National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
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- Ambulatory Care and Surgery (1)
- Anxiety (2)
- Asthma (1)
- Behavioral Health (4)
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- (-) Implementation (44)
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- Policy (1)
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- Prevention (7)
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- Primary Care: Models of Care (5)
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- Quality Improvement (12)
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- Quality of Life (1)
- Racial and Ethnic Minorities (2)
- Research Methodologies (4)
- Respiratory Conditions (2)
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- Social Determinants of Health (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
26 to 44 of 44 Research Studies DisplayedFiori KP, Rehm CD, Sanderson D
Integrating social needs screening and community health workers in primary care: the community linkage to care program.
This study used logistic regression to identify factors associated with successful social service uptake in an urban pediatric practice. Out of 4948 households screened for social needs from December 2017 to November 2018, 20% self-reported at least one factor. Only 43% of the 287 households with unmet needs reported social service uptake. Greater than 4 outreach encounters were significantly associated with successful referrals. This study suggests the need for additional research and an opportunity for further program optimization.
AHRQ-funded; HS026396.
Citation: Fiori KP, Rehm CD, Sanderson D .
Integrating social needs screening and community health workers in primary care: the community linkage to care program.
Clin Pediatr 2020 Jun;59(6):547-56. doi: 10.1177/0009922820908589..
Keywords: Children/Adolescents, Community-Based Practice, Primary Care, Social Determinants of Health, Implementation, Low-Income
McHugh M, Brown T, Walunas TL
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
The authors sought to identify patterns of contrasting perspectives on implementation issues between practice leaders and their practice facilitators as well as factors that may contribute to them. Through individual interviews, they found that turnover of staff was frequently reported in dyads with contrasting perspectives. They recommended that planners of quality improvement initiatives using practice facilitation consider taking steps to minimize contrasting perspectives by addressing turnover challenges and encouraging opportunities to share perspectives.
AHRQ-funded; HS023921.
Citation: McHugh M, Brown T, Walunas TL .
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
J Healthc Qual 2020 May/Jun;42(3):e32-e38. doi: 10.1097/jhq.0000000000000223..
Keywords: Primary Care, Quality Improvement, Quality of Care, Implementation, Communication, Provider
Ngo-Metzger Q, Mabry-Hernandez IR
AHRQ Author: Ngo-Metzger Q, Mabry-Hernandez
Implementation of evidence-based recommendations for preventive services in the Veterans Health Administration.
The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. To date, there has been scant research on how VHA adopts clinical preventive services guidelines and how U.S. Preventive Services Task Force recommendations factor into the process. In this study, the investigators conducted semistructured interviews with eight VHA leaders to examine how they adopt, disseminate, and measure adherence to recommendations. They concluded that provision of evidence-based clinical preventive services is an important part of VHA's effort to provide high-quality care for Veterans.
AHRQ-authored.
Citation: Ngo-Metzger Q, Mabry-Hernandez IR .
Implementation of evidence-based recommendations for preventive services in the Veterans Health Administration.
J Healthc Qual 2020 May/Jun;42(3):148-56. doi: 10.1097/jhq.0000000000000217..
Keywords: U.S. Preventive Services Task Force (USPSTF), Prevention, Evidence-Based Practice, Guidelines, Implementation
Penedo FJ, Oswald LB, Kronenfeld JP
The increasing value of eHealth in the delivery of patient-centred cancer care.
This paper is an appraisal of peer literature over the past 10 years on patient-centered eHealth to improve cancer care delivery. Uses of eHealth include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. Challenges of, and opportunities for accessibility, scalability, and implementation of these technologies is also discussed.
AHRQ-funded; HS026170.
Citation: Penedo FJ, Oswald LB, Kronenfeld JP .
The increasing value of eHealth in the delivery of patient-centred cancer care.
Lancet Oncol 2020 May;21(5):e240-e51. doi: 10.1016/s1470-2045(20)30021-8.
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Keywords: Cancer, Patient-Centered Healthcare, Healthcare Delivery, Telehealth, Health Information Technology (HIT), Quality of Life, Implementation
Lewis CC, Boyd MR, Walsh-Bailey C
A systematic review of empirical studies examining mechanisms of implementation in health.
