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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 25 of 1427 Research Studies DisplayedBui LN, Knox M, Miller-Rosales C
Hospital capabilities associated with behavioral health integration within emergency departments.
The objective of this study was to identify hospital capabilities associated with behavioral health processes in emergency departments. Responses to the National Survey of Healthcare Organizations and Systems were linked American Hospital Association Annual Survey data. Most hospitals reported screening for behavioral health conditions and provided direct referrals to community-based clinicians. Approximately half the hospitals used team approaches to behavioral health. Hospitals that reported more barriers to care delivery innovations also reported less screening and usage of a team approach. The authors concluded that research and interventions which focus on removing barriers or adding processes to disseminate best practices offer a path to accelerate behavioral health integration in emergency departments.
AHRQ-funded; HS024075.
Citation: Bui LN, Knox M, Miller-Rosales C .
Hospital capabilities associated with behavioral health integration within emergency departments.
Med Care 2024 Mar; 62(3):170-74. doi: 10.1097/mlr.0000000000001973.
Keywords: Behavioral Health, Emergency Department, Hospitals, Substance Abuse, Teams, Telehealth, Health Information Technology (HIT)
Barwise AK, Curtis S, Diedrich DA
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
The objectives of this planned qualitative study were to use machine learning predictive analytics to identify patients with language barriers and complex medical needs in order to prioritize them for in-person interpreters. The authors conducted semi-structured interviews with clinicians, interpreters, and staff involved in caring for patients or organizing interpreters to understand perceived risks and benefits of artificial intelligence (AI) in this domain. Perceived risks included concerns about transparency, accuracy, redundancy, privacy, stigmatization among patients, alert fatigue, and supply-demand issues; perceived benefits included increased awareness of in-person interpreters, improved standard of care, and prioritization for interpreter utilization. They concluded that the use of AI to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
AHRQ-funded; HS028475.
Citation: Barwise AK, Curtis S, Diedrich DA .
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
J Am Med Inform Assoc 2024 Feb 16; 31(3):611-21. doi: 10.1093/jamia/ocad224.
Keywords: Health Information Technology (HIT), Disparities, Communication, Clinician-Patient Communication
Dullabh P, Leaphart D, Dhopeshwarkar R
Patient-centered clinical decision support-where are we and where to next?
This paper is a literature review of the current state of patient-centered clinical decision support (PC CDS) that includes digital health tools that support patients, caregivers, and care teams in healthcare decisions that incorporate patient-centered factors related to four components: knowledge, data, delivery, and use. It explores the current state of each factor and how each factor promotes patient-centeredness in healthcare. The authors reviewed 175 peer-reviewed and grey literature, and eighteen key informant interviews. They found there is a need for more research on how to incorporate patient input into the guideline selection and prioritization for PC CDS, development and implementation of PC CDS tools, technical challenges for capturing patient contributed data, and optimizing PC CDS across various settings to meet patient and caregiver needs.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Leaphart D, Dhopeshwarkar R .
Patient-centered clinical decision support-where are we and where to next?
Stud Health Technol Inform 2024 Jan 25; 310:444-48. doi: 10.3233/shti231004..
Keywords: Patient-Centered Healthcare, Clinical Decision Support (CDS), Health Information Technology (HIT)
Olaya F, Brin M, Caraballo PB
A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol.
The purpose of this study is to test the effectiveness of an mHealth tool to improve adherence to HIV medication in Spanish-speaking people living in New York City and the Dominican Republic. The researchers developed the WiseApp study as a two-arm randomized controlled trial. The 248 participants from New York and the Dominican Republic were randomly assigned to receive a CleverCap pill bottle that is linked to the WiseApp (intervention) or to the standard of care (control). The participants completed surveys at the baseline, 3-month, 6-month, and 12-month follow-up visits. Through blood draws at each study timepoint, the study team collected HIV-1 viral load and CD4 count results. Results will be forthcoming.
AHRQ-funded; HS028523.
Citation: Olaya F, Brin M, Caraballo PB .
A randomized controlled trial of the dissemination of an mHealth intervention for improving health outcomes: the WiseApp for Spanish-speakers living with HIV study protocol.
