National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Behavioral Health (1)
- Burnout (5)
- Cardiovascular Conditions (1)
- Care Management (1)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (2)
- COVID-19 (3)
- Decision Making (2)
- Diagnostic Safety and Quality (2)
- Electronic Health Records (EHRs) (2)
- Electronic Prescribing (E-Prescribing) (1)
- Evidence-Based Practice (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (3)
- Heart Disease and Health (1)
- Hospitals (2)
- Imaging (2)
- Medicare (1)
- Medication (3)
- Opioids (2)
- Organizational Change (2)
- Pain (1)
- Patient-Centered Healthcare (1)
- Patient Safety (2)
- Policy (1)
- Practice Improvement (1)
- Practice Patterns (2)
- Primary Care (9)
- Primary Care: Models of Care (2)
- Provider (11)
- (-) Provider: Clinician (19)
- Provider: Health Personnel (1)
- Provider: Nurse (5)
- Provider: Physician (11)
- Quality of Care (1)
- Respiratory Conditions (1)
- Risk (1)
- Simulation (1)
- Social Determinants of Health (1)
- Stress (4)
- Teams (1)
- Training (1)
- Workforce (2)
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 19 of 19 Research Studies DisplayedGallo T, Heise CW, Woosley RL
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
The purpose of this study was to create an advanced torsades de pointes (TdP) clinical decision support (CDS) advisory that provides relevant, patient-specific information, including 1-click management options, and to evaluate clinician satisfaction with the CDS. The researchers implemented the advanced TdP CDS across a health system comprising 29 hospitals. A brief electronic survey was developed to collect clinician feedback on the advisory and was emailed to 442 clinicians who received the advisory. Feedback was generally positive across the 38 responding providers, with 79% of respondents reporting that the advisory assisted with their care for their patients and 87% responding that the alerts clearly specified alternative actions. The researchers concluded that providers who receive an advanced TdP risk CDS alert generally view the alert favorably.
AHRQ-funded; HS026662.
Citation: Gallo T, Heise CW, Woosley RL .
Clinician satisfaction with advanced clinical decision support to reduce the risk of torsades de pointes.
J Patient Saf 2022 Sep 1;18(6):e1010-e13. doi: 10.1097/pts.0000000000000996..
Keywords: Clinical Decision Support (CDS), Decision Making, Risk, Provider: Clinician, Heart Disease and Health, Cardiovascular Conditions
Fraze TK, Beidler LB, Gottlieb LM
A missed opportunity? How health care organizations engage primary care clinicians in formal social care efforts.
The purpose of this study was to explore how health care organizations include clinicians in formal social care efforts. Administrators of 29 health care organizations participated in 33 semi-structured interviews in 2019. Administrators were hesitant to increase primary care providers' responsibilities with social care activities, but believed clinicians could engage in social care programs in 4 ways: 1) Strengthen relationships with patients by discussing social risks; 2) adjust follow-up clinical care plans based on social risks; 3) adapt prescriptions based on social risks; and (4) refer patients to other care team members who can directly assist with social risks.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Gottlieb LM .
A missed opportunity? How health care organizations engage primary care clinicians in formal social care efforts.
Popul Health Manag 2022 Aug;25(4):509-16. doi: 10.1089/pop.2021.0306..
Keywords: Primary Care, Provider: Clinician, Social Determinants of Health
Williams JP, Nathanson R, LoPresti CM
Current use, training, and barriers in point-of-care ultrasound in hospital medicine: a national survey of VA hospitals.
This study aimed to characterize current point-of-care ultrasound (POCUS) use, training needs, and barriers to use among hospital medicine groups (HMGs). This prospective observation study looked at all Veterans Affairs (VA) medical centers from August 2019 to March 2020 using a web-based survey sent to all chiefs of HMGs. There was a 90% response rate from 117 HMGs. Procedural POCUS use decreased by 19% from 2015 to 2020 but increased for diagnostic use for cardiac (8%), pulmonary (7%), and abdominal (8%) applications. The most common barrier to POCUS use was lack of training (89%), with only 34% of HMGs having access to POCUS training. Access to ultrasound equipment was the least common barrier at 57%, however with the proportion of HMGs with ≥1 ultrasound machine increasing from 29% to 71% from 2015 to 2020. In 2020 an average of 3.6 ultrasound devices per HMG was available, and 45% were handheld devices.
