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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
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1 to 25 of 44 Research Studies DisplayedGoldberg DG, Soylu TG, Kitsantas P
Burnout among primary care providers and staff: evaluating the association with practice adaptive reserve and individual behaviors.
The purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioral response to change and burnout among healthcare professionals in primary care. Using data from the EvidenceNOW Heart of Virginia Healthcare initiative, the study’s findings showed that, as organizational capacity for change increased, burnout in healthcare professionals decreased by 51%. As healthcare professionals showed improved response toward change, burnout decreased by 84%. Increased hours of work per week was associated with higher odds of burnout across healthcare professional groups.
AHRQ-funded; HS023913.
Citation: Goldberg DG, Soylu TG, Kitsantas P .
Burnout among primary care providers and staff: evaluating the association with practice adaptive reserve and individual behaviors.
J Gen Intern Med 2021 May;36(5):1222-28. doi: 10.1007/s11606-020-06367-z..
Keywords: Burnout, Primary Care, Provider: Nurse, Provider: Clinician, Provider: Physician, Provider
Kandaswamy S, Pruitt Z, Kazi S
Clinician perceptions on the use of free-text communication orders.
The aim of this study was to investigate (1) why ordering clinicians use free-text orders to communicate medication information; (2) what risks physicians and nurses perceive when free-text orders are used for communicating medication information; and (3) how electronic health records (EHRs) could be improved to encourage the safe communication of medication information. The investigators concluded that clinicians' use of free-text orders as a workaround to insufficient structured order entry can create unintended patient safety risks.
AHRQ-funded; HS025136; HS024755.
Citation: Kandaswamy S, Pruitt Z, Kazi S .
Clinician perceptions on the use of free-text communication orders.
Appl Clin Inform 2021 May;12(3):484-94. doi: 10.1055/s-0041-1731002..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Electronic Health Records (EHRs), Medication: Safety, Medication, Patient Safety, Communication, Provider: Clinician, Provider, Risk
Dymek C, Kim B, Melton GB
Building the evidence-base to reduce electronic health record-related clinician burden.
This paper looks at the evidence-base to reduce electronic health record-related (EHR-related) clinician burden. Evidence-based informatics approaches, pragmatic next steps, and future research directions are presented to improve three of the highest contributors to EHR burden: documentation, chart review, and inbox tasks. Perspectives are also offered on how EHR vendors, healthcare system leaders, and policymakers can play an integral role to make EHR easier to use.
AHRQ-authored; AHRQ-funded; HS027363.
Citation: Dymek C, Kim B, Melton GB .
Building the evidence-base to reduce electronic health record-related clinician burden.
J Am Med Inform Assoc 2021 Apr 23;28(5):1057-61. doi: 10.1093/jamia/ocaa238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Evidence-Based Practice, Provider: Clinician, Provider: Physician, Provider
Fekieta R, Rosenberg A, Jenq GY
A new tool to assess clinician experience with patient care transitions.
The authors developed a brief survey to gauge clinician experience with patient care transfers that occur within a hospital. They found that, overall, the survey was feasible to implement and was built to optimize content, construct, and response process validity. Survey results drove practical improvement work, such as informing a verbal transfer protocol to improve nursing preparedness to receive patients on general medicine units. They concluded that, as a practical tool, the survey and its results can help hospital administrators to focus on categories of transfer activities that are most problematic for clinicians and to track trends for quality improvement.
AHRQ-funded; HS023554.
Citation: Fekieta R, Rosenberg A, Jenq GY .
A new tool to assess clinician experience with patient care transitions.
Qual Manag Health Care 2021 Apr-Jun;30(2):87-96. doi: 10.1097/qmh.0000000000000290..
Keywords: Transitions of Care, Quality Improvement, Quality of Care, Provider: Clinician, Provider
Friese CR, Mendelsohn-Victor K, Medvec BR
Factors associated with job satisfaction in medical oncology practices: results from a multisite survey.
This is a job satisfaction survey of clinicians from 29 ambulatory medical oncology practices conducted in 2017. The survey also examined clinician-to-clinician communication, and perceptions of patient safety. Of the 280 clinicians who responded, 85% reported that they were very satisfied or satisfied with their current position. Patient safety and accuracy of clinician communication were positively associated with job satisfaction.
AHRQ-funded; HS024914.
Citation: Friese CR, Mendelsohn-Victor K, Medvec BR .
Factors associated with job satisfaction in medical oncology practices: results from a multisite survey.
J Nurs Adm 2021 Apr;51(4):200-05. doi: 10.1097/nna.0000000000000998..
