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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
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1 to 25 of 74 Research Studies Displayed
Atkinson MK, Singer SJ
Managing organizational constraints in innovation teams: a qualitative study across four health systems.
This study examined how interdisciplinary teams are affected by and manage external constraints over the lifecycle of their innovation project. The authors used a multimethod qualitative approach consisting of over 3 years of participant observation data to analyze how four interdisciplinary teams across different health system experienced and managed constraints as they pursued process innovations. Their findings point to several practical implications concerning innovation processes in healthcare: 1) how conditions in the organizational context, or constraints, can impede team progress at different stages of innovation; and 2) the collective efforts, or tactics, teams use to manage or work around those constraints to further progress on their innovations.
AHRQ-funded; HS024453.
Citation:
Atkinson MK, Singer SJ .
Managing organizational constraints in innovation teams: a qualitative study across four health systems.
Med Care Res Rev 2021 Oct;78(5):521-36. doi: 10.1177/1077558720925993..
Keywords:
Learning Health Systems, Healthcare Systems, Innovations and Emerging Issues, Teams
Kandel ZK, Rittenhouse DR, Bibi S
The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices.
The Centers for Medicare and Medicaid Services' (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. The authors investigated whether SIM improved health information technology (HIT) and care management capabilities of physician practices. They found that the CMS SIM Initiative did not accelerate the adoption of ten foundational physician practice capabilities beyond national trends.
AHRQ-funded; HS024075.
Citation:
Kandel ZK, Rittenhouse DR, Bibi S .
The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices.
Med Care Res Rev 2021 Aug;78(4):350-60. doi: 10.1177/1077558719901217..
Keywords:
Health Information Technology (HIT), Healthcare Delivery, Payment, Healthcare Systems, Innovations and Emerging Issues
McGuier EA, Kolko DJ, Klem M
Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol.
Implementation of evidence-based practices and other innovations in these settings requires teams to work together to change processes and behaviors. Accordingly, team functioning may be a key determinant of implementation outcomes. This systematic review identified and summarized empirical research examining associations between team functioning and implementation outcomes in healthcare and human service settings.
AHRQ-funded; HS026862.
Citation:
McGuier EA, Kolko DJ, Klem M .
Team functioning and implementation of innovations in healthcare and human service settings: a systematic review protocol.
Syst Rev 2021 Jun 26;10(1):189. doi: 10.1186/s13643-021-01747-w..
Keywords:
Teams, Innovations and Emerging Issues, Implementation
Solberg LI, Kuzel A, Parchman ML
A taxonomy for external support for practice transformation.
There is no commonly accepted comprehensive framework for describing the practical specifics of external support for practice change. In this study, the researchers’goal was to develop a taxonomy that could be used by both external groups or researchers and health care leaders. The leaders of 8 grants from Agency for Research and Quality for the EvidenceNOW study of improving cardiovascular preventive services in over 1500 primary care practices nationwide worked collaboratively over 18 months to develop descriptions of key domains that might comprehensively characterize any external support intervention.
AHRQ-funded; HS023940.
Citation:
Solberg LI, Kuzel A, Parchman ML .
A taxonomy for external support for practice transformation.
J Am Board Fam Med 2021 Jan-Feb;34(1):32-39. doi: 10.3122/jabfm.2021.01.200225..
Keywords:
Primary Care: Models of Care, Primary Care, Healthcare Delivery, Cardiovascular Conditions, Evidence-Based Practice, Prevention, Innovations and Emerging Issues, Quality Improvement, Quality of Care, Practice Improvement
Brewster AL, Fraze TK, Gottlieb LM
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
The authors studied the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. Their results indicated that implementation of social risk screening was not associated with overall exposure to value-based payment for physician practices. They recommended expanding social risk screening in order to reduce the level of innovative capacity required.
AHRQ-funded; HS024075.
Citation:
Brewster AL, Fraze TK, Gottlieb LM .
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
Milbank Q 2020 Dec;98(4):1114-33. doi: 10.1111/1468-0009.12480..
Keywords:
Payment, Social Determinants of Health, Practice Patterns, Innovations and Emerging Issues, Screening, Risk, Value, Nutrition, Vulnerable Populations
Zimmerman S, Wretman CJ, Ward K
Fidelity and sustainability of Mouth Care Without a Battle and lessons for other innovations in care.
