National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (15)
- Adverse Drug Events (ADE) (54)
- Adverse Events (87)
- Alcohol Use (6)
- Ambulatory Care and Surgery (35)
- Antibiotics (7)
- Antimicrobial Stewardship (4)
- Anxiety (4)
- Arthritis (12)
- Asthma (15)
- Autism (4)
- Back Health and Pain (1)
- Behavioral Health (42)
- Blood Clots (2)
- Blood Pressure (22)
- Blood Thinners (8)
- Brain Injury (7)
- Breast Feeding (3)
- Burnout (11)
- Cancer (57)
- Cancer: Breast Cancer (8)
- Cancer: Colorectal Cancer (2)
- Cancer: Lung Cancer (6)
- Cancer: Prostate Cancer (3)
- Cardiovascular Conditions (50)
- Care Coordination (25)
- Caregiving (45)
- Care Management (31)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Centers for Education and Research on Therapeutics (CERTs) (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (109)
- Chronic Conditions (88)
- Clinical Decision Support (CDS) (130)
- Clinician-Patient Communication (62)
- Clostridium difficile Infections (1)
- Colonoscopy (1)
- Communication (96)
- Community-Acquired Infections (1)
- Community-Based Practice (19)
- Community Partnerships (1)
- Comparative Effectiveness (26)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (4)
- COVID-19 (48)
- Critical Care (15)
- Cultural Competence (5)
- Data (43)
- Dementia (10)
- Dental and Oral Health (1)
- Depression (14)
- Diabetes (50)
- Diagnostic Safety and Quality (71)
- Digestive Disease and Health (10)
- Disabilities (5)
- Disparities (20)
- Domestic Violence (3)
- Ear Infections (1)
- Education: Continuing Medical Education (9)
- Education: Patient and Caregiver (54)
- Elderly (76)
- Electronic Health Records (EHRs) (599)
- Electronic Prescribing (E-Prescribing) (20)
- Emergency Department (76)
- Emergency Medical Services (EMS) (20)
- Emergency Preparedness (2)
- Evidence-Based Practice (51)
- Eye Disease and Health (1)
- Falls (11)
- Family Health and History (1)
- Genetics (8)
- Guidelines (9)
- Healthcare-Associated Infections (HAIs) (19)
- Healthcare Cost and Utilization Project (HCUP) (5)
- Healthcare Costs (13)
- Healthcare Delivery (77)
- Healthcare Utilization (19)
- Health Information Exchange (HIE) (41)
- (-) Health Information Technology (HIT) (1440)
- Health Insurance (5)
- Health Literacy (28)
- Health Promotion (8)
- Health Services Research (HSR) (24)
- Health Status (5)
- Health Systems (14)
- Heart Disease and Health (26)
- Hepatitis (1)
- Home Healthcare (22)
- Hospital Discharge (16)
- Hospitalization (28)
- Hospital Readmissions (15)
- Hospitals (79)
- Human Immunodeficiency Virus (HIV) (14)
- Imaging (28)
- Implementation (23)
- Infectious Diseases (8)
- Influenza (4)
- Injuries and Wounds (14)
- Inpatient Care (28)
- Intensive Care Unit (ICU) (20)
- Kidney Disease and Health (6)
- Labor and Delivery (1)
- Learning Health Systems (5)
- Lifestyle Changes (16)
- Long-Term Care (18)
- Low-Income (9)
- Maternal Care (10)
- Medicaid (3)
- Medical Devices (3)
- Medical Errors (55)
- Medical Expenditure Panel Survey (MEPS) (2)
- Medicare (5)
- Medication (147)
- Medication: Safety (45)
- Men's Health (2)
- Mortality (9)
- Neonatal Intensive Care Unit (NICU) (2)
- Neurological Disorders (20)
- Newborns/Infants (10)
- Nursing (19)
- Nursing Homes (26)
- Nutrition (8)
- Obesity (15)
- Obesity: Weight Management (8)
- Opioids (11)
- Organizational Change (2)
- Orthopedics (6)
- Osteoporosis (2)
- Outcomes (42)
- Pain (9)
- Palliative Care (4)
- Patient-Centered Healthcare (55)
- Patient-Centered Outcomes Research (66)
- Patient Adherence/Compliance (29)
- Patient and Family Engagement (64)
- Patient Experience (31)
- Patient Safety (195)
- Patient Self-Management (48)
- Payment (7)
- Pneumonia (2)
- Policy (14)
- Practice-Based Research Network (PBRN) (1)
- Practice Patterns (18)
- Pregnancy (17)
- Pressure Ulcers (7)
- Prevention (38)
- Primary Care (102)
- Primary Care: Models of Care (6)
- Provider (49)
- Provider: Clinician (12)
- Provider: Health Personnel (7)
- Provider: Nurse (19)
- Provider: Pharmacist (14)
- Provider: Physician (28)
- Provider Performance (11)
- Public Health (14)
- Public Reporting (3)
- Quality Improvement (57)
- Quality Indicators (QIs) (10)
- Quality Measures (21)
- Quality of Care (91)
- Quality of Life (10)
- Racial and Ethnic Minorities (38)
- Registries (18)
- Rehabilitation (3)
- Research Methodologies (30)
- Respiratory Conditions (15)
- Risk (40)
- Rural/Inner-City Residents (3)
- Rural Health (20)
