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
101 to 125 of 199 Research Studies DisplayedLiang C, Miao Q, Kang H
Leveraging patient safety research: efforts made fifteen years since To Err Is Human.
The present study sought to explore the associations between federal incentives of patient safety research and the outcomes from 1995 to 2014, in which two historical events - the release of To Err Is Human and the American Recovery and Reinvestment Act - were considered in the analysis. They concluded that their findings suggested a positive outcome in patient safety research.
AHRQ-funded; HS022895.
Citation: Liang C, Miao Q, Kang H .
Leveraging patient safety research: efforts made fifteen years since To Err Is Human.
Stud Health Technol Inform 2019 Aug 21;264:983-87. doi: 10.3233/shti190371..
Keywords: Patient Safety, Medical Errors, Adverse Events, Clinical Decision Support (CDS), Health Information Technology (HIT)
Hoonakker PLT, Carayon P, Salwei ME
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
One possible explanation for user resistance to clinical decision support (CDS) procedures may be poor CDS design. This study describes the design of PE Dx, a CDS built to aid in the diagnosis of pulmonary embolism in the emergency department using human factors methods.
AHRQ-funded; HS022086.
Citation: Hoonakker PLT, Carayon P, Salwei ME .
The design of PE Dx, a CDS to support pulmonary embolism diagnosis in the ED.
Stud Health Technol Inform 2019 Aug 9;265:134-40. doi: 10.3233/shti190152..
Keywords: Blood Clots, Clinical Decision Support (CDS), Decision Making, Diagnostic Safety and Quality, Emergency Department, Respiratory Conditions
Harle CA, DiIulio J, Downs SM
Decision-centered design of patient information visualizations to support chronic pain care.
The objective of this study was to describe a decision-centered design process, and resultant interactive patient information displays, to support key clinical decision requirements in chronic noncancer pain care. Through critical decision method interviews and a half-day multidisciplinary design workshop, researchers designed an interactive prototype, the Chronic Pain Treatment Tracker. This prototype summarizes the current treatment plan, past treatment history, potential future treatments, and treatment options that require caution. The researchers concluded that the Chronic Pain Treatment Tracker presents clinicians with the information they need in a structure that promotes quick uptake, understanding, and action.
AHRQ-funded; HS023306.
Citation: Harle CA, DiIulio J, Downs SM .
Decision-centered design of patient information visualizations to support chronic pain care.
Appl Clin Inform 2019 Aug;10(4):719-28. doi: 10.1055/s-0039-1696668..
Keywords: Pain, Chronic Conditions, Decision Making, Health Information Technology (HIT), Clinical Decision Support (CDS), Care Management, Healthcare Delivery
Ruaño G, Holford T, Seip RL
Pharmacogenetic clinical decision support for psychiatric hospitalization: design of the CYP-GUIDES randomized controlled trial.
The CYP-GUIDES (Cytochrome Psychotropic Genotyping Under Investigation for Decision Support) trial aims to establish evidence for clinical pharmacogenetics in psychotropic prescription in severely depressed inpatients. This article describes the design of a Randomized Controlled Trial (RCT) of CYP2D6 genotype-guided versus standard care psychotropic prescription. The CYP-GUIDES trial will assess whether clinical prescribing guided by CYP2D6 functional status can improve the treatment of psychiatric inpatients, shorten the length of hospitalization, and reduce readmission.
AHRQ-funded; HS022304.
Citation: Ruaño G, Holford T, Seip RL .
Pharmacogenetic clinical decision support for psychiatric hospitalization: design of the CYP-GUIDES randomized controlled trial.
Contemp Clin Trials 2019 Aug;83:27-36. doi: 10.1016/j.cct.2019.06.008..
Keywords: Behavioral Health, Hospitalization, Clinical Decision Support (CDS), Health Information Technology (HIT), Genetics
Patterson BW, Pulia MS, Ravi S
Scope and influence of electronic health record-integrated clinical decision support in the emergency department: a systematic review.
