National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (3)
- Adverse Events (5)
- Ambulatory Care and Surgery (1)
- Antibiotics (11)
- Antimicrobial Stewardship (7)
- Asthma (1)
- Back Health and Pain (1)
- Behavioral Health (2)
- Blood Clots (2)
- Blood Pressure (2)
- Blood Thinners (5)
- Burnout (1)
- Cancer (2)
- Cancer: Breast Cancer (2)
- Cardiovascular Conditions (7)
- Caregiving (1)
- Care Management (2)
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- Children/Adolescents (2)
- Chronic Conditions (9)
- Clinical Decision Support (CDS) (15)
- Clinician-Patient Communication (2)
- Clostridium difficile Infections (2)
- Communication (1)
- Comparative Effectiveness (3)
- (-) Decision Making (71)
- Dementia (2)
- Dental and Oral Health (1)
- Diabetes (3)
- Diagnostic Safety and Quality (2)
- Digestive Disease and Health (2)
- Education: Patient and Caregiver (3)
- Elderly (13)
- Electronic Health Records (EHRs) (4)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Medical Services (EMS) (1)
- Evidence-Based Practice (2)
- Genetics (2)
- Guidelines (3)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Costs (5)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (15)
- Health Insurance (1)
- Health Literacy (1)
- Heart Disease and Health (4)
- Hepatitis (1)
- Hospitals (2)
- Inpatient Care (3)
- Long-Term Care (3)
- Maternal Care (1)
- Medical Errors (1)
- (-) Medication (71)
- Medication: Safety (8)
- Neurological Disorders (2)
- Nursing Homes (4)
- Opioids (5)
- Osteoporosis (2)
- Outcomes (2)
- Pain (4)
- Patient-Centered Healthcare (8)
- Patient-Centered Outcomes Research (4)
- Patient Adherence/Compliance (2)
- Patient and Family Engagement (3)
- Patient Safety (14)
- Policy (1)
- Practice Patterns (7)
- Pregnancy (1)
- Prevention (7)
- Primary Care (5)
- Provider (3)
- Provider: Clinician (1)
- Provider: Pharmacist (1)
- Provider: Physician (2)
- Quality Improvement (3)
- Quality of Care (4)
- Respiratory Conditions (3)
- Screening (1)
- Sepsis (1)
- Sickle Cell Disease (1)
- Stroke (2)
- Substance Abuse (3)
- Surgery (3)
- Tools & Toolkits (1)
- Treatments (2)
- Urinary Tract Infection (UTI) (2)
- Women (1)
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 71 Research Studies DisplayedSomohano VC, Smith CL, Saha S
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
This article examined the role that trust in a prescribing provider has on shared decision-making and opioid misuse in opioid-specific pain management. A secondary analysis of data from a prospective cohort study was conducted of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator, such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant.
AHRQ-funded; HS026370.
Citation: Somohano VC, Smith CL, Saha S .
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
J Gen Intern Med 2023 Sep; 38(12):2755-60. doi: 10.1007/s11606-023-08212-5..
Keywords: Decision Making, Opioids, Medication, Substance Abuse, Behavioral Health, Pain, Chronic Conditions
Rao Rao, Akrobetu DJ, Dickert NW
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
The purpose of this study was to characterize patient-cardiologist discussions concerning out-of-pocket costs associated with sacubitril/valsartan during the early post-approval period. Researchers conducted a content analysis of 222 deidentified transcripts of audio-recorded outpatient encounters in which cardiologists and patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. Issues of cost occurred in nearly half the discussions, but the researchers note that cost conversations were generally superficial, rarely addressing affordability or cost-value judgments. Cardiologists frequently provided patients with free sacubitril/valsartan samples with no plan to address costs after the sample course ran out.
AHRQ-funded; HS026081.
Citation: Rao Rao, Akrobetu DJ, Dickert NW .
Deciding whether to take sacubitril/valsartan: how cardiologists and patients discuss out-of-pocket costs.