AHRQ-funded; HS025979.
Citation: Williams JP, Nathanson R, LoPresti CM .
Current use, training, and barriers in point-of-care ultrasound in hospital medicine: a national survey of VA hospitals.
J Hosp Med 2022 Aug;17(8):601-08. doi: 10.1002/jhm.12911..
Keywords: Imaging, Training, Hospitals, Diagnostic Safety and Quality, Provider: Clinician
Evans LV, Ray JM, Bonz JW
Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol.
The purpose of this study will be to simultaneously assess the challenges and facilitators of COVID-19 preparedness in the emergency department (ED) and the mitigation of emergency physician stress, test the effectiveness of a simulation preparedness intervention on physician physiological stress, and improve physician preparedness while decreasing physician stress and anxiety.
AHRQ-funded; HS028340.
Citation: Evans LV, Ray JM, Bonz JW .
Improving patient and clinician safety during COVID-19 through rapidly adaptive simulation and a randomised controlled trial: a study protocol.
BMJ Open 2022 May 19;12(5):e058980. doi: 10.1136/bmjopen-2021-058980..
Keywords: COVID-19, Patient Safety, Simulation, Burnout, Provider: Clinician
Smith LB
The effect of nurse practitioner scope of practice laws on primary care delivery.
Nurse practitioners (NPs) are an increasingly integral part of the primary care workforce. NPs' authority to practice without physician oversight is regulated by state-level scope of practice (SOP) restrictions. To the extent that SOP restrictions prevent NPs from practicing to their full abilities and capacity, they could create inefficiencies and restrict access to health care. The purpose of this paper was to explore what occurs at primary care practices when states ease their scope of practice (SOP) laws. The researcher utilized a novel dataset of claims and electronic health records to quantify the effects of easing SOP laws in 3 areas: 1. Nurse Practitioners' autonomy in their everyday jobs; 2. Total workload and the allocation of patients between physicians and NPs; and 3. The delivery of low-value services at primary care practices. The study found no evidence that easing SOP laws impacts neither the volume or allocation of patients to NPs, nor the delivery of low-value services.
AHRQ-funded; HS026659.
Citation: Smith LB .
The effect of nurse practitioner scope of practice laws on primary care delivery.
Health Econ 2022 Jan; 31(1):21-41. doi: 10.1002/hec.4438..
Keywords: Primary Care, Healthcare Delivery, Policy, Provider: Clinician, Provider: Nurse
O'Leary KJ, Manojlovich M, Johnson JK
A multisite study of interprofessional teamwork and collaboration on general medical services.
This multisite study of four mid-sized hospitals measured teamwork climate of nurses, nurse assistants, and physicians working on general medical services. Teamwork climate scores for 380 participants (80 hospitalists, 13 resident physicians, 193 nurses, and 94 nurses) were measured using the Safety Attitudes Questionnaire. Hospitalists had the highest median teamwork climate score and nurses had the lowest, but it was not a statistically significant difference. A higher percentage of hospitalists (63.3%) rated the quality of collaboration with nurses as high or very high, but only 48.7% of nurses rated the collaboration with hospitalists as high or very high. There were significant differences in perceptions of teamwork climate across sites and across professional categories.
AHRQ-funded; HS025649.
Citation: O'Leary KJ, Manojlovich M, Johnson JK .
A multisite study of interprofessional teamwork and collaboration on general medical services.
Jt Comm J Qual Patient Saf 2020 Dec;46(12):667-72. doi: 10.1016/j.jcjq.2020.09.009..
Keywords: Teams, Hospitals, Patient Safety, Provider: Clinician, Provider: Physician, Provider: Nurse, Provider
Everson J, Cheng AK, Patrick SW
Association of electronic prescribing of controlled substances with opioid prescribing rates.
The purpose of this study was to assess the association between use of electronic prescribing of controlled substances (EPCS) and trends in opioid prescribing. Results suggested that an increased use of EPCS was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing. Recommendations included levers to ensure that EPCS is integrated with outside data and that information is actively used to inform prescribing decisions.
AHRQ-funded; HS026395.
Citation: Everson J, Cheng AK, Patrick SW .
Association of electronic prescribing of controlled substances with opioid prescribing rates.