- Screening (26)
- Sepsis (13)
- Sex Factors (1)
- Sexual Health (6)
- Shared Decision Making (85)
- Sickle Cell Disease (8)
- Simulation (6)
- Social Determinants of Health (20)
- Social Media (11)
- Stress (3)
- Stroke (12)
- Substance Abuse (16)
- Surgery (50)
- Surveys on Patient Safety Culture (1)
- System Design (8)
- Teams (14)
- Telehealth (222)
- Tobacco Use (6)
- Tobacco Use: Smoking Cessation (3)
- Tools & Toolkits (8)
- Training (10)
- Transitions of Care (18)
- Transplantation (9)
- Trauma (8)
- Treatments (3)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Urban Health (3)
- Urinary Tract Infection (UTI) (2)
- Vaccination (12)
- Vitamins and Supplements (1)
- Vulnerable Populations (16)
- Web-Based (42)
- Women (29)
- Workflow (20)
- Workforce (5)
- Young Adults (9)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
76 to 100 of 1440 Research Studies DisplayedSaver BG, Marquard JL, Gummeson J
Buy or build: challenges developing consumer digital health interventions.
The study explored issues arising from "buy or build" decisions in developing two digital health interventions aimed at improving hypertension control and HIV medication adherence. Despite spanning years, both projects encountered common challenges, including mismatches between technologies, stability concerns, and resource limitations. These findings highlight the importance of careful planning and consideration of "buy or build" decisions, particularly in creating technologies for interventions that may represent “edge cases” in existing commercial systems.
AHRQ-funded; HS018461.
Citation: Saver BG, Marquard JL, Gummeson J .
Buy or build: challenges developing consumer digital health interventions.
Appl Clin Inform 2023 Aug; 14(4):803-10. doi: 10.1055/a-2148-8036.
Keywords: Health Information Technology (HIT)
Rome D, Sales A, Cornelius T
Impact of telemedicine modality on quality metrics in diverse settings: implementation science-informed retrospective cohort study.
The objective of this study was to assess telemedicine uptake during the COVID-19 pandemic and impact of visit modality on primary care quality metrics in diverse, low socioeconomic status settings. Research was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Researchers found that there were marginally better quality metrics for in-person care versus video and phone visits, and that de-adoption of telemedicine was marked within 2 years in the study population. They concluded that the impact of visit modality on quality outcomes, provider and patient preferences, and technological barriers in historically marginalized settings should be considered.
AHRQ-funded; HS025198.
Citation: Rome D, Sales A, Cornelius T .
Impact of telemedicine modality on quality metrics in diverse settings: implementation science-informed retrospective cohort study.
J Med Internet Res 2023 Jul 26; 25:e47670. doi: 10.2196/47670..
Keywords: Telehealth, Health Information Technology (HIT), Implementation, Quality Measures, Quality of Care
Wissel BD, Greiner HM, Glauser TA
Automated, machine learning-based alerts increase epilepsy surgery referrals: a randomized controlled trial.
Researchers conducted a prospective, randomized controlled trial of a natural language processing-based clinical decision support system in the electronic health record at 14 pediatric neurology outpatient clinics to determine whether automated, electronic alerts increased referrals for epilepsy surgery. Children with epilepsy and at least two prior neurology visits were screened by the system prior to their scheduled visit to identify potential surgical candidates, and the potential candidates randomized 2:1 for their providers to receive an alert or standard of care (no alert). The results showed that patients whose providers received an alert were more likely to be referred for a presurgical evaluation. The researchers concluded that machine learning-based automated alerts may improve the utilization of referrals for epilepsy surgery evaluations.
AHRQ-funded; HS024977.
Citation: Wissel BD, Greiner HM, Glauser TA .
Automated, machine learning-based alerts increase epilepsy surgery referrals: a randomized controlled trial.
Epilepsia 2023 Jul; 64(7):1791-99. doi: 10.1111/epi.17629..
Keywords: Neurological Disorders, Surgery, Health Information Technology (HIT)
Ahmed N, Brown J, Parau C
Bridging the digital health divide: characterizing patient portal users and nonusers in the U.S.