J Am Heart Assoc 2023 Apr 4; 12(7):e028278. doi: 10.1161/jaha.122.028278..
Keywords: Decision Making, Medication, Cardiovascular Conditions, Healthcare Costs
Vo H, Valentine KD, Barry MJ
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
The objectives of this study were to examine the reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions. Researchers conducted a secondary data analysis of more than 6,000 participants who made decisions about breast, colon, or prostate cancer screening or taking medication for menopause, depression, hypertension or high cholesterol. They concluded that the SDM Process scale demonstrated construct validity and retest reliability.
AHRQ-funded; HS025718.
Citation: Vo H, Valentine KD, Barry MJ .
Evaluation of the shared decision-making process scale in cancer screening and medication decisions.
Patient Educ Couns 2023 Mar;108:107617. doi: 10.1016/j.pec.2022.107617.
Keywords: Decision Making, Cancer, Medication, Screening
Gomez Lumbreras A, Reese TJ, Del Fiol G
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
This study evaluated a tool called DDInteract that was developed to enhance and support shared decision-making (SDM) between patients and physicians when both warfarin and NSAIDs are used concurrently. The study used case vignettes with physicians and patients on warfarin to conduct simulated virtual clinical encounters where they discussed the use of taking ibuprofen and warfarin concurrently and determined an appropriate therapeutic plan based on the patient’s individualized risk. Participants completed a postsession interview and SDM process survey, including the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), tool usability and workload National Aeronautics and Space Administration (NASA) Task Load Index, Unified Theory of Acceptance and Use of Technology (UTAUT), Perceived Behavioral Control (PBC) scale, System Usability Scale (SUS), and Decision Conflict Scale (DCS). A total of 12 physician-patient dyads were used, with over 91% of the patients over 50 and 75% had been taking warfarin for over 2 years. Most participants rated DDInteract higher than usual care (UC) and would be willing to use the tool for an interaction involving warfarin and NSAIDs.
AHRQ-funded; HS027099.
Citation: Gomez Lumbreras A, Reese TJ, Del Fiol G .
Shared decision-making for drug-drug interactions: formative evaluation of an anticoagulant drug interaction.
JMIR Form Res 2022 Oct 19;6(10):e40018. doi: 10.2196/40018..
Keywords: Decision Making, Medication, Blood Thinners, Clinical Decision Support (CDS), Health Information Technology (HIT), Medication: Safety, Patient Safety
Kagarmanova A, Sparkman H, Laiteerapong N
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
This article describes a protocol for an upcoming study on the planned implementation and evaluation of I-COPE (Improving Chicago Older Adult Opioid and Pain Management through Patient-centered Clinical Decision Support and Project ECHO®) to improve care for older adults with chronic pain, opioid use, and opioid use disorder (OUD). The study will be implemented in 35 clinical sites across the metropolitan Chicago area for patients aged ≥ 65 with chronic pain, opioid use, or OUD who receive primary care at one of the clinics. I-COPE includes the integration of patient-reported data on symptoms and preferences, clinical decision support tools and shared decision making into routine primary care. Primary care providers will be trained on the tools through web-based videos and an optional Project ECHO® course, entitled "Pain Management and OUD in Older Adults." A framework called RE-AIM will be used to assess the I-COPE implementation. Outcomes considered effective include an increased variety of recommended pain treatments, decreased prescriptions of higher-risk pain treatments, and decreased patient pain scores. Outcomes will be evaluated at 6 and 12 months after implementation, and PCPs participating in Project ECHO® will be evaluated on changes in knowledge, attitudes, and self-efficacy using pre- and post-course surveys.
AHRQ-funded; HS027910.
Citation: Kagarmanova A, Sparkman H, Laiteerapong N .
Improving the management of chronic pain, opioid use, and opioid use disorder in older adults: study protocol for i-cope study.
Trials 2022 Jul 27;23(1):602. doi: 10.1186/s13063-022-06537-w..
