National Healthcare Quality and Disparities Report
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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
176 to 200 of 201 Research Studies DisplayedTannenbaum D, Doctor JN, Persell SD
Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.
The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. It found that provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise.
AHRQ-funded; RC4 AG039115 (NIA/AHRQ).
Citation: Tannenbaum D, Doctor JN, Persell SD .
Nudging physician prescription decisions by partitioning the order set: results of a vignette-based study.
J Gen Intern Med 2015 Mar;30(3):298-304. doi: 10.1007/s11606-014-3051-2..
Keywords: Electronic Health Records (EHRs), Primary Care, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication
Hendrix KS, Downs SM, Carroll AE
Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?
The authors tested whether selectively highlighting clinical decision support prompts in yellow would improve physicians' responsiveness. They found that highlighting reminder prompts did not increase physicians' responsiveness. They suggested possible explanations and offer alternative strategies to increasing physician responsiveness to prompts.
AHRQ-funded; HS020640; HS018453; HS017939.
Citation: Hendrix KS, Downs SM, Carroll AE .
Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?
Acad Pediatr 2015 Mar-Apr;15(2):158-64. doi: 10.1016/j.acap.2014.10.009.
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Keywords: Clinical Decision Support (CDS), Children/Adolescents, Primary Care, Practice Patterns, Quality Improvement
Scheife RT, Hines LE, Boyce RD
Consensus recommendations for systematic evaluation of drug-drug interaction evidence for clinical decision support.
An expert workgroup developed recommendations by consensus for systematic evaluation of evidence for DDIs from the scientific literature, drug product labeling, and regulatory documents. It concluded that evidence-based clinical decision support for drug–drug interactions (DDIs) requires consistent application of transparent and systematic methods to evaluate the evidence.
AHRQ-funded; HS021826; HS019461.
Citation: Scheife RT, Hines LE, Boyce RD .
Consensus recommendations for systematic evaluation of drug-drug interaction evidence for clinical decision support.
Drug Saf 2015 Feb;38(2):197-206. doi: 10.1007/s40264-014-0262-8..
Keywords: Clinical Decision Support (CDS), Guidelines, Evidence-Based Practice, Comparative Effectiveness
Nguyen C, McElroy LM, Abecassis MM
The use of technology for urgent clinician to clinician communications: a systematic review of the literature.
The aim of this study was to review the literature examining the role of devices and technology in facilitating urgent clinician–clinician communication to identify critical areas for future research. It found that most studies examining the effectiveness of communication devices in urgent contexts are before-and-after studies that relied on quantitative metrics focused on user satisfaction, method of use, and/or the effect on clinical communication.
AHRQ-funded; HS000078.
Citation: Nguyen C, McElroy LM, Abecassis MM .
The use of technology for urgent clinician to clinician communications: a systematic review of the literature.
Int J Med Inform 2015 Feb;84(2):101-10. doi: 10.1016/j.ijmedinf.2014.11.003..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Communication
Shaikh U, Berrong J, Nettiksimmons J
Impact of electronic health record clinical decision support on the management of pediatric obesity.
The investigators assessed the impact of electronic health record-based clinical decision support in improving the diagnosis and management of pediatric obesity. They found a statistically significant increase in the diagnosis of overweight/obesity, scheduling of follow-up appointments, frequency of ordering recommended laboratory investigations, and assessment and counseling for nutrition and physical activity.
AHRQ-funded; HS018567.
Citation: Shaikh U, Berrong J, Nettiksimmons J .
Impact of electronic health record clinical decision support on the management of pediatric obesity.
Am J Med Qual 2015 Jan-Feb;30(1):72-80. doi: 10.1177/1062860613517926.
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Keywords: Care Management, Children/Adolescents, Clinical Decision Support (CDS), Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Obesity, Obesity: Weight Management
Gilbert AL, Downs SM
Medical legal partnership and health informatics impacting child health: interprofessional innovations.