The purpose of this study was to 1) review variations in demographics between patient portal users and nonusers; and 2) review variations in health literacy, patient self-efficacy, and technology utilization and attitudes between patient portal users and nonusers. The researchers collected data from Amazon Mechanical Turk (MTurk) workers between December 2021 and January 2022. 489 Participants completed an online survey with questions on their attitudes about media and technology, attitudes about their health, their access to technology, health literacy, patient self-efficacy, and patient portal use. The study results indicated qualitative differences between users and nonusers of patient portals as related to type of neighborhood, income, education, disability status, comorbidity, type of insurance, and the presence or absence of primary care providers. Quantitative results supported the qualitative results, revealing that participants with insurance, a primary care provider, or a disability or comorbid condition had a greater likelihood of having a patient portal account.
AHRQ-funded; HS026298.
Citation: Ahmed N, Brown J, Parau C .
Bridging the digital health divide: characterizing patient portal users and nonusers in the U.S.
Med Care 2023 Jul; 61(7):448-55. doi: 10.1097/mlr.0000000000001869..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Literacy
Hoopes AJ, Cushing-Haugen KL, Coley RY
Characteristics of adolescents who use secure messaging on a health system's patient portal.
Drupal date: Jul 1, 2023
The purpose of this study was to identify and describe adolescent characteristics related with patient portal secure messaging use within a health system. The researchers analyzed monthly data from patients aged 13 to 17 who met study eligibility criteria from 2019 to 2021. The primary study outcome was any secure messages sent from an adolescent's account during each observed study month. The study found that of 667,678 observed months, 50.8% occurred among non-transgender males, 51.5% among those identifying as non-Hispanic white, and 83.3% among the privately insured. The adjusted relative risks of secure messaging use were significantly higher for individuals with female sex and transgender identities, those with prior portal use and those with a recent preventive care visit. The adjusted relative risks of portal secure messaging use were significantly lower among those with public insurance.
The purpose of this study was to identify and describe adolescent characteristics related with patient portal secure messaging use within a health system. The researchers analyzed monthly data from patients aged 13 to 17 who met study eligibility criteria from 2019 to 2021. The primary study outcome was any secure messages sent from an adolescent's account during each observed study month. The study found that of 667,678 observed months, 50.8% occurred among non-transgender males, 51.5% among those identifying as non-Hispanic white, and 83.3% among the privately insured. The adjusted relative risks of secure messaging use were significantly higher for individuals with female sex and transgender identities, those with prior portal use and those with a recent preventive care visit. The adjusted relative risks of portal secure messaging use were significantly lower among those with public insurance.
AHRQ-funded; HS026369.
Citation: Hoopes AJ, Cushing-Haugen KL, Coley RY .
Characteristics of adolescents who use secure messaging on a health system's patient portal.
Pediatrics 2023 Jul 1; 152(1). doi: 10.1542/peds.2022-060271..
Keywords: Children/Adolescents, Health Information Technology (HIT)
Garber A, Garabedian P, Wu L
Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.
This study’s objective was to describe a user-centered approach to develop, pilot test, and refine requirements for 3 electronic health record (EHR)-integrated interventions that target key diagnostic process failures in hospitalized patients. The interventions to be developed were a Diagnostic Safety Column (DSC) within an EHR-integrated dashboard to identify at-risk patients; a Diagnostic Time-Out (DTO) for clinicians to reassess the working diagnosis; and a Patient Diagnosis Questionnaire (PDQ) to gather patient concerns about the diagnostic process. After initial refinement from an analysis, final requirements were created for 10 test cases predicted by the DSC, 18 clinician DTO participants, and 39 PDQ responses including the following: DSC configurable parameters (variables, weights) to adjust baseline risk estimates in real-time based on new clinical data collected during hospitalization; more concise DTO wording and flexibility for clinicians to conduct the DTO with or without the patient present; and integration of PDQ responses into the DSC to ensure closed-looped communication with clinicians. An analysis of focus groups confirmed that tight integration of the interventions with the EHR would be necessary to prompt clinicians to reconsider the working diagnosis in cases with elevated diagnostic error (DE) risk or uncertainty. Potential implementation barriers identified included alert fatigue and distrust of the risk algorithm (DSC); time constraints, redundancies, and concerns about disclosing uncertainty to patients (DTO); and patient disagreement with the care team's diagnosis (PDQ).
AHRQ-funded; HS026613.
Citation: Garber A, Garabedian P, Wu L .
Developing, pilot testing, and refining requirements for 3 EHR-integrated interventions to improve diagnostic safety in acute care: a user-centered approach.
JAMIA Open 2023 Jul; 6(2):ooad031. doi: 10.1093/jamiaopen/ooad031..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Diagnostic Safety and Quality, Patient Safety
Linfield GH, Patel S, Ko HJ
Evaluating the comparability of patient-level social risk data extracted from electronic health records: a systematic scoping review.
