National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Behavioral Health (3)
- Cancer (1)
- Cardiovascular Conditions (3)
- Care Coordination (2)
- Chronic Conditions (2)
- Communication (2)
- Community-Based Practice (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (6)
- Healthcare Costs (1)
- Healthcare Delivery (6)
- Health Information Technology (HIT) (2)
- Health Services Research (HSR) (1)
- Heart Disease and Health (1)
- (-) Implementation (17)
- Organizational Change (4)
- Outcomes (1)
- Palliative Care (1)
- (-) Patient-Centered Healthcare (17)
- Patient-Centered Outcomes Research (4)
- Patient Experience (1)
- Patient Safety (2)
- Practice Improvement (4)
- Prevention (3)
- Primary Care (13)
- Primary Care: Models of Care (3)
- Quality Improvement (6)
- Quality of Care (6)
- Quality of Life (2)
- Risk (1)
- Teams (1)
- Telehealth (1)
- Urban Health (1)
- Vulnerable Populations (1)
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
1 to 17 of 17 Research Studies DisplayedChyr LC, DeGroot L, Waldfogel JM
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
The purpose of this study was to assess the implementation of models for integrating palliative care into ambulatory care for adults with noncancer serious chronic illness. Between January 2000 to May 2020, the researchers reviewed 3 electronic databases and included qualitative, mixed methods studies, and randomized and nonrandomized controlled trial studies. Quantitative analysis included 14 studies of 2,934 US adult patients. The study found that when compared to usual care the models assessed were not more effective for improving patient health-related quality of life (HRQOL) or for patient depressive symptom scores. Qualitative analysis included 5 studies of 146 patients. There was variance in patient preferences for appropriate timing of palliative care; barriers to implementation included costs, additional visits, and travel. The researchers concluded that models were not more effective than usual care for improving HRQOL or depressive symptom scores and may have little to no effect on decreasing overall symptom burden but were more effective for increasing AD documentation.
AHRQ-funded; 2902015000061
Citation: Chyr LC, DeGroot L, Waldfogel JM .
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
Ann Fam Med 2022 Jan-Feb;20(1):77-83. doi: 10.1370/afm.2754..
Keywords: Chronic Conditions, Palliative Care, Implementation, Patient-Centered Healthcare, Quality of Life
Oberlander T, Scholle SH, Marsteller J
Implementation of patient safety structures and processes in the patient-centered medical home.
This study's objectives were to identify patient-centered medical home (PCMH) standards relevant to patient safety, to construct a measure of patient safety activity implementation, and to examine differences in adoptions of these activities by practice and community characteristics. Findings showed that implementation of patient safety activities varied; the few military practices studied had the highest, and community clinics the lowest, patient safety score, both overall and across specific domains, while other practice and community characteristics were not associated with the patient safety score.
AHRQ-funded; HS024859.
Citation: Oberlander T, Scholle SH, Marsteller J .
Implementation of patient safety structures and processes in the patient-centered medical home.
J Healthc Qual 2021 Nov-Dec;43(6):324-39. doi: 10.1097/jhq.0000000000000312..
Keywords: Patient-Centered Healthcare, Patient Safety, Implementation, Primary Care
Cykert S, Keyserling TC, Pignone M
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Researchers assessed the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. They found that a risk-stratified, population management dashboard combined with practice facilitation led to substantial reductions of 10-year atherosclerotic cardiovascular disease risk for patients at high risk. They recommended utilizing similar approaches to lead to effective dissemination and implementation of other new evidence, especially in rural and other under-resourced practices.
AHRQ-funded; HS023912.
Citation: Cykert S, Keyserling TC, Pignone M .
A controlled trial of dissemination and implementation of a cardiovascular risk reduction strategy in small primary care practices.
Health Serv Res 2020 Dec;55(6):944-53. doi: 10.1111/1475-6773.13571..