This project examined the fidelity and sustainability of Mouth Care Without a Battle (MCWB), an evidence-based program conducted in a two-year cluster randomized trial in 14 nursing homes. The investigators found that results that triangulated two sources of data indicated that fidelity decreased after the first year; results provided guidance to promote fidelity and sustainability of this and other new care practices in nursing homes, including ongoing education, coaching, evaluation, feedback, and sufficient resources.
AHRQ-funded; HS022298.
Citation:
Zimmerman S, Wretman CJ, Ward K .
Fidelity and sustainability of Mouth Care Without a Battle and lessons for other innovations in care.
Geriatr Nurs 2020 Nov-Dec;41(6):878-84. doi: 10.1016/j.gerinurse.2020.06.002..
Keywords:
Elderly, Nursing Homes, Long-Term Care, Innovations and Emerging Issues, Evidence-Based Practice
Carter E, Monane R, Peccoralo L
Missed opportunities to engage patients in collaborative care challenge program sustainability: a qualitative study.
The authors examined barriers and accompanying strategies to patient engagement in the context of collaborative care sustainability. They concluded that their research signals the need for improved patient engagement at the time of diagnosis and referral, and they suggested innovative areas for quality improvement in primary care settings, including e-handoffs, culturally-tailored preference-driven treatment, collaborative care vs. psychiatry referral algorithms, and community-based paraprofessionals.
AHRQ-funded; HS025198.
Citation:
Carter E, Monane R, Peccoralo L .
Missed opportunities to engage patients in collaborative care challenge program sustainability: a qualitative study.
Gen Hosp Psychiatry 2020 Nov-Dec;67:158-59. doi: 10.1016/j.genhosppsych.2020.05.007..
Keywords:
Patient and Family Engagement, Primary Care: Models of Care, Primary Care, Behavioral Health, Patient-Centered Healthcare, Innovations and Emerging Issues
Rodríguez HP, Fulton BD, Phillips AZ
The early impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-day hospital readmissions among adults with diabetes.
The Centers for Medicare & Medicaid Services (CMS) State Innovation Models (SIM) Initiative funds states to accelerate delivery system and payment reforms. All SIM states focus on improving diabetes care, but SIM's effect on 30-day readmissions among adults with diabetes remains unclear. In this study, the investigators found no evidence that SIM reduced 30-day readmission rates among adults with diabetes during the first 2 years of round 1 implementation, even among CMS beneficiaries.
AHRQ-funded; HS022241.
Citation:
Rodríguez HP, Fulton BD, Phillips AZ .
The early impact of the Centers for Medicare & Medicaid Services State Innovation Models Initiative on 30-day hospital readmissions among adults with diabetes.
Med Care 2020 Jun;58(6 Suppl 1):S22-s30. doi: 10.1097/mlr.0000000000001276..
Keywords:
Diabetes, Chronic Conditions, Hospital Readmissions, Innovations and Emerging Issues, Quality Improvement, Quality of Care
Grembowsk D, Conrad DA, Naranjo D
RE-AIM Evaluation Plan for Washington State Innovation Models Project.
The authors sought to present the state-level evaluation methods for Washington State's State Innovation Models (SIM). They applied the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) evaluation framework to structure their evaluation, then created a conceptual model and plan to use multiple and mixed methods to study SIM performance in the RE-AIM components from a statewide, population-based perspective.
AHRQ-funded; HS013853.
Citation:
Grembowsk D, Conrad DA, Naranjo D .
RE-AIM Evaluation Plan for Washington State Innovation Models Project.
Qual Manag Health Care 2020 Apr/Jun;29(2):81-94. doi: 10.1097/qmh.0000000000000246..
Keywords:
Healthcare Delivery, Quality of Care, Innovations and Emerging Issues
Louisias M, Wright L, Phipatanakul W
Asthma in the melting pot.
This article highlights research advances related to asthma health disparities, and offers recommendations regarding innovative approaches to achieve equity and social justice for minority and low-income populations. Since traditional randomized controlled trials may not always be the most appropriate approach to health disparities research interventions, the authors suggest appropriate alternatives, such as the stepped-wedge design; or, because intervention trials are not always feasible, alternative analytic approaches such as mediation analysis or modeling could be used instead. Dissemination and implementation (D&I) research and the use of biomarkers to measure the social disadvantage impact of asthma outcomes are also discussed.
