National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Children/Adolescents (1)
- Communication (1)
- Community-Based Practice (1)
- Electronic Health Records (EHRs) (2)
- Healthcare Delivery (5)
- Health Information Technology (HIT) (1)
- Implementation (2)
- Lifestyle Changes (1)
- Organizational Change (3)
- Patient Experience (1)
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- (-) Primary Care (11)
- Primary Care: Models of Care (2)
- Provider (2)
- Provider Performance (1)
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- Social Determinants of Health (1)
- Teams (2)
- Urban Health (1)
- (-) Workflow (11)
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 11 of 11 Research Studies DisplayedHung DY, Mujal G, Jin A
Patient experiences after implementing lean primary care redesigns.
The authors examined the effect of Lean primary care redesigns on patient satisfaction with care and timeliness of care received. After implementation of Lean redesigns, they found that patients reported a 44.8 percent increase in satisfaction with the adequacy of time spent with care providers during office visits. They also reported 71.6 percent higher satisfaction with their care provider's ability to listen to their concerns and a 55.4 percent increase in perceived staff helpfulness at the visit. The amount of time elapsed between a patient request for a routine appointment and the scheduled visit day decreased. On the day of the visit, patient wait times to be seen also decreased gradually.
AHRQ-funded; HS024529.
Citation: Hung DY, Mujal G, Jin A .
Patient experiences after implementing lean primary care redesigns.
Health Serv Res 2021 Jun;56(3):363-70. doi: 10.1111/1475-6773.13605..
Keywords: Patient Experience, Primary Care: Models of Care, Primary Care, Workflow, Quality Improvement, Quality of Care
Freedman S, Golberstein E, Huang TY
Docs with their eyes on the clock? The effect of time pressures on primary care productivity.
J Health Econ 2021 May;77:102442. doi: 10.1016/j.jhealeco.2021.102442.
Investigators examined how time pressure, an important constraint faced by medical care providers, affects productivity in primary care. Data was taken from the electronic health records of a large integrated delivery system. They found that greater time pressure reduced the number of diagnoses recorded during a visit and increased both scheduled and unscheduled follow-up care. Further, they found evidence of increased low-value care, decreased preventive care, and decreased opioid prescribing.
Investigators examined how time pressure, an important constraint faced by medical care providers, affects productivity in primary care. Data was taken from the electronic health records of a large integrated delivery system. They found that greater time pressure reduced the number of diagnoses recorded during a visit and increased both scheduled and unscheduled follow-up care. Further, they found evidence of increased low-value care, decreased preventive care, and decreased opioid prescribing.
AHRQ-funded; HS000036.
Citation: Freedman S, Golberstein E, Huang TY .
Docs with their eyes on the clock? The effect of time pressures on primary care productivity.
J Health Econ 2021 May;77:102442. doi: 10.1016/j.jhealeco.2021.102442..
Keywords: Primary Care, Healthcare Delivery, Workflow
Linke SE, Kallenberg GR, Kronick R
Integrating "Exercise Is Medicine" into primary care workflow: a study protocol.
As a major contributor to the burden of most chronic diseases, insufficient physical activity (PA) creates a significant financial burden on the health care system. Exercise Is Medicine (EIM) is a global health initiative committed to the belief that PA is integral to the prevention and treatment of diseases and should be routinely assessed as a vital sign and treated in the health care setting. This paper described an in-progress embedded quality improvement (QI) project that integrated EIM into routine clinical practice.
AHRQ-funded; HS026517.
Citation: Linke SE, Kallenberg GR, Kronick R .
Integrating "Exercise Is Medicine" into primary care workflow: a study protocol.
Transl Behav Med 2021 Apr 26;11(4):921-29. doi: 10.1093/tbm/ibaa088..
Keywords: Primary Care, Lifestyle Changes, Workflow, Healthcare Delivery
Hung DY, Truong QA, Liang SY
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
Investigators examined 3-year impacts of Lean implementation on the amount of time taken for physicians to complete common clinical tasks. They found that Lean redesigns led to improvements in timely completion of 3 out of 4 common clinical tasks, thus supporting the use of Lean techniques to engage teams in routine aspects of patient care. They recommended more research to understand the mechanisms by which Lean promotes quality improvement and effectiveness of care team workflows.
AHRQ-funded; HS024529.
Citation: Hung DY, Truong QA, Liang SY .
Implementing lean quality improvement in primary care: impact on efficiency in performing common clinical tasks.
J Gen Intern Med 2021 Feb;36(2):274-79. doi: 10.1007/s11606-020-06317-9..
Keywords: Primary Care, Quality Improvement, Quality of Care, Primary Care: Models of Care, Primary Care, Implementation, Workflow, Teams, Healthcare Delivery
Read JM, Weiler DT, Satterly T
Provider preference in exam room layout design and computing.