Keywords: Provider: Clinician, Provider: Physician, Provider: Nurse, Provider, Communication
Gettel CJ, Canavan ME, D'Onofrio G
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
This study looked at the clinical focus of emergency department (ED) workers using the 2017 Medicare Public Use Files for clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services for Medicare fee-for-service Part B. Clinicians were categorized as EM physicians, non-EM physicians, and advanced practice providers (APPs). Of the 65,710 unique clinicians providing care, 59.4% were classified as EM physicians, 12.4% as non-EM physicians, and 28.5% as APPs. EM physicians have twice as much clinician median focus in comparison to EM physicians providing emergency care (92.8% vs 45.2) and APPs are focused 100%.
AHRQ-funded; HS023614.
Citation: Gettel CJ, Canavan ME, D'Onofrio G .
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
Am J Emerg Med 2021 Apr;42:228-32. doi: 10.1016/j.ajem.2020.11.069..
Keywords: Emergency Department, Workforce, Provider: Physician, Provider: Clinician, Provider, Medicare
Loo S, Brochier A, Wexler MG
Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.
The purpose of this study was to assess pediatric hematology clinic staff's perspectives regarding barriers and facilitators in addressing unmet basic needs for children with sickle cell disease. Six focus groups were held at urban pediatric hematology clinics in the Northeastern region of the U.S. Four themes emerged: families of children with SCD have numerous unmet basic needs; clinic staff felt they had a role to play in addressing these needs; staff felt their ability to address these needs depended upon caregivers' capacity to act on staff recommendations; clinic staff's ability to address these needs was limited by organizational and systemic factors beyond their control. These findings have important implications for how best to address adverse social determinants of health for this vulnerable pediatric population so that urban-based pediatric hematology clinics can more equitably support families.
AHRQ-funded; HS022242.
Citation: Loo S, Brochier A, Wexler MG .
Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.
BMC Health Serv Res 2021 Jan 12;21(1):55. doi: 10.1186/s12913-020-06055-y..
Keywords: Children/Adolescents, Sickle Cell Disease, Chronic Conditions, Social Determinants of Health, Provider: Clinician, Provider: Physician, Provider, Urban Health
O'Leary KJ, Manojlovich M, Johnson JK
A multisite study of interprofessional teamwork and collaboration on general medical services.
This multisite study of four mid-sized hospitals measured teamwork climate of nurses, nurse assistants, and physicians working on general medical services. Teamwork climate scores for 380 participants (80 hospitalists, 13 resident physicians, 193 nurses, and 94 nurses) were measured using the Safety Attitudes Questionnaire. Hospitalists had the highest median teamwork climate score and nurses had the lowest, but it was not a statistically significant difference. A higher percentage of hospitalists (63.3%) rated the quality of collaboration with nurses as high or very high, but only 48.7% of nurses rated the collaboration with hospitalists as high or very high. There were significant differences in perceptions of teamwork climate across sites and across professional categories.
AHRQ-funded; HS025649.
Citation: O'Leary KJ, Manojlovich M, Johnson JK .
A multisite study of interprofessional teamwork and collaboration on general medical services.
Jt Comm J Qual Patient Saf 2020 Dec;46(12):667-72. doi: 10.1016/j.jcjq.2020.09.009..
Keywords: Teams, Hospitals, Patient Safety, Provider: Clinician, Provider: Physician, Provider: Nurse, Provider
Everson J, Cheng AK, Patrick SW
Association of electronic prescribing of controlled substances with opioid prescribing rates.
The purpose of this study was to assess the association between use of electronic prescribing of controlled substances (EPCS) and trends in opioid prescribing. Results suggested that an increased use of EPCS was not associated with decreased opioid prescribing or a decrease in the amount prescribed and may have been associated with a small increase in opioid prescribing. Recommendations included levers to ensure that EPCS is integrated with outside data and that information is actively used to inform prescribing decisions.
AHRQ-funded; HS026395.
Citation: Everson J, Cheng AK, Patrick SW .
Association of electronic prescribing of controlled substances with opioid prescribing rates.
JAMA Netw Open 2020 Dec;3(12):e2027951. doi: 10.1001/jamanetworkopen.2020.27951..
Keywords: Electronic Prescribing (E-Prescribing), Health Information Technology (HIT), Opioids, Medication, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Militello LG, Hurley RW, Cook RL
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
Investigators sought a better understanding of primary care clinicians’ approaches to managing patients with chronic pain and explored implications for technological and administrative interventions. They found that primary care clinicians’ beliefs about opioid therapy generally align with the clinical evidence but may have some important gaps, suggesting the potential value of interventions that include improved access to research findings, organizational changes to support spending time with patients to develop rapport, and the need for innovative clinical cognitive support.
AHRQ-funded; HS023306.
Citation: Militello LG, Hurley RW, Cook RL .
