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
1 to 25 of 32 Research Studies DisplayedBranca A, Tellez D, Berkenbosch J
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Researchers evaluated the effect of the timing of the PICU fellow academic cycle on tracheal intubation-associated events in a retrospective cohort study of 37 PICUs participating in the National Emergency Airway Registry for Children.. They found that the New Trainee Effect in tracheal intubation safety outcomes was not observed in various types of PICUs. There was a significant improvement in pediatric critical care medicine fellows' first attempt success and a significant decline in tracheal intubation-associated event rates, indicating substantial skills acquisition throughout pediatric critical care medicine fellowship.
AHRQ-funded; HS021583; HS022464; HS024511.
Citation: Branca A, Tellez D, Berkenbosch J .
The new trainee effect in tracheal intubation procedural safety across PICUs in North America: a report from National Emergency Airway Registry for Children.
Pediatr Crit Care Med 2020 Dec;21(12):1042-50. doi: 10.1097/pcc.0000000000002480..
Keywords: Children/Adolescents, Critical Care, Intensive Care Unit (ICU), Adverse Events, Patient Safety, Registries, Education: Continuing Medical Education, Training
Burgdorf JG, Arbaje AI, Wolff JL
Training needs among family caregivers assisting during home health, as identified by home health clinicians.
This study’s objective was to estimate the proportion of family caregivers assisting older adults during Medicare home health who have an identified need for activity-specific training and identify characteristics associated with caregiver training needs. This nationally representative retrospective cohort study included 1758 Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011 and 2016. More than 1 in 3 family caregivers assisting older adults during Medicare home health had an identified training need with at least 1 caregiving activity. Training needs varied widely, from 8.6% among caregiving helping with advocacy to 48.2% among caregivers helping with medical procedures. Weighted analyses adjusted for older adults’ health and function showed family caregivers were less likely to have identified training needs when assisting older adults with ongoing disability or who received caregiver assistance before home health admission.
AHRQ-funded; HS000029.
Citation: Burgdorf JG, Arbaje AI, Wolff JL .
Training needs among family caregivers assisting during home health, as identified by home health clinicians.
J Am Med Dir Assoc 2020 Dec;21(12):1914-19. doi: 10.1016/j.jamda.2020.05.032..
Keywords: Caregiving, Home Healthcare, Education: Patient and Caregiver, Training
Brady AK, Brown W, Denson JL
Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship.
This study looked at outcomes of participation of fellows for Pulmonary and Critical Medicine (PCCM) training in endotracheal intubation in the medical intensive care unit (ICU). The authors administered a survey to a convenience sample of US PCCM fellows. A total of 89 discrete US PCCM and Internal Medicine CCM training programs were represented. Almost half (43%) of PCCM fellows were “always or almost always” designed the primary operator for intubation, whereas 21% of programs had the PCCM fellow “rarely or never” the primary operator responsible for intubating in the ICU. Various influencing factors included time of day, hospital policies, attending skill or preference, ICU census and acuity, and patient factors. There was an association between location of the training program but not program size whether the PCCM fellow was the primary operator.
AHRQ-funded; HS026122.
Citation: Brady AK, Brown W, Denson JL .
Variation in intensive care unit intubation practices in pulmonary critical care medicine fellowship.
ATS Sch 2020 Dec;1(4):395-405. doi: 10.34197/ats-scholar.2020-0004OC..
Keywords: Intensive Care Unit (ICU), Respiratory Conditions, Training, Education: Academic, Critical Care
Brown W, Santhosh L, Brady AK
A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit.
This article presents a review of endotracheal intubation (EI) training for healthcare professionals in pulmonary and critical care medicine (PCCM). Although the ACGME mandates that trainees in PCCM achieve competence, only 60% of US PCCM trainees feel they are proficient in EI upon graduation. This article includes a review of EI training literature; the recommendations of a national group of PCCM, anesthesiology, emergency medicine, and pediatric experts; and a call for further research, collaboration, and consensus guidelines.
Citation: Brown W, Santhosh L, Brady AK .
A call for collaboration and consensus on training for endotracheal intubation in the medical intensive care unit.
Crit Care 2020 Oct 22;24(1):621. doi: 10.1186/s13054-020-03317-3..