This study’s objective was to evaluate how and from where social risk data are extracted from electronic health records (EHRs) for research purposes, and how observed differences may impact study generalizability. A systematic scoping review was conducted of peer-reviewed literature that used patient-level EHR data to assess 1 ± 6 social risk domains: housing, transportation, food, utilities, safety, social support/isolation. The authors found 111 of 9022 identified articles met inclusion criteria. By domain, martial/partner status was most often included, predominantly defined by marital partner status, and extracted from structured sociodemographic data. Structured housing data was extracted most from billing codes and screening tools. Across domains, data were predominantly sourced from structured fields (n = 89/111) versus unstructured free text (n = 32/111).
AHRQ-funded; HS026383.
Citation: Linfield GH, Patel S, Ko HJ .
Evaluating the comparability of patient-level social risk data extracted from electronic health records: a systematic scoping review.
Health Informatics J 2023 Jul-Sep; 29(3):14604582231200300. doi: 10.1177/14604582231200300..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Social Determinants of Health, Risk
Corby S, Ash JS, Florig ST
How providers can optimize effective and Safe Scribe use: a qualitative study.
Providers have begun hiring scribed to address the increase in after-hours and weekend work for providers due to the use of electronic health records. New patient safety risks could be created from the lack of scribe industry standards and the broad variation in how providers and scribes work together. The aim of this secondary analysis study of qualitative data was to describe how providers can optimize the use of scribes safely and effectively. Subject matter experts, providers, informaticians, medical scribes, medical assistants, administrators, social scientists, medical students, and qualitative researchers were included. The study results revealed 3 themes: 1) communication aspects, 2) teamwork efforts, and 3) provider characteristics. Each theme included relevant activities so providers can utilize scribes safely and with a standardized methodology.
AHRQ-funded; HS025141.
Citation: Corby S, Ash JS, Florig ST .
How providers can optimize effective and Safe Scribe use: a qualitative study.
J Gen Intern Med 2023 Jul; 38(9):2052-58. doi: 10.1007/s11606-022-07942-2..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Health Personnel
Shannon EM, Mueller SK, Schnipper JL
Patient, caregiver, and clinician experience with a technologically enabled pillbox: a qualitative study.
The purpose of this study was to explore whether medication safety could be improved by the use of a technologically-enabled pillbox prescribed to patients at hospital discharge. The study included semi-structured telephone interviews with patients, patient caregivers, and inpatient and outpatient clinicians who participated in the Smart Pillbox Transition Study. The researchers utilized the Systems Engineering Initiative for Patient Safety (SEIPS) framework to develop an interview guide, which included the a priori domains of 1) barriers to implementation, 2) facilitators of the intervention, and 3) general feedback regarding experience with the intervention. The study found patient-endorsed barriers in the theme of technology and tools included signal issues, inappropriate alarms, and portability. Barriers in the theme of logistics and tasks included coordination with pharmacists in the event of a prescription change. Barriers mentioned by clinicians included patients who were poor fits for the intervention and competing demands at discharge (under the themes of personnel and patients, and logistics and tasks, respectively). Facilitators that were reported often by patients and caregivers in the theme of technology and tools included useful alarms and ease of use. Clinicians reported that communication with pharmacy and study staff facilitated the intervention.
AHRQ-funded.
Citation: Shannon EM, Mueller SK, Schnipper JL .
Patient, caregiver, and clinician experience with a technologically enabled pillbox: a qualitative study.
ACI Open 2023 Jul; 7(2):e61-e70..
Keywords: Medication, Health Information Technology (HIT), Patient Self-Management, Hospital Discharge, Medication: Safety, Patient Safety
Soares A, Afshar M, Moesel C
AHRQ Author: Lomotan EA
Playing in the clinical decision support sandbox: tools and training for all.
This AHRQ-authored paper introduces the CDS-Sandbox, a cloud-based virtual machine created to facilitate Clinical Decision Support (CDS) developers and implementers in the use of FHIR- and CQL-based open-source tools and technologies for building and testing CDS artifacts. The CDS-Sandbox was demonstrated at two workshops at the 2020 and 2021 AMIA Annual Symposia and includes components that enable workflows for authoring and testing CDS artifacts. At both workshops, participants demonstrated use and understanding of the workshop materials and provided positive feedback after the workshops.
AHRQ-authored; AHRQ-funded; 75FCMC18D0047; 75Q80119F8005.
Citation: Soares A, Afshar M, Moesel C .
Playing in the clinical decision support sandbox: tools and training for all.
JAMIA Open 2023 Jul; 6(2):ooad038. doi: 10.1093/jamiaopen/ooad038..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Training
Narindrarangkura P, Alafaireet PE, Khan U
Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset.