Keywords: Cardiovascular Conditions, Risk, Prevention, Primary Care, Implementation, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Yeung K, Richards J, Goemer E
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
The purpose of this study was to describe the cost of using evidence-based implementation strategies for sustained behavioral health integration (BHI) involving population-based screening, assessment, and identification at 25 primary care sites of Kaiser Permanente Washington (2015-2018). The investigators concluded that when spread across patients screened in a single year, BHI implementation costs were well within the range for commonly used diagnostic assessments in primary care (eg, laboratory tests).
AHRQ-funded; HS023173.
Citation: Yeung K, Richards J, Goemer E .
Costs of using evidence-based implementation strategies for behavioral health integration in a large primary care system.
Health Serv Res 2020 Dec;55(6):913-23. doi: 10.1111/1475-6773.13592..
Keywords: Healthcare Costs, Evidence-Based Practice, Implementation, Behavioral Health, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare
Quigley DD, Qureshi N, Masarweh LA
Practice leaders report targeting several types of changes in care experienced by patients during patient-centered medical home transformation.
This study looked at how primary care practices implemented changes during the transition to becoming a patient-centered medical home (PCMH). The authors examined 105 primary care practice leader experiences during PCMH transformation using semi-structured interviews. Practices most commonly targeted changes in care coordination (30%), access to care (25%), and provider communication (24%). Reported areas for PCMH transformation were measured by Clinician & Group CAHPS, PCMH CAHPS, or supplemental CAHPS survey items, including team-based care (35%), providing more on-site services (28%), care management (22%), patient-centered culture (18%), and chronic condition health education (13%). Many PCMH changes are captured by CAHPS survey items, but some are not.
AHRQ-funded; HS025920.
Citation: Quigley DD, Qureshi N, Masarweh LA .
Practice leaders report targeting several types of changes in care experienced by patients during patient-centered medical home transformation.
J Patient Exp 2020 Dec;7(6):1509-18. doi: 10.1177/2374373520934231..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Patient Experience, Care Coordination, Quality Improvement, Quality of Care, Implementation
Penedo FJ, Oswald LB, Kronenfeld JP
The increasing value of eHealth in the delivery of patient-centred cancer care.
This paper is an appraisal of peer literature over the past 10 years on patient-centered eHealth to improve cancer care delivery. Uses of eHealth include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. Challenges of, and opportunities for accessibility, scalability, and implementation of these technologies is also discussed.
AHRQ-funded; HS026170.
Citation: Penedo FJ, Oswald LB, Kronenfeld JP .
The increasing value of eHealth in the delivery of patient-centred cancer care.
Lancet Oncol 2020 May;21(5):e240-e51. doi: 10.1016/s1470-2045(20)30021-8.
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Keywords: Cancer, Patient-Centered Healthcare, Healthcare Delivery, Telehealth, Health Information Technology (HIT), Quality of Life, Implementation
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
Schuttner L, Wong ES, Rosland AM
Association of the patient-centered medical home implementation with chronic disease quality in patients with multimorbidity.
The purpose of this retrospective cohort study was to examine the association of Patient-Aligned Care Team (PACT) implementation, the Veterans Health Administration (VA) PCMH model, and care quality for multimorbid patients enrolled in VA primary care from 2012 to 2014. The investigators found that for one-third of metrics (5/15), greater implementation of PACT in 2012 was associated with higher predicted probability of meeting the quality metric in 2013-2014. This association persisted for only two metrics among patients with > 5 chronic diseases.
AHRQ-funded; HS026369.
Citation: Schuttner L, Wong ES, Rosland AM .
Association of the patient-centered medical home implementation with chronic disease quality in patients with multimorbidity.
J Gen Intern Med 2020 Oct;35(10):2932-38. doi: 10.1007/s11606-020-06076-7..