Keywords: Elderly, Pain, Chronic Conditions, Opioids, Medication, Substance Abuse, Behavioral Health, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT)
Nanji KC, Garabedian PM, Langlieb ME
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
The purpose of this study was assess the usability of a newly developed, comprehensive, medication-related operating room clinical decision support (CDS) software and compare it with the standard electronic health record (EHR) medication workflow. Forty participants were randomized to a CDS group (n=20) or a control group (n=20) and asked to complete 7 simulation tasks. The study found that in a simulation setting the new CDS software improved efficiency and quality of care and reduced task time, excelling over the current EHR workflow.
AHRQ-funded; HS024764.
Citation: Nanji KC, Garabedian PM, Langlieb ME .
Usability of a perioperative medication-related clinical decision support software application: a randomized controlled trial.
J Am Med Inform Assoc 2022 Jul 12;29(8):1416-24. doi: 10.1093/jamia/ocac035..
Keywords: Medication, Clinical Decision Support (CDS), Health Information Technology (HIT), Surgery, Decision Making
Kunneman M, Branda ME, Ridgeway JL
Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
The purpose of this trial was to determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Findings showed that using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence, or improved diabetes control in patients with type 2 diabetes.
AHRQ-funded; HS018339.
Citation: Kunneman M, Branda ME, Ridgeway JL .
Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention.
Endocrine 2022 Feb;75(2):377-91. doi: 10.1007/s12020-021-02861-4..
Keywords: Diabetes, Medication, Decision Making, Patient-Centered Healthcare, Clinician-Patient Communication, Chronic Conditions
Rosenthal M, Poling J, Wec A
"Medication is just one piece of the whole puzzle": how nursing homes change their use of antipsychotic medications.
This article investigated health professionals’ experiences with decision-making during changes under the National Partnership to Improve Dementia Care in Nursing Homes and its companion coalitions. These programs were introduced in 2012 for the purpose of encouraging reductions in antipsychotic use and increasing use of nonpharmacological treatments for dementia. Interviews were conducted with 40 nursing home physicians and staff in seven states. The authors found that reducing antipsychotics is more time and resource-intensive than relying on medication. However, respondents supported reductions in antipsychotic use. They indicated that with supported staffing, effective communications, and training, they could create or implement individualized treatments.
AHRQ-funded; HS023464.
Citation: Rosenthal M, Poling J, Wec A .
"Medication is just one piece of the whole puzzle": how nursing homes change their use of antipsychotic medications.
J Appl Gerontol 2022 Jan;41(1):62-72. doi: 10.1177/0733464820958919..
Keywords: Elderly, Medication, Nursing Homes, Dementia, Neurological Disorders, Long-Term Care, Decision Making
Xiong KZ, Shah S, Stone JA
Using a scenario-based hybrid approach to understand participant health behavior.
This study described a scenario-based hybrid approach that included a simulation exercise and a situational interview to understand how older adults first select and then take OTC medication. The authors concluded that the scenario-based hybrid approach not only yielded detailed information about behavior, but also allowed investigators to discern participants' decision-making, influences, and the rationales they used when selecting and taking OTC medications.
AHRQ-funded; HS024490.
Citation: Xiong KZ, Shah S, Stone JA .
Using a scenario-based hybrid approach to understand participant health behavior.
Res Social Adm Pharm 2021 Dec;17(12):2070-74. doi: 10.1016/j.sapharm.2021.02.020..
Keywords: Elderly, Medication, Decision Making
Morris AO, Gilson A, Chui MA
Utilizing a cognitive engineering approach to conduct a hierarchical task analysis to understand complex older adult decision-making during over-the-counter medication selection.
This study characterized older adults' cognitive decision-making process when seeking to self-medicate with over-the-counter (OTC) medications from their community pharmacy, and demonstrated how hierarchical task analysis (HTA) can be used to evaluate a pharmacy intervention's impact on their decision-making. Findings showed that, while selecting an OTC, older adults considered quantity, cost, form, regimen, safety, strength, appropriateness of OTC safety, generic/name-brand, past experiences, and ingredients. The study intervention reduced by half the number of factors considered. Findings suggested that HTA-informed decision profiles may provide pharmacists with critical insights into safety issues that older adults may not be considering so that pharmacists can support their decision-making.
