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- Ambulatory Care and Surgery (1)
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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
1 to 20 of 20 Research Studies DisplayedHahn AL, Michaels CL, Khawly G
Comparison of evaluation methods for improving the usability of a Spanish mHealth tool.
The purpose of this study was to compare two usability evaluation methods for adapting an evidence-based mHealth tool from English into Spanish. The authors conducted cognitive interviews and usability assessments using a think-aloud protocol to evaluate the usability of an HIV mHealth application among 40 Spanish-speaking adults with HIV in New York City and in La Romana in the Dominican Republic. Findings highlighted contributions and limitations of including these methods in mHealth usability testing. The authors concluded that future research should employ a multi-method approach that incorporated complementary usability evaluation methods and engaged participants in multiple assessments.
AHRQ-funded; HS028523.
Citation: Hahn AL, Michaels CL, Khawly G .
Comparison of evaluation methods for improving the usability of a Spanish mHealth tool.
Int J Med Inform 2024 Apr; 184:105355. doi: 10.1016/j.ijmedinf.2024.105355.
Keywords: Telehealth, Health Information Technology (HIT)
Simpson RL, Lee JA, Li Y
Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.
This case report outlines the development and implementation of Amazon Web Services (AWS) at Emory University to securely store and analyze research data from the Centers for Medicare and Medicaid Services (CMS). Several interdisciplinary teams collaborated and ensured compliance with CMS policy. Results showed successful transition to a cloud-based environment with enhanced security measures and regular review processes. User training addressed cloud computing challenges. Lessons learned from challenges benefited CMS and interdisciplinary teams university-wide.
AHRQ-funded; HS026232.
Citation: Simpson RL, Lee JA, Li Y .
Medicare meets the cloud: the development of a secure platform for the storage and analysis of claims data.
JAMIA Open 2024 Apr; 7(1):ooae007. doi: 10.1093/jamiaopen/ooae007.
Keywords: Medicare, Health Information Technology (HIT)
Milliren CE, Ozonoff A, Fournier KA
Enhancing pressure injury surveillance using natural language processing.
This study’s goal was to assess the feasibility of using nursing handoff notes to identify underreported hospital-acquired pressure injury (HAPI) events. The authors established a natural language processing-assisted manual review process and workflow for data extraction from a corpus of nursing notes across all medical inpatient and intensive care units in a tertiary care pediatric center. Their workflow started with keywords around HAPI and treatments, then regular expressions, distributive semantics, and finally a document classifier. They generated 3 models: a tri-gram classifier, binary logistic regression model using the regular expressions as predictors, and a random forest model using both models together. Their final output was generated using a random forest model validated using derivation and validation sets. Their initial data set involved 70,981 notes during a 1-year period from 5484 unique admissions for 4220 patients. Their interrater human reviewer agreement on identifying HAPI was high. Their random forest model had 95% sensitivity, 71.2% specificity, and 78.7% accuracy. A total of 264 notes from 148 unique admissions were identified describing likely HAPI, with 61 describing new injuries, and 64 describing known yet possibly evolving injuries. HAPI incidence was 11.9 per 1000 discharges, and incidence rate was 1.2 per 1000 bed-days.
AHRQ-funded; HS026246.
Citation: Milliren CE, Ozonoff A, Fournier KA .
Enhancing pressure injury surveillance using natural language processing.
J Patient Saf 2024 Mar 1; 20(2):119-24. doi: 10.1097/pts.0000000000001193.
Keywords: Pressure Ulcers, Healthcare-Associated Infections (HAIs), Health Information Technology (HIT)
Bui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Salwei ME, Hoonakker P, Carayon P
Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation.
A human-centered design process was followed to assess the usability and adoption of human factors (HF)-based clinical decision support (CDS) in the emergency department (ED). A CDS was developed to aid in pulmonary embolism (PE) diagnosis, showing high usability in testing. However, despite positive perceptions, actual CDS usage remained low due to integration issues with clinician workflow. The findings highlight the need for ongoing refinement of CDS design to align with clinical workflows and enhance usability.