Keywords: Patient-Centered Healthcare, Implementation, Chronic Conditions, Primary Care: Models of Care, Primary Care, Quality Improvement, Quality of Care
Meyers D, Miller T, Genevro J
AHRQ Author: Meyers D, Miller T, Genevro J, Zhan C, De La Mare J, Fournier A, Bennett H, McNellis RJ
EvidenceNOW: Balancing primary care implementation and implementation research.
In 2015, AHRQ invested in the largest primary care research project in its history. EvidenceNOW is a $112 million effort to disseminate and implement patient-centered outcomes research evidence in more than 1,500 primary care practices and to study how quality-improvement support can build the capacity of primary care practices to understand and apply evidence. EvidenceNOW comprises 7 implementation research grants, each funded to provide external quality-improvement support to primary care practices to implement evidence-based cardiovascular care and to conduct rigorous internal evaluations of their work.
AHRQ-authored.
Citation: Meyers D, Miller T, Genevro J .
EvidenceNOW: Balancing primary care implementation and implementation research.
Ann Fam Med 2018 Apr;16(Suppl 1):S5-s11. doi: 10.1370/afm.2196.
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Keywords: Cardiovascular Conditions, Communication, Evidence-Based Practice, Heart Disease and Health, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention, Primary Care, Quality of Care, Quality Improvement, Implementation
Tomoaia-Cotisel A, Farrell TW, Solberg LI
AHRQ Author: Harrison MI, Genevro JL
Implementation of care management: an analysis of recent AHRQ research.
This article describes care management (CM) implementation and associated lessons from 12 Agency for Healthcare Research and Quality-sponsored projects. Two rounds of data collection resulted in project-specific narratives that were analyzed using an iterative approach analogous to framework analysis. Informants also participated as coauthors. Variation emerged across practices and over time regarding CM services provided, personnel delivering these services, target populations, and setting(s).
AHRQ-authored; AHRQ-funded; HS021933; 2902007.
Citation: Tomoaia-Cotisel A, Farrell TW, Solberg LI .
Implementation of care management: an analysis of recent AHRQ research.
Med Care Res Rev 2018 Feb;75(1):46-65. doi: 10.1177/1077558716673459.
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Keywords: Care Coordination, Patient-Centered Healthcare, Primary Care, Implementation
Ono SS, Crabtree BF, Hemler JR
Taking innovation to scale in primary care practices: the functions of health care extension.
Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. This article describes how cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement.
AHRQ-funded; HS023940.
Citation: Ono SS, Crabtree BF, Hemler JR .
Taking innovation to scale in primary care practices: the functions of health care extension.
Health Aff 2018 Feb;37(2):222-30. doi: 10.1377/hlthaff.2017.1100.
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Keywords: Primary Care, Implementation, Cardiovascular Conditions, Evidence-Based Practice, Healthcare Delivery, Practice Improvement, Quality Improvement, Quality of Care, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention
Hoff T, Scott S
The strategic nature of individual change behavior: how physicians and their staff implement medical home care.
The purpose of this study was to gain insight into patient-centered medical home (PCMH) implementation at the workplace level by understanding better how primary care physicians and staff perceive, experience, and use certain types of PCMH work for adapting to new demands. The investigators indicated that the findings showed that particular forms of PCMH work not only advanced patient care in favorable ways but also enhanced individual and organizational capacity for adapting to this innovative model and its demands.
AHRQ-funded; HS020931.
Citation: Hoff T, Scott S .
The strategic nature of individual change behavior: how physicians and their staff implement medical home care.
Health Care Manage Rev 2017 Jul/Sep;42(3):226-36. doi: 10.1097/hmr.0000000000000109..
Keywords: Patient-Centered Healthcare, Primary Care, Organizational Change, Practice Improvement, Implementation
Clark KD, Miller BF, Green LA
Implementation of behavioral health interventions in real world scenarios: managing complex change.
This paper reports the change management strategies employed by practice leaders making changes to integrate care, as observed by independent investigators. It offers an empirically based set of actionable recommendations that are relevant to a range of leaders (policymakers, medical directors) and practice members who wish to effectively manage the complex changes associated with integrated primary care.