Primary care clinicians' beliefs and strategies for managing chronic pain in an era of a national opioid epidemic.
J Gen Intern Med 2020 Dec;35(12):3542-48. doi: 10.1007/s11606-020-06178-2..
Keywords: Primary Care, Opioids, Medication, Pain, Chronic Conditions, Provider: Physician, Provider: Clinician, Provider, Care Management
Fraze TK, Briggs ADM, Whitcomb EK
Role of nurse practitioners in caring for patients with complex health needs.
The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics. Findings showed that nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.
AHRQ-funded; HS024075.
Citation: Fraze TK, Briggs ADM, Whitcomb EK .
Role of nurse practitioners in caring for patients with complex health needs.
Med Care 2020 Oct;58(10):853-60. doi: 10.1097/mlr.0000000000001364..
Keywords: Provider: Clinician, Provider: Nurse, Provider, Chronic Conditions, Primary Care, Medicare
Poghosyan L, Ghaffari A, Liu J
Organizational support for nurse practitioners in primary care and workforce outcomes.
Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. In this study, the researchers investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. The investigators concluded that nurse practitioners from primary care practices with higher levels of organizational support were more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Organizational support for nurse practitioners in primary care and workforce outcomes.
Nurs Res 2020 Jul/Aug;69(4):280-88. doi: 10.1097/nnr.0000000000000425..
Keywords: Provider: Clinician, Provider, Primary Care, Burnout, Stress, Workforce, Organizational Change
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
Poghosyan L, Ghaffari A, Liu J
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
Primary care practices increasingly rely on the growing workforce of nurse practitioners (NPs) to meet primary care demand. Understanding teamwork between NPs and physicians in primary care practices is critically important. In this study, the investigators assessed teamwork between NPs and physicians practicing within the same primary care practice and determined how teamwork affected their job satisfaction, intent to leave their current job, and quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
J Gen Intern Med 2020 Apr;35(4):1021-28. doi: 10.1007/s11606-019-05509-2..
Keywords: Primary Care: Models of Care, Primary Care, Provider: Clinician, Provider: Physician, Provider, Workforce, Quality of Care
Adler-Milstein J, Zhao W, Willard-Grace R
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
This study examined whether objective measures of electronic health record (EHR) use-related to time, volume of work, and proficiency are associated with either exhaustion or cynicism. The authors combined Maslach Burnout Inventory survey measures with objective, vendor-defined EHR use measures from log files. Data was collected from all primary care clinics of a large, urban medical academic center in early 2018. One-third of clinicians had high cynicism and 51% had high emotional exhaustion. The clinicians with the most exhaustion spent time using the EHR after hours.
AHRQ-funded; HS022241.
Citation: Adler-Milstein J, Zhao W, Willard-Grace R .
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
J Am Med Inform Assoc 2020 Apr;27(4):531-38. doi: 10.1093/jamia/ocz220..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Clinician, Provider: Physician, Provider, Primary Care
Kohut MR, Keller SC, Linder JA
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Researchers conducted semi-structured interviews with clinicians to determine how they perceive demand for antibiotics in the outpatient setting. They conducted interviews with 25 clinicians from nine practices across three states. Patient demand was the most common reason why non-indicated antibiotics were prescribed. Clinicians felt that if they didn’t prescribe them they would experience repercussions in their reputation and practice and that certain patients are impossible to please without an antibiotic prescription regardless of the diagnosis.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Kohut MR, Keller SC, Linder JA .
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Fam Pract 2020 Mar 25;37(2):276-82. doi: 10.1093/fampra/cmz066..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Ambulatory Care and Surgery, Provider: Clinician, Provider: Physician, Provider
Kennedy-Metz L, Weiss P, Parker SH
Results of exploratory investigation into adherence to auditory coping instructions during an acutely stressful task.
Healthcare providers often perform under significant stress, during which their performance must be optimal, but is known to suffer. Stress management interventions in this context can provide cognitive support to rescue performance. This exploratory study sought to evaluate the effect of stress intervention components on stress and performance while clinicians engaged in two versions of a computer-based task, differing in overall level of demand: one high-stress and one low-stress.
AHRQ-funded; HS023465.
Citation: Kennedy-Metz L, Weiss P, Parker SH .
Results of exploratory investigation into adherence to auditory coping instructions during an acutely stressful task.
Stress 2020 Mar;23(2):144-52. doi: 10.1080/10253890.2019.1660317..
Keywords: Stress, Provider: Clinician, Provider
Gomes KM, Ratwani RM
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
In this research letter, the authors studied usability of electronic health records (EHR) with the system usability scale (SUS). They found that SUS scores decreased for 44% of vendors. Clinician satisfaction with EHR usability is not improving for many widely used products, and the authors recommended increased focus on clinician end users during product design and development as well as optimized certification requirements in order to improve usability.