AHRQ-funded; HS022986.
Citation:
Louisias M, Wright L, Phipatanakul W .
Asthma in the melting pot.
Ann Allergy Asthma Immunol 2019 Feb;122(2):136-39. doi: 10.1016/j.anai.2018.11.009.
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Keywords:
Asthma, Disparities, Innovations and Emerging Issues, Low-Income, Racial / Ethnic Minorities, Respiratory Conditions
Chan B, Edwards ST, Devoe M
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Medically complex urban patients experiencing homelessness comprise a disproportionate number of high-cost, high-need patients. There are few studies of interventions to improve care for these populations; their social complexity makes them difficult to study and requires clinical and research collaboration. In this paper, the authors present a protocol for a trial of the streamlined unified meaningfully managed interdisciplinary team (SUMMIT) team, an ambulatory ICU (A-ICU) intervention to improve utilization and patient experience that uses control populations to address limitations of prior research.
AHRQ-funded; HS022981.
Citation:
Chan B, Edwards ST, Devoe M .
The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale.
Addict Sci Clin Pract 2018 Dec 14;13(1):27. doi: 10.1186/s13722-018-0128-y..
Keywords:
Healthcare Delivery, Innovations and Emerging Issues, Patient-Centered Healthcare, Primary Care, Vulnerable Populations
Berenson R, Singh H
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Researchers examined ways that payment innovations could be used to improve diagnostic accuracy and reduce diagnostic error among Medicare patients. They recommended three different approaches: 1) coding changes in the Medicare Physician Fee schedule; new Alternative Payment Models (APMs) that could improve accuracy in challenging cases and even provide second or third opinions; and 3) have a method that accurate diagnoses would trigger APM payments and establish payment amounts.
AHRQ-funded; HS022087; HS017820.
Citation:
Berenson R, Singh H .
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Health Aff 2018 Nov;37(11):1828-35. doi: 10.1377/hlthaff.2018.0714..
Keywords:
Diagnostic Safety and Quality, Innovations and Emerging Issues, Medical Errors, Medicare, Patient Safety, Payment, Prevention, Quality of Care, Quality Improvement
Brimhall KC, Mor Barak ME
The critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
Using a sample of 213 participants within 21 departmental units in a diverse human service organization, the authors performed multilevel path analysis to examine the critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
AHRQ-funded; HS024650.
Citation:
Brimhall KC, Mor Barak ME .
The critical role of workplace inclusion in fostering innovation, job satisfaction, and quality of care in a diverse human service organization.
Hum Serv Organ Manag Leadersh Gov 2018 Nov/Dec;42(5):474-92..
Keywords:
Innovations and Emerging Issues, Provider, Workforce, Organizational Change, Quality of Care
Carpenter D, Hassell S, Mardon R
Ambulatory Surgery, Cost-Effectiveness, Health Care Costs, Evidence-based Practice, Organization and Administration
This paper describes the concept of using learning communities to support adoption of health care innovations. The authors assert that the learning community model of group learning can serve as an effective method to support dissemination and implementation of innovations, and to achieve desired outcomes in local settings.
AHRQ-funded; 290201100001C.
Citation:
Carpenter D, Hassell S, Mardon R .
Ambulatory Surgery, Cost-Effectiveness, Health Care Costs, Evidence-based Practice, Organization and Administration
Jt Comm J Qual Patient Saf 2018 Oct;44(10):566-73. doi: 10.1016/j.jcjq.2018.03.010..
Keywords:
Innovations and Emerging Issues, Patient-Centered Healthcare, Quality Improvement, Implementation
Wagner EH, LeRoy L, Schaefer J
How do innovative primary care practices achieve the quadruple aim?
The Patient-Centered Medical Home (PCMH) defines excellent primary care but there is little empiric evidence that helps practices, payers, or policy makers understand how high-performing practices have improved outcomes. This paper reports findings from 38 high-performing practices. The authors describe how these practices execute 8 functions that collectively meet patient needs.
AHRQ-authored.
Citation:
Wagner EH, LeRoy L, Schaefer J .
