine (PCCM) training in endotracheal intubation in the medical intensive care unit (ICU). The authors administered a survey to a convenience sample of US PCCM fellows. A total of 89 discrete US PCCM and Internal Medicine CCM training programs were represented. Almost half (43%) of PCCM fellows were “always or almost always” designed the primary operator for intubation, whereas 21% of programs had the PCCM fellow “rarely or never” the primary operator responsible for intubating in the ICU. Various influencing factors included time of day, hospital policies, attending skill or preference, ICU census and acuity, and patient factors. There was an association between location of the training program but not program size whether the PCCM fellow was the primary operator.
Citation: Brady AK, Brown W, Denson JL . Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship. ATS Sch 2020 Dec;1(4):395-405. doi: 10.34197/ats-scholar.2020-0004OC..
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Training, Education: Academic, Critical Care
Brown W, Santhosh L, Brady AK
A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit.
This article presents a review of endotracheal intubation (EI) training for healthcare professionals in pulmonary and critical care medicine (PCCM). Although the ACGME mandates that trainees in PCCM achieve competence, only 60% of US PCCM trainees feel they are proficient in EI upon graduation. This article includes a review of EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.
Citation: Brown W, Santhosh L, Brady AK . A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit. Crit Care 2020 Oct 22;24(1):621. doi: 10.1186/s13054-020-03317-3..
Keywords: Training, Education: Continuing Medical Education, Critical Care, Intensive Care Unit (ICU), Guidelines
Alley L, Novak K, Havlin T
Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists
The authors developed the Resources Encouraging Safe Prescription Opioid and Naloxone Dispensing (RESPOND) Toolkit to enhance community pharmacists' understanding of their role in addressing opioid safety; to improve integration of prescription drug monitoring program (PDMP) into daily workflow; and to enhance communication between pharmacists, prescribers, and patients. In this paper, they described the development of the RESPOND Toolkit and summarized their findings from initial pilot testing. They concluded that the RESPOND Toolkit has promise as an effective and scalable approach to providing community pharmacist-tailored training to promote behavioral shifts supporting opioid safety for patients.
Citation: Alley L, Novak K, Havlin T . Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists Res Social Adm Pharm 2020 Oct;16(10):1422-30. doi: 10.1016/j.sapharm.2019.12.023..
Keywords: Opioids, Substance Abuse, Medication, Medication: Safety, Patient Safety, Tools & Toolkits, Communication, Provider: Pharmacist, Provider, Training
Glass M, Rana S, Coghlan R
Global palliative care education in the time of COVID-19.
This paper describes the Global Palliative Education Collaborative (GPEC), which is a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U.S., and international palliative care (PC) programs in Uganda and India. U.S.-based fellowships are offered by GPEC to learn about resource-limited PC provision, gain perspectives on global challenges to caring for patients at the end of life, and cultivate resiliency. They also offer a novel educational project that the GPEC faculty and fellows are participating in called the Resilient Inspirational Storytelling Empathy Project. Palliative care has become even more important during the COVID-19 pandemic.
Citation: Glass M, Rana S, Coghlan R . Global palliative care education in the time of COVID-19. J Pain Symptom Manage 2020 Oct;60(4):e14-e19. doi: 10.1016/j.jpainsymman.2020.07.018..
Keywords: Palliative Care, COVID-19, Education: Continuing Medical Education, Training
Zittleman L, Curcija K, Sutter C
Building capacity for medication assisted treatment in rural primary care Practices: the IT MATTTRs practice team training.
In response to rural communities and practice concerns related to opioid use disorder (OUD), the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study (IT MATTTRs) developed a training intervention for full primary care practice (PCP) teams in MAT for OUD. This evaluation reports on training implementation, participant satisfaction, and impact on perceived ability to deliver MAT.
Citation: Zittleman L, Curcija K, Sutter C . Building capacity for medication assisted treatment in rural primary care Practices: the IT MATTTRs practice team training. J Prim Care Community Health 2020 Jan-Dec;11:2150132720953723. doi: 10.1177/2150132720953723..
Keywords: Medication, Primary Care, Opioids, Substance Abuse, Rural Health, Training, Education: Continuing Medical Education
Costar DM, Hall KK
Improving team performance and patient safety on the job through team training and performance support tools: a systematic review.
This systematic review’s objective was to identify recent studies that implemented practices to improve teamwork in health care and were associated with positive improvements on the job. Two databases were searched to identify relevant articles published between 2008 and 2018. Twenty articles were selected for inclusion. Across studies, measures assessing teamwork skills on the job were most often collected and sustained improvements were shown for up to 12 months. Evidence of improved clinical practices and increased patient safety was found in both studies team training interventions, as well as those that introduced performance support tools. All studies were conducted in hospitals with very few studies found in other health care settings such as office-based care.
Citation: Costar DM, Hall KK . Improving team performance and patient safety on the job through team training and performance support tools: a systematic review. J Patient Saf 2020 Sep;16(3S Suppl 1):S48-s56. doi: 10.1097/pts.0000000000000746..
Keywords: Teams, Patient Safety, Training, Patient Safety, Provider Performance, Quality Improvement, Quality of Care
Kraut AS, Sheehy L, Schnapp BH
Effect of resident physicians in a supervisory role on efficiency in the emergency department.
The authors sought to examine the impact of a staffing model involving a supervisory resident "pre-attending" (PAT) on emergency department (ED) throughput and length of stay (LOS). Over 26,000 unique patient encounters at a university-affiliated community ED were retrospectively analyzed. They found that the presence of a PAT is associated with a statistically significant increase in service time of five minutes, but this magnitude is likely operationally insignificant. They concluded that the negligible increase in service time is offset by the benefit to residents' training.
Citation: Kraut AS, Sheehy L, Schnapp BH . Effect of resident physicians in a supervisory role on efficiency in the emergency department. West J Emerg Med 2020 Aug 24;21(5):1266-69. doi: 10.5811/westjem.2020.7.46587..
Keywords: Emergency Department, Education: Academic, Training
Thomas GW, Long S, Tatum M
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
In this paper, a vision is presented to elevate community orthopedic practice and improve patient safety by advancing the use of simulators for training and assessing surgical skills. Key elements of this vision included 1) methods for the objective and rigorous assessment of the performance of practicing surgeons now exist, 2) simulators are sufficiently mature and sophisticated that practicing surgeons will use them, and 3) practicing surgeons can improve their performance with appropriate feedback and coaching.
AHRQ-funded; HS022077; HS025353.
Citation: Thomas GW, Long S, Tatum M . A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery. Iowa Orthop J 2020;40(1):25-34..
Keywords: Orthopedics, Surgery, Simulation, Training, Provider: Physician, Provider
Daly Guris RJ, Doshi A, Boyer DL
Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management.
This paper describes the development and enactment of a number of simulation exercises, increasing in complexity for clinicians to practice intubation of critically ill children while wearing personal protective equipment due to coronavirus disease. The simulations ended up aiding in a real-life situation that then occurred less than 12 hours later that validated potential failure points and effectiveness of rapidly generated guidance. From this simulation a COVID-19 airway bundle template was created.
AHRQ-funded; HS026939; HS024511.
Citation: Daly Guris RJ, Doshi A, Boyer DL . Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management. Pediatr Crit Care Med 2020 Aug;21(8):e485-e90. doi: 10.1097/pcc.0000000000002435..
Keywords: Children/Adolescents, COVID-19, Respiratory Conditions, Workflow, Simulation, Training