This systematic review examined the scope and influence of electronic health record-integrated clinical decision support (CDS) technologies implemented in hospital emergency departments. A literature search was conducted using 4 databases from the inception of these CDS systems through January 2018. Out of 2,558 potential studies identified, 42 met inclusion criteria. Common uses for CDS technologies included medication and radiology ordering practices, and more comprehensive systems supporting diagnosis and treatment for specific diseases. The majority of studies (83%) reported positive effects on outcomes, with most studies using a pre-post experimental design (76%). The authors concluded that although most studies show positive effects of CDS technologies, many of the studies were small and poorly controlled.
AHRQ-funded; HS024342; HS024558; HS022086.
Citation: Patterson BW, Pulia MS, Ravi S .
Scope and influence of electronic health record-integrated clinical decision support in the emergency department: a systematic review.
Ann Emerg Med 2019 Aug;74(2):285-96. doi: 10.1016/j.annemergmed.2018.10.034..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Emergency Department
Asti L, Bartsch SM, Umscheid CA
The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia.
Researchers developed a decision model to determine the economic and clinical value of using sputum cultures in the treatment of community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) from the hospital perspective under various conditions. They found that, overall, obtaining sputum cultures does not provide significant clinical or economic benefits for CAP or HCAP patients; however, it can reduce costs and shorten overall length of stay under some circumstances. They recommended that clinicians consider their local conditions when making decisions about sputum culture use.
AHRQ-funded; HS023317.
Citation: Asti L, Bartsch SM, Umscheid CA .
The potential economic value of sputum culture use in patients with community-acquired pneumonia and healthcare-associated pneumonia.
Clin Microbiol Infect 2019 Aug;25(8):1038.e1-38.e9. doi: 10.1016/j.cmi.2018.11.031..
Keywords: Pneumonia, Community-Acquired Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Healthcare Costs, Clinical Decision Support (CDS), Decision Making
Powers EM, Shiffman RN, Melnick ER
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
Clinical decision support (CDS) hard-stop alerts-those in which the user is either prevented from taking an action altogether or allowed to proceed only with the external override of a third party-are increasingly common but can be problematic. To understand their appropriate application, the investigators explored 3 key questions: (1) To what extent are hard-stop alerts effective in improving patient health and healthcare delivery outcomes? (2) What are the adverse events and unintended consequences of hard-stop alerts? (3) How do hard-stop alerts compare to soft-stop alerts?
AHRQ-funded; HS024332.
Citation: Powers EM, Shiffman RN, Melnick ER .
Efficacy and unintended consequences of hard-stop alerts in electronic health record systems: a systematic review.
J Am Med Inform Assoc 2018 Nov;25(11):1556-66. doi: 10.1093/jamia/ocy112..
Keywords: Clinical Decision Support (CDS), Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Patient Safety
Magrath M, Yang E, Ahn C
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
The goal of this study was to characterize guideline adherence of surveillance recommendations after implementation of an electronic medical record (EMR)-based Colonoscopy Pathology Reporting and Clinical Decision Support System (CoRS). Results showed that an EMR-based CoRS was widely used and significantly improved guideline adherence of surveillance recommendations.
AHRQ-funded; HS022418.
Citation: Magrath M, Yang E, Ahn C .
Impact of a clinical decision support system on guideline adherence of surveillance recommendations for colonoscopy after polypectomy.
J Natl Compr Canc Netw 2018 Nov;16(11):1321-28. doi: 10.6004/jnccn.2018.7050..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Colonoscopy, Cancer: Colorectal Cancer, Screening, Cancer, Guidelines, Evidence-Based Practice, Patient-Centered Outcomes Research, Prevention
Gianfrancesco MA, Tamang S, Yazdany J
Potential biases in machine learning algorithms using electronic health record data.
This Special Communication outlines the potential biases that may be introduced into machine learning-based clinical decision support tools that use electronic health record data and proposes potential solutions to the problems of overreliance on automation, algorithms based on biased data, and algorithms that do not provide information that is clinically meaningful.
