National Healthcare Quality and Disparities Report
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- Access to Care (2)
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- (-) Ambulatory Care and Surgery (21)
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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 21 of 21 Research Studies DisplayedHood-Medland EA, White AEC, Kravitz RL
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
This study looked at primary care visit opening styles to assess use of agenda and non-agenda setting visit openings and their effects on participant experience with patients taking opioids for chronic pain. The study analyzed 83 video-recorded US primary care visits at a single academic medical center in California. A total of 49 family medicine and internal resident physicians and 83 patients were filmed. The authors developed a coding scheme that assessed the presence of agenda setting, distinct visit opening styles, and the number of total topics, major topics, surprise patient topics, and returns to prior topics discusses. They identified 2 visit opening styles with agenda setting (agenda eliciting, agenda reframing) and 3 non-agenda opening styles (open-ended question, patient launch, physician launch). Only 11% of visits included agenda setting and was associated with fewer surprise patient topics than visits without agenda setting.
AHRQ-funded; HS022236.
Citation: Hood-Medland EA, White AEC, Kravitz RL .
Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain.
BMC Fam Pract 2021 Jan 4;22(1):4. doi: 10.1186/s12875-020-01317-4..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Clinician-Patient Communication, Communication, Ambulatory Care and Surgery
Stephens KA, Ike B, Baldwin LM
Challenges and approaches to population management of long-term opioid therapy patients.
Primary care is challenged with safely prescribing opioids for patients with chronic noncancer pain (CNCP), specifically to address risks for overdose, opioid use disorder, and death. In this study, the investigators identified sociotechnical challenges, approaches, and recommendations in primary care to effectively track and monitor patients on long-term opioid therapy, a key component for supporting adoption of opioid prescribing guidelines.
AHRQ-funded; HS023750.
Citation: Stephens KA, Ike B, Baldwin LM .
Challenges and approaches to population management of long-term opioid therapy patients.
J Am Board Fam Med 2021 Jan-Feb;34(1):89-98. doi: 10.3122/jabfm.2021.01.190100..
Keywords: Opioids, Pain, Chronic Conditions, Care Management, Medication, Primary Care, Ambulatory Care and Surgery
McClellan C, Maclean JC, Saloner B
AHRQ Author: McClellan C
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
This study provided the first population-level evidence on the effects of Medicaid health homes (HH) on behavioral health care service use. As of 2016, 16 states had adopted an HH for enrollees with serious mental illness and/or substance use disorder. Using data from the National Survey on Drug Use and Health, the authors found that HH adoption increased service use among enrollees and enrollee self-reported health improved post-HH.
AHRQ-authored.
Citation: McClellan C, Maclean JC, Saloner B .
Integrated care models and behavioral health care utilization: quasi-experimental evidence from Medicaid health homes.
Health Econ 2020 Sep;29(9):1086-97. doi: 10.1002/hec.4027..
Keywords: Behavioral Health, Medicaid, Substance Abuse, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Patient-Centered Outcomes Research
Kuhns LM, Carlino B, Greeley K
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
This study looked at rates of substance use screening and related documentation among adolescents aged 12-17 in outpatient pediatric clinics in a large academic medical center. The authors abstracted a random sample of 127 records and coded clinical notes to describe screening cases and related characteristics. They then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and identify related factors. Rates of screening by providers was 72% for each common substance and a total of 6% of patients reported substance use during screening.
AHRQ-funded; HS026385.
Citation: Kuhns LM, Carlino B, Greeley K .
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
Subst Abuse Treat Prev Policy 2020 May 25;15(1):36. doi: 10.1186/s13011-020-00276-4..
Keywords: Children/Adolescents, Substance Abuse, Screening, Ambulatory Care and Surgery, Alcohol Use, Practice Patterns, Primary Care
Knox M, Murphy EJ, Leslie T
e-Consult implementation success: lessons from 5 county-based delivery systems.
This study evaluated organizational factors for e-consult implementation across five publicly financed, county-based health systems in California. Health system leaders whose systems received grant funding to plan and implement e-consult were interviewed to discuss platform selection, electronic health record compatibility, primary care clinician and specialist opinions, and project governance. Findings showed that three of the 5 systems successfully implemented e-consults. Existing primary care clinician-specialist relationships emerged as the strongest facilitator. E-consult-EHR technology integration was also important. These findings add to existing e-consult implementation literature that emphasizes reimbursement and leadership champions.