Keywords: Training, Education: Continuing Medical Education, Critical Care, Intensive Care Unit (ICU), Guidelines
Alley L, Novak K, Havlin T
Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists
The authors developed the Resources Encouraging Safe Prescription Opioid and Naloxone Dispensing (RESPOND) Toolkit to enhance community pharmacists' understanding of their role in addressing opioid safety; to improve integration of prescription drug monitoring program (PDMP) into daily workflow; and to enhance communication between pharmacists, prescribers, and patients. In this paper, they described the development of the RESPOND Toolkit and summarized their findings from initial pilot testing. They concluded that the RESPOND Toolkit has promise as an effective and scalable approach to providing community pharmacist-tailored training to promote behavioral shifts supporting opioid safety for patients.
AHRQ-funded; HS024227.
Citation: Alley L, Novak K, Havlin T .
Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists
Res Social Adm Pharm 2020 Oct;16(10):1422-30. doi: 10.1016/j.sapharm.2019.12.023..
Keywords: Opioids, Substance Abuse, Medication, Medication: Safety, Patient Safety, Tools & Toolkits, Communication, Provider: Pharmacist, Provider, Training
Glass M, Rana S, Coghlan R
Global palliative care education in the time of COVID-19.
This paper describes the Global Palliative Education Collaborative (GPEC), which is a training partnership between Harvard, University of California San Francisco, and Tulane medical schools in the U.S., and international palliative care (PC) programs in Uganda and India. U.S.-based fellowships are offered by GPEC to learn about resource-limited PC provision, gain perspectives on global challenges to caring for patients at the end of life, and cultivate resiliency. They also offer a novel educational project that the GPEC faculty and fellows are participating in called the Resilient Inspirational Storytelling Empathy Project. Palliative care has become even more important during the COVID-19 pandemic.
AHRQ-funded; HS026383.
Citation: Glass M, Rana S, Coghlan R .
Global palliative care education in the time of COVID-19.
J Pain Symptom Manage 2020 Oct;60(4):e14-e19. doi: 10.1016/j.jpainsymman.2020.07.018..
Keywords: Palliative Care, COVID-19, Education: Continuing Medical Education, Training
Zittleman L, Curcija K, Sutter C
Building capacity for medication assisted treatment in rural primary care Practices: the IT MATTTRs practice team training.
In response to rural communities and practice concerns related to opioid use disorder (OUD), the Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado study (IT MATTTRs) developed a training intervention for full primary care practice (PCP) teams in MAT for OUD. This evaluation reports on training implementation, participant satisfaction, and impact on perceived ability to deliver MAT.
AHRQ-funded; HS025065.
Citation: Zittleman L, Curcija K, Sutter C .
Building capacity for medication assisted treatment in rural primary care Practices: the IT MATTTRs practice team training.
J Prim Care Community Health 2020 Jan-Dec;11:2150132720953723. doi: 10.1177/2150132720953723..
Keywords: Medication, Primary Care, Opioids, Substance Abuse, Rural Health, Training, Education: Continuing Medical Education
Costar DM, Hall KK
Improving team performance and patient safety on the job through team training and performance support tools: a systematic review.
This systematic review’s objective was to identify recent studies that implemented practices to improve teamwork in health care and were associated with positive improvements on the job. Two databases were searched to identify relevant articles published between 2008 and 2018. Twenty articles were selected for inclusion. Across studies, measures assessing teamwork skills on the job were most often collected and sustained improvements were shown for up to 12 months. Evidence of improved clinical practices and increased patient safety was found in both studies team training interventions, as well as those that introduced performance support tools. All studies were conducted in hospitals with very few studies found in other health care settings such as office-based care.
AHRQ-funded; HHSP233201500013I.
Citation: Costar DM, Hall KK .
Improving team performance and patient safety on the job through team training and performance support tools: a systematic review.
J Patient Saf 2020 Sep;16(3S Suppl 1):S48-s56. doi: 10.1097/pts.0000000000000746..
Keywords: Teams, Patient Safety, Training, Patient Safety, Provider Performance, Quality Improvement, Quality of Care
Kraut AS, Sheehy L, Schnapp BH
Effect of resident physicians in a supervisory role on efficiency in the emergency department.
The authors sought to examine the impact of a staffing model involving a supervisory resident "pre-attending" (PAT) on emergency department (ED) throughput and length of stay (LOS). Over 26,000 unique patient encounters at a university-affiliated community ED were retrospectively analyzed. They found that the presence of a PAT is associated with a statistically significant increase in service time of five minutes, but this magnitude is likely operationally insignificant. They concluded that the negligible increase in service time is offset by the benefit to residents' training.
AHRQ-funded; HS024558.
Citation: Kraut AS, Sheehy L, Schnapp BH .
Effect of resident physicians in a supervisory role on efficiency in the emergency department.