AHRQ-funded; HS026395; HS024558; HS022086. NIH 142099
Citation: Salwei ME, Hoonakker P, Carayon P .
Usability of a human factors-based clinical decision support in the emergency department: lessons learned for design and implementation.
Hum Factors 2024 Mar; 66(3):647-57. doi: 10.1177/00187208221078625.
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Emergency Department, Implementation
Wu J, Yuan CT, Moyal-Smith R
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
This study examines the role of electronic health records (EHRs) in implementing enhanced recovery pathways (ERPs) for perioperative surgical care. Interviews with informaticians and clinicians from eight US hospitals revealed three thematic clusters: "EHR difficulties," "EHR enablers," and "EHR barriers." Researchers concluded that high performers and improvers successfully integrated ERPs into EHRs with dedicated multidisciplinary teams, while others faced challenges. Early involvement of informatics expertise benefited ERP implementation and sustainability.
AHRQ-funded; 2332015000201.
Citation: Wu J, Yuan CT, Moyal-Smith R .
Electronic health record-supported implementation of an evidence-based pathway for perioperative surgical care.
J Am Med Inform Assoc 2024 Feb 16; 31(3):591-99. doi: 10.1093/jamia/ocad237.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Surgery, Evidence-Based Practice, Hospitals
Barwise AK, Curtis S, Diedrich DA
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
The objectives of this planned qualitative study were to use machine learning predictive analytics to identify patients with language barriers and complex medical needs in order to prioritize them for in-person interpreters. The authors conducted semi-structured interviews with clinicians, interpreters, and staff involved in caring for patients or organizing interpreters to understand perceived risks and benefits of artificial intelligence (AI) in this domain. Perceived risks included concerns about transparency, accuracy, redundancy, privacy, stigmatization among patients, alert fatigue, and supply-demand issues; perceived benefits included increased awareness of in-person interpreters, improved standard of care, and prioritization for interpreter utilization. They concluded that the use of AI to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
AHRQ-funded; HS028475.
Citation: Barwise AK, Curtis S, Diedrich DA .
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
J Am Med Inform Assoc 2024 Feb 16; 31(3):611-21. doi: 10.1093/jamia/ocad224.
Keywords: Health Information Technology (HIT), Disparities, Communication, Clinician-Patient Communication
Weiss CR, Roberts M, Florell M
Best Practices for telehealth in nurse-led care settings-a qualitative study.
This study explored the implementation of telehealth in nurse-led care models during the COVID-19 pandemic in Colorado. Through interviews with 18 providers and 30 patients, best practices such as: using multiple modalities, tailored triage and scheduling, safety measures, and managing patient relationships emerged. These findings indicate that telehealth can enhance equitable care delivery, particularly in diverse communities, with nurse leaders playing a vital role in its effective utilization.
AHRQ-funded; HS028085.
Citation: Weiss CR, Roberts M, Florell M .
Best Practices for telehealth in nurse-led care settings-a qualitative study.
Policy Polit Nurs Pract 2024 Feb; 25(1):47-57. doi: 10.1177/15271544231201417.
Keywords: Telehealth, Health Information Technology (HIT), Nursing, Provider: Nurse, COVID-19
Sequeira GM, Asante PG, Bocek K
Evaluating an electronic consultation platform to support pediatric primary care providers in caring for transgender and nonbinary adolescents.
An electronic consultation (e-consult) platform was introduced to conduct a study to aid pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. A study assessed its impact on PCP confidence and referral patterns. Results showed increased confidence and a 19% decrease in specialty referrals among PCPs. The platform received positive usability feedback, suggesting its potential to enhance care access and reduce specialty referrals for TNB adolescents.
AHRQ-funded; HS026393.
Citation: Sequeira GM, Asante PG, Bocek K .
Evaluating an electronic consultation platform to support pediatric primary care providers in caring for transgender and nonbinary adolescents.
Telemed J E Health 2024 Feb; 30(2):595-600. doi: 10.1089/tmj.2023.0266.
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Primary Care, Vulnerable Populations
Zhou Z, Yeung W, Soleymani S
Using explainable machine learning to uncover the kinase-substrate interaction landscape.
Researchers explored the challenge of understanding how human protein kinases selectively predict phosphorylate substrates. Leveraging recent peptide library datasets, the researchers developed an explainable Transformer model for kinase-peptide interaction prediction, achieving state-of-the-art performance. The model's multitask learning paradigm enables predictions on virtually any kinase-peptide pair. Using explainable machine learning methods, they uncovered the model's inner workings and provided a web interface for predicting kinase-substrate associations.
AHRQ-funded; HS029009.
Citation: Zhou Z, Yeung W, Soleymani S .
Using explainable machine learning to uncover the kinase-substrate interaction landscape.
Bioinformatics 2024 Feb; 40(2). doi: 10.1093/bioinformatics/btae033.
Keywords: Health Information Technology (HIT)
Dullabh P, Leaphart D, Dhopeshwarkar R
Patient-centered clinical decision support-where are we and where to next?
This paper is a literature review of the current state of patient-centered clinical decision support (PC CDS) that includes digital health tools that support patients, caregivers, and care teams in healthcare decisions that incorporate patient-centered factors related to four components: knowledge, data, delivery, and use. It explores the current state of each factor and how each factor promotes patient-centeredness in healthcare. The authors reviewed 175 peer-reviewed and grey literature, and eighteen key informant interviews. They found there is a need for more research on how to incorporate patient input into the guideline selection and prioritization for PC CDS, development and implementation of PC CDS tools, technical challenges for capturing patient contributed data, and optimizing PC CDS across various settings to meet patient and caregiver needs.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Leaphart D, Dhopeshwarkar R .
Patient-centered clinical decision support-where are we and where to next?
Stud Health Technol Inform 2024 Jan 25; 310:444-48. doi: 10.3233/shti231004..
Keywords: Patient-Centered Healthcare, Clinical Decision Support (CDS), Health Information Technology (HIT)
Olaya F, Brin M, Caraballo PB
A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol.
The purpose of this study is to test the effectiveness of an mHealth tool to improve adherence to HIV medication in Spanish-speaking people living in New York City and the Dominican Republic. The researchers developed the WiseApp study as a two-arm randomized controlled trial. The 248 participants from New York and the Dominican Republic were randomly assigned to receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or to the standard of care (control). The participants completed surveys at the baseline, 3-month, 6-month, and 12-month follow-up visits. Through blood draws at each study timepoint, the study team collected HIV-1 viral load and CD4 count results. Results will be forthcoming.
AHRQ-funded; HS028523.
Citation: Olaya F, Brin M, Caraballo PB .
A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol.
BMC Public Health 2024 Jan 17; 24(1):201. doi: 10.1186/s12889-023-17538-y..
Keywords: Human Immunodeficiency Virus (HIV), Telehealth, Health Information Technology (HIT), Cultural Competence, Outcomes
Powell KR, Farmer M, Liu J
A survey of technology abandonment in US nursing homes.
This study examined abandonment of health information technology (HIT) by US nursing homes (NHs) and its association with organizational characteristics among a national sample of US NHs. This longitudinal, retrospective analysis used data from 2 sources: the HIT Maturity Survey and Staging model and public data from the Care Compare database. The authors used a random sample of 299 NHs representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019-August 2020 and year 2 (Y2) was June 2020-August 2021. The primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain; and independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. Results were that over the 2-year period HIT abandonment occurred in 28% of NHs compared with 44% that experienced growth in HIT systems. Capabilities in resident care was abandoned most frequently. They found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. They concluded that technology abandonment can increase strain on scarce resources and may impact administrators' ability to oversee clinical operations, especially in large NHs.
AHRQ-funded; HS022497.
Citation: Powell KR, Farmer M, Liu J .