AHRQ-funded; HS022241.
Citation: Knox M, Murphy EJ, Leslie T .
e-Consult implementation success: lessons from 5 county-based delivery systems.
Am J Manag Care 2020 Jan;26(1):e21-e27. doi: 10.37765/ajmc.2020.42149..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Delivery, Implementation, Primary Care, Ambulatory Care and Surgery
Samples H, Stuart EA, Saloner B
The role of screening in depression diagnosis and treatment in a representative sample of US primary care visits.
This study aimed to examine depression screening patterns and the role of screening in depression diagnosis and treatment in the outpatient primary care setting. The investigators found that physicians appeared to use depression screening selectively based on patients' presenting symptoms. Higher screening rates were associated with higher odds of depression diagnosis and treatment. The investigators suggest that even modest increases in screening rates could meaningfully increase population-level rates of depression identification and treatment in primary care.
AHRQ-funded; HS000029.
Citation: Samples H, Stuart EA, Saloner B .
The role of screening in depression diagnosis and treatment in a representative sample of US primary care visits.
J Gen Intern Med 2020 Jan;35(1):12-20. doi: 10.1007/s11606-019-05192-3..
Keywords: Depression, Behavioral Health, Diagnostic Safety and Quality, Primary Care, Screening, Ambulatory Care and Surgery
Chan B, Hulen E, Edwards S
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
AHRQ-funded; HS022981.
Citation: Chan B, Hulen E, Edwards S .
"It's like riding out the chaos": caring for socially complex patients in an ambulatory intensive care unit (A-ICU).
Ann Fam Med 2019 Nov;17(6):495-501. doi: 10.1370/afm.2464..
Keywords: Primary Care, Primary Care: Models of Care, Ambulatory Care and Surgery, Vulnerable Populations, Patient-Centered Healthcare, Healthcare Delivery
Howard SD, Lee KL, Nathan AG
Healthcare experiences of transgender people of color.
Researchers investigated how transgender people of color (TPOC) healthcare experiences are shaped by both race/ethnicity and gender identity. Using interviews and focus groups with participants in the Chicago area, they found that all participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender-friendly in an effort to avoid discrimination, but feared experiencing racism there. When describing positive healthcare experiences, participants were most likely to highlight providers' respect for their gender identity. The researchers concluded that TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities and recommended that providers improve understanding of intersectional experiences of TPOC to improve quality of care.
AHRQ-funded; HS023050.
Citation: Howard SD, Lee KL, Nathan AG .
Healthcare experiences of transgender people of color.
J Gen Intern Med 2019 Oct;34(10):2068-74. doi: 10.1007/s11606-019-05179-0..
Keywords: Patient Experience, Vulnerable Populations, Cultural Competence, Racial and Ethnic Minorities, Primary Care, Ambulatory Care and Surgery
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Abara NO, Huang N, Raji MA
Effect of retail clinic use on continuity of care among Medicare beneficiaries.
Researchers examined the relationship between retail clinic use and primary care physician (PCP) continuity among Medicare enrollees in the Houston metropolitan area. They found that retail clinic use was lower in the elderly population, compared with the previously published rate in the younger populations. The lower rate of continuity of care observed among retail clinic users was an issue of concern, especially for those with chronic medical conditions.
AHRQ-funded; HS020642.
Citation: Abara NO, Huang N, Raji MA .
Effect of retail clinic use on continuity of care among Medicare beneficiaries.
J Am Board Fam Med 2019 Jul-Aug;32(4):531-38. doi: 10.3122/jabfm.2019.04.180349..
Keywords: Medicare, Transitions of Care, Ambulatory Care and Surgery, Primary Care
Feemster K, Localio R, Grundmeier R
Incidence of healthcare-associated influenza-like illness after a primary care encounter among young children.
The authors evaluated whether exposure to a pediatric clinic visit was associated with subsequent influenza-like illness (ILI) using electronic health record data. They found that pediatric clinic visits during a respiratory virus season were significantly associated with an increased incidence of subsequent ILI among children aged 2 to 6 years but not among those aged less than 2 years. They concluded that their findings support the hypothesis that respiratory virus transmission in a pediatric clinic can result in healthcare-associated ILI in young children.