The authors conducted this systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms. They found that researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but this review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance their research agenda. They recommend greater precision to achieve conceptual clarity, testable hypotheses about how and why variables are related, and concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.
AHRQ-funded; HS025632.
Citation: Lewis CC, Boyd MR, Walsh-Bailey C .
A systematic review of empirical studies examining mechanisms of implementation in health.
Implement Sci 2020 Apr 16;15(1):21. doi: 10.1186/s13012-020-00983-3..
Keywords: Research Methodologies, Implementation
Richesson RL, Bray BE, Dymek C
AHRQ Author: Dymek C
Summary of second annual MCBK public meeting: mobilizing computable biomedical knowledge-a movement to accelerate translation of knowledge into action.
The Mobilizing Computable Biomedical Knowledge (MCBK) community formed in 2016. This report summarizes the main outputs of the Second Annual MCBK public meeting, which was held at the National Institutes of Health on July 18-19, 2019 and brought together over 150 participants from various domains to frame and address important dimensions for mobilizing CBK.
AHRQ-authored.
Citation: Richesson RL, Bray BE, Dymek C .
Summary of second annual MCBK public meeting: mobilizing computable biomedical knowledge-a movement to accelerate translation of knowledge into action.
Learn Health Syst 2020 Apr;4(2):e10222. doi: 10.1002/lrh2.10222..
Keywords: Implementation, Evidence-Based Practice, Learning Health Systems
Smith JD, Rafferty MR, Heinemann AW
Pragmatic adaptation of implementation research measures for a novel context and multiple professional roles: a factor analysis study.
In this study, the investigators examined the internal consistency, factor structure, and structural invariance of four well-validated measures of inner setting factors across four groups of respondents. The items in these measures were adapted as part of an evaluation of a large-scale organizational change in a rehabilitation hospital, which involved transitioning to a new building and a new model of patient care, facilitated by a significant redesign of patient care and research spaces.
AHRQ-funded; HS025077.
Citation: Smith JD, Rafferty MR, Heinemann AW .
Pragmatic adaptation of implementation research measures for a novel context and multiple professional roles: a factor analysis study.
BMC Health Serv Res 2020 Mar 30;20(1):257. doi: 10.1186/s12913-020-05118-4..
Keywords: Implementation, Health Services Research (HSR), Organizational Change
Fiscella K, Sanders M, Holder T
The role of data and safety monitoring boards in implementation trials: when are they justified?
This paper examined the appropriateness of the establishment of data and safety monitoring boards (DSMBs) for all phase III clinical trials sponsored by the National Heart, Lung and Blood Institute (NHLBI). The authors reviewed the unique features of implementation trials and reflected on key questions regarding the justification for DSMBs and their potential role and monitoring targets within implementation trials.
AHRQ-funded; HS021667.
Citation: Fiscella K, Sanders M, Holder T .
The role of data and safety monitoring boards in implementation trials: when are they justified?
J Clin Transl Sci 2020 Mar 5;4(3):229-32. doi: 10.1017/cts.2020.19..
Keywords: Research Methodologies, Implementation
Sweeney SM, Hemler JR, Baron AN
Dedicated workforce required to support large-scale practice improvement.
Facilitation is an effective approach for helping practices implement sustainable evidence-based practice improvements. Few studies examine the facilitation infrastructure and support needed for large-scale dissemination and implementation initiatives. In this paper, the authors discuss a project by the Agency for Health care Research and Quality in which it funded 7 Cooperatives, each of which worked with over 200 primary care practices to rapidly disseminate and implement improvements in cardiovascular preventive care.
AHRQ-funded; HS023940.
Citation: Sweeney SM, Hemler JR, Baron AN .
Dedicated workforce required to support large-scale practice improvement.
J Am Board Fam Med 2020 Mar-Apr;33(2):230-39. doi: 10.3122/jabfm.2020.02.190261..
Keywords: Practice Improvement, Primary Care, Cardiovascular Conditions, Healthcare Delivery, Quality Improvement, Quality of Care, Prevention, Implementation, Evidence-Based Practice
Jiang V, Brooks EM, Tong ST
Factors influencing uptake of changes to clinical preventive guidelines.
Despite widespread recognition that adherence to clinical preventive guidelines improves patient outcomes, clinicians struggle to implement guideline changes in a timely manner. Multiple factors influence guideline adoption and effective implementation. However, few studies evaluate their collective and inter-related effects. This qualitative study provided a comprehensive picture of the interplay between multiple factors on uptake of new or changed preventive guidelines.
AHRQ-funded; HS025032.
Citation: Jiang V, Brooks EM, Tong ST .
Factors influencing uptake of changes to clinical preventive guidelines.
J Am Board Fam Med 2020 Mar-Apr;33(2):271-78. doi: 10.3122/jabfm.2020.02.190146..
Keywords: Guidelines, Evidence-Based Practice, Implementation, Prevention
Gaynes BN, Lux L, Gartlehner G
Defining treatment-resistant depression.
The authors conducted a review for the Centers for Medicare & Medicaid Services and AHRQ to clarify how experts and investigators have defined treatment-resistant depression (TRD) and to review systematically how well this definition comports with TRD definitions in clinical trials through July 5, 2019. They found that no consensus definition existed for TRD. While depressive outcomes and clinical global impressions were commonly measured, functional impairment and quality-of-life tools were rarely used. They recommend stronger approaches to designing and conducting TRD research in order to foster better evidence to translate into clearer guidelines for treating patients with TRD.
AHRQ-funded; 290201500011I.
Citation: Gaynes BN, Lux L, Gartlehner G .
Defining treatment-resistant depression.
Depress Anxiety 2020 Feb;37(2):134-45. doi: 10.1002/da.22968..
Keywords: Depression, Behavioral Health, Evidence-Based Practice, Implementation, Research Methodologies
Businger AC, Fuller TE, Schnipper JL
Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.
This paper describes the challenges, recommendations and lessons learned while developing and implementing a Patient Safety Learning Laboratory (PSLL) project, which is comprised of a suite of HIT tools integrated with a newly implemented Electronic Health Record (EHR) vendor system in the acute care setting of a large academic medical center. The PSLL Administrative Core engaged stakeholders and study personnel throughout all phases of the project. Challenges to implementation included stakeholder engagement, project scope and complexity, technology and governance, and team structure. Some changes were implemented during the trial and others were labeled as lessons learned for future iterative interventions. A willingness to think outside of current workflows and processes to change health system culture around adverse event prevention was one of the keys to success.
AHRQ-funded; HS023535.
Citation: Businger AC, Fuller TE, Schnipper JL .
Lessons learned implementing a complex and innovative patient safety learning laboratory project in a large academic medical center.
J Am Med Inform Assoc 2020 Feb;27(2):301-07. doi: 10.1093/jamia/ocz193.
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Keywords: Patient Safety, Implementation, Health Information Technology (HIT), Quality Improvement, Quality of Care, Patient-Centered Healthcare, Electronic Health Records (EHRs), Evidence-Based Practice
Petkovic J, Riddle A, Akl EA
AHRQ Author: Chang SM
Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation.
Stakeholder engagement has become widely accepted as a necessary component of guideline development and implementation. While frameworks for developing guidelines express the need for those potentially affected by guideline recommendations to be involved in their development, there is a lack of consensus on how this should be done in practice. In this study, the investigators aimed to develop guidance for the meaningful and equitable engagement of multiple stakeholders in guideline development and implementation.
AHRQ-authored.
Citation: Petkovic J, Riddle A, Akl EA .
Protocol for the development of guidance for stakeholder engagement in health and healthcare guideline development and implementation.
Syst Rev 2020 Feb 1;9(1):21. doi: 10.1186/s13643-020-1272-5..
Keywords: Guidelines, Implementation, Evidence-Based Practice
Ray-Barruel G, Cooke M, Chopra V
The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation.
This study assessed the I-DECIDED clinical decision-making tool for peripheral intravenous catheter (PIVC) assessment and safe removal. A clinimetric validation process was designed and conducted in three distinct phases. Content validity testing was conducted via online survey with vascular access experts and clinicians from Australia, the UK, Canada, and the US. Then inter-rater reliability was conducted between 34 pairs of assessors for a total of 68 PIVC assessments. The tool demonstrated strong content validity among international vascular access experts and clinicians and high inter-rater reliability in seven adult medical-surgical wards of three Australian hospitals. Overall, inter-rater reliability was 87.13%. Time to complete assessments averaged 2 minutes, and nurse-reported acceptability was also high.
AHRQ-funded; HS025891.
Citation: Ray-Barruel G, Cooke M, Chopra V .
The I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: a clinimetric evaluation.
BMJ Open 2020 Jan 21;10(1):e035239. doi: 10.1136/bmjopen-2019-035239..
Keywords: Decision Making, Patient Safety, Tools & Toolkits, Implementation
Parchman ML, Ike B, Osterhage KP
Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
This paper discusses the barriers and facilitators to implementing changes in opioid prescription in rural areas using the Six Building Blocks evidence-based program to reduce opioid prescription in primary care practices. The program was implemented at 6 rural and rural-serving organizations with 20 clinic locations over a 15-month period. Interviews and focus groups with conducted with the organizations at the end of the program period. Facilitators included a desire to help patients and their community; external pressures to make changes in opioid management; a desire to reduce workplace stress; external support for the clinic; supportive clinic leadership; and receptivity of patients. Barriers included competing demands on clinicians and staff; a culture of clinician autonomy; inadequate data systems; and a lack of patient resources in rural areas.
AHRQ-funded; HS023750.
Citation: Parchman ML, Ike B, Osterhage KP .
Barriers and facilitators to implementing changes in opioid prescribing in rural primary care clinics.
J Clin Transl Sci 2020 Jan 10;4(5):425-30. doi: 10.1017/cts.2019.448..
Keywords: Opioids, Medication, Rural Health, Primary Care, Primary Care: Models of Care, Implementation, Pain, Chronic Conditions, Healthcare Delivery
Guise JM, Reid E, Fiordalisi CV
AHRQ Author: Borsky A, Chang S
AHRQ series on improving translation of evidence: progress and promise in supporting learning health systems.
The authors discuss the articles in the AHRQ EPC series published in this journal over the past six months. They state that satisfaction, care, and costs would all improve if health care delivery were as efficient and effective as possible given current knowledge. They conclude that millions of health decisions must be made by clinicians, patients, and health care systems, and they believe better decisions will be made with evidence.
AHRQ-authored; AHRQ-funded; 290201700003C.
Citation: Guise JM, Reid E, Fiordalisi CV .
AHRQ series on improving translation of evidence: progress and promise in supporting learning health systems.
Jt Comm J Qual Patient Saf 2020 Jan;46(1):51-52. doi: 10.1016/j.jcjq.2019.10.008..
Keywords: Implementation, Evidence-Based Practice, Learning Health Systems, Health Systems, Healthcare Delivery, Decision Making
Knox M, Murphy EJ, Leslie T
e-Consult implementation success: lessons from 5 county-based delivery systems.
This study evaluated organizational factors for e-consult implementation across five publicly financed, county-based health systems in California. Health system leaders whose systems received grant funding to plan and implement e-consult were interviewed to discuss platform selection, electronic health record compatibility, primary care clinician and specialist opinions, and project governance. Findings showed that three of the 5 systems successfully implemented e-consults. Existing primary care clinician-specialist relationships emerged as the strongest facilitator. E-consult-EHR technology integration was also important. These findings add to existing e-consult implementation literature that emphasizes reimbursement and leadership champions.
AHRQ-funded; HS022241.
Citation: Knox M, Murphy EJ, Leslie T .
e-Consult implementation success: lessons from 5 county-based delivery systems.
Am J Manag Care 2020 Jan;26(1):e21-e27. doi: 10.37765/ajmc.2020.42149..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Delivery, Implementation, Primary Care, Ambulatory Care and Surgery
Baron AN, Hemler JR, Sweeney SM
Effects of practice turnover on primary care quality improvement implementation.
This study examined the effect primary care practice turnover has on quality improvement (QI) implementation. It often stops momentum in the improvement process, especially if key members leave. Key member turnover causes loss of institutional memory about QI purpose, processes, and long-term vision.
AHRQ-funded; HS023940.
Citation: Baron AN, Hemler JR, Sweeney SM .
Effects of practice turnover on primary care quality improvement implementation.
Am J Med Qual 2020 Jan/Feb;35(1):16-22. doi: 10.1177/1062860619844001..
Keywords: Primary Care, Quality Improvement, Quality of Care, Workforce, Implementation
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