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
126 to 150 of 583 Research Studies DisplayedRogith D, Satterly T, Singh H
Application of human factors methods to understand missed follow-up of abnormal test results.
This study demonstrated application of human factors methods for understanding causes for lack of timely follow-up of abnormal test results ("missed results") in outpatient settings. The investigators identified 30 cases of missed test results by querying electronic health record data, developed a critical decision method based interview guide to understand decision-making processes, and interviewed physicians who ordered these tests. They analyzed transcribed responses, developed a CI-based flow model, and conducted a fault tree analysis to identify hierarchical relationships between factors that delayed action.
AHRQ-funded; HS022087; HS022901.
Citation: Rogith D, Satterly T, Singh H .
Application of human factors methods to understand missed follow-up of abnormal test results.
Appl Clin Inform 2020 Oct;11(5):692-98. doi: 10.1055/s-0040-1716537..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Decision Making, Diagnostic Safety and Quality, Communication, Clinician-Patient Communication
Ruhnke GW, Tak HJ, Meltzer DO
Association of preferences for participation in decision-making with care satisfaction among hospitalized patients.
The purpose of this study was to investigate the association of hospitalized patients' desire to delegate decisions to their physician with care dissatisfaction. The investigators indicated that the findings suggested that patient preferences to participate in medical decision-making were statistically significantly associated with dissatisfaction of hospitalized patients. The authors assert that clinicians should individualize their encouragement of patient participation in diagnostic and management decisions to maximize patient satisfaction.
AHRQ-funded; HS016967.
Citation: Ruhnke GW, Tak HJ, Meltzer DO .
Association of preferences for participation in decision-making with care satisfaction among hospitalized patients.
JAMA Netw Open 2020 Oct;3(10):e2018766. doi: 10.1001/jamanetworkopen.2020.18766..
Keywords: Decision Making, Patient and Family Engagement, Patient Experience, Hospitalization, Hospitals
Gutnik L, Allen CM, Presson AP
Breast cancer surgery decision role perceptions and choice of surgery.
This study examined the finding that breast cancer patients who reported more personal responsibility for the surgery decision were more likely to undergo aggressive surgery. Retrospective cohort data was used from 100 newly diagnosed breast cancer patients. Surgery types compared were mastectomy, lumpectomy, and unilateral versus bilateral mastectomy. Patients’ decision-making role was identified using the Patient Preference Scale. Type of surgery and patient role concordance was compared as well as patient decision role performance, role perception, and provider role perception. Patient decision role and perceptions were not associated with type of surgery. Patient role preference depended on the stage of disease. Stage III patients preferred the most active roles with stage I and stage II patients preferring a more collaborative role. Providers perceived more passive patient roles in the mastectomy group.
AHRQ-funded; HS024784.
Citation: Gutnik L, Allen CM, Presson AP .
Breast cancer surgery decision role perceptions and choice of surgery.
Ann Surg Oncol 2020 Oct;27(10):3623-32. doi: 10.1245/s10434-020-08485-8.
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Keywords: Cancer: Breast Cancer, Cancer, Decision Making, Surgery, Women
Hargraves IG, Fournier AK, Montori VM
AHRQ Author: Fournier AK, Montori VM, Bierman AS.
Generalized shared decision making approaches and patient problems. adapting AHRQ's SHARE Approach for Purposeful SDM.
This article focuses on the AHRQ development of SHARE, which is a generalized shared decision making (SDM) approach for clinicians and patients to make decisions together. The authors hope to adapt SHARE to the different problems that patients face using a matrix to relate SHARE steps and use the Purposeful SDM schema published in 2019. They hope that SDM in education, practice, and tools may be supported by adapting generalized SDM approaches in patients’ problems.
AHRQ-authored.
Citation: Hargraves IG, Fournier AK, Montori VM .
Generalized shared decision making approaches and patient problems. adapting AHRQ's SHARE Approach for Purposeful SDM.
Patient Educ Couns 2020 Oct;103(10):2192-99. doi: 10.1016/j.pec.2020.06.022..
Keywords: Decision Making, Patient and Family Engagement
Chen DW, Reyes-Gastelum D, Radhakrishnan A
Physician-reported misuse of thyroid ultrasonography.
The authors explored physician-reported use of thyroid ultrasonography. They found that a substantial number of physicians endorsed the use of ultrasonography for reasons not supported by clinical guidelines and in conflict with the Choosing Wisely recommendations. They concluded that their study highlights the need for focused physician education on clinically supported and unsupported indications for use of thyroid ultrasonography, with potential roles for future clinical practice guidelines, patient decision-making aids, and clinical decision-making support tools.
AHRQ-funded; HS024512.
Citation: Chen DW, Reyes-Gastelum D, Radhakrishnan A .