This study examined the impact of electronic health records (EHRs) on exam room design which would make it easier for providers to promote flexibility, mobility, and body orientation directed towards the patient. Semistructured interviews with 28 providers was conducted and the interviews were audio recorded and transcribed for analysis. Flexibility in sharing the computer screen with patients was an important theme as well as exam room layout, exam room computing and provider workflow.
AHRQ-funded; HS024488.
Citation: Read JM, Weiler DT, Satterly T .
Provider preference in exam room layout design and computing.
Appl Clin Inform 2019 Oct;10(5):972-80. doi: 10.1055/s-0039-3401813..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow, Primary Care, Provider
Hung DY, Harrison MI, Liang SY
AHRQ Author: Harrison MI
Contextual conditions and performance improvement in primary care.
This study examined organizational features of primary care clinics that had gone through Lean redesigns and had experienced the greatest performance improvements. They surveyed 1333 physicians and staff in 43 primary care clinics across a large primary care system. They found that clinics with prior experience with quality improvement had the highest increases in efficiency. Clinics reporting the highest levels of burnout and work stress before the redesign also made efficiency gains. Physician productivity gains was associated with a history of change, staff participation and leadership support. The greatest improvements in patient satisfaction occurred where there was the lowest stress levels with highest levels of teamwork, staff engagement and leadership support.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Harrison MI, Liang SY .
Contextual conditions and performance improvement in primary care.
Qual Manag Health Care 2019 Apr/Jun;28(2):70-77. doi: 10.1097/qmh.0000000000000198..
Keywords: Organizational Change, Healthcare Delivery, Primary Care, Provider Performance, Quality Improvement, Quality of Care, Workflow
Fiori K, Patel M, Sanderson D
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
The authors described their experience implementing a novel social needs screening program at an academic pediatric clinic. They found that, on average, 76% of providers had their patients screened on more than half of eligible well-child visits. Their experience suggested that screening for social needs at well-child visits is feasible as part of routine primary care. They recommended that success would best be achieved by leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.
AHRQ-funded; HS026396.
Citation: Fiori K, Patel M, Sanderson D .
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719899207. doi: 10.1177/2150132719899207..
Keywords: Children/Adolescents, Community-Based Practice, Healthcare Delivery, Implementation, Screening, Social Determinants of Health, Urban Health, Workflow, Primary Care
Hung DY, Gray CP, Truong QA
AHRQ Author: Harrison MI
Sustainment of lean redesigns for primary care teams.
This mixed-methods study examined the sustainment of Lean workflow redesigns for primary care teams several years after being implemented in a large, ambulatory care delivery system. Results showed that staff participation in Lean redesign is a key to facilitating buy-in and adherence to changes. Change ownership and continued availability of time for improvement activities are also critical to the long-term success of Lean implementation in primary care.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Hung DY, Gray CP, Truong QA .
Sustainment of lean redesigns for primary care teams.
Qual Manag Health Care 2019 Jan/Mar;28(1):15-24. doi: 10.1097/qmh.0000000000000200..
Keywords: Primary Care, Workflow, Teams, Organizational Change, Quality Improvement, Quality of Care
Menon S, Murphy DR, SIngh H
Workarounds and test results follow-up in electronic health record-based primary care.
This study sought to understand why primary care practitioners use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management. It concluded that workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs.
AHRQ-funded; HS022901; HS022087.
Citation: Menon S, Murphy DR, SIngh H .
Workarounds and test results follow-up in electronic health record-based primary care.
Appl Clin Inform 2016 Jun 22;7(2):543-59. doi: 10.4338/aci-2015-10-ra-0135.
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Keywords: Communication, Electronic Health Records (EHRs), Primary Care, Workflow
Gray CP, Harrison MI, Hung D
AHRQ Author: Harrison MI
Medical assistants as flow managers in primary care: challenges and recommendations.
Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, the authors found that using medical assistants (Mas) as flow managers required overcoming several challenges. These included entrenched social and occupational hierarchies between physicians and MAs, a lack of adequate training and mentorship, and difficulty attracting and retaining talented MAs.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Gray CP, Harrison MI, Hung D .
Medical assistants as flow managers in primary care: challenges and recommendations.
J Healthc Manag 2016 May-Jun;61(3):181-91.
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Keywords: Primary Care, Organizational Change, Practice Improvement, Quality Improvement, Quality of Care, Workflow, Provider
Holman GT, Beasley JW, Karsh BT
The myth of standardized workflow in primary care.
This analysis evaluates workflow variation in terms of the sequence of tasks performed during patient visits. It concluded that the prevalence of specific tasks shifts significantly as primary care visits progress to their conclusion but, notably, PCPs collect patient information throughout the visit.
AHRQ-funded; HS017115; HS017014.
Citation: Holman GT, Beasley JW, Karsh BT .
The myth of standardized workflow in primary care.
J Am Med Inform Assoc 2016 Jan;23(1):29-37. doi: 10.1093/jamia/ocv107.
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Keywords: Primary Care, Workflow