How do innovative primary care practices achieve the quadruple aim?
J Ambul Care Manage 2018 Oct/Dec;41(4):288-97. doi: 10.1097/jac.0000000000000249..
Keywords:
Evidence-Based Practice, Innovations and Emerging Issues, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care
Stockwell DC, Landrigan CP, Toomey SL
Adverse events in hospitalized pediatric patients.
Patient safety concerns over the past 2 decades have prompted widespread efforts to reduce adverse events (AEs). This study used a validated safety surveillance tool, the Global Assessment of Pediatric Patient Safety, to measure temporal trends (2007-2012) in AE rates among hospitalized children. The study concluded that AE rates in pediatric inpatients are high and did not improve from 2007 to 2012. Pediatric AE rates were substantially higher in teaching hospitals as well as in patients with more chronic conditions.
AHRQ-funded; HS020513
Citation:
Stockwell DC, Landrigan CP, Toomey SL .
Adverse events in hospitalized pediatric patients.
Pediatrics 2018 Aug;142(2). doi: 10.1542/peds.2017-3360..
Keywords:
Adverse Events, Children/Adolescents, Hospitalization, Innovations and Emerging Issues, Patient Safety
Howard J, Miller WL, Willard-Grace R
Creating and sustaining care teams in primary care: perspectives from innovative patient-centered medical homes.
The purpose of this study was to learn from the experiences of innovative primary care practices that have successfully developed care teams. The authors assert that team-based care is possible and valuable in primary care but that it is difficult to develop and sustain, and requires dedicated time and resources. They suggest that the challenges described by the highly motivated practices, in their paper, raised the question of feasibility for more average practices in the current funding environment.
AHRQ-funded.
Citation:
Howard J, Miller WL, Willard-Grace R .
Creating and sustaining care teams in primary care: perspectives from innovative patient-centered medical homes.
Qual Manag Health Care 2018 Jul/Sep;27(3):123-29. doi: 10.1097/qmh.0000000000000176..
Keywords:
Healthcare Delivery, Innovations and Emerging Issues, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Reiter-Palmon R, Kennel V, Allen J
Good catch! Using interdisciplinary teams and team reflexivity to improve patient safety.
This article considers the role of reflexivity in team innovation implementation and its association with inpatient fall rates. The study it describes examined 16 small rural hospitals in which interdisciplinary teams intended to decrease fall risk were implemented, supported, and evaluated. Team reflexivity was assessed at the start and at the end of the 2-year intervention, and innovation implementation assessed at the end of the intervention. The hospitals reported objective fall event data and patient days throughout the project. Both the theoretical and practical applications of the results are discussed.
AHRQ-funded; HS021429; HS024630.
Citation:
Reiter-Palmon R, Kennel V, Allen J .
Good catch! Using interdisciplinary teams and team reflexivity to improve patient safety.
Group & Organization Management 2018 Jun;43(3):414-39. doi: 10.1177/1059601118768163..
Keywords:
Adverse Events, Falls, Innovations and Emerging Issues, Inpatient Care, Patient Safety, Prevention, Teams
Hung DY, Harrison MI , Truong Q
Experiences of primary care physicians and staff following lean workflow redesign.
The researchers examined the work experiences of primary care physicians and staff after implementing Lean-based workflow redesigns. They found that both physicians and nonphysician staff reported higher levels of engagement and teamwork after implementing redesigns. However, the subjects also experienced higher levels of burnout and perceptions of the workplace as stressful.
AHRQ-authored; AHRQ-funded; 290201000022I.
Citation:
Hung DY, Harrison MI , Truong Q .
Experiences of primary care physicians and staff following lean workflow redesign.
BMC Health Serv Res 2018 Apr 10;18(1):274. doi: 10.1186/s12913-018-3062-5.
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Keywords:
Organizational Change, Innovations and Emerging Issues, Primary Care: Models of Care, Primary Care, Workflow, Provider: Physician, Provider, Burnout
Callahan CM, Bateman DR, Wang S
State of science: bridging the science-practice gap in aging, dementia and mental health.
This article describes why new models of care in aging, dementia, and mental health diffuse inadequately into the healthcare systems and communities where they might benefit older adults. The investigators review a general framework for the diffusion of innovations and highlight the importance of other features of innovations that deter or facilitate diffusion.