This article describes the interprofessional nature of the Medical Legal Partnership ( MLP) model itself, illustrates the work that was done to craft this innovative health informatics approach to implementing MLP, and demonstrates how pediatricians social workers and attorneys may work together to improve child health outcomes.
AHRQ-funded; HS020640.
Citation: Gilbert AL, Downs SM .
Medical legal partnership and health informatics impacting child health: interprofessional innovations.
J Interprof Care 2015;29(6):564-9. doi: 10.3109/13561820.2015.1029066..
Keywords: Health Information Technology (HIT), Children/Adolescents, Clinical Decision Support (CDS)
McCullagh LJ, Sofianou A, Kannry J
User centered clinical decision support tools: adoption across clinician training level.
This study examined the differences in adoption of CDS tools across providers’ training level. It found that the completion rates of the CDS calculator and medication order sets were higher among first year residents compared to all other training levels. Attending physicians were the less likely to accept the initial step of the CDS tool (29.3 percent) or complete the medication order sets (22.4 percent) that guided their prescription decisions.
AHRQ-funded; HS018491.
Citation: McCullagh LJ, Sofianou A, Kannry J .
User centered clinical decision support tools: adoption across clinician training level.
Appl Clin Inform 2014 Dec 17;5(4):1015-25. doi: 10.4338/aci-2014-05-ra-0048.
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Keywords: Clinical Decision Support (CDS), Shared Decision Making, Practice Patterns
Einbinder J, Hebel E, Wright A
The number needed to remind: a measure for assessing CDS effectiveness.
The purpose of this paper is to provide a better understanding of population based clinical decision support (CDS) performance measurement, to identify best practices for designing and implementing CDS, and to introduce two new quality measures, titled Reminder Performance (RP) and the Number Needed to Remind (NNR) for evaluating the effectiveness of clinical reminders in the context of the CDS Dashboards.
AHRQ-funded; 290200810010.
Citation: Einbinder J, Hebel E, Wright A .
The number needed to remind: a measure for assessing CDS effectiveness.
AMIA Annu Symp Proc 2014 Nov 14;2014:506-15..
Keywords: Shared Decision Making, Clinical Decision Support (CDS), Quality Measures, Quality of Care
Boyce RD, Perera S, Nace DA
A survey of nursing home physicians to determine laboratory monitoring adverse drug event alert preferences.
The researchers conducted a survey to learn about the laboratory value thresholds that clinical event monitors should use to generate alerts about potential adverse drug events (ADEs). They found that the majority of physicians surveyed prefer alerting thresholds that would generally lead to fewer alerts than if widely accepted standardized laboratory ranges were used.
AHRQ-funded; HS019461; HS018721.
Citation: Boyce RD, Perera S, Nace DA .
A survey of nursing home physicians to determine laboratory monitoring adverse drug event alert preferences.
Appl Clin Inform 2014 Oct 29;5(4):895-906. doi: 10.4338/aci-2014-06-ra-0053..
Keywords: Nursing Homes, Clinical Decision Support (CDS), Adverse Events
Welch BM, Eilbeck K, Del Fiol G
Technical desiderata for the integration of genomic data with clinical decision support.
The objective of this study is to develop and validate a guiding set of technical desiderata for supporting the clinical use of the whole genome sequence (WGS) through clinical decision support (CDS). A panel of domain experts in genomics and CDS developed a proposed set of seven additional requirements. These additional desiderata provide important guiding principles for the technical development of CDS capabilities for the clinical use of WGS information.
AHRQ-funded; HS018352.
Citation: Welch BM, Eilbeck K, Del Fiol G .
Technical desiderata for the integration of genomic data with clinical decision support.
J Biomed Inform 2014 Oct;51:3-7. doi: 10.1016/j.jbi.2014.05.014..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Genetics, Electronic Health Records (EHRs), Shared Decision Making
Ranji SR, Rennke S, Wachter RM
Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review.