AHRQ-funded; HS020939.
Citation: Feemster K, Localio R, Grundmeier R .
Incidence of healthcare-associated influenza-like illness after a primary care encounter among young children.
J Pediatric Infect Dis Soc 2019 Jul 1;8(3):191-96. doi: 10.1093/jpids/piy023..
Keywords: Children/Adolescents, Healthcare-Associated Infections (HAIs), Infectious Diseases, Influenza, Primary Care, Healthcare Delivery, Ambulatory Care and Surgery, Respiratory Conditions
Harrison MI, Grantham S
AHRQ Author: Harrison MI
Learning from implementation setbacks: identifying and responding to contextual challenges.
The authors addressed organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. They found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics; however, team redesign was leading to improvements in chronic care and prevention and eased provider burden. Redesign and system leaders engaged in more thorough organizational learning. Their responses to challenges helped to strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health.
AHRQ-authored; AHRQ-funded; 2902010000341.
Citation: Harrison MI, Grantham S .
Learning from implementation setbacks: identifying and responding to contextual challenges.
Learn Health Syst 2018 Oct;2(4):e10068. doi: 10.1002/lrh2.10068..
Keywords: Organizational Change, Learning Health Systems, Health Systems, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Implementation
Saleem JJ, Weiler DT, Satterly T
Field investigation of ambulatory clinic exam room design with respect to computing devices: a pilot study.
The authors of this paper conducted observations and interviews with primary care providers and their patients from three locations within the Phoenix VA Health Care System, in a pilot study comparing the new exam room design standard with the older legacy exam rooms. The study results suggested that the new exam room design did contribute to a greater degree of patient centeredness, though more thorough evaluations are required to support these preliminary results.
AHRQ-funded; HS024488.
Citation: Saleem JJ, Weiler DT, Satterly T .
Field investigation of ambulatory clinic exam room design with respect to computing devices: a pilot study.
Proc Hum Factors Ergon Soc Annu Meet 2018 Sep;62(1):518-22. doi: 10.1177/1541931218621118..
Keywords: Ambulatory Care and Surgery, Patient-Centered Healthcare, Primary Care
LaForge K, Gold R, Cottrell E
How 6 organizations developed tools and processes for social determinants of health screening in primary care: an overview.
Little is known about how health care organizations are developing tools for identifying/addressing patients' social determinants of health (SDH). The authors of this paper describe the processes recently used by 6 organizations to develop SDH screening tools for ambulatory care and the barriers they faced during those efforts.
AHRQ-funded; HS023324.
Citation: LaForge K, Gold R, Cottrell E .
How 6 organizations developed tools and processes for social determinants of health screening in primary care: an overview.
J Ambul Care Manage 2018 Jan/Mar;41(1):2-14. doi: 10.1097/jac.0000000000000221..
Keywords: Ambulatory Care and Surgery, Prevention, Primary Care, Screening, Social Determinants of Health
Ray KN, Martsolf GR, Mehrotra A
Trends in visits to specialist physicians involving nurse practitioners and physician assistants, 2001 to 2013.
The purpose of this study is to examine trends in specialist physician visits where nurse practitioners (NPs) and physician assistants (PAs) provide care, based on the hypothesis that NPs and PAs provide care to patients of specialist physicians in increasing numbers, primarily for routine follow-up visits. Using the National Ambulatory Medical Care Survey (NAMCS) information on samples office visits, researchers identified visits to specialist physicians, divided these into surgical and medical specialists and examined unadjusted trends from 2001 - 2013 in the percentage of visits with NP or PA involvement. Visit characteristics associated with higher likelihood of NP or PA involvement were examined.
AHRQ-funded; HS022989.
Citation: Ray KN, Martsolf GR, Mehrotra A .
Trends in visits to specialist physicians involving nurse practitioners and physician assistants, 2001 to 2013.
JAMA Intern Med 2017 Aug;177(8):1213-16. doi: 10.1001/jamainternmed.2017.1630..