JAMA Netw Open 2020 Dec;3(12):e2027951. doi: 10.1001/jamanetworkopen.2020.27951..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Opioids, Medication, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Militello LG, Hurley RW, Cook RL
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
Investigators sought a better understanding of primary care clinicians’ approaches to managing patients with chronic pain and explored implications for technological and administrative interventions. They found that primary care clinicians’ beliefs about opioid therapy generally align with the clinical evidence but may have some important gaps, suggesting the potential value of interventions that include improved access to research findings, organizational changes to support spending time with patients to develop rapport, and the need for innovative clinical cognitive support.
AHRQ-funded; HS023306.
Citation: Militello LG, Hurley RW, Cook RL .
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
J Gen Intern Med 2020 Dec;35(12):3542-48. doi: 10.1007/s11606-020-06178-2..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Provider: Physician, Provider: Clinician, Provider, Care Management
Fraze TK, Briggs ADM, Whitcomb EK
Role of nurse practitioners in caring for patients with complex health needs.
The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics. Findings showed that nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.
AHRQ-funded; HS024075.
Citation: Fraze TK, Briggs ADM, Whitcomb EK .
Role of nurse practitioners in caring for patients with complex health needs.
Med Care 2020 Oct;58(10):853-60. doi: 10.1097/mlr.0000000000001364..
Keywords: Provider: Clinician, Provider: Nurse, Provider, Chronic Conditions, Primary Care, Medicare
Shechter A, Diaz F, Moise N
Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.
The mental health toll of COVID-19 on healthcare workers (HCW) is not yet fully described. In this study the authors, using a cross-sectional web survey, characterized distress, coping, and preferences for support among NYC HCWs during the COVID-19 pandemic. They concluded that NYC HCWs, especially nurses and advanced practice providers, were experiencing COVID-19-related psychological distress.
AHRQ-funded; HS024262.
Citation: Shechter A, Diaz F, Moise N .
Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic.
Gen Hosp Psychiatry 2020 Sep-Oct;66:1-8. doi: 10.1016/j.genhosppsych.2020.06.007..
Keywords: COVID-19, Stress, Provider: Clinician, Provider: Physician, Provider: Nurse, Provider: Health Personnel, Behavioral Health
Poghosyan L, Ghaffari A, Liu J
Organizational support for nurse practitioners in primary care and workforce outcomes.
Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. In this study, the researchers investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. The investigators concluded that nurse practitioners from primary care practices with higher levels of organizational support were more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Organizational support for nurse practitioners in primary care and workforce outcomes.
Nurs Res 2020 Jul/Aug;69(4):280-88. doi: 10.1097/nnr.0000000000000425..
Keywords: Provider: Clinician, Provider, Primary Care, Burnout, Stress, Workforce, Organizational Change
Bansal P, Bingemann TA, Greenhawt M
Clinician wellness during the COVID-19 pandemic: extraordinary times and unusual challenges for the allergist/immunologist.
This article describes current challenges for the allergy/immunology community due to the COVID-19 pandemic. The need for social distancing adds to complexity of care and can create isolation and anxiety. The authors suggests that tools such as the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation approach, wellness apps, mindfulness and gratitude can be used to help reduce issues contributing to burnout, depression, anxiety, substance abuse, and posttraumatic stress disorder.
AHRQ-funded; HS024599.
Citation: Bansal P, Bingemann TA, Greenhawt M .
Clinician wellness during the COVID-19 pandemic: extraordinary times and unusual challenges for the allergist/immunologist.
J Allergy Clin Immunol Pract 2020 Jun;8(6):1781-90.e3. doi: 10.1016/j.jaip.2020.04.001..
Keywords: COVID-19, Burnout, Stress, Provider: Clinician, Provider: Physician
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
AHRQ-funded; HS025701.
Citation: Westafer LM, Kunz A, Bugajska P .
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Poghosyan L, Ghaffari A, Liu J
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
Primary care practices increasingly rely on the growing workforce of nurse practitioners (NPs) to meet primary care demand. Understanding teamwork between NPs and physicians in primary care practices is critically important. In this study, the investigators assessed teamwork between NPs and physicians practicing within the same primary care practice and determined how teamwork affected their job satisfaction, intent to leave their current job, and quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
J Gen Intern Med 2020 Apr;35(4):1021-28. doi: 10.1007/s11606-019-05509-2..