Physician-reported misuse of thyroid ultrasonography.
JAMA Surg 2020 Oct;155(10):984-86. doi: 10.1001/jamasurg.2020.2507..
Keywords: Imaging, Decision Making, Guidelines, Evidence-Based Practice
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
Greenhawt M
Shared decision-making in the care of a patient with food allergy.
The purpose of this study was to determine the value of shared decision-making in the care of patients with food allergy. Data was compiled via a narrative review of the shared decision-making and food allergy outcomes literature for the past 20 years. Findings showed that shared decision-making was an approach that could greatly enhance food allergy care and improve patient-reported outcomes.
AHRQ-funded; HS024599.
Citation: Greenhawt M .
Shared decision-making in the care of a patient with food allergy.
Ann Allergy Asthma Immunol 2020 Sep;125(3):262-67. doi: 10.1016/j.anai.2020.05.031..
Keywords: Decision Making, Clinician-Patient Communication, Patient and Family Engagement
Abrams EM, Shaker M, Oppenheimer J
The challenges and opportunities for shared decision making highlighted by COVID-19.
This article discusses the challenges and opportunities for shared decision making (SDM) that have been emphasized more recently due to the COVID-19 pandemic. It has changed how clinicians deliver care due to the need for social distancing and health service reallocation. It is causing clinicians to reevaluate common practices and enhance effectiveness of their management strategies.
AHRQ-funded; HS024599.
Citation: Abrams EM, Shaker M, Oppenheimer J .
The challenges and opportunities for shared decision making highlighted by COVID-19.
J Allergy Clin Immunol Pract 2020 Sep;8(8):2474-80.e1. doi: 10.1016/j.jaip.2020.07.003.
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Keywords: Decision Making, COVID-19, Healthcare Delivery, Patient and Family Engagement, Patient-Centered Healthcare
Giardina JC, Cha T, Atlas SJ
Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data.
The purpose of this study was to develop and validate an algorithm to identify patients receiving four elective orthopedic surgeries to promote shared decision-making. The surgeries included were: 1) knee arthroplasty to treat knee osteoarthritis (KOA); 2) hip arthroplasty to treat hip osteoarthritis (HOA); 3) spinal surgery to treat lumbar spinal stenosis (SpS); and 4) spinal surgery to treat lumber herniated disc (HD). Electronic medical records were reviewed to ascertain a “gold standard” determination of the procedure and primary indication status. Each case had electronic algorithms consisting of ICD-10 and CPT codes for each combination and indication applied to their record. A total of 790 procedures were included in the study. The sensitivity of the algorithms ranged from 0.70 (HD) to 0.92 (KOA). Specificity ranged from 0.94 (SpS) to 0.99 (HOA, KOA).
AHRQ-funded; HS000055.
Citation: Giardina JC, Cha T, Atlas SJ .
Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data.
BMC Med Inform Decis Mak 2020 Aug 12;20(1):187. doi: 10.1186/s12911-020-01175-1.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Orthopedics, Surgery, Arthritis, Decision Making
Smith ME, Vitous CA, Hughes TM
Barriers and facilitators to de-implementation of the Choosing Wisely((R)) guidelines for low-value breast cancer surgery.
The objective of this study was to understand why surgeons stop performing certain unnecessary cancer operations but not others and how best to de-implement entrenched and emerging unnecessary procedures. The investigators concluded that with a growing focus on the elimination of ineffective, unproven or low value practices, it is imperative that the behavioral determinants are understood and targeted with specific interventions to decrease utilization rapidly.
AHRQ-funded; HS026030.
Citation: Smith ME, Vitous CA, Hughes TM .
Barriers and facilitators to de-implementation of the Choosing Wisely((R)) guidelines for low-value breast cancer surgery.
Ann Surg Oncol 2020 Aug;27(8):2653-63. doi: 10.1245/s10434-020-08285-0..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Decision Making, Guidelines, Women
Macheel C, Reicks P, Sybrant C
Clinical decision support intervention for rib fracture treatment.
The authors developed an evidence-based rib fracture protocol and clinical decision support intervention (CDSI) at their institution. The purpose of their study was to evaluate implementation and clinical outcomes using this CDSI. They found that the development and use of a CDSI resulted in improved provider delivery of evidence-based practice and was associated with reduced hospital length of stay.
AHRQ-funded; HS026379.
Citation: Macheel C, Reicks P, Sybrant C .
Clinical decision support intervention for rib fracture treatment.
J Am Coll Surg 2020 Aug;231(2):249-56.e2. doi: 10.1016/j.jamcollsurg.2020.04.023..