AHRQ-funded; HS024490.
Citation: Morris AO, Gilson A, Chui MA .
Utilizing a cognitive engineering approach to conduct a hierarchical task analysis to understand complex older adult decision-making during over-the-counter medication selection.
Res Social Adm Pharm 2021 Dec;17(12):2116-26. doi: 10.1016/j.sapharm.2021.07.005..
Keywords: Elderly, Decision Making, Medication
Reese TJ, Del Fiol G, Morgan K
A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: design and usability study.
Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric. This study aimed to design and examine the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs.
AHRQ-funded; HS026198.
Citation: Reese TJ, Del Fiol G, Morgan K .
A shared decision-making tool for drug interactions between warfarin and nonsteroidal anti-inflammatory drugs: design and usability study.
JMIR Hum Factors 2021 Oct 26;8(4):e28618. doi: 10.2196/28618..
Keywords: Blood Thinners, Medication: Safety, Medication, Clinical Decision Support (CDS), Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Adverse Drug Events (ADE), Adverse Events, Patient Safety
Campbell NL, Holden RJ, Tang Q
Multicomponent behavioral intervention to reduce exposure to anticholinergics in primary care older adults.
This study tested the effectiveness of a multicomponent behavioral intervention to reduce the use of high-risk anticholinergic medications in primary care older adults. Ten primary care clinics within Eskenazi Health in Indianapolis were selected to test the intervention. The intervention included provider- and patient-focused components. The provider-focused component was a computerized decision support system alerting the presence of a high-risk anticholinergic and offering dose- and indication-specific alternatives; while the patient-focused component was a story-based video providing education and modeling an interaction with a healthcare provider. The intervention occurred from April 2019 through March 2020. A total of 552 older adults had primary care visits during the study period. Only 3 out of 259 provider-focused alerts led to a medication change. Of the 276 staff alerts, 4.7% were confirmed to activate the patient-focused intervention.
AHRQ-funded; P30HS024384.
Citation: Campbell NL, Holden RJ, Tang Q .
Multicomponent behavioral intervention to reduce exposure to anticholinergics in primary care older adults.
J Am Geriatr Soc 2021 Jun;69(6):1490-99. doi: 10.1111/jgs.17121..
Keywords: Elderly, Medication, Primary Care, Clinical Decision Support (CDS), Decision Making
Ridgway JP, Robicsek A, Shah N
A randomized controlled trial of an electronic clinical decision support tool for inpatient antimicrobial stewardship.
The weighted incidence syndromic combination antibiogram (WISCA) is an antimicrobial stewardship tool that utilizes electronic medical record data to provide real-time clinical decision support regarding empiric antibiotic prescription in the hospital setting. The aim of this study was to determine the impact of WISCA utilization for empiric antibiotic prescription on hospital length of stay (LOS).
AHRQ-funded; HS022283.
Citation: Ridgway JP, Robicsek A, Shah N .
A randomized controlled trial of an electronic clinical decision support tool for inpatient antimicrobial stewardship.
Clin Infect Dis 2021 May 4;72(9):e265-e71. doi: 10.1093/cid/ciaa1048..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT)
Iroz CB, Dahl CM, Cassimatis IR
Prophylactic anticoagulation for preterm premature rupture of membranes: a decision analysis.
The objective of this study was to determine the optimal modality for venous thromboembolism prophylaxis during hospitalization for preterm premature rupture of membranes using a decision analysis model. The investigators concluded that their results did not support the routine use of prophylactic anticoagulation in women admitted to the hospital for preterm premature rupture of membranes.
AHRQ-funded; HS000084.
Citation: Iroz CB, Dahl CM, Cassimatis IR .
Prophylactic anticoagulation for preterm premature rupture of membranes: a decision analysis.
Am J Obstet Gynecol MFM 2021 May;3(3):100311. doi: 10.1016/j.ajogmf.2021.100311..