A survey of technology abandonment in US nursing homes.
J Am Med Dir Assoc 2024 Jan; 25(1):6-11. doi: 10.1016/j.jamda.2023.09.002..
Keywords: Nursing Homes, Health Information Technology (HIT), Long-Term Care
Jolliff A, Coller RJ, Kearney H
An mHealth design to promote medication safety in children with medical complexity.
This study describes an effort to design a health information technology tool to improve medication safety for children with medical complexity (CMC). The study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a co-design process to identify: 1) medication safety challenges experienced by CMC caregivers and, 2) design requirements for a mobile health application to improve medication safety for CMC in the home. Family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program participated in virtual co-design sessions. During these sessions, the facilitator guided 16 co-designers in generating and converging upon medication safety challenges and design requirements. These sessions were recorded and reviewed after conclusion to confirm that all designer comments had been captured. An analysis yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines.
AHRQ-funded; HS028409.
Citation: Jolliff A, Coller RJ, Kearney H .
An mHealth design to promote medication safety in children with medical complexity.
Appl Clin Inform 2024 Jan; 15(1):45-54. doi: 10.1055/a-2214-8000..
Keywords: Children/Adolescents, Medication: Safety, Medication, Health Information Technology (HIT), Chronic Conditions, Telehealth, Caregiving
Haimovich AD, Shah MN, Southerland LT
Automating risk stratification for geriatric syndromes in the emergency department.
This study discussed using automated risk stratification to implement screening programs for geriatric syndromes in the emergency department (ED). This method would reduce significant workloads at a time of record-breaking ED patient volumes, staff shortages, and hospital boarding crises. The authors defined the concept of automated risk stratification and screening using existing electronic health record (EHR) data. They discussed progress made in three potential use cases in the ED: falls, cognitive impairment, and end-of-life and palliative care; emphasizing the importance of linking automated screening with systems of healthcare delivery. They found that research progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end-of-life care, but should still be considered a potential solution.
AHRQ-funded; HS027735.
Citation: Haimovich AD, Shah MN, Southerland LT .
Automating risk stratification for geriatric syndromes in the emergency department.
J Am Geriatr Soc 2024 Jan; 72(1):258-67. doi: 10.1111/jgs.18594..
Keywords: Elderly, Emergency Department, Risk, Health Information Technology (HIT)
Kaufman BG, Holland DE, Vanderboom CE
Implementation costs of technology-enhanced transitional palliative care for rural caregivers.
Rural FCG experience higher levels of burden accessing coordinated care for their loved ones during and after hospitalization than urban family caregivers (FCG). The role of technology-enhanced transitional palliative care (TPC) on caregiver outcomes is currently being assessed in a randomized control trial. The purpose of this study was to assess resource use and health system costs of this FCG-focused TPC intervention and potential Medicare reimbursement mechanisms. The researchers randomized rural caregivers of hospitalized patients into an 8-week intervention which included video visits conducted by a registered nurse certified in palliative care, and supplemented with phone calls and texts (n = 215), or attentional control. The researchers estimated labor costs for a registered nurse and compared to scenario analyses utilizing a nurse practitioner or social worker wages. Medicare reimbursement scenarios included Transitional Care Management (TCM) and Chronic Care Management (CCM) CPT codes. The researchers found the base case, TPC cost was $395 per FCG conducted by a registered nurse, compared to $337 and $585 if conducted by a social worker or nurse practitioner, respectively. Reimbursement in the CCM-only scenario was $348 and $274 for complex and non-complex patients, respectively. Average Medicare reimbursement in the TCM-only scenario was $322 and $260 for high or moderate complexity patients, respectively. Reimbursement in the TCM+CCM scenario was $496 and $397, for high/complex and moderate/non-complex patients, respectively.
AHRQ-funded; HS026379.
Citation: Kaufman BG, Holland DE, Vanderboom CE .
Implementation costs of technology-enhanced transitional palliative care for rural caregivers.