This study’s goal was to determine the risk factors for suicidal behaviors of people with diabetes as they have a higher risk than the general population. The authors investigated risk factors and predicted suicide attempts in people with diabetes using the Least Absolute Shrinkage and Selection Operator (LASSO) regression. They used data from Cerner Real-World Data™ and included over 3 million diabetes patients in the study. They analyzed gender-, diabetes-type, and depression-specific LASSO regression models. The study included 7764 subjects diagnosed with suicide attempts with an average age of 45. They found risk factors for suicide attempts in diabetes patients, such as being an American Indian or Alaska Native, atypical agents, benzodiazepines, and antihistamines. Amyotrophy had a negative coefficient for suicide attempts with males with diabetes but had a positive coefficient for females. Using MAOI had a negative coefficient for suicide attempts in T1DM patients. Patients less than 20 years of age had a positive coefficient for suicide in depressed and non-depressed patients with diabetes.
AHRQ-funded; HS028032.
Citation: Narindrarangkura P, Alafaireet PE, Khan U .
Predicting suicide attempts among people with diabetes using a large multicenter electronic health records dataset.
Int J Psychiatry Med 2023 Jul; 58(4):302-24. doi: 10.1177/00912174231162477..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Behavioral Health, Diabetes, Chronic Conditions
Balk EM, Danilack VA, Cao W
Televisits compared with in-person visits for routine antenatal care: a systematic review.
This systematic review’s objective was to compare benefits and harms of televisits and in-person visits in people receiving routine antenatal visit care. The search was conducted in multiple databases searching for antenatal (prenatal) care, pregnancy, obstetrics, telemedicine, remote care, smartphones, telemonitoring, and related terms. Abstrackr was used for double independent screening for studies comparing televisits and in person routine antenatal care visits for maternal, child, health care utilization, and harm outcomes. The authors found two randomized controlled trials, four nonrandomized comparative studies, and one survey that compared visit types between 2004 and 2020, three of which were conducted during the COVID-19 pandemic. The studies found low-strength evidence that hybrid (televisits and in-person visits) and all in-person visits did not indicate differences in rates of neonatal intensive care unit admission of the newborn or preterm births. However, the COVID-19 pandemic confounded the association between the use of hybrid visits and preterm birth. The authors also found there is low-strength evidence that satisfaction with overall antenatal care was greater in people who were pregnant and receiving hybrid visits.
AHRQ-funded; 75Q80120D00001.
Citation: Balk EM, Danilack VA, Cao W .
Televisits compared with in-person visits for routine antenatal care: a systematic review.
Obstet Gynecol 2023 Jul 1; 142(1):19-29. doi: 10.1097/aog.0000000000005194..
Keywords: Telehealth, Health Information Technology (HIT), Maternal Care, Women
Lin YJ, Ranusch A, Seagull FJ
Dynamic interplay between available resources and implementation climate across phases of implementation: a qualitative study of a VA national population health tool.
This study analyzed the factors that may determine successful implementation of an intervention by examining the co-occurrence patterns between available resources and implementation climate across different implementation phases. There have been very few studies that have investigated how the required resources change over the phases of implementation. The authors conducted a secondary analysis of interviews that were conducted with 20 anticoagulation professionals at 17 clinical sites in the Veterans Health Administration health system about their experiences with a population health dashboard for anticoagulant management. Key relationships between available resources and implementation climate were identified and summarized. Resources necessary to support the successful implementation of an intervention were found to not be static, Both quantity and types of resources shift based on the phases of the intervention. Increased resource availability does not guarantee the sustainment of intervention success. New technological interventions require resources in the form of technological support and social/emotional support to help users establish trust. Resources that foster and maintain collaboration between users and other stakeholders can help them stay motivated during sustainment.
AHRQ-funded; HS026874.
Citation: Lin YJ, Ranusch A, Seagull FJ .
Dynamic interplay between available resources and implementation climate across phases of implementation: a qualitative study of a VA national population health tool.
Implement Sci Commun 2023 Jun 29; 4(1):74. doi: 10.1186/s43058-023-00460-0..
Keywords: Implementation, Health Information Technology (HIT)
Patel M, Berlin H, Rajkumar A
Barriers to telemedicine use: qualitative analysis of provider perspectives during the COVID-19 pandemic.
The objective of this study was to describe perceived barriers and facilitators to the use of web-based visits to inform quality improvement efforts and promote sustainability. Medical providers at a large, midwestern academic institution were surveyed. Four overarching categories of provider experience with web-based visits emerged: quality of care, patient rapport, visit flow, and equity. The authors concluded that their findings demonstrated key barriers to the maintenance of telemedicine services following the COVID pandemic, and that these findings might help to prioritize impactful methods of sustaining and expanding telemedicine availability for patients.
AHRQ-funded; HS027632.
Citation: Patel M, Berlin H, Rajkumar A .