BMC Public Health 2024 Jan 17; 24(1):201. doi: 10.1186/s12889-023-17538-y..
Keywords: Human Immunodeficiency Virus (HIV), Telehealth, Health Information Technology (HIT), Cultural Competence, Outcomes
Powell KR, Farmer M, Liu J
A survey of technology abandonment in US nursing homes.
This study examined abandonment of health information technology (HIT) by US nursing homes (NHs) and its association with organizational characteristics among a national sample of US NHs. This longitudinal, retrospective analysis used data from 2 sources: the HIT Maturity Survey and Staging model and public data from the Care Compare database. The authors used a random sample of 299 NHs representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019-August 2020 and year 2 (Y2) was June 2020-August 2021. The primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain; and independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. Results were that over the 2-year period HIT abandonment occurred in 28% of NHs compared with 44% that experienced growth in HIT systems. Capabilities in resident care was abandoned most frequently. They found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. They concluded that technology abandonment can increase strain on scarce resources and may impact administrators' ability to oversee clinical operations, especially in large NHs.
AHRQ-funded; HS022497.
Citation: Powell KR, Farmer M, Liu J .
A survey of technology abandonment in US nursing homes.
J Am Med Dir Assoc 2024 Jan; 25(1):6-11. doi: 10.1016/j.jamda.2023.09.002..
Keywords: Nursing Homes, Health Information Technology (HIT), Long-Term Care
Jolliff A, Coller RJ, Kearney H
An mHealth design to promote medication safety in children with medical complexity.
This study describes an effort to design a health information technology tool to improve medication safety for children with medical complexity (CMC). The study engaged family caregivers, secondary caregivers, and clinicians who work with CMC in a co-design process to identify: 1) medication safety challenges experienced by CMC caregivers and, 2) design requirements for a mobile health application to improve medication safety for CMC in the home. Family caregivers, secondary caregivers, and clinicians from a children's hospital-based pediatric complex care program participated in virtual co-design sessions. During these sessions, the facilitator guided 16 co-designers in generating and converging upon medication safety challenges and design requirements. These sessions were recorded and reviewed after conclusion to confirm that all designer comments had been captured. An analysis yielded 11 challenges to medication safety and 11 corresponding design requirements that fit into three broader challenges: giving the right medication at the right time; communicating with others about medications; and accommodating complex medical routines.
AHRQ-funded; HS028409.
Citation: Jolliff A, Coller RJ, Kearney H .
An mHealth design to promote medication safety in children with medical complexity.
Appl Clin Inform 2024 Jan; 15(1):45-54. doi: 10.1055/a-2214-8000..
Keywords: Children/Adolescents, Medication: Safety, Medication, Health Information Technology (HIT), Chronic Conditions, Telehealth, Caregiving
Haimovich AD, Shah MN, Southerland LT
Automating risk stratification for geriatric syndromes in the emergency department.
This study discussed using automated risk stratification to implement screening programs for geriatric syndromes in the emergency department (ED). This method would reduce significant workloads at a time of record-breaking ED patient volumes, staff shortages, and hospital boarding crises. The authors defined the concept of automated risk stratification and screening using existing electronic health record (EHR) data. They discussed progress made in three potential use cases in the ED: falls, cognitive impairment, and end-of-life and palliative care; emphasizing the importance of linking automated screening with systems of healthcare delivery. They found that research progress and operational deployment vary by use case, ranging from deployed solutions in falls screening to algorithmic validation in cognitive impairment and end-of-life care, but should still be considered a potential solution.
AHRQ-funded; HS027735.
Citation: Haimovich AD, Shah MN, Southerland LT .
Automating risk stratification for geriatric syndromes in the emergency department.
J Am Geriatr Soc 2024 Jan; 72(1):258-67. doi: 10.1111/jgs.18594..
Keywords: Elderly, Emergency Department, Risk, Health Information Technology (HIT)
Kaufman BG, Holland DE, Vanderboom CE
Implementation costs of technology-enhanced transitional palliative care for rural caregivers.
Rural FCG experience higher levels of burden accessing coordinated care for their loved ones during and after hospitalization than urban family caregivers (FCG). The role of technology-enhanced transitional palliative care (TPC) on caregiver outcomes is currently being assessed in a randomized control trial. The purpose of this study was to assess resource use and health system costs of this FCG-focused TPC intervention and potential Medicare reimbursement mechanisms. The researchers randomized rural caregivers of hospitalized patients into an 8-week intervention which included video visits conducted by a registered nurse certified in palliative care, and supplemented with phone calls and texts (n = 215), or attentional control. The researchers estimated labor costs for a registered nurse and compared to scenario analyses utilizing a nurse practitioner or social worker wages. Medicare reimbursement scenarios included Transitional Care Management (TCM) and Chronic Care Management (CCM) CPT codes. The researchers found the base case, TPC cost was $395 per FCG conducted by a registered nurse, compared to $337 and $585 if conducted by a social worker or nurse practitioner, respectively. Reimbursement in the CCM-only scenario was $348 and $274 for complex and non-complex patients, respectively. Average Medicare reimbursement in the TCM-only scenario was $322 and $260 for high or moderate complexity patients, respectively. Reimbursement in the TCM+CCM scenario was $496 and $397, for high/complex and moderate/non-complex patients, respectively.
AHRQ-funded; HS026379.
Citation: Kaufman BG, Holland DE, Vanderboom CE .
Implementation costs of technology-enhanced transitional palliative care for rural caregivers.
Am J Hosp Palliat Care 2024 Jan; 41(1):38-44. doi: 10.1177/10499091231156145..
Keywords: Rural Health, Caregiving, Palliative Care, Health Information Technology (HIT)
Scharp D, Hobensack M, Davoudi A
Natural language processing applied to clinical documentation in post-acute care settings: a scoping review.
The purpose of this scoping review was to assess the scope of the application of natural language processing to free-text clinical notes in post-acute care and provide a foundation for future natural language processing-based research in the same settings. The researchers searched PubMed, Cumulative Index of Nursing and Allied Health Literature, and Embase in February 2023. Twenty-one eligible studies. Almost all of which were conducted in home health care settings, had quantitative designs that utilized natural language processing applied to clinical documentation in post-acute care settings. Most studies extracted data from electronic health records to explore the risk for negative outcomes, including acute care utilization, medication errors, and suicide mortality. About half of the studies did not report age, sex, race, or ethnicity data or utilize standardized terminologies. Only 8 studies included variables from socio-behavioral domains. Most studies fulfilled all quality appraisal indicators.
AHRQ-funded; HS027742.
Citation: Scharp D, Hobensack M, Davoudi A .
Natural language processing applied to clinical documentation in post-acute care settings: a scoping review.
J Am Med Dir Assoc 2024 Jan; 25(1):69-83. doi: 10.1016/j.jamda.2023.09.006..
Keywords: Health Information Technology (HIT), Home Healthcare
Balbin CA, Kawamoto K
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
To address the need for electronic health record (EHR) systems to accept the connection of any patient-facing digital health app using the SMART on FHIR standard, the authors proposed the Standards-based Implementation Maximizing Portability Leveraging the EHR (SIMPLE). SIMPLE’s architectural pattern was designed to meet several key requirements, such as not requiring patients to install new software; not retaining patient data outside of the EHR; leveraging existing personal health record (PHR) capabilities to optimize user experience; and maximizing portability.
AHRQ-funded; HS028791.
Citation: Balbin CA, Kawamoto K .
The SIMPLE architectural pattern for integrating patient-facing apps into clinical workflows: desiderata and application for lung cancer screening.
AMIA Annu Symp Proc 2024 Jan 11; 2023:844-53..
Keywords: Workflow, Health Information Technology (HIT), Cancer: Lung Cancer, Cancer, Screening
Jeffery AD, Reale C, Faiman J
Inpatient nurses' preferences and decisions with risk information visualization.
The purpose of this study was to explore the effect of 4 different risk information formats on inpatient nurses' preferences and decisions with an acute clinical deterioration decision-support system. The researchers implemented a comparative usability evaluation in which participants provided responses to multiple user interface options in a simulated setting. Qualitative data was collected using think aloud methods, asking participants which action they would perform after each time point in 3 different patient scenarios. The 6 participants preferred the probability format over relative risk ratios (n = 2), absolute differences (n = 2), and number of persons out of 100 (n = 0). Participants preferred average lines, having a trend graph to supplement the risk estimate, and consistent colors between trend graphs and possible actions. Participants did not prefer too much text information or the presence of confidence intervals. The utilization of the probability format was related with higher concordance in actions taken by participants compared to the other 3 risk information formats.
AHRQ-funded; HS026395.
Citation: Jeffery AD, Reale C, Faiman J .
Inpatient nurses' preferences and decisions with risk information visualization.
J Am Med Inform Assoc 2023 Dec 22; 31(1):61-69. doi: 10.1093/jamia/ocad209..
Keywords: Provider: Nurse, Clinical Decision Support (CDS), Health Information Technology (HIT)
Frimpong JA, Liu X, Liu L
AHRQ Author: Liu L
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
The purpose of this study was to explore the adoption of electronic health record (EHR) systems in substance use disorder (SUD) programs, with an emphasis on changes in adoption from 2014 to 2017, and identify organizational-level variables related with EHR adoption. The researchers utilized data from the 2014 and 2017 National Drug Abuse Treatment System Surveys, and analyzed 1,027 SUD programs. The study found the adoption of EHR increased significantly from 57.6% in 2014 to 69.2% in 2017. Nearly one-third of SUD programs had not yet adopted an EHR system by 2017. The researchers identified a significant increase in technology use and ownership by a parent company and a decrease in the percentage of uninsured patients in 2017 compared to 2014. Further analysis revealed significant differences by adoption status for three main barriers to adoption: 1. Costs of start-up, 2. Ongoing financial costs, and 3. Privacy or security concerns. Programs that used computerized scheduling and billing systems had a greater likelihood of adopting EHR. Ownership type, such as private nonprofit and public, or interest in taking part in a patient-centered medical home were related with a greater likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014.
AHRQ-authored.
Citation: Frimpong JA, Liu X, Liu L .
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
J Med Internet Res 2023 Dec 14; 25:e45238. doi: 10.2196/45238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Substance Abuse, Behavioral Health
Lopez K, Li H, Lipkin-Moore Z
Deep learning prediction of hospital readmissions for asthma and COPD.
The purpose of this observational study was to identify Electronic Health Record (EHR) features of severe asthma and COPD exacerbations and assess the performance of four machine learning (ML) and one deep learning (DL) model in predicting readmissions using EHR data. The study included 31, 2017 patients hospitalized with asthma and COPD exacerbations. The study found that Black and Hispanic patients had a greater likelihood of readmission for asthma. Patients with COPD readmissions included a high percentage of Blacks and Hispanics. To identify patients at high risk of readmission, index hospitalization data of a subset of 2,682 patients, 777 with asthma and 1,905 with COPD, was analyzed with four ML models, and one DL model. The researchers discovered that multilayer perceptron, the DL method, had the best sensitivity and specificity compared to the four ML methods implemented in the same dataset.
AHRQ-funded; HS027626.
Citation: Lopez K, Li H, Lipkin-Moore Z .
Deep learning prediction of hospital readmissions for asthma and COPD.
Respir Res 2023 Dec 13; 24(1):311. doi: 10.1186/s12931-023-02628-7..
Keywords: Asthma, Respiratory Conditions, Hospital Readmissions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Mueller SK, Garabedian P, Goralnick E
Advancing health information during interhospital transfer: an interrupted time series.
The researchers report that health information exchange (HIE) during the interhospital transfer (IHT) of patients between acute care hospitals is subject to fragmented communication and unreliable access to clinical information. This proposed study will design, implement, and rigorously evaluate the implementation of a HIE platform to improve data access during IHT. The four-fold purposes of this study are to: 1) optimize clinician workflow, data visualization, and interoperability through user-centered design sessions for HIE platform development; 2) evaluate the impact of the intervention on clinician-reported medical errors among 500 pre- and 500 postintervention IHT patients using interrupted time series methodology; 3) evaluate intervention fidelity, use, and perceived usability of the platform, and barriers and facilitators of implementation from interprofessional stakeholder input, using mixed-methods evaluation; and 4) combine primary findings to develop a toolkit for spread and sustainability.
AHRQ-funded; HS028982.
Citation: Mueller SK, Garabedian P, Goralnick E .
Advancing health information during interhospital transfer: an interrupted time series.
J Hosp Med 2023 Dec; 18(12):1063-71. doi: 10.1002/jhm.13221..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals, Transitions of Care
Dullabh P, Heaney-Huls KK, Chiao AB
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
This paper describes a pilot intervention of a smartphone app for postpartum monitoring of hypertensive disorders of pregnancy (HDP) that integrates patient-contributed data into electronic health records (EHRs) to support monitoring and clinical decision-making. Results from the pilot evaluation highlighted the resources needed when implementing the app, challenges for integrating an app into the EHR, and the usability and utility of the HDP monitoring app for patient and clinician users. Key observations of the implementation team included the importance of a local clinical champion, more robust patient involvement and support for the remote patient monitoring program, an impetus for EHR developers to adopt data integration standards, and a need to expand the capabilities of the standards to support interventions using patient-contributed data.
AHRQ-funded; 233201500023I.
Citation: Dullabh P, Heaney-Huls KK, Chiao AB .
Implementation and evaluation of an electronic health record-integrated app for postpartum monitoring of hypertensive disorders of pregnancy using patient-contributed data collection.
JAMIA Open 2023 Dec; 6(4):ooad098. doi: 10.1093/jamiaopen/ooad098..
Keywords: Electronic Health Records (EHRs), Maternal Care, Blood Pressure, Telehealth, Health Information Technology (HIT), Women
Miller MJ, Miller MJ, Pak SS, Keller DR SS, Keller DR
Physical therapist telehealth delivery at 1 year into COVID-19.
This study’s purpose was to examine telehealth physical therapy utilization 1 year into the COVID-19 pandemic and identify factors that influence physical therapists' delivery of telehealth in an urban academic medical center. Data was extracted from electronic medical records from March 22 to May 15, 2021. The proportion of physical therapy sessions delivered via telehealth were identified, and patient characteristics were compared by telehealth volume (0 vs ≥1 session, 1 vs >1 session). Telehealth was used for 3793 of 8038 (47.2%) physical therapist sessions, and 1028 unique patients had at least 2 physical therapist sessions (without telehealth: 6.6%, telehealth once: 39.1%, telehealth more than once: 54.3%). Patients who did not use telehealth were older, non-English speaking, had non-commercial insurance, and had at least 1 chronic health condition. Patients who used telehealth more than once had a neurologic diagnosis and lived farther from the treating clinic. Factors that influenced telehealth delivery were physical therapist clinical skills and knowledge, technical proficiency, telehealth-specific interpersonal skills, and cognitive flexibility. External factors outside of the physical therapist that influenced telehealth delivery included the environment, patient equipment and technology proficiency, physical therapist equipment, clinic factors, and patient and referring provider perspectives.
AHRQ-funded; HS026379.
Citation: Miller MJ, Miller MJ, Pak SS, Keller DR SS, Keller DR .
Physical therapist telehealth delivery at 1 year into COVID-19.
Phys Ther 2022 Nov 6; 102(11). doi: 10.1093/ptj/pzac121..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT)
Hua Y, Wang L, Nguyen V
A deep learning approach for transgender and gender diverse patient identification in electronic health records.
The research described in this article used transgender and gender diverse (TGD) populations as a case study to build an accurate patient gender identity predictive, deep learning model; the goal was to address challenges in identifying relevant patient-level information from electronic health record (EHR) data. Participants were adult patients in a large healthcare system in Boston, MA. The deep learning model significantly outperformed rule-based algorithms. The researchers concluded that future work should evaluate additional diverse data sources for more generalizable algorithms.
AHRQ-funded; HS028916.
Citation: Hua Y, Wang L, Nguyen V .
A deep learning approach for transgender and gender diverse patient identification in electronic health records.
J Biomed Inform 2023 Nov; 147:104507. doi: 10.1016/j.jbi.2023.104507..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations
Moffit R, McTigue K, Conroy MB
Aspects of program engagement in an online physical activity intervention and baseline predictors of engagement.
The authors described participant engagement in ActiveGOALS, a 3-month, self-directed online physical activity (PA) intervention and identified the baseline factors related to engagement. Participants were adult primary care patients aged 21-70 years. Program engagement was found to be high, but average time between completed lessons was longer than expected and participants only contacted their coach about 1 of every 3 weeks. Individual predictors related to health, health care, demographics, lifestyle, and quality of life were significantly related to engagement. The authors concluded that examining multiple aspects of engagement and a large number of potential predictors might be needed to determine facilitators and barriers for high engagement in multi-faceted online intervention programs.
AHRQ-funded; HS022989.
Citation: Moffit R, McTigue K, Conroy MB .
Aspects of program engagement in an online physical activity intervention and baseline predictors of engagement.
Am J Health Promot 2023 Nov; 37(8):1100-08. doi: 10.1177/08901171231194176..
Keywords: Patient and Family Engagement, Health Promotion, Health Information Technology (HIT)
Zhong A, Amat MJ, Anderson TS
Completion of recommended tests and referrals in telehealth vs in-person visits.
The purpose of this retrospective cohort study was to explore the prevalence of diagnostic loop closure for tests and referrals ordered at telehealth visits when compared to in-person visits and characterize related factors. The study included test and referral orders for 4,133 patients A total 27.8% of the orders were placed during a telehealth visit. The study found that of the telehealth orders, 42.6% were completed within the designated time frame vs 58.4% of those ordered during in-person visits and 57.4% of those ordered without a visit. In an adjusted analysis, when compared with patients with in persons visits, patients with telehealth visits were less likely to close the loop for all test types.
AHRQ-funded; HS027282.
Citation: Zhong A, Amat MJ, Anderson TS .
Completion of recommended tests and referrals in telehealth vs in-person visits.
JAMA Netw Open 2023 Nov; 6(11):e2343417. doi: 10.1001/jamanetworkopen.2023.43417..
Keywords: Telehealth, Health Information Technology (HIT), Patient Adherence/Compliance
Kukhareva PV, Li H, Caverly TJ
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
The authors conducted pre- and post-intervention analysis in primary care and pulmonary clinics to explore whether clinician-facing electronic health record (EHR) prompts and an EHR-integrated shared decision-making (SDM) tool designed to support incorporation of SDM into primary care could improve low-dose computer tomography scan imaging ordering and completion. Subjects were patients who met US Preventive Services Task Force criteria for lung cancer screening (LCS). The results indicated that EHR prompts and the EHR-integrated SDM tool were promising approaches to improving LCS in the primary care setting. The authors noted that further research is warranted.
AHRQ-funded; HS026198; HS028791.
Citation: Kukhareva PV, Li H, Caverly TJ .
Implementation of lung cancer screening in primary care and pulmonary clinics: pragmatic clinical trial of electronic health record-integrated everyday shared decision-making tool and clinician-facing prompts.
Chest 2023 Nov; 164(5):1325-38. doi: 10.1016/j.chest.2023.04.040..
Keywords: Cancer: Lung Cancer, Cancer, Screening, Primary Care, Electronic Health Records (EHRs), Health Information Technology (HIT), Shared Decision Making
Hose BZ, Carayon P, Hoonakker PLT
Work system barriers and facilitators of a team health information technology.
This study’s objective was to identify work design barriers and facilitators to the use of a team health IT that supports care transitions for pediatric trauma patients. The authors conducted an analysis on 36 interviews - representing 12 roles - collected from a scenario-based evaluation of T(3). They identified eight dimensions with both barriers and facilitators in all five work system elements: person (experience), task (task performance, workload/efficiency), technology (usability, specific features of T(3)), environment (space, location), and organization (communication/coordination). They concluded that designing technology that meets every role's needs is challenging; in particular, when trade-offs need to be managed, e.g., additional workload for one role or divergent perspectives regarding specific features.
AHRQ-funded; HS023837
Citation: Hose BZ, Carayon P, Hoonakker PLT .
Work system barriers and facilitators of a team health information technology.
Appl Ergon 2023 Nov; 113:104105. doi: 10.1016/j.apergo.2023.104105..
Keywords: Health Information Technology (HIT), Teams
Reed KG, Sun Z, Yabes JG
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
The purpose of this study was to evaluate variations among patients who do and do not visit Commission on Cancer (CoC) accredited facilities. The researchers utilized Pennsylvania Cancer Registry data linked to facility records for 87,472 patients diagnosed with cancer between 2018 and 2019. The study found that patients in the most advantaged Area Deprivation Index quartiles were more likely to visit CoC facilities compared with other quartiles. Urban patients were more likely than rural to be seen at a CoC facility as were Hispanic patients and non-Hispanic Black patients compared with White patients.
AHRQ-funded; HS027396.
Citation: Reed KG, Sun Z, Yabes JG .
Assessing characteristics of populations seen at Commission on Cancer facilities using Pennsylvania linked data.
JNCI Cancer Spectr 2023 Oct 31; 7(6). doi: 10.1093/jncics/pkad080..
Keywords: Cancer, Health Information Technology (HIT), Racial and Ethnic Minorities, Rural Health, Rural/Inner-City Residents
Boxley C, Fujimoto M, Ratwani RM
A text mining approach to categorize patient safety event reports by medication error type.
This study examined whether natural language processing can be used to better categorize medication related patient safety event reports. A total of 3,861 medication related patient safety event reports that were previously annotated using a consolidated medication error taxonomy were used to develop three models using the following algorithms: (1) logistic regression, (2) elastic net, and (3) XGBoost. The models were tested and performance was analyzed. The authors found the XGBoost model performed best across all medication error categories. 'Wrong Drug', 'Wrong Dosage Form or Technique or Route', and 'Improper Dose/Dose Omission' categories performed best across the three models. In addition, they identified five words most closely associated with each medication error category and which medication error categories were most likely to co-occur.
AHRQ-funded; HS026481.
Citation: Boxley C, Fujimoto M, Ratwani RM .
A text mining approach to categorize patient safety event reports by medication error type.
Sci Rep 2023 Oct 26; 13(1):18354. doi: 10.1038/s41598-023-45152-w..
Keywords: Health Information Technology (HIT), Patient Safety, Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events
Ranusch A, Lin YJ, Dorsch MP
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
The objective of this study was to examine how individual authority of clinical pharmacists and anticoagulation nurses is affected by the implementation success of an electronic health record (EHR) direct oral anticoagulant (DOAC) Dashboard for safe DOAC medication prescribing. Researchers conducted semistructured interviews with pharmacists and nurses after the implementation of the EHR DOAC Dashboard at three clinical sites. Results showed that a high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard; conversely, a lack of individual authority was associated with key barriers to effective use. The researchers concluded that increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard.
AHRQ-funded; HS026874.
Citation: Ranusch A, Lin YJ, Dorsch MP .
Role of individual clinician authority in the implementation of informatics tools for population-based medication management: qualitative semistructured interview study.
JMIR Hum Factors 2023 Oct 24; 10:e49025. doi: 10.2196/49025..
Keywords: Medication, Provider: Pharmacist, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Blood Thinners
Kornfield R, Lattie EG, Nicholas J
"Our job is to be so temporary": designing digital tools that meet the needs of care managers and their patients with mental health concerns.
The purpose of this study was to improve understanding of how to integrate digital tools in routine healthcare, especially for patients with both physical and mental health needs. The researchers conducted interviews and design workshops with 1. a group of care managers who support patients with complex health needs, and 2. their patients whose health needs include mental health concerns. The researchers examined both groups' views of potential applications of digital tools within care management. The study found that care managers felt underprepared to addressing mental health issues on an ongoing basis and had concerns about the burden and confusion of providing support through new digital channels. Patients envisioned benefiting from ongoing mental health support from care managers, including support in using digital tools. The needs of patients and care managers may be so different that meeting both through the same tools represents a substantial challenge, and could require altering these professionals' roles in mental health support.
AHRQ-funded; HS028003.
Citation: Kornfield R, Lattie EG, Nicholas J .
"Our job is to be so temporary": designing digital tools that meet the needs of care managers and their patients with mental health concerns.
Proc ACM Hum Comput Interact 2023 Oct; 7(CSCW2):302. doi: 10.1145/3610093..
Keywords: Behavioral Health, Health Information Technology (HIT), Care Coordination