The authors searched AHRQ's Patient Safety Net to identify reviews of the effect of computerised provider order entry (CPOE) combined with clinical decision support systems (CDSS) on adverse drug event (ADE) rates in inpatient and outpatient settings. They found that CPOE+CDSS was consistently reported to reduce prescribing errors, but does not appear to prevent clinical ADEs in either the inpatient or outpatient setting. Implementation of CPOE+CDSS profoundly changes staff workflow, often leading to unintended consequences and new safety issues (such as alert fatigue) which limit the system's safety effects.
AHRQ-funded; 2902007100621.
Citation: Ranji SR, Rennke S, Wachter RM .
Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review.
BMJ Qual Saf 2014 Sep;23(9):773-80. doi: 10.1136/bmjqs-2013-002165.
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Keywords: Adverse Drug Events (ADE), Adverse Events, Medical Errors, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication, Patient Safety
Islam R, Weir C, Del Fiol G
Heuristics in managing complex clinical decision tasks in experts' decision making.
The authors sought to understand how clinicians manage complexity while dealing with complex clinical decision tasks. They found that experts cope with complexity in a variety of ways, including using efficient and fast decision strategies to simplify complex decision tasks, mentally simulating outcomes, and focusing on only the most relevant information.
AHRQ-funded; HS023349.
Citation: Islam R, Weir C, Del Fiol G .
Heuristics in managing complex clinical decision tasks in experts' decision making.
IEEE Int Conf Healthc Inform 2014 Sep;2014:186-93. doi: 10.1109/ichi.2014.32.
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Keywords: Clinical Decision Support (CDS), Shared Decision Making, Patient Safety
Baillie CA, Epps M, Hanish A
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
The researchers evaluated the usability and effectiveness of a computerized clinical decision support (CDS) intervention aimed at reducing the duration of urinary tract catheterizations. They found that usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time periods, as did CAUTIs per 1,000 patient-days. They concluded that the usability of the reminder was highly dependent on its user interface, with a homegrown version of the reminder resulting in higher impact than a stock reminder.
AHRQ-funded; HS016946.
Citation: Baillie CA, Epps M, Hanish A .
Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
Infect Control Hosp Epidemiol 2014 Sep;35(9):1147-55. doi: 10.1086/677630.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Urinary Tract Infection (UTI)
Carroll AE, Bauer NS, Dugan TM
Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.
A study to determine whether a computerized clinical decision support system is an effective approach to improve standardized developmental surveillance and screening (DSS) within primary care practices found that use of such a system significantly increased the number of children screened at 9, 18, and 30 months of age. It also increased the number of children who ultimately were diagnosed as having a developmental delay.
AHRQ-funded; HS017939
Citation: Carroll AE, Bauer NS, Dugan TM .
Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.
JAMA Pediatr. 2014 Sep;168(9):815-21. doi: 10.1001/jamapediatrics.2014.464..
Keywords: Health Information Technology (HIT), Clinical Decision Support (CDS), Primary Care, Children/Adolescents
Galanter WL, Bryson ML, Falck S
Indication alerts intercept drug name confusion errors during computerized entry of medication orders.
The authors measured whether indication alerts at the time of computerized physician order entry (CPOE) can intercept drug name confusion errors. They found that indication alerts intercepted 1.4 drug name confusion errors per 1000 alerts and recommended that institutions with CPOE consider using indication prompts to intercept drug name confusion errors.
AHRQ-funded; HS021093.
Citation: Galanter WL, Bryson ML, Falck S .
Indication alerts intercept drug name confusion errors during computerized entry of medication orders.
PLoS One 2014 Jul 15;9(7):e101977. doi: 10.1371/journal.pone.0101977.