Keywords: Access to Care, Ambulatory Care and Surgery, Healthcare Delivery, Primary Care, Provider
Davis MM, Howk S, Spurlock M
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
Researchers conducted this study to explore what clinic and community-based users want in intervention toolkits and to identify the factors that support application in practice. They found that participants wanted toolkits targeted at the right audience and demonstrated to be effective. Well organized toolkits, often with a quick start guide, with tools that were easy to tailor and apply were desired.
AHRQ-funded; HS022981.
Citation: Davis MM, Howk S, Spurlock M .
A qualitative study of clinic and community member perspectives on intervention toolkits: "unless the toolkit is used it won't help solve the problem.".
BMC Health Serv Res 2017 Jul 18;17(1):497. doi: 10.1186/s12913-017-2413-y.
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Keywords: Provider: Health Personnel, Ambulatory Care and Surgery, Primary Care, Tools & Toolkits, Implementation
Federman AD, Sanchez-Munoz A, Jandorf L
Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design.
The researchers explored patients' and clinicians' perspectives on electronic health record (EHR)-generated outpatient after-visit summaries (AVSs) to inform efforts to maximize the document's utility. They learned that core themes included the use and purpose of the AVS, content modification and prioritization, formatting improvements, customization, privacy and accuracy concerns, and clinician workflow concerns.
AHRQ-funded; HS023844.
Citation: Federman AD, Sanchez-Munoz A, Jandorf L .
Patient and clinician perspectives on the outpatient after-visit summary: a qualitative study to inform improvements in visit summary design.
J Am Med Inform Assoc 2017 Apr;24(e1):e61-e68. doi: 10.1093/jamia/ocw106.
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Keywords: Electronic Health Records (EHRs), Ambulatory Care and Surgery, Primary Care, Clinician-Patient Communication, Education: Patient and Caregiver
Michaelidis CI, Fine MJ, Lin CJ
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
This study estimated the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. It concluded that each ambulatory antibiotic prescription is associated with a hidden societal cost of antibiotic resistance (SCAR) that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.
AHRQ-funded; HS024930.
Citation: Michaelidis CI, Fine MJ, Lin CJ .
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
BMC Infect Dis 2016 Nov 8;16(1):655. doi: 10.1186/s12879-016-1990-4.
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Keywords: Medication, Primary Care, Hospitalization, Healthcare Costs, Ambulatory Care and Surgery
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
James KA, Fernald DH, Huff J
AHRQ Author: Ricciardi R
GAPS in implementing health assessments in primary care: a literature review.
The authors conducted a systematic review of literature about health assessments in ambulatory and primary care. They found that training and standardization of practice workflows improves implementation of health assessments, but gaps remain on identification and selection of health assessments, integration with electronic health records, and optimal intervals of health assessments administration.
AHRQ-authored; AHRQ-funded; 29020071008.
Citation: James KA, Fernald DH, Huff J .
GAPS in implementing health assessments in primary care: a literature review.
J Ambul Care Manage 2014 Jan-Mar;37(1):2-10. doi: 10.1097/jac.0000000000000000.
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Keywords: Electronic Health Records (EHRs), Health Status, Ambulatory Care and Surgery, Primary Care, Practice Patterns
Basu J, Mobley LR, Thumula V
AHRQ Author: Basu J
The small area predictors of ambulatory care sensitive hospitalizations: a comparison of changes over time.
The investigators examined the predictors of ambulatory care sensitive conditions (ACSCs) admissions in small geographic areas in two cross-sections spanning an 11-year time interval (1995-2005). They found that ACSC admission rates were inversely related to the availability of local primary care physicians, and managed care was associated with declines in ACSC admissions for the elderly. Additionally, minorities, aged elderly, and percent under federal poverty level were found to be associated with higher ACSC rates. They concluded that improvements in socioeconomic conditions and geographic access may have helped improve the quality of primary care received by the elderly over the last decade, particularly among some minority groups.
AHRQ-authored.
Citation: Basu J, Mobley LR, Thumula V .
The small area predictors of ambulatory care sensitive hospitalizations: a comparison of changes over time.
Soc Work Public Health 2014;29(2):176-88. doi: 10.1080/19371918.2013.776316.
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Keywords: Access to Care, Hospitalization, Ambulatory Care and Surgery, Primary Care