Am J Hosp Palliat Care 2024 Jan; 41(1):38-44. doi: 10.1177/10499091231156145..
Keywords: Rural Health, Caregiving, Palliative Care, Health Information Technology (HIT)
Scharp D, Hobensack M, Davoudi A
Natural language processing applied to clinical documentation in post-acute care settings: a scoping review.
The purpose of this scoping review was to assess the scope of the application of natural language processing to free-text clinical notes in post-acute care and provide a foundation for future natural language processing-based research in the same settings. The researchers searched PubMed, Cumulative Index of Nursing and Allied Health Literature, and Embase in February 2023. Twenty-one eligible studies. Almost all of which were conducted in home health care settings, had quantitative designs that utilized natural language processing applied to clinical documentation in post-acute care settings. Most studies extracted data from electronic health records to explore the risk for negative outcomes, including acute care utilization, medication errors, and suicide mortality. About half of the studies did not report age, sex, race, or ethnicity data or utilize standardized terminologies. Only 8 studies included variables from socio-behavioral domains. Most studies fulfilled all quality appraisal indicators.
AHRQ-funded; HS027742.
Citation: Scharp D, Hobensack M, Davoudi A .
Natural language processing applied to clinical documentation in post-acute care settings: a scoping review.
J Am Med Dir Assoc 2024 Jan; 25(1):69-83. doi: 10.1016/j.jamda.2023.09.006..
Keywords: Health Information Technology (HIT), Home Healthcare
Balbin CA, Kawamoto K
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
To address the need for electronic health record (EHR) systems to accept the connection of any patient-facing digital health app using the SMART on FHIR standard, the authors proposed the Standards-based Implementation Maximizing Portability Leveraging the EHR (SIMPLE). SIMPLE’s architectural pattern was designed to meet several key requirements, such as not requiring patients to install new software; not retaining patient data outside of the EHR; leveraging existing personal health record (PHR) capabilities to optimize user experience; and maximizing portability.
AHRQ-funded; HS028791.
Citation: Balbin CA, Kawamoto K .
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
AMIA Annu Symp Proc 2024 Jan 11; 2023:844-53..
Keywords: Workflow, Health Information Technology (HIT), Cancer: Lung Cancer, Cancer, Screening
Hekman DJ, Barton HJ, Maru AP
Dashboarding to monitor machine-learning-based clinical decision support interventions.
This case report described the creation of a dashboard that allowed the intervention development team and operational stakeholders to identify potential issues that may require corrective action by bridging the monitoring gap between model outputs and patient outcomes. The authors proposed that monitoring machine-learning-based clinical decision support (ML-CDS) algorithms with regular dashboards that allow both context-level views of the system and drilled down views of specific components is a critical part of implementing these algorithms to ensure that these tools function appropriately within the broader care system.
AHRQ-funded; HS027735.
Citation: Hekman DJ, Barton HJ, Maru AP .
Dashboarding to monitor machine-learning-based clinical decision support interventions.
Appl Clin Inform 2024 Jan; 15(1):164-69. doi: 10.1055/a-2219-5175.
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT)
Geary CR, Hook M, Popejoy L
Ambulatory care coordination data gathering and use.
The purpose of this study was to identify information gathered and used to support care coordination in ambulatory settings. Survey respondents, most of whom were nurses, provided demographic information and their practice patterns, including use of electronic health records. Most described at least a partial use of electronic health records, but two respondents described paper documentation systems. The authors concluded that the responses demonstrated significant heterogeneity in ambulatory care coordination data usage, but noted that additional research is needed to identify common data elements to support knowledge development in the context of a learning health system.
AHRQ-funded; HS028000.
Citation: Geary CR, Hook M, Popejoy L .
Ambulatory care coordination data gathering and use.
Comput Inform Nurs 2024 Jan; 42(1):63-70. doi: 10.1097/cin.0000000000001069.
Keywords: Care Coordination, Ambulatory Care and Surgery, Electronic Health Records (EHRs), Health Information Technology (HIT)