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Keywords: Clinical Decision Support (CDS), Adverse Drug Events (ADE), Adverse Events, Medical Errors, Health Information Technology (HIT), Medication, Patient Safety
Bennett WE, Jr., Hendrix KS, Thompson-Fleming RT
Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
The researchers used a novel computerized decision support system to gather data from multiple general pediatrics offices.They found an association between the introduction of cow's milk before 1 year of age and the rate of delayed developmental milestones after 1 year of age, adding strength to the recommendations from the AAP and IOM to delay cow's milk introduction until after 1 year of age.
AHRQ-funded; HS017939; HS018453; HS020640.
Citation: Bennett WE, Jr., Hendrix KS, Thompson-Fleming RT .
Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
Eur J Pediatr 2014 Jul;173(7):887-92. doi: 10.1007/s00431-014-2265-y.
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Keywords: Clinical Decision Support (CDS), Disabilities, Health Information Technology (HIT), Newborns/Infants, Nutrition
Crane HM, Heckbert SR, Drozd DR
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
In this study, a team of researchers developed, implemented, and evaluated a myocardial infarction (MI) adjudication protocol for cohort research of human immunodeficiency virus. They found that central adjudication is crucial and that clinical diagnoses alone are insufficient for ascertainment of MI. Over half the events ultimately determined to be MIs were not identified by clinical diagnoses.
AHRQ-funded; HS019515
Citation: Crane HM, Heckbert SR, Drozd DR .
Lessons learned from the design and implementation of myocardial infarction adjudication tailored for HIV clinical cohorts.
Am J Epidemiol. 2014 Apr 15;179(8):996-1005. doi: 10.1093/aje/kwu010..
Keywords: Human Immunodeficiency Virus (HIV), Heart Disease and Health, Clinical Decision Support (CDS), Diagnostic Safety and Quality
Olsho LE, Spector WD, Williams CS
AHRQ Author: Spector WD
Evaluation of AHRQ's on-time pressure ulcer prevention program: a facilitator-assisted clinical decision support intervention for nursing homes.
The researchers evaluated the effectiveness of the On-Time Quality Improvement for Long Term Care (On-Time) program in reducing the rate of in-house-acquired pressure ulcers among nursing home residents. They found that On-Time implementation is associated with sizable reductions in pressure ulcer incidence.
AHRQ-authored; AHRQ-funded; 290200600011I.
Citation: Olsho LE, Spector WD, Williams CS .
Evaluation of AHRQ's on-time pressure ulcer prevention program: a facilitator-assisted clinical decision support intervention for nursing homes.
Med Care 2014 Mar;52(3):258-66. doi: 10.1097/mlr.0000000000000080.
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Keywords: Clinical Decision Support (CDS), Long-Term Care, Nursing Homes, Pressure Ulcers, Prevention
Pevnick JM, Li N, Asch SM
Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence.
The researchers evaluated whether formulary decision support (FDS) could reduce patient medication costs, and thereby improve adherence. In the studied population, interruptive FDS shifted prescribing toward preferred tier medications, but these medications were only minimally less expensive for patients. Thus, FDS did not significantly increase adherence.
AHRQ-funded; HS016391.
Citation: Pevnick JM, Li N, Asch SM .
Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence.
BMC Med Inform Decis Mak 2014;14:79. doi: 10.1186/1472-6947-14-79..
Keywords: Electronic Prescribing (E-Prescribing), Medication, Patient Adherence/Compliance, Clinical Decision Support (CDS), Health Information Technology (HIT)
Nagykaldi ZJ, Yeaman B, Jones M
HIE-i-health information exchange with intelligence.
This article reports on the development and pilot testing of an innovative approach to implement health information exchange with intelligence (HIE-i) in primary care settings. Records of 346 patients were studied in 6 primary care practices. The results suggest that coupling a geographically inclusive set of clinical data with HIE-based clinical decision support for prevention can considerably improve prospective care delivery.
AHRQ-funded; 290200710009I.
Citation: Nagykaldi ZJ, Yeaman B, Jones M .