AHRQ-funded; HS025136.
Citation: Gomes KM, Ratwani RM .
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
JAMA Netw Open 2019 Dec 2;2(12):e1916651. doi: 10.1001/jamanetworkopen.2019.16651..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Southern WN, Applebaum JR, Salmasian H
Clinician experience of electronic health record configurations displaying 1 vs 4 records at a time.
Most electronic health record (EHR) systems have the capability to display more than 1 patient record at a time; however, there is wide variation in practice. In this study, the investigators looked at clinician satisfaction of EHR configuration with varying numbers of records displayed.
AHRQ-funded; HS026121.
Citation: Southern WN, Applebaum JR, Salmasian H .
Clinician experience of electronic health record configurations displaying 1 vs 4 records at a time.
JAMA Intern Med 2019 Dec;179(12):1723-25. doi: 10.1001/jamainternmed.2019.3688..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Clinician, Provider
Adams DR, Williams NJ, Becker-Haimes EM
Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices.
In this study, the investigators prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. The investigators expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. They found that, controlling for covariates, financial strain predicted therapist turnover but not for therapists who participated in an EBP training initiative.
AHRQ-funded; HS000084.
Citation: Adams DR, Williams NJ, Becker-Haimes EM .
Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices.
Adm Policy Ment Health 2019 Nov;46(6):713-23. doi: 10.1007/s10488-019-00949-8..
Keywords: Healthcare Costs, Evidence-Based Practice, Behavioral Health, Provider, Provider: Clinician, Training, Workforce
Zikmund-Fisher BJ, Solomon JB, Scherer AM
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
Patient portals of electronic health record systems currently present patients with tables of laboratory test results, but visual displays can increase patient understanding and sensitivity to result variations. In this study, the investigators sought to assess physician preferences and concerns about visual display designs as potential motivators or barriers to their implementation.
Citation: Zikmund-Fisher BJ, Solomon JB, Scherer AM .
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
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Keywords: Primary Care, Electronic Health Records (EHRs), Education: Patient and Caregiver, Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Bernstein A, Rogers KM, Possin KL
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
The prevalence of dementia, a neurocognitive disorder (NCD), is expected to triple in the next 30 years. In this study, the investigators surveyed a national sample of primary care physicians to characterize their attitudes and practices with respect to the evaluation and management of NCDs.
AHRQ-funded; HS022241.
Citation: Bernstein A, Rogers KM, Possin KL .
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
J Gen Intern Med 2019 Sep;34(9):1691-92. doi: 10.1007/s11606-019-05013-7..
Keywords: Dementia, Neurological Disorders, Provider: Physician, Provider: Clinician, Provider, Primary Care
Rogers ES, Cuthel AM, Berry CA
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
This study examined the effectiveness of practice facilitation to improve cardiovascular disease in 257 small independent primary care practices (SIPs) enrolled in the AHRQ-funded EvidenceNOW initiative called HealthyHearts. These SIPs were enrolled in HealthyHearts NYC in New York City. Interviews were conducted with SIPs with 3 or fewer office staff and their answers were compared with interviews with practices with more than 3 office staff. Three facilitation benefits were found to the most important, including 1. Creating awareness of quality gaps; 2. Connecting practices to information, resources, and strategies, and; 3. Optimizing the HER for QI goals.
AHRQ-funded; HS023922.
Citation: Rogers ES, Cuthel AM, Berry CA .
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S17-s23. doi: 10.1370/afm.2427..
Keywords: Primary Care, Provider: Clinician, Provider: Physician, Provider, Quality Improvement, Quality of Care, Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Poghosyan L, Ghaffari A, Shaffer J
Nurse practitioner primary care organizational climate questionnaire: item response theory and differential item functioning.
This study evaluated the Nurse Practitioner Primary Care Organization Climate Questionnaire (NP-PCOCQ) and the items on the questionnaire using item response theory (IRT) and also conducted differential item functioning (DIF) analysis. The questionnaire was sent to 278 primary nurse practitioners (NPs) in New York State, and 314 NPs in Massachusetts. Data was collected online in NY and a mail survey was used in MA in 2012. Out of 29 items on the questionnaire, only 5 exhibited DIF. Out of these results, a shortened 24-item questionnaire was developed.
AHRQ-funded; HS020999.
Citation: Poghosyan L, Ghaffari A, Shaffer J .
Nurse practitioner primary care organizational climate questionnaire: item response theory and differential item functioning.
J Clin Nurs 2019 Aug;28(15-16):2934-45. doi: 10.1111/jocn.14895..
Keywords: Primary Care, Provider: Clinician, Provider: Nurse, Provider
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