Keywords: Decision Making, Clinical Decision Support (CDS), Injuries and Wounds, Evidence-Based Practice
Wang T, Baskin AS, Dossett LA
Deimplementation of the choosing wisely recommendations for low-value breast cancer surgery: a systematic review.
Overtreatment of early-stage breast cancer results in increased morbidity and cost without improving survival. Major surgical organizations participating in the Choosing Wisely campaign identified 4 breast cancer operations as low value. The purpose of this study was to evaluate the extent to which these procedures have been deimplemented, determine the implications of decreased use, and recognize possible barriers and facilitators to deimplementation.
AHRQ-funded; HS026030.
Citation: Wang T, Baskin AS, Dossett LA .
Deimplementation of the choosing wisely recommendations for low-value breast cancer surgery: a systematic review.
JAMA Surg 2020 Aug;155(8):759-70. doi: 10.1001/jamasurg.2020.0322..
Keywords: Cancer: Breast Cancer, Cancer, Surgery, Decision Making, Women, Evidence-Based Practice
Curran RL, Kukhareva PV, Taft T
Integrated displays to improve chronic disease management in ambulatory care: a SMART on FHIR application informed by mixed-methods user testing.
This study’s objective was to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. The authors designed an application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). They used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Two patient scenarios were presented to the participants using the regular EHR with and without access to their prototype. Results measured was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. The 13 participants complete more recommended care using the prototype (81% vs 48%) and recommended tasks per minute over long sessions. Keystrokes per task were also lower with the prototype (6 vs 18). While there was a learning curve for this application, it will increase efficiency and patient care with practice.
AHRQ-funded; HS026198.
Citation: Curran RL, Kukhareva PV, Taft T .
Integrated displays to improve chronic disease management in ambulatory care: a SMART on FHIR application informed by mixed-methods user testing.
J Am Med Inform Assoc 2020 Aug;27(8):1225-34. doi: 10.1093/jamia/ocaa099..
Keywords: Chronic Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT), Care Management, Ambulatory Care and Surgery, Clinical Decision Support (CDS), Decision Making
Abrahamson K, Hass Z, Arling G
Shall I stay or shall I go? The choice to remain in the nursing home among residents with high potential for discharge.
This study examines why private-pay nursing home (NH) residents who expressed a desire for discharge and had relatively low-care needs chose to remain in the NH. The Minnesota Return to Community Initiative (RTCI) is a program that assists those residents to return to the community. Those who remained were more likely to beolder, more cognitively impaired, unmarried, had behavior problems, or diagnosed with dementia. At a 90-day assessment, residents who remained in the facility had a small decline in cognitive status, their continence improved, and they become more independent in activities of daily living (ADLs). Seventy-four percent of those remaining reported a perception of health barriers to discharge.
AHRQ-funded; HS020224.
Citation: Abrahamson K, Hass Z, Arling G .
Shall I stay or shall I go? The choice to remain in the nursing home among residents with high potential for discharge.
J Appl Gerontol 2020 Aug;39(8):863-70. doi: 10.1177/0733464818807818..
Keywords: Elderly, Nursing Homes, Long-Term Care, Transitions of Care, Decision Making
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
Shaffer VA, Wegier P, Valentine KD
Use of enhanced data visualization to improve patient judgments about hypertension control.
Uncontrolled hypertension is driven by clinical uncertainty around blood pressure data. This research sought to determine whether decision support-in the form of enhanced data visualization-could improve judgments about hypertension control. The investigators concluded that enhancing data visualization with the use of a smoothing function to minimize the variability present in raw blood pressure data significantly improved judgments about hypertension control.
AHRQ-funded; HS023328.
Citation: Shaffer VA, Wegier P, Valentine KD .
Use of enhanced data visualization to improve patient judgments about hypertension control.
Med Decis Making 2020 Aug;40(6):785-96. doi: 10.1177/0272989x20940999..
Keywords: Blood Pressure, Decision Making, Chronic Conditions, Cardiovascular Conditions, Health Information Technology (HIT)
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
Adami G, Saag KG, Mudano G, Saag KG, Mudano AS
Factors associated with the contemplative stage of readiness to initiate osteoporosis treatment.
Osteoporos Int 2020 Jul;31(7):1283-90. doi: 10.1007/s00198-020-05312-4.
AHRQ-funded; HS023009.
Citation: Adami G, Saag KG, Mudano G, Saag KG, Mudano AS .
Factors associated with the contemplative stage of readiness to initiate osteoporosis treatment.
Osteoporos Int 2020 Jul;31(7):1283-90. doi: 10.1007/s00198-020-05312-4..
Keywords: Osteoporosis, Women, Decision Making
Dowding D, Russell D, Trifilio M
Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study.