AHRQ-funded; HS024384.
Citation:
Callahan CM, Bateman DR, Wang S .
State of science: bridging the science-practice gap in aging, dementia and mental health.
J Am Geriatr Soc 2018 Apr;66(Suppl 1):S28-s35. doi: 10.1111/jgs.15320..
Keywords:
Elderly, Dementia, Behavioral Health, Healthcare Delivery, Neurological Disorders, Implementation, Innovations and Emerging Issues, Evidence-Based Practice
Alderwick H, Shortell SM, Briggs ADM
Can accountable care organisations really improve the English NHS? Lessons from the United States.
The authors summarize evidence on accountable care organizations in the US - including what they look like, their effect on the quality and cost of healthcare, and how they are redesigning care. Recognizing major differences in context, they offer lessons from the US experience for National Health Service policy makers as they consider the future of similar ventures in England.
AHRQ-funded; HS022241; HS024075.
Citation:
Alderwick H, Shortell SM, Briggs ADM .
Can accountable care organisations really improve the English NHS? Lessons from the United States.
BMJ 2018 Mar 2;360:k921. doi: 10.1136/bmj.k921.
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Keywords:
Healthcare Costs, Quality of Care, Health Services Research (HSR), Innovations and Emerging Issues, Policy
Dorr DA, Cohen DJ, Adler-Milstein J
Data-driven diffusion of innovations: successes and challenges in 3 large-scale innovative delivery models.
This study assessed where data-driven innovation is occurring and where challenges lie. It found that implementation of some technological components of innovation (for example, electronic health records) has occurred among health care organizations, but core functions needed to use data to drive innovation are lacking. Deficits include the inability to extract and aggregate data from the records.
AHRQ-funded; HS023940.
Citation:
Dorr DA, Cohen DJ, Adler-Milstein J .
Data-driven diffusion of innovations: successes and challenges in 3 large-scale innovative delivery models.
Health Aff 2018 Feb;37(2):257-65. doi: 10.1377/hlthaff.2017.1133.
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Keywords:
Health Information Technology (HIT), Innovations and Emerging Issues, Primary Care
Rangachari P
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in health care organizations (HCOs). It summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
AHRQ-funded; HS024335.
Citation:
Rangachari P .
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
Innov Entrep Health 2018;5:1-14. doi: 10.2147/ieh.s151040.
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Keywords:
Evidence-Based Practice, Healthcare Systems, Health Information Technology (HIT), Innovations and Emerging Issues, Quality Improvement
Nix M, McNamara P, Genevro J
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
The authors examined AHRQ's experience with learning collaboratives to characterize their attributes, identify factors that might contribute to their success or failure, and assess the challenges they encountered. Building on the literature and insights from AHRQ's experience, they propose a taxonomy that can offer guidance to decision makers and funders about the factors they should consider in developing collaboratives.
AHRQ-authored.
Citation:
Nix M, McNamara P, Genevro J .
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
Health Aff 2018 Feb;37(2):205-12. doi: 10.1377/hlthaff.2017.1144.
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Keywords:
Healthcare Delivery, Healthcare Systems, Innovations and Emerging Issues, Quality of Care, Quality Improvement
Ono SS, Crabtree BF, Hemler JR
Taking innovation to scale in primary care practices: the functions of health care extension.
Health care extension is an approach to providing external support to primary care practices with the aim of diffusing innovation. EvidenceNOW was launched to rapidly disseminate and implement evidence-based guidelines for cardiovascular preventive care in the primary care setting. This article describes how cooperatives varied in their approaches to extension and provides early empirical evidence that health care extension is a feasible and potentially useful approach for providing quality improvement.
AHRQ-funded; HS023940.
Citation:
Ono SS, Crabtree BF, Hemler JR .
Taking innovation to scale in primary care practices: the functions of health care extension.
Health Aff 2018 Feb;37(2):222-30. doi: 10.1377/hlthaff.2017.1100.
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Keywords:
Cardiovascular Conditions, Communication, Evidence-Based Practice, Health Services Research (HSR), Healthcare Delivery, Heart Disease and Health, Innovations and Emerging Issues, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention, Primary Care, Quality of Care, Quality Improvement, Implementation