Keywords: Blood Clots, Blood Thinners, Prevention, Decision Making, Pregnancy, Maternal Care, Inpatient Care, Women, Medication
Tamma PD, Miller MA, Cosgrove SE
AHRQ Author: Miller MA
Recalibrating our approach to the management of sepsis: how the four moments of antibiotic decision-making can help.
In this paper, the authors describe The Four Moments of Antibiotic Decision Making. The Four Moments were conceived as part of the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use. The Four Moments provide a pragmatic approach to the core principle of antibiotic stewardship – ensuring patients who require antibiotic therapy promptly receive regimens associated with clinical success, while protecting patients from potential harm associated with unnecessary exposure to antibiotics.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Cosgrove SE .
Recalibrating our approach to the management of sepsis: how the four moments of antibiotic decision-making can help.
Ann Am Thorac Soc 2021 Feb;18(2):200-03. doi: 10.1513/AnnalsATS.202005-484IP..
Keywords: Sepsis, Antibiotics, Antimicrobial Stewardship, Medication, Decision Making, Medication: Safety, Patient Safety
Tamma PD, Miller MA, Dullabh P
AHRQ Author: Miller MA
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
Regulatory agencies and professional organizations recommend antibiotic stewardship programs (ASPs) in US hospitals. The optimal approach to establish robust, sustainable ASPs across diverse hospitals is unknown. The purpose of this study was to assess whether the Agency for Healthcare Research and Quality (AHRQ) Safety Program for Improving Antibiotic Use was associated with reductions in antibiotic use across US hospitals. The investigators concluded that AHRQ Safety Program appeared to enable diverse hospitals to establish ASPs and teach frontline clinicians to self-steward their antibiotic use.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Tamma PD, Miller MA, Dullabh P .
Association of a safety program for improving antibiotic use with antibiotic use and hospital-onset Clostridioides difficile infection rates among US hospitals.
JAMA Netw Open 2021 Feb;4(2):e210235. doi: 10.1001/jamanetworkopen.2021.0235..
Keywords: Antimicrobial Stewardship, Antibiotics, Medication, Decision Making, Clostridium difficile Infections, Patient Safety, Quality Improvement, Quality of Care, Hospitals
Hanlon JT, Perera S, Schweon S
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
This study evaluated the impact of an educational quality improvement initiative on the appropriateness of antibiotic prescribing restricted to uncomplicated cystitis in older noncatheterized nursing home residents. This 1-year case-control study used 25 participating nursing homes that were randomized to the intervention or usual care group by strata that included state, urban/rural status, bed size, and geographic separation. A total of 75 cases of cystitis were found in the intervention groups and 92 in the control groups. The intervention group had a nonsignificant 21% reduction in the risk of antibiotic prescribing. There was a favorable comparison in appropriateness of duration. However, the intervention group had more problems with drug-drug interactions than the control group (8% vs 1%). There were also more problems with dosage in the intervention group. Both groups had similar rates of problems with choice or effectiveness (44% vs 45%). The most common antibiotic class that was prescribed inappropriately was quinolones.
AHRQ-funded; R18 HS023779.
Citation: Hanlon JT, Perera S, Schweon S .
Improvements in antibiotic appropriateness for cystitis in older nursing home residents: a quality improvement study with randomized assignment.
J Am Med Dir Assoc 2021 Jan;22(1):173-77. doi: 10.1016/j.jamda.2020.07.040..
Keywords: Elderly, Nursing Homes, Long-Term Care, Antibiotics, Medication, Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Decision Making
Beeber AS, Kistler CE, Zimmerman S
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
This study’s goal was to determine what information is most important to registered nurses (RNs) decisions to call clinicians about suspected urinary tract infections (UTIs) in nursing home residents. An online survey was conducted with a convenience sample of 881 RNs recruited from a health care research panel. Clinical scenarios from 10 categories of resident characteristics were used: UTI risk, resident type, functional status, mental status, lower urinary tract status, body temperature, physical exam, urinalysis, antibiotic request, and goals of care. Participants were randomized into 2 deliberation conditions: self-paced (n=437) and forced deliberation (n=444). Painful or difficult urinary, obvious blood in urine and temperature at 101.5° had the highest odds of a RN calling a clinician by the forced-deliberation group. For the self-paced group, painful or difficult urination had the highest odds.