AHRQ-funded; HS022981.
Citation: Clark KD, Miller BF, Green LA .
Implementation of behavioral health interventions in real world scenarios: managing complex change.
Fam Syst Health 2017 Mar;35(1):36-45. doi: 10.1037/fsh0000239.
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Keywords: Behavioral Health, Patient-Centered Healthcare, Primary Care, Implementation, Organizational Change, Healthcare Delivery
Quigley DD, Predmore ZS, Chen AY
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Researchers conducted interviews at 14 primary care practices undergoing patient-centered medical home (PCMH) transformation in a large urban federally qualified health center in California and used grounded theory to identify common themes and patterns. They concluded that full PCMH transformation took time and effort and relied on a sequential approach, with an early focus on foundational changes that included use of a robust quality improvement strategy.
AHRQ-funded; HS000029.
Citation: Quigley DD, Predmore ZS, Chen AY .
Implementation and sequencing of practice transformation in urban practices with underserved patients.
Qual Manag Health Care 2017 Jan/Mar;26(1):7-14. doi: 10.1097/qmh.0000000000000118.
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Keywords: Patient-Centered Healthcare, Urban Health, Vulnerable Populations, Practice Improvement, Organizational Change, Quality Improvement, Quality of Care, Primary Care, Healthcare Delivery, Implementation, Teams
Balasubramanian BA, Fernald D, Dickinson LM
REACH of interventions integrating primary care and behavioral health.
This study reports REACH (the extent to which an intervention or program was delivered to the identified target population) of interventions integrating primary care and behavioral health implemented by real-world practices. Practices that implemented systematic protocols to identify patients needing integrated care had a significantly higher screening REACH compared with practices that used clinicians' discretion.
AHRQ-funded; HS022981.
Citation: Balasubramanian BA, Fernald D, Dickinson LM .
REACH of interventions integrating primary care and behavioral health.
J Am Board Fam Med 2015 Sep-Oct;28 Suppl 1:S73-85. doi: 10.3122/jabfm.2015.S1.150055.
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Keywords: Behavioral Health, Healthcare Delivery, Patient-Centered Healthcare, Primary Care, Community-Based Practice, Implementation, Community-Based Practice, Implementation
Fontaine P, Whitebird R, Solberg LI
Minnesota's early experience with medical home implementation: viewpoints from the front lines.
This study aimed to identify the facilitators and barriers encountered by nine diverse primary care practices selected from the first 80 to achieve patient-centered medical home (PCMH) certification in Minnesota. It found that facilitators to achieve PCMH certification included a requirement for patient involvement, which pushed practices to create patient-centered innovations, and new reimbursement models based on quality indicators for a population.
AHRQ-funded; HS019161.
Citation: Fontaine P, Whitebird R, Solberg LI .
Minnesota's early experience with medical home implementation: viewpoints from the front lines.
J Gen Intern Med 2015 Jul;30(7):899-906. doi: 10.1007/s11606-014-3136-y..
Keywords: Patient-Centered Healthcare, Primary Care, Implementation, Organizational Change, Healthcare Delivery, Practice Improvement, Health Services Research (HSR)
Borden WB, Chiang YP, Kronick R
AHRQ Author: Kronick, R
Bringing patient-centered outcomes research to life.
Achieving better health outcomes requires both the generation of new patient-centered outcomes research (PCOR) knowledge and the appropriate and timely dissemination of that knowledge into practice. This article highlights the work AHRQ has done, is doing, and will do to improve the uptake of PCOR findings.
AHRQ-authored
Citation: Borden WB, Chiang YP, Kronick R .
Bringing patient-centered outcomes research to life.
Value Health. 2015 Jun;18(4):355-7. doi: 10.1016/j.jval.2015.01.010..
Keywords: Communication, Evidence-Based Practice, Outcomes, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Implementation