Keywords: Primary Care: Models of Care, Primary Care, Provider: Clinician, Provider: Physician, Provider, Workforce, Quality of Care
Adler-Milstein J, Zhao W, Willard-Grace R
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
This study examined whether objective measures of electronic health record (EHR) use-related to time, volume of work, and proficiency are associated with either exhaustion or cynicism. The authors combined Maslach Burnout Inventory survey measures with objective, vendor-defined EHR use measures from log files. Data was collected from all primary care clinics of a large, urban medical academic center in early 2018. One-third of clinicians had high cynicism and 51% had high emotional exhaustion. The clinicians with the most exhaustion spent time using the EHR after hours.
AHRQ-funded; HS022241.
Citation: Adler-Milstein J, Zhao W, Willard-Grace R .
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
J Am Med Inform Assoc 2020 Apr;27(4):531-38. doi: 10.1093/jamia/ocz220..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Clinician, Provider: Physician, Provider, Primary Care
Kohut MR, Keller SC, Linder JA
AHRQ Author: Miller MA
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Researchers conducted semi-structured interviews with clinicians to determine how they perceive demand for antibiotics in the outpatient setting. They conducted interviews with 25 clinicians from nine practices across three states. Patient demand was the most common reason why non-indicated antibiotics were prescribed. Clinicians felt that if they didn’t prescribe them they would experience repercussions in their reputation and practice and that certain patients are impossible to please without an antibiotic prescription regardless of the diagnosis.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Kohut MR, Keller SC, Linder JA .
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Fam Pract 2020 Mar 25;37(2):276-82. doi: 10.1093/fampra/cmz066..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Ambulatory Care and Surgery, Provider: Clinician, Provider: Physician, Provider
Kennedy-Metz L, Weiss P, Parker SH
Results of exploratory investigation into adherence to auditory coping instructions during an acutely stressful task.
Healthcare providers often perform under significant stress, during which their performance must be optimal, but is known to suffer. Stress management interventions in this context can provide cognitive support to rescue performance. This exploratory study sought to evaluate the effect of stress intervention components on stress and performance while clinicians engaged in two versions of a computer-based task, differing in overall level of demand: one high-stress and one low-stress.
AHRQ-funded; HS023465.
Citation: Kennedy-Metz L, Weiss P, Parker SH .
Results of exploratory investigation into adherence to auditory coping instructions during an acutely stressful task.
Stress 2020 Mar;23(2):144-52. doi: 10.1080/10253890.2019.1660317..
Keywords: Stress, Provider: Clinician, Provider
Babbott S, Manwell LB, Brown R
Electronic medical records and physician stress in primary care: results from the MEMO Study.
In this paper, the investigators assessed relationships between the number of EMR functions, primary care work conditions, and physician satisfaction, stress and burnout. The authors concluded that stress may rise for physicians with a moderate number of EMR functions; they found that time pressure was associated with poor physician outcomes mainly in the high EMR cluster.
AHRQ-funded; HS011955.
Citation: Babbott S, Manwell LB, Brown R .
Electronic medical records and physician stress in primary care: results from the MEMO Study.
J Am Med Inform Assoc 2014 Feb;21(e1):e100-6. doi: 10.1136/amiajnl-2013-001875..
Keywords: Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider: Clinician, Provider: Physician
Bleser WK, Miller-Day M, Naughton D
Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home.
In this paper the authors describe strategies for obtaining organizational buy-in to and whole-staff engagement of patient-centered medical home (PCMH) transformation and practice improvement. The investigators suggest that their study provides a list of strategies useful for facilitating PCMH transformation in primary care. They assert that these strategies could be investigated empirically in future research, used to guide medical practices undergoing or considering PCMH transformation, and used to inform health care policy makers.
AHRQ-funded; HS019150.
Citation: Bleser WK, Miller-Day M, Naughton D .
Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home.
Ann Fam Med 2014 Jan-Feb;12(1):37-45. doi: 10.1370/afm.1564..
Keywords: Patient-Centered Healthcare, Organizational Change, Primary Care: Models of Care, Primary Care, Practice Improvement, Provider: Nurse, Provider: Physician, Provider: Clinician, Provider