AHRQ-funded; HS024519.
Citation: Beeber AS, Kistler CE, Zimmerman S .
Nurse decision-making for suspected urinary tract infections in nursing homes: potential targets to reduce antibiotic overuse.
J Am Med Dir Assoc 2021 Jan;22(1):156-63. doi: 10.1016/j.jamda.2020.06.053..
Keywords: Urinary Tract Infection (UTI), Antibiotics, Antimicrobial Stewardship, Medication, Nursing Homes, Long-Term Care, Decision Making, Diagnostic Safety and Quality
Dickert NW, Mitchell AR, Venechuk GE
Show me the money: patients' perspectives on a decision aid for sacubitril/valsartan addressing out-of-pocket cost.
This study reported patients' perspectives on a decision aid for sacubitril/valsartan that explicitly addressed out-of-pocket costs. Findings indicated that patients were receptive to the inclusion of out-of-pocket cost as relevant in a decision aid for sacubitril/valsartan. Key challenges to effective integration of cost in these decisions included developing mechanisms for acquiring reliable patient-specific cost estimates and addressing patients' difficulties applying trial evidence to their own situation.
AHRQ-funded; HS026081.
Citation: Dickert NW, Mitchell AR, Venechuk GE .
Show me the money: patients' perspectives on a decision aid for sacubitril/valsartan addressing out-of-pocket cost.
Circ Cardiovasc Qual Outcomes 2020 Dec;13(12):e007070. doi: 10.1161/circoutcomes.120.007070..
Keywords: Decision Making, Medication, Healthcare Costs
Shah S, Gilson AM, Jacobson N
Understanding the factors influencing older adults' decision-making about their use of over-the-counter medications-a scenario-based approach.
The potential risks of over-the-counter (OTC) medications are often aggravated in vulnerable populations, such as older adults. The elevated patterns of older-adult OTC medication use do not necessarily translate into a greater understanding of these medications or their safety implications. The objective of this study was to assess how older adults' knowledge, beliefs, and attitudes informed their decision-making regarding OTC use.
AHRQ-funded; HS024490.
Citation: Shah S, Gilson AM, Jacobson N .
Understanding the factors influencing older adults' decision-making about their use of over-the-counter medications-a scenario-based approach.
Pharmacy 2020 Sep 18;8(3). doi: 10.3390/pharmacy8030175..
Keywords: Elderly, Decision Making, Medication, Medication: Safety, Patient Safety, Health Literacy
Patterson ES, DiLoreto GN, Vanam R
Enhancing usefulness and usability of a clinical decision support prototype for antibiotic stewardship.
This paper describes a multi-method approach to improve clinical decision support (CDS) for antibiotic stewardship. A heuristic review was employed to generate recommendations to improve the usability of a prototype CDS in the hospital setting. The authors then engaged in a design improvement cycle in collaboration with software programmers that enhanced their prototype. The revised prototype was then demonstrated to physician and pharmacist subject matter experts in three walkthrough interviews. These interviews generated recommendations to improve the interface, functionality, and tailoring for groups of users. Common elements for the recommendations are discussed for models for using clinical decision support in general.
AHRQ-funded; HS024379.
Citation: Patterson ES, DiLoreto GN, Vanam R .
Enhancing usefulness and usability of a clinical decision support prototype for antibiotic stewardship.
Proc Int Symp Hum Factors Ergon Healthc 2020 Sep;9(1):61-65. doi: 10.1177/2327857920091034..