HIE-i-health information exchange with intelligence.
J Ambul Care Manage 2014 Jan-Mar;37(1):20-31. doi: 10.1097/jac.0000000000000002..
Keywords: Clinical Decision Support (CDS), Health Information Exchange (HIE), Health Information Technology (HIT), Prevention, Primary Care
Bauer NS, Carroll AE, Downs SM
Understanding the acceptability of a computer decision support system in pediatric primary care.
In this study, the investigators examine the attitudes and opinions of pediatric users' toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. The investigators found that pediatric users appreciated the system's automation and enhancements that allowed relevant and meaningful clinical data to be accessible at point of care.
AHRQ-funded; HS018453; HS017939.
Citation: Bauer NS, Carroll AE, Downs SM .
Understanding the acceptability of a computer decision support system in pediatric primary care.
J Am Med Inform Assoc 2014 Jan-Feb;21(1):146-53. doi: 10.1136/amiajnl-2013-001851..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care
Bauer NS, Carroll AE, Downs SM
Understanding the acceptability of a computer decision support system in pediatric primary care.
In this study, the investigators examine the attitudes and opinions of pediatric users' toward the Child Health Improvement through Computer Automation (CHICA) system, a computer decision support system linked to an electronic health record in four community pediatric clinics. The investigators found that pediatric users appreciated the system's automation and enhancements that allowed relevant and meaningful clinical data to be accessible at point of care.
AHRQ-funded; HS018453; HS017939.
Citation: Bauer NS, Carroll AE, Downs SM .
Understanding the acceptability of a computer decision support system in pediatric primary care.
J Am Med Inform Assoc 2014 Jan-Feb;21(1):146-53. doi: 10.1136/amiajnl-2013-001851..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care
Falck S, Adimadhyam S, Meltzer DO
A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation.
The authors measured the accuracy and completeness of electronic problem list additions using indication-based prescribing of antihypertensives. They found that clinical decision support using indication-based prescribing of antihypertensives produced accurate problem placement roughly two-thirds of the time with fewer than 5% inaccurate problems placed; performance of alerts was sensitive to the number of potential indications of the medication and attendings vs. other clinicians prescribing.
AHRQ-funded; HS016967.
Citation: Falck S, Adimadhyam S, Meltzer DO .
A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation.
Int J Med Inform 2013 Oct;82(10):996-1003. doi: 10.1016/j.ijmedinf.2013.07.003.
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Keywords: Blood Pressure, Medication, Clinical Decision Support (CDS), Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Del Fiol G, Curtis C, Cimino JJ
Disseminating context-specific access to online knowledge resources within electronic health record systems.
This paper describes OpenInfobutton (www.openinfobutton.org): a standards-based, open source Web service that was designed to disseminate infobutton capabilities in multiple electronic health record systems and healthcare organizations. Included in this overview are the OpenInfobutton architecture, knowledge resource integration, and experiences at five large healthcare organizations.
AHRQ-funded; HS018352.
Citation: Del Fiol G, Curtis C, Cimino JJ .
Disseminating context-specific access to online knowledge resources within electronic health record systems.
Stud Health Technol Inform 2013;192:672-6..
Keywords: Clinical Decision Support (CDS), Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Web-Based
Lobach DF, Kawamoto K, Anstrom KJ
A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.
This study tested the impact of 3 clinical decision support modalities (emails to care managers, printed reports to clinic administrators, and letters to patients) on the use and cost of medical services for Medicaid patients. It found that some modalities can significantly reduce emergency department use and medical costs, while other interventions may have had detrimental consequences.
AHRQ-funded; HS015057
Citation: Lobach DF, Kawamoto K, Anstrom KJ .
A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.
J Med Syst. 2013 Feb;37(1):9922. doi: 10.1007/s10916-012-9922-3..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Medicaid, Emergency Medical Services (EMS), Quality of Care