Barriers to telemedicine use: qualitative analysis of provider perspectives during the COVID-19 pandemic.
JMIR Hum Factors 2023 Jun 26; 10:e39249. doi: 10.2196/39249..
Keywords: Telehealth, COVID-19, Public Health, Health Information Technology (HIT), Provider: Health Personnel
Stonko DP, Weller JH, Gonzalez Salazar AJ
A pilot machine learning study using trauma admission data to identify risk for high length of stay.
The purpose of this study was to design a tool that used only data available at time of admission for trauma to predict prolonged hospital length of stay (LOS). Data was collected from the trauma registry at an urban level-one adult trauma center. Single layer and deep artificial neural networks were trained to identify patients in the top quartile of LOS and optimized under the receiver operator characteristic curve. The results indicated that machine learning can predict which trauma patients will have prolonged LOS with physiologic and demographic data available at the time of admission. The authors concluded these patients may benefit from additional disposition planning resources at the time of admission.
AHRQ-funded; HS026640; HS024547; HS027793.
Citation: Stonko DP, Weller JH, Gonzalez Salazar AJ .
A pilot machine learning study using trauma admission data to identify risk for high length of stay.
Surg Innov 2023 Jun; 30(3):356-65. doi: 10.1177/15533506221139965..
Keywords: Trauma, Hospitalization, Health Information Technology (HIT)
Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW
Documentation dynamics: note composition, burden, and physician efficiency.
This study’s objective was to analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. This cross-sectional study examined EHR metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. The authors calculated physician-level averages for four measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. They found that physicians in the top decile of note length demonstrated greater burden and lower efficiency than physicians in the median decile level, spending 39% more time in the EHR after hours and closing 5.6 percentage points fewer visits on the same day. Copy/paste use demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day and spending more time in the EHR after hours and on days off. Templated text such as Epic’s SmartTools demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
AHRQ-funded; HS026116.
Citation: Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW .
Documentation dynamics: note composition, burden, and physician efficiency.
Health Serv Res 2023 Jun; 58(3):674-85. doi: 10.1111/1475-6773.14097..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Anderson NW, Halfon N, Eisenberg D
Mixed signals in child and adolescent mental health and well-being indicators in the United States: a call for improvements to population health monitoring.
The authors of this paper suggest that policies targeting social indicators of youth status may not have improved overall mental health and well-being. They contend this absence of impact is evidenced by the divergence between social indicators which are improving, such as high school graduation, food insecurity, and smoking, and those which are worsening, such as mental health and well-being. The researchers report that available data indicates that one or more common exposures may be to blame, including those inadequately captured by existing social indicators.
AHRQ-funded; HS000046.
Citation: Anderson NW, Halfon N, Eisenberg D .
Mixed signals in child and adolescent mental health and well-being indicators in the United States: a call for improvements to population health monitoring.
Milbank Q 2023 Jun; 101(2):259-86. doi: 10.1111/1468-0009.12634..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Ambulatory Care and Surgery, Cardiovascular Conditions
Blecker S, Gannon M, De Leon S
Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial.
This paper describes a protocol for a study that will be conducted to compare the effect of hypertension-focused clinical decision support (CDS) plus practice facilitation on blood pressure (BP) control, as compared to CDS alone. The investigators will conduct a cluster randomized control trial that will include initial training on the CDS and a review of current guidelines along with follow-up for coaching and integration support. They will randomize 46 small primary care practices in New York City who use the same electronic health record vendor to intervention or control. They will also assess implementation of CDS in all practices and practice facilitation in the intervention group.
AHRQ-funded; HS027120.
Citation: Blecker S, Gannon M, De Leon S .
Practice facilitation for scale up of clinical decision support for hypertension management: study protocol for a cluster randomized control trial.
Contemp Clin Trials 2023 Jun; 129:107177. doi: 10.1016/j.cct.2023.107177..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Blood Pressure, Cardiovascular Conditions
Khor S, Heagerty PJ, Basu A
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
This study examined whether the accuracy of a proxy for colorectal cancer (CRC) recurrence differed by race/ethnicity and the possible mechanisms that drove the differences. Using data from a large integrated health care system, the authors identified a stratified random sample of 282 Black/African American (AA), Hispanic, and non-Hispanic White (NHW) patients with CRC who received primary treatment. The recurrence proxy was found to have excellent overall accuracy (positive predictive value [PPV] 89.4%; negative predictive value 96.5%; mean difference in timing 1.96 months); however, accuracy varied by race/ethnicity. Compared with NHW patients, PPV was 14.9% lower among Hispanic patients and 4.3% lower among Black/AA patients. The proxy disproportionately inflated the 5-year recurrence incidence for Hispanic patients by 10.6%. Compared with NHW patients, proxy recurrences for Hispanic patients were almost three times as likely to have been misclassified as positive (adjusted risk ratio 2.91). The authors theorize that higher false positives among racial/ethnic minorities may be related to higher prevalence of noncancerous lung-related problems and substantial delays in primary treatment because of insufficient patient-provider communication and abnormal treatment patterns.