West J Emerg Med 2020 Aug 24;21(5):1266-69. doi: 10.5811/westjem.2020.7.46587..
Keywords: Emergency Department, Education: Academic, Training
Thomas GW, Long S, Tatum M
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
In this paper, a vision is presented to elevate community orthopedic practice and improve patient safety by advancing the use of simulators for training and assessing surgical skills. Key elements of this vision included 1) methods for the objective and rigorous assessment of the performance of practicing surgeons now exist, 2) simulators are sufficiently mature and sophisticated that practicing surgeons will use them, and 3) practicing surgeons can improve their performance with appropriate feedback and coaching.
AHRQ-funded; HS022077; HS025353.
Citation: Thomas GW, Long S, Tatum M .
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
Iowa Orthop J 2020;40(1):25-34..
Keywords: Orthopedics, Surgery, Simulation, Training, Provider: Physician, Provider
Daly Guris RJ, Doshi A, Boyer DL
Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management.
This paper describes the development and enactment of a number of simulation exercises, increasing in complexity for clinicians to practice intubation of critically ill children while wearing personal protective equipment due to coronavirus disease. The simulations ended up aiding in a real-life situation that then occurred less than 12 hours later that validated potential failure points and effectiveness of rapidly generated guidance. From this simulation a COVID-19 airway bundle template was created.
AHRQ-funded; HS026939; HS024511.
Citation: Daly Guris RJ, Doshi A, Boyer DL .
Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management.
Pediatr Crit Care Med 2020 Aug;21(8):e485-e90. doi: 10.1097/pcc.0000000000002435..
Keywords: Children/Adolescents, COVID-19, Respiratory Conditions, Workflow, Simulation, Training
Lurie JD, Zagaria AB, Ellis L
Surface perturbation training to prevent falls in older adults: a highly pragmatic, randomized controlled trial.
This study’s objective was to determine if adding a component of surface-perturbation training to usual gait/balance training was more effective than gait/balance training alone for reducing falls and fall-related injuries in high-risk older adults referred to physical therapy. This multi-center trial took place at 8 outpatient physical therapy clinics. The cohort included 506 patients aged 65 and older at high fall risk. The group was randomized between treatment with and without surface-perturbation treadmill training. The results were that the training did not significantly reduce risk of any fall but did significantly reduce chance of a fall-related injury after the first 3 months.
AHRQ-funded; HS018459.
Citation: Lurie JD, Zagaria AB, Ellis L .
Surface perturbation training to prevent falls in older adults: a highly pragmatic, randomized controlled trial.
Phys Ther 2020 Jul 19;100(7):1153-62. doi: 10.1093/ptj/pzaa023..
Keywords: Elderly, Falls, Prevention, Training
Panchal AR, Finnegan G, Way DP
Assessment of paramedic performance on difficult airway simulation.
The purpose of this study was to assess paramedic comprehensive airway management practices during a difficult airway simulation through which paramedics were obligated to consider alternatives to endotracheal intubation (ETI). The investigators concluded that in a difficult airway management scenario designed for low ETI success rates, even experienced paramedics were challenged with comprehensive airway management. This was exemplified by difficulties with the use of backup airway devices.
AHRQ-funded; HS021456.
Citation: Panchal AR, Finnegan G, Way DP .
Assessment of paramedic performance on difficult airway simulation.
Prehosp Emerg Care 2020 May-Jun;24(3):411-20. doi: 10.3109/10903127.2015.1102993..
Keywords: Simulation, Emergency Medical Services (EMS), Training, Quality of Care, Care Management, Provider Performance
Anton NE, Bean EA, Myers E
Optimizing learner engagement during mental skills training: a pilot study of small group vs. individualized training.
This study compared small group versus individualized training results for a group of residents learning laparoscopic suturing. Residents at one institution completed small group training and the second institution completed individualized training. After mental skills training, the completed FLS training at which time they completed the Short State Stress Questionnaire detailing the training. Twenty-one residents completed the training. Individualized training showed greater engagement and mental skills than small group training.
AHRQ-funded; HS022080.
Citation: Anton NE, Bean EA, Myers E .
Optimizing learner engagement during mental skills training: a pilot study of small group vs. individualized training.
Am J Surg 2020 Feb;219(2):335-39. doi: 10.1016/j.amjsurg.2019.12.022..
Keywords: Training, Education: Continuing Medical Education, Simulation, Surgery, Education: Curriculum
Salzman DH, Rising KL, Cameron KA
Setting a minimum passing standard for the uncertainty communication checklist through patient and physician engagement.
Historically, medically trained experts have served as judges to establish a minimum passing standard (MPS) for mastery learning. As mastery learning expands from procedure-based skills to patient-centered domains, such as communication, there is an opportunity to incorporate patients as judges in setting the MPS. In this study, the investigators described their process of incorporating patients as judges to set the minimum passing standard (MPS) and compared the MPS set by patients and emergency medicine residency program directors (PDs).
AHRQ-funded; HS025651.
Citation: Salzman DH, Rising KL, Cameron KA .
Setting a minimum passing standard for the uncertainty communication checklist through patient and physician engagement.
J Grad Med Educ 2020 Feb;12(1):58-65. doi: 10.4300/jgme-d-19-00483.1..
Keywords: Clinician-Patient Communication, Communication, Patient and Family Engagement, Patient Safety, Education: Continuing Medical Education, Training, Provider Performance
Boehm LM, Stolldorf DP, Jeffery AD
Implementation science training and resources for nurses and nurse scientists.
This study discusses the need for implementation science training for nurses and nurse scientists and to encourage training in implementation science for these professions. The differences between quality improvement and implementation science is described as well. Implementation science educational opportunities were reviewed internationally along with organizations and literature. The role of nurses and nurse scientists in translating evidence into routine practice was also examined.
AHRQ-funded; HS025486.
Citation: Boehm LM, Stolldorf DP, Jeffery AD .
Implementation science training and resources for nurses and nurse scientists.
J Nurs Scholarsh 2020 Jan;52(1):47-54. doi: 10.1111/jnu.12510..
Keywords: Provider: Nurse, Provider, Implementation, Training, Evidence-Based Practice
Fernandez R, Rosenman ED, Olenick J
Simulation-based team leadership training improves team leadership during actual trauma resuscitations: a randomized controlled trial.
This study’s objective was to assess the clinical impact of simulation-based leadership training on team leadership and patient care during trauma resuscitations. A total of 79 second- and third-year residents at the Harborview Medical Center (a level 1 trauma center) were randomized and 360 resuscitations were analyzed. Participant-led actual trauma resuscitations were video recorded and then coded for leadership behaviors and patient care. Then the residents were randomized to a 4-hour simulation-based leadership training (intervention) or standard orientation (control) condition. The leadership behaviors were then scored pre- and post-training. There was a significant difference in post-training leadership behaviors between the intervention and control conditions.
AHRQ-funded; HS022458.
Citation: Fernandez R, Rosenman ED, Olenick J .
Simulation-based team leadership training improves team leadership during actual trauma resuscitations: a randomized controlled trial.
Crit Care Med 2020 Jan;48(1):73-82. doi: 10.1097/ccm.0000000000004077..
Keywords: Teams, Trauma, Simulation, Training, Provider
Thomas KS, Allen SM
Interagency partnership to deliver veteran-directed home and community-based services: interviews with Aging and Disability Network agency personnel regarding their experience with partner Department of Veterans Affairs medical centers.
The objective of this article is to describe the Aging and Disability Network agency (ADNA) personnel's perceptions of the implementation of the VD-HCBS program with partner Department of Veterans Affairs medical centers (VAMCs). Results suggest that the majority of ADNA personnel interviewed perceive the collaboration experience to be positive. Interviewees reported several key mechanisms for facilitating a successful partnership.
AHRQ-funded; HS000011.
Citation: Thomas KS, Allen SM .
Interagency partnership to deliver veteran-directed home and community-based services: interviews with Aging and Disability Network agency personnel regarding their experience with partner Department of Veterans Affairs medical centers.
J Rehabil Res Dev 2016;53(5):611-18. doi: 10.1682/jrrd.2015.02.0019.
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Keywords: Community-Based Practice, Provider: Health Personnel, Home Healthcare, Training
Komaromy M, Duhigg D, Metcalf A
Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders.
ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning. This article describes a teleECHO clinic that is focused on treatment of substance use disorders (SUDs) and behavioral health disorders. It concluded that the ECHO model can promote expansion of access to treatment for opioid use disorder and other SUDs, particularly in underserved areas.
AHRQ-funded; HS016510.
Citation: Komaromy M, Duhigg D, Metcalf A .
Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders.
Subst Abus 2016;37(1):20-4. doi: 10.1080/08897077.2015.1129388.
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Keywords: Community-Based Practice, Primary Care, Substance Abuse, Training, Health Information Technology (HIT)
Thomas GW, Rojas-Murillo S, Hanley JM
Skill assessment in the interpretation of 3D fracture patterns from radiographs.
The researchers determined if 3D radiographic image interpretation can be reliably assessed, and whether this assessment varies by level of training. They concluded that the interpretation of radiographs to discern 3D information is a promising and a relatively unexplored area for surgical skill education and assessment.
AHRQ-funded; HS022077.
Citation: Thomas GW, Rojas-Murillo S, Hanley JM .
Skill assessment in the interpretation of 3D fracture patterns from radiographs.
Iowa Orthop J 2016;36:1-6.
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Keywords: Diagnostic Safety and Quality, Education: Continuing Medical Education, Injuries and Wounds, Imaging, Training
Barsuk JH, Cohen ER, Williams MV
The effect of simulation-based mastery learning on thoracentesis referral patterns.
This study aimed to (1) assess the effect of simulation-based mastery learning (SBML) on internal medicine residents' simulated thoracentesis skills and (2) compare thoracentesis referral patterns, self-confidence, and reasons for referral between traditionally trained residents (non-SBML-trained), SBML-trained residents, and hospitalist physicians. This study identified confidence and time as reasons physicians refer thoracenteses rather than perform them at the bedside.
AHRQ-funded; HS021202.
Citation: Barsuk JH, Cohen ER, Williams MV .
The effect of simulation-based mastery learning on thoracentesis referral patterns.
J Hosp Med 2016 Nov;11(11):792-95. doi: 10.1002/jhm.2623..
Keywords: Education: Continuing Medical Education, Provider Performance, Training
Long S, Thomas GW, Anderson DD
Designing an affordable wire navigation surgical simulator.
This project was focused on developing a more affordable surgical simulator that could provide high-fidelity training for the task of wire navigation. The goal of the simulator, was to provide simulated X-ray images of a real K-wire as it is placed into an artificial bone. In testing the performance of the simulator, only of the 491 reconstructions were deemed as failed reconstructions, a success rate of roughly 98 percent.
AHRQ-funded; HS022077.
Citation: Long S, Thomas GW, Anderson DD .
Designing an affordable wire navigation surgical simulator.
J Med Device 2016 Sep;10(3). doi: 10.1115/1.4033799.
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Keywords: Surgery, Simulation, Patient Safety, Training
Grenda TR, Pradarelli JC, Dimick JB
Using surgical video to improve technique and skill.
The authors argue that video analysis affords the opportunity to study both surgical technique (i.e. the details of how an operation is conducted) and surgical skill (i.e. how well a surgeon performs a procedure). This strategy may be particularly applicable for technically complex procedures that already have the capability to capture video (e.g. advanced laparoscopy, robotic surgery, video-assisted thoracoscopic surgery). Furthermore, this work could also be extended to open procedures using other video-recording modalities.
AHRQ-funded; HS000053.
Citation: Grenda TR, Pradarelli JC, Dimick JB .
Using surgical video to improve technique and skill.
Ann Surg 2016 Jul;264(1):32-3. doi: 10.1097/sla.0000000000001592.
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Keywords: Patient Safety, Surgery, Training
Kamal AH, Anderson WG, Boss RD
The Cambia Sojourns Scholars Leadership Program: project summaries from the inaugural scholar cohort.
The Cambia Health Foundation designed the Sojourns Scholar Leadership Program to facilitate leadership development among budding palliative care leaders. This paper presents the background, aims, and results to date of each of the projects from the scholars of the inaugural cohort.
AHRQ-funded; HS023681.
Citation: Kamal AH, Anderson WG, Boss RD .
The Cambia Sojourns Scholars Leadership Program: project summaries from the inaugural scholar cohort.
J Palliat Med 2016 Jun;19(6):591-600. doi: 10.1089/jpm.2016.0086.
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Keywords: Healthcare Delivery, Education: Continuing Medical Education, Palliative Care, Training
Olin SC, O'Connor BC, Storfer-Isser A
Access to care for youth in a state mental health system: a simulated patient approach.
The researchers examined access to psychiatric care for adolescents with depression in outpatient specialty clinics within a state mental health system, using a simulated patient approach. They concluded that access to psychiatric care for youth with depression was variable in a state system. State-sponsored trainings on strategies to reduce wait times appear to improve care access.
AHRQ-funded; HS020503.
Citation: Olin SC, O'Connor BC, Storfer-Isser A .
Access to care for youth in a state mental health system: a simulated patient approach.
J Am Acad Child Adolesc Psychiatry 2016 May;55(5):392-9. doi: 10.1016/j.jaac.2016.02.014.
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Keywords: Access to Care, Children/Adolescents, Behavioral Health, Depression, Training