Keywords: Clinical Decision Support (CDS), Decision Making, Antimicrobial Stewardship, Antibiotics, Medication
Co Z, Holmgren AJ, Classen DC
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
This study evaluated the overall performance of hospitals that used the Computerized Physician Order Entry Evaluation Tool in 2017 and 2018 and compared performances for fatal orders and nuisance orders each year. The authors evaluated 1599 hospitals that took the test by using their overall percentage scores along with the percentage of fatal orders appropriately alerted on and the percentage of nuisance orders incorrectly alerted on. Overall hospital scores improved from 58.1% in 2017 to 66.2% in 2018. Fatal order performance improved slightly from 78.8% to 83.0%, but there no very little change in nuisance order performance (89.0% to 89.7%). Conclusions were that perhaps hospitals are not targeting the deadliest orders first and some hospitals may be achieving higher scores by over-alerting. This has the potential to cause clinician burnout and even worsen patient safety.
AHRQ-funded; HS023696.
Citation: Co Z, Holmgren AJ, Classen DC .
The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support.
J Am Med Inform Assoc 2020 Aug;27(8):1252-58. doi: 10.1093/jamia/ocaa098..
Keywords: Medication: Safety, Medication, Patient Safety, Clinical Decision Support (CDS), Decision Making, Burnout, Hospitals, Health Information Technology (HIT), Quality of Care
Greenhawt M, Shaker M, Winders T
Development and acceptability of a shared decision-making tool for commercial peanut allergy therapies.
The goal of this study was to develop a shared decision-making (SDM) tool for patients and clinicians for commercial peanut allergy therapies. The decision aid was created in 3 stages: a qualitative study, development of a draft decision aid through multiple iterations, and decisional self-efficacy related to using the decision aid. The aid went through 9 iterations, resulting in a 4-page aid with 7 parts. A total of 24 subjects assessed the decision aid and scored it on acceptability, decisional self-efficacy, and low decisional conflict.
Citation: Greenhawt M, Shaker M, Winders T .
Development and acceptability of a shared decision-making tool for commercial peanut allergy therapies.
Ann Allergy Asthma Immunol 2020 Jul;125(1):90-96. doi: 10.1016/j.anai.2020.01.030..
Keywords: Decision Making, Medication, Respiratory Conditions
Ramirez M, Chen K, Follett RW
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
The aim of the study was to evaluate whether the implementation of the Best Practice Advisory (BPA) was associated with changes in angiotensin-converting enzyme inhibitor (ACEI) and angiotensin-receptor blocker (ARB) prescribing during primary care encounters for patients with diabetes. The investigators concluded that a BPA with a "chart closure" hard stop is a promising tool for the treatment of patients with comorbid diabetes and hypertension with an ACEI or ARB, especially when implemented within the context of team-based care, wherein clinical pharmacists support the work of primary care providers.
AHRQ-funded; HS00046.
Citation: Ramirez M, Chen K, Follett RW .
Impact of a "chart closure" hard stop alert on prescribing for elevated blood pressures among patients with diabetes: quasi-experimental study.
JMIR Med Inform 2020 Apr 17;8(4):e16421. doi: 10.2196/16421..
Keywords: Blood Pressure, Medication, Diabetes, Clinical Decision Support (CDS), Decision Making, Chronic Conditions
Pinto D, Prabhakaran S, Tipton E
Why physicians prescribe prophylactic seizure medications after intracerebral hemorrhage: an adaptive conjoint analysis.
Seizures are a morbid complication of intracerebral hemorrhage (ICH) and increase the risk for herniation, status epilepticus, and worse patient outcomes. Prophylactic levetiracetam is administered to approximately 40% of patients with ICH. It is unclear which patients are consciously selected for treatment by physicians. In this study, the investigators sought to determine how patients are selected for treatment with prophylactic levetiracetam after ICH.
AHRQ-funded; HS023437.
Citation: Pinto D, Prabhakaran S, Tipton E .
Why physicians prescribe prophylactic seizure medications after intracerebral hemorrhage: an adaptive conjoint analysis.
J Stroke Cerebrovasc Dis 2020 Apr;29(4):104628. doi: 10.1016/j.jstrokecerebrovasdis.2019.104628..
Keywords: Neurological Disorders, Medication, Prevention, Cardiovascular Conditions, Stroke, Decision Making