Investigators sought to understand if and how home care nurses identify patients at high risk of infection and which strategies they use to mitigate that risk. Interviews with fifty nurses were audio recorded and transcribed. Factors identified by the nurses as putting a patient at higher risk of infection included being older, having diabetes, and inadequate nutrition as well as inadequate clinical information available at start of care. The main strategy for infection prevention was patient and caregiver education. Nurses also discussed the importance of their own infection prevention behaviors and the ability to adjust a patient's plan of care according to their infection risk.
AHRQ-funded; HS024723.
Citation: Dowding D, Russell D, Trifilio M .
Home care nurses' identification of patients at risk of infection and their risk mitigation strategies: a qualitative interview study.
Int J Nurs Stud 2020 Jul;107:103617. doi: 10.1016/j.ijnurstu.2020.103617..
Keywords: Home Healthcare, Community-Acquired Infections, Infectious Diseases, Patient Safety, Prevention, Nursing, Decision Making
Despins LA, Wakefield BJ
Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: a qualitative study.
The purpose of this study was to describe individuals' with type 2 diabetes mellitus sense-making of blood glucose data and other influences impacting self-management behavior. One-on-one interviews with adults diagnosed with type 2 diabetes mellitus were used. Results showed that individuals used self-monitored glucose values and/or HbA1C values to evaluate glucose control. Recommendations included having nurses assess sense-making processes in self-management decisions and providing periodic refresher diabetes education for individuals with type 2 diabetes mellitus.
AHRQ-funded; HS022140.
Citation: Despins LA, Wakefield BJ .
Making sense of blood glucose data and self-management in individuals with type 2 diabetes mellitus: a qualitative study.
J Clin Nurs 2020 Jul;29(13-14):2572-88. doi: 10.1111/jocn.15280..
Keywords: Patient Self-Management, Diabetes, Chronic Conditions, Patient Adherence/Compliance, Decision Making
Schoenfeld EM, Houghton C, Patel PM
Shared decision making in patients with suspected uncomplicated ureterolithiasis: a decision aid development study.
The objective of this study was to develop a decision aid (DA) to facilitate shared decision making (SDM) around whether to obtain computed tomography (CT) imaging in patients presenting to the emergency department (ED) with suspected uncomplicated ureterolithiasis. Using stakeholder engagement and qualitative inquiry, the investigators developed their evidence-based DA. They indicated that future research will test the efficacy of the DA in facilitating SDM.
AHRQ-funded; HS025701.
Citation: Schoenfeld EM, Houghton C, Patel PM .
Shared decision making in patients with suspected uncomplicated ureterolithiasis: a decision aid development study.
Acad Emerg Med 2020 Jul;27(7):554-65. doi: 10.1111/acem.13917..
Keywords: Decision Making, Emergency Department, Imaging, Diagnostic Safety and Quality
Panattoni L, Stults CD, Chan AS
The human resource costs of implementing autopend clinical decision support to improve health maintenance.
This study estimated the costs of developing and implementing the Sutter Health autopend functionality within an existing electronic health maintenance (HM) reminder system. Findings showed that developing and implementing autopend took more than 3 years, involved 6 managers and 3 Epic programmers, and cost $201,500 and 2670 total hours, excluding the costs of implementing the initial HM reminder system. The autopend clinical decision support might be similarly costly for other organizations to implement if their managers need to complete comparable activities. However, electronic health record vendors could include autopend as a standard package to reduce development costs and improve the uptake of this promising clinical decision support tool.
AHRQ-funded; HS022631.
Citation: Panattoni L, Stults CD, Chan AS .
The human resource costs of implementing autopend clinical decision support to improve health maintenance.
Am J Manag Care 2020 Jul;26(7):e232-e36. doi: 10.37765/ajmc.2020.43766..
Keywords: Clinical Decision Support (CDS), Decision Making, Implementation
Lin JS, Murad MH, Leas B
A narrative review and proposed framework for using health system data with systematic reviews to support decision-making.
This paper addresses when and how the use of health system data might make systematic reviews more useful to decisionmakers. The authors have developed a framework to guide the use of health system data alongside systematic reviews based on a narrative review of the literature and empirical experience. They recommend future methodological work on how best to handle internal and external validity concerns of health system data in the context of systematically reviewed data and work on developing infrastructure to do this type of work.
AHRQ-funded; 290201500007I; 29032001T05; 290201500005I; 290201500009I.
Citation: Lin JS, Murad MH, Leas B .
A narrative review and proposed framework for using health system data with systematic reviews to support decision-making.
J Gen Intern Med 2020 Jun;35(6):1830-35. doi: 10.1007/s11606-020-05783-5..
Keywords: Learning Health Systems, Health Systems, Evidence-Based Practice, Data, Decision Making
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
AHRQ-funded; HS025701.
Citation: Westafer LM, Kunz A, Bugajska P .
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider