National Healthcare Quality and Disparities Report
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Topics
- Antibiotics (1)
- Asthma (1)
- Care Management (2)
- Children/Adolescents (4)
- Clinician-Patient Communication (1)
- Communication (2)
- Diagnostic Safety and Quality (1)
- Education: Continuing Medical Education (3)
- Electronic Health Records (EHRs) (2)
- (-) Emergency Department (17)
- Guidelines (1)
- Healthcare Delivery (2)
- Health Information Technology (HIT) (3)
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- Medication (4)
- Newborns/Infants (1)
- Opioids (1)
- Pain (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (1)
- Patient Experience (1)
- Patient Safety (2)
- Pneumonia (1)
- Practice Patterns (1)
- Prevention (1)
- (-) Provider (17)
- Provider: Clinician (3)
- Provider: Nurse (1)
- Provider: Pharmacist (1)
- Provider: Physician (12)
- Respiratory Conditions (1)
- Sepsis (1)
- Shared Decision Making (1)
- Sickle Cell Disease (2)
- Simulation (1)
- Surgery (2)
- Transitions of Care (1)
- Trauma (1)
- Workflow (2)
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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 17 of 17 Research Studies DisplayedGettel CJ, Canavan ME, D'Onofrio G
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
This study looked at the clinical focus of emergency department (ED) workers using the 2017 Medicare Public Use Files for clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services for Medicare fee-for-service Part B. Clinicians were categorized as EM physicians, non-EM physicians, and advanced practice providers (APPs). Of the 65,710 unique clinicians providing care, 59.4% were classified as EM physicians, 12.4% as non-EM physicians, and 28.5% as APPs. EM physicians have twice as much clinician median focus in comparison to EM physicians providing emergency care (92.8% vs 45.2) and APPs are focused 100%.
AHRQ-funded; HS023614.
Citation: Gettel CJ, Canavan ME, D'Onofrio G .
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
Am J Emerg Med 2021 Apr;42:228-32. doi: 10.1016/j.ajem.2020.11.069..
Keywords: Emergency Department, Workforce, Provider: Physician, Provider: Clinician, Provider, Medicare
Smulowitz PB, O'Malley AJ, Zaborski L
Variation in emergency department admission rates among Medicare patients: does the physician matter?
Hospitalizations account for the largest share of health care spending. New payment models increasingly encourage health care providers to reduce hospital admissions. Although emergency department (ED) physicians play a major role in the decision to admit a patient, the extent to which admission rates vary among ED physicians even within the same hospital remains poorly understood. In this study the investigators examined physician-level variation in ED admission rates for Medicare patients.
AHRQ-funded; HS025408.
Citation: Smulowitz PB, O'Malley AJ, Zaborski L .
Variation in emergency department admission rates among Medicare patients: does the physician matter?
Health Aff 2021 Feb;40(2):251-57. doi: 10.1377/hlthaff.2020.00670..
Keywords: Emergency Department, Hospitalization, Medicare, Provider: Physician, Provider
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
McCarthy DM, Powell RE, Cameron KA
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial.
The purpose of this study was to evaluate the effectiveness of the Uncertainty Communication Education Module (UCEM) in improving physician communications. Patients' understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. This trial has been designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake.
AHRQ-funded; HS025651.
Citation: McCarthy DM, Powell RE, Cameron KA .
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial.
BMC Med Educ 2020 Feb 19;20(1):49. doi: 10.1186/s12909-020-1926-y..
Keywords: Education: Continuing Medical Education, Clinician-Patient Communication, Communication, Emergency Department, Simulation, Provider: Physician, Provider
Michelson KA, Nigrovic LE, Nagler J
Research interest in pediatric emergency medicine fellows.
The authors sought to determine the prevalence and determinants of interest in research careers among pediatric emergency medicine (PEM) fellows. They performed an electronically distributed national survey of current PEM fellows, assessing demographics, barriers to successful research, and beliefs about research using 4-point ordinal scales. The authors found that most fellows expect to devote a minority of their career to clinical research. Enthusiasm about research was strongly correlated with career research interest.
AHRQ-funded; HS000063.
Citation: Michelson KA, Nigrovic LE, Nagler J .
Research interest in pediatric emergency medicine fellows.
Pediatr Emerg Care 2020 Feb;36(2):e38-e42. doi: 10.1097/pec.0000000000001085..
Keywords: Emergency Department, Children/Adolescents, Health Services Research (HSR), Provider: Physician, Provider, Education: Continuing Medical Education
Oslock WM, Paredes AZ, Baselice HE
Women surgeons and the emergence of acute care surgery programs.
The authors sought to examine predictors of women surgeons in emergency general surgery (EGS) generally, and in acute care surgery (ACS) particularly. They found that 50.4% of hospitals studied had zero women surgeons. Women were more likely to be among EGS surgeons at hospitals with ACS models. They concluded that their study highlighted the dearth of women representation within EGS hospitals nationally and illuminated some of the underlying characteristics of ACS that may draw women: urban, academic, and staffed by more recently trained surgeons.
AHRQ-funded; HS022694.
Citation: Oslock WM, Paredes AZ, Baselice HE .
Women surgeons and the emergence of acute care surgery programs.
Am J Surg 2019 Oct;218(4):803-08. doi: 10.1016/j.amjsurg.2019.07.008..
Keywords: Surgery, Provider: Physician, Provider, Emergency Department
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
Aronson PL, Schaeffer P, Fraenkel L
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
This paper discusses the reasons for wide variation in the decision to perform lumbar punctures (LPs) in febrile infants 8 weeks or less. Semi-structured interviews were conducted with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Five themes emerged from the interviews that included: age of the infant, the physician’s clinical experience, physician’s use of research findings, the physician’s values, and the role of the primary care pediatrician.
AHRQ-funded; HS026006.
Citation: Aronson PL, Schaeffer P, Fraenkel L .
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
Hosp Pediatr 2019 Jun;9(6):405-14. doi: 10.1542/hpeds.2019-0002..
Keywords: Newborns/Infants, Shared Decision Making, Provider: Physician, Provider: Nurse, Provider: Clinician, Provider, Emergency Department, Diagnostic Safety and Quality
Sharp B, Johnson J, Hamedani AG
What are we measuring? Evaluating physician-specific satisfaction scores between emergency departments.
The goals of this study were to determine whether Press Ganey ED satisfaction scores for emergency physicians working at two different sites were consistent between sites, and to identify factors contributing to any variation. The investigators found that Press Ganey satisfaction scores for the same group of emergency physicians varied significantly between sites. They indicated that this suggests these scores are more dependent on site-specific factors, such as wait times, than a true representation of the quality of care provided by the physician.
AHRQ-funded; HS024558.
Citation: Sharp B, Johnson J, Hamedani AG .
What are we measuring? Evaluating physician-specific satisfaction scores between emergency departments.
West J Emerg Med 2019 May;20(3):454-59. doi: 10.5811/westjem.2019.4.41040..
Keywords: Emergency Department, Patient Experience, Provider: Physician, Provider
Trent SA, Havranek EP, Ginde AA
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
This study examined the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for patients with severe sepsis. A quasi-experiment was conducted with attending physicians randomized into 6 clusters at a single urban safety net hospital. Feedback with blinded peer comparison significantly improved guideline adherence from 52% to 65% with feedback.
AHRQ-funded; HS022400.
Citation: Trent SA, Havranek EP, Ginde AA .
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
Am J Med Qual 2019 May/Jun;34(3):217-25. doi: 10.1177/1062860618796947..
Keywords: Antibiotics, Emergency Department, Guidelines, Infectious Diseases, Inpatient Care, Medication, Pneumonia, Provider, Provider: Physician, Sepsis
Knight LMJ, Onsomu EO, Bosworth HB
Exploring emergency department provider experiences with and perceptions of weight-based versus individualized vaso-occlusive treatment protocols in sickle cell disease.
This study compared perceptions of nurses and physicians on protocols to treat sickle cell disease vaso-occlusive episodes (VOEs) in emergency rooms (ERs). Two different protocols were used for VOEs: weight –based and individualized vaso-occlusive. Nurses were less satisfied with clarity of the protocols than physicians. Pain management protocol perceptions differed widely between physicians, residents, physician assistants, nurse practitioners and nurses.
AHRQ-funded; HS024501.
Citation: Knight LMJ, Onsomu EO, Bosworth HB .
Exploring emergency department provider experiences with and perceptions of weight-based versus individualized vaso-occlusive treatment protocols in sickle cell disease.
Adv Emerg Nurs J 2019 Jan/Mar;41(1):86-97. doi: 10.1097/tme.0000000000000232..
Keywords: Emergency Department, Medication, Opioids, Pain, Provider, Sickle Cell Disease
Goldman MP, Wong AH, Bhatnagar A
Providers' perceptions of caring for pediatric patients in community hospital emergency departments: a mixed-methods analysis.
Approximately 90% of pediatric emergency care is provided in community emergency departments (CEDs) that care for both adults and children. Paradoxically, the majority of pediatric emergency medicine knowledge generation, quality improvement work, and clinical training occurs in children's hospitals. There is a paucity of information of perceptions on pediatric care from CED providers. The objective of this study was to explore interprofessional CED providers' perceptions of caring for pediatric patients.
AHRQ-funded; HS020286.
Citation: Goldman MP, Wong AH, Bhatnagar A .
Providers' perceptions of caring for pediatric patients in community hospital emergency departments: a mixed-methods analysis.
Acad Emerg Med 2018 Dec;25(12):1385-95. doi: 10.1111/acem.13509..
Keywords: Children/Adolescents, Emergency Department, Hospitals, Provider
Fong A, Ratwani RM
Understanding emergency medicine physicians multitasking behaviors around interruptions.
Interruptions can adversely impact human performance, particularly in fast-paced and high-risk environments such as the emergency department (ED). In this paper, the investigators present a comprehensive framework for understanding interruptions that is composed of three phases, each with multiple levels: interruption start transition, interruption engagement, and interruption end transition. This three-phase framework is not constrained to discrete task transitions, providing a robust method to categorize multitasking behaviors around interruptions. They apply this framework in categorizing 457 interruption episodes.
AHRQ-funded; HS022362.
Citation: Fong A, Ratwani RM .
Understanding emergency medicine physicians multitasking behaviors around interruptions.
Acad Emerg Med 2018 Oct;25(10):1164-68. doi: 10.1111/acem.13496..
Keywords: Emergency Department, Workflow, Patient Safety, Provider: Physician, Provider
Denton CA, Soni HC, Kannampallil TG
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
In this article, the authors investigated the perceived effects of electronic health record (EHR) use on clinical workflow and meaningful use (MU) performance metrics. The investigators concluded that physicians' perception of EHRs was likely to influence their practices. They suggested that with negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.
AHRQ-funded; HS022670.
Citation: Denton CA, Soni HC, Kannampallil TG .
Emergency physicians' perceived influence of EHR use on clinical workflow and performance metrics.
Appl Clin Inform 2018 Jul;9(3):725-33. doi: 10.1055/s-0038-1668553..
Keywords: Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Workflow, Provider: Physician, Provider
Kannampallil TG, Denton CA, Shapiro JS
Efficiency of emergency physicians: insights from an observational study using EHR log files.
The authors investigated the nature of electronic health records use and their effect on an emergency department's throughput and efficiency. They found that longer time spent on reviewing information on the electronic health record is potentially associated with decreased emergency department throughput efficiency. The authors also note that balancing between these competing goals is a challenge for physicians, and implications for patient safety are discussed.
AHRQ-funded; HS022670.
Citation: Kannampallil TG, Denton CA, Shapiro JS .
Efficiency of emergency physicians: insights from an observational study using EHR log files.
Appl Clin Inform 2018 Jan;9(1):99-104. doi: 10.1055/s-0037-1621705..
Keywords: Electronic Health Records (EHRs), Emergency Department, Healthcare Delivery, Health Information Technology (HIT), Provider, Provider: Physician
Gernant SA, Snyder ME, Jaynes H
The effectiveness of pharmacist-provided telephonic medication therapy management on emergency department utilization in home health patients.
This article's objective is to evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing emergency department utilization within a Medicare-insured home health population. The authors found that this pharmacist-delivered telephonic medication therapy management program did not decrease emergency department utilization overall but may further reduce the such risk among patients who are at lower risk of utilization.
AHRQ-funded; HS022119.
Citation: Gernant SA, Snyder ME, Jaynes H .
The effectiveness of pharmacist-provided telephonic medication therapy management on emergency department utilization in home health patients.
J Pharm Technol 2016 Oct 1;32(5):179-84. doi: 10.1177/8755122516660376.
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Keywords: Care Management, Emergency Department, Medication, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention, Provider: Pharmacist, Provider
Kayle M, Brennan-Cook J, Carter BM
Evaluation of a sickle cell disease educational website for emergency providers.
Electronic surveys were used to conduct a formal evaluation of the accuracy and relevance of the website's content, as well as the effectiveness of the education modules in improving knowledge among health care providers. Both sickle cell disease experts and ED providers agreed that the module content was clear and easy to understand, accurate, comprehensive, relevant, and met module objectives.
AHRQ-funded; HS019646.
Citation: Kayle M, Brennan-Cook J, Carter BM .
Evaluation of a sickle cell disease educational website for emergency providers.
Adv Emerg Nurs J 2016 Apr-Jun;38(2):123-32. doi: 10.1097/tme.0000000000000099.
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Keywords: Education: Continuing Medical Education, Emergency Department, Health Information Technology (HIT), Provider, Sickle Cell Disease