AHRQ-funded; HS013853.
Citation: Khor S, Heagerty PJ, Basu A .
Racial disparities in the ascertainment of cancer recurrence in electronic health records.
JCO Clin Cancer Inform 2023 Jun; 7:e2300004. doi: 10.1200/cci.23.00004..
Keywords: Cancer, Electronic Health Records (EHRs), Health Information Technology (HIT), Racial and Ethnic Minorities, Disparities
Cho Y, Yang R, Gong Y
Use of electronic communication with clinicians among cancer survivors: Health Information National Trend Survey in 2019 and 2020.
This study’s objective was to describe cancer survivors' use of electronic communication (e-communication) with clinicians and identify factors associated with their use, including the COVID-19 pandemic. The authors conducted a secondary analysis of cancer survivors (N = 1,482) from the combined Health Information National Trends Survey HINTS 5 Cycle 3 and Cycle 4. Survivors' use of e-communication was defined by at least one of four e-communication use behaviors in the previous 12 months. Cancer survivors had a 64% prevalence of e-communication use, with older adults (≥65 years old) were less likely to use e-communication. Survivors who were white, living in a metro area, diagnosed with breast cancer, seeking cancer-related information previously, or having a regular health care provider were more likely to use e-communication. The start of the COVID-19 pandemic was marginally associated with the increased e-communication use when other variables were controlled.
AHRQ-funded; HS027846.
Citation: Cho Y, Yang R, Gong Y .
Use of electronic communication with clinicians among cancer survivors: Health Information National Trend Survey in 2019 and 2020.
Telemed J E Health 2023 Jun; 29(6):866-74. doi: 10.1089/tmj.2022.0203..
Keywords: Clinician-Patient Communication, Communication, Cancer, Telehealth, Health Information Technology (HIT)
Huo T, Glueck DH, Shenkman EA
Stratified split sampling of electronic health records
Data extracted from electronic health records may require very different approaches for model building and analysis than data from clinical research. Because electronic health record data is designed for clinical use, researchers need to engage in the iterative process of defining and provide clear definitions of outcome and predictor variables and assessing associations. This process can increase Type I error rates and decrease the chance of replicability. Failure to consider subgroups may mask heterogeneous relationships between predictor and outcome by subgroups, thus decreasing the generalizability of the findings. To improve the likelihood of both replicability and generalizability, the researchers recommended utilizing a stratified split sample approach for studies using electronic health records. The researchers illustrate the approach through an electronic health record study of the relationships between socio-demographic factors and uptake of hepatic cancer screening, and potential heterogeneity of association in subgroups defined by gender, self-identified race and ethnicity, census-tract level poverty and insurance type.
AHRQ-funded; HS028283.
Citation: Huo T, Glueck DH, Shenkman EA .
Stratified split sampling of electronic health records
BMC Med Res Methodol 2023 May 25; 23(1):128. doi: 10.1186/s12874-023-01938-0..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Research Methodologies, Health Services Research (HSR)
Burstin H, Curry S, Ranney ML
AHRQ Author: Jain A
Identifying credible sources of health information in social media: phase 2-considerations for non-accredited nonprofit organizations, for-profit entities, and individual sources.
This paper (which included an AHRQ author) objective was to develop principles and attitudes to guide social media and other digital platforms to rigorously identify credible sources of health information. This paper was partially funded by YouTube. Phase 1 of this study was completed in 2021 by an expert advisory group convened by the National Academy of Medicine (NAM) which yielded foundational principles and attributes for determining credibility of health information sources, but only for US sources. This paper describes Phase 2, which was carried out by a multidisciplinary, independent advisory committee convened by the Council of Medical Specialty Societies (CMSS) in collaboration with NAM and WHO and expanded from Phase 1 to include global sources. The Phase 2 advisory committee examined and deliberated on the three principles established during Phase 1 and their defining attributes in individual breakout groups. The focus was on one of three potential sources of credible health information: for-profit organizations, non-accredited nonprofit organizations, and individuals. A draft of the proposed new attributes, a related questionnaire and a preliminary draft of this paper was posted for public comment from September 9 to 19, 2022. A final virtual meeting was convened so the entire committee could discuss and incorporate feedback from the public comments. The principles of diversity, equity, and inclusion (DEI) was identified as of sufficient importance to elevate it as a new principle. A table showing the four principles and the attributes for each of the sources is included.
AHRQ-authored.
Citation: Burstin H, Curry S, Ranney ML .
Identifying credible sources of health information in social media: phase 2-considerations for non-accredited nonprofit organizations, for-profit entities, and individual sources.
NAM Perspect 2023 May 23; 2023. doi: 10.31478/202305b..
Keywords: Social Media, Education: Patient and Caregiver, Health Information Technology (HIT)
Ahmad FA, Chan P, McGovern C
Adapting an electronic STI risk assessment program for use in pediatric primary care.
This study’s goal was to evaluate the usability of an electronic risk assessment tool to support sexually transmitted disease (STI) testing in the authors’ pediatric emergency department that they had previously designed and implemented. They conducted qualitative interviews of pediatricians, clinic staff, and adolescents from 4 pediatric practices as part of a study whose goal is to ultimately implement STI screening in pediatric primary care. The goal of the interviews was (1) to understand contextual factors related to STI screening in primary care, which they reported previously, and (2) to obtain feedback on their electronic platform, the questionnaire content, and their perspective on implementing it in primary care settings. They received quantitative feedback using the System Usability Scale (SUS). The SUS is a validated, reliable tool to measure the usability of hardware, software, websites, and applications, with a score of 68 (range 0-100) being average usability. They recruited 14 physicians, 9 clinic staff, and 12 adolescents. Participants rated the tool with a median score of 92.5, which shows a high level of usability.
AHRQ-funded; HS026704.
Citation: Ahmad FA, Chan P, McGovern C .
Adapting an electronic STI risk assessment program for use in pediatric primary care.
J Prim Care Community Health 2023 Jan-Dec; 14:21501319231172900. doi: 10.1177/21501319231172900..
Keywords: Children/Adolescents, Sexual Health, Infectious Diseases, Primary Care, Health Information Technology (HIT), Screening, Prevention
Chu CD, Lenoir KM, Rai NK
Concordance between clinical outcomes in the systolic blood pressure intervention trial and in the electronic health record.
This study examined the role that electronic health records (EHRs) can play in follow-up for concordance with trial-ascertained outcomes. The authors linked EHR and trial data for participants in the Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial comparing intensive and standard blood pressure targets. Among participants with available EHR data concurrent to trial-ascertained outcomes, they calculated sensitivity, specificity, positive predictive value, and negative predictive value for EHR-recorded cardiovascular disease (CVD) events, using the gold standard of SPRINT-adjudicated outcomes (myocardial infarction (MI)/acute coronary syndrome (ACS), heart failure, stroke, and composite CVD events). They additionally compared the incidence of non-CVD adverse events (hyponatremia, hypernatremia, hypokalemia, hyperkalemia, bradycardia, and hypotension) in trial versus EHR data. Of the 2468 SPRINT participants included, EHR data demonstrated ≥80% sensitivity and specificity, and ≥99% negative predictive value for MI/ACS, heart failure, stroke, and composite CVD events. Positive predictive value ranged from 26% for heart failure to 52% for MI/ACS. Conclusions were that EHR data uniformly identified more non-CVD adverse events and higher incidence rates compared with trial ascertainment.
AHRQ-funded; HS026383.
Citation: Chu CD, Lenoir KM, Rai NK .
Concordance between clinical outcomes in the systolic blood pressure intervention trial and in the electronic health record.
Contemp Clin Trials 2023 May; 128:107172. doi: 10.1016/j.cct.2023.107172..
Keywords: Blood Pressure, Electronic Health Records (EHRs), Health Information Technology (HIT), Cardiovascular Conditions
Hewner S, Smith E, Sullivan SS
Identifying high-need primary care patients using nursing knowledge and machine learning methods.
This study examined how patient cohorts generated by machine learning can be enhanced with clinical knowledge to increase translational value and provide a practical approach to patient segmentation based on a mix of medical, behavioral, and social factors. The authors used a primary care practice dataset (N=3438) of high need patients defined by practice criteria and parsed it to a subset population of patients with diabetes (n=1233). Three expert nurses selected variables for k-means cluster analysis using knowledge of critical factors for care coordination, and their knowledge was again applied to describe the psychosocial phenotypes in four prominent clusters, aligned with social and medical care plans. Four distinct clusters were used to create four cohorts including: (1) A large cluster of racially diverse female, non-English speakers with low medical complexity, and history of childhood illness; (2) A large cluster of English speakers with significant comorbidities (obesity and respiratory disease); (3) A small cluster of males with substance use disorder and significant comorbidities (mental health, liver and cardiovascular disease) who frequently visit the hospital; and (4) A moderate cluster of older, racially diverse patients with renal failure.
AHRQ-funded; HS028000.
Citation: Hewner S, Smith E, Sullivan SS .
Identifying high-need primary care patients using nursing knowledge and machine learning methods.
Appl Clin Inform 2023 May; 14(3):408-17. doi: 10.1055/a-2048-7343..
Keywords: Primary Care, Health Information Technology (HIT), Nursing