AHRQ-funded; HS024412.
Citation: Gianfrancesco MA, Tamang S, Yazdany J .
Potential biases in machine learning algorithms using electronic health record data.
JAMA Intern Med 2018 Nov;178(11):1544-47. doi: 10.1001/jamainternmed.2018.3763..
Keywords: Electronic Health Records (EHRs), Clinical Decision Support (CDS), Health Information Technology (HIT), Decision Making
Leeds IL, Rosenblum AJ, Wise PE
Eye of the beholder: risk calculators and barriers to adoption in surgical trainees.
This study examined barriers to surgical trainees in using risk calculator tools before surgery. A total of 124 surgical residents responded to a survey and most still favored more traditional methods for risk calculation including direct verbal communication, sketch diagrams, and brochures. Only about half or less were familiar with more contemporary tools such as best-worst case scenario framing, case-specific risk calculators, and all-procedure calculators.
AHRQ-funded; HS024736.
Citation: Leeds IL, Rosenblum AJ, Wise PE .
Eye of the beholder: risk calculators and barriers to adoption in surgical trainees.
Surgery 2018 Nov;164(5):1117-23. doi: 10.1016/j.surg.2018.07.002..
Keywords: Clinical Decision Support (CDS), Decision Making, Education: Continuing Medical Education, Risk, Surgery
Anand V, Carroll AE, Biondich PG
Pediatric decision support using adapted Arden Syntax.
This study reviewed the use of a medical logic module (MLM) called the Arden Syntax in pediatrics. The Arden Syntax was adapted for the Child Health Improvement through Computer Automation System (CHICA) in waiting rooms. This system is used in pediatrician’s offices to screen patient families and alert physicians during office visits. It has been used in 7 pediatric clinics and has served over 44,000 patients in the last decade. The researchers concluded that it is an effective system for use in routine care and only needs some minor modifications.
AHRQ-funded; HS017939; HS018453.
Citation: Anand V, Carroll AE, Biondich PG .
Pediatric decision support using adapted Arden Syntax.
Artif Intell Med 2018 Nov;92:15-23. doi: 10.1016/j.artmed.2015.09.006..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Health Information Technology (HIT)
Panattoni L, Chan A, Yang Y
Nudging physicians and patients with autopend clinical decision support to improve diabetes management.
This study’s objective was to determine the impact on routine glycalated hemoglobin (A1C) laboratory test completion of incorporating an autopend laboratory order functionality into clinical decision support. The clinical decision support includes 1) routing provider alerts to a separate electronic folder, 2) automatically populating preauthorization forms, and 3) linking the timing and content of electronic patient health maintenance topic (HMT) reminders to the provider authorization. The likelihood of A1C laboratory test completion increased after autopend by between 21% to 33.9%.
AHRQ-funded; HS019167.
Citation: Panattoni L, Chan A, Yang Y .
Nudging physicians and patients with autopend clinical decision support to improve diabetes management.
Am J Manag Care 2018 Oct;24(10):479-83..
Keywords: Clinical Decision Support (CDS), Decision Making, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT)
Slight SP, Seger DL, Franz C
The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States.
Investigators worked to determine the national cost of adverse drug events (ADEs) in the United States in 2014. They used three different regression models. They used a random sample of 40,990 adult inpatients at the Brigham and Women’s Hospital in Boston with over 1.6 million medication orders. They extrapolated the medication orders using 2014 National Inpatient Sample (NIS) data. They estimated that out of 78.8 million total medication alerts, 5.5 million medication alerts would have been inappropriately overridden resulting in 196,660 ADEs. They estimated it would have cost between $871 million and $1.8 billion for treating these preventable ADEs in the United States.
AHRQ-funded; HS021094.
Citation: Slight SP, Seger DL, Franz C .
The national cost of adverse drug events resulting from inappropriate medication-related alert overrides in the United States.
J Am Med Inform Assoc 2018 Sep;25(9):1183-88. doi: 10.1093/jamia/ocy066..
Keywords: Healthcare Cost and Utilization Project (HCUP), Adverse Drug Events (ADE), Adverse Events, Clinical Decision Support (CDS), Health Information Technology (HIT), Healthcare Costs, Medical Errors, Medication
Ray-Barruel G, Cooke M, Mitchell M
Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study.
This study aims to validate an evidence-based peripheral intravenous catheter (PIVC) assessment and decision-making tool called I-DECIDED and evaluate the effect of implementing this tool into acute hospital clinical practice.
AHRQ-funded; HS022835.
Citation: Ray-Barruel G, Cooke M, Mitchell M .
Implementing the I-DECIDED clinical decision-making tool for peripheral intravenous catheter assessment and safe removal: protocol for an interrupted time-series study.
BMJ Open 2018 Jun 4;8(6):e021290. doi: 10.1136/bmjopen-2017-021290..
Keywords: Clinical Decision Support (CDS), Decision Making, Patient Safety, Tools & Toolkits
Patterson ES, Dewart CM, Stevenson K
A mixed methods approach to tailoring evidence-based guidance for antibiotic stewardship to one medical system.
The purpose of the study is to operationalize a novel antibiotic advisor, called the personalized weighted incidence syndromic combination antibiogram (pWISCA), intended to help physicians with initial antibiotic choice in hospitals. This paper presents findings from applying a mixed methods approach to identifying and prioritizing antibiotic medications and associated contextual data to display in a clinical decision support tailored to the local hospital.
AHRQ-funded; HS024379.
Citation: Patterson ES, Dewart CM, Stevenson K .
A mixed methods approach to tailoring evidence-based guidance for antibiotic stewardship to one medical system.
Proc Int Symp Hum Factors Ergon Healthc 2018 Jun;7(1):224-31. doi: 10.1177/2327857918071053..
Keywords: Antibiotics, Clinical Decision Support (CDS), Evidence-Based Practice, Health Services Research (HSR), Hospitals
Marcial LH, Richardson JE, Lasater B
AHRQ Author: Lomotan and Al-Showk
The imperative for patient-centered clinical decision support.
This commentary introduces the Patient-Centered Clinical Decision Support (PCCDS) Learning Network, which is collaborating with AcademyHealth to publish "Better Decisions Together" as part of eGEMs. The PCCDS Learning Network has developed a framework, referred to as the Analytic Framework for Action (AFA), to organize thinking and activities around PCCDS. A wide array of activities the PCCDS Learning Network is engaging in to inform and connect stakeholders is discussed.
AHRQ-authored.
Citation: Marcial LH, Richardson JE, Lasater B .
The imperative for patient-centered clinical decision support.
eGEMS 2018 May 30;6(1):12. doi: 10.5334/egems.259..
Keywords: Clinical Decision Support (CDS), Decision Making, Patient-Centered Healthcare
Keller SC, Tamma PD, Cosgrove SE
AHRQ Author: Miller MA
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
The authors conducted a systematic review to identify controlled interventions and qualitative studies of ambulatory antibiotic stewardship (AS) interventions and determine whether and how they incorporated principles from a human factors engineering model, the Systems Engineering Initiative for Patient Safety 2.0 model. They concluded that studies have not focused on clinic-wide approaches to AS.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Keller SC, Tamma PD, Cosgrove SE .
Ambulatory antibiotic stewardship through a human factors engineering approach: a systematic review.
J Am Board Fam Med 2018 May-Jun;31(3):417-30. doi: 10.3122/jabfm.2018.03.170225.
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Keywords: Antibiotics, Clinical Decision Support (CDS), Primary Care: Models of Care, Ambulatory Care and Surgery, Patient Safety
MacLaughlin KL, Kessler ME, Komandur Elayavilli R
Impact of patient reminders on Papanicolaou test completion for high-risk patients identified by a clinical decision support system.
The researchers aimed to assess the effect of a complex clinical decision support system, incorporating national guidelines for high-risk patient screening and abnormal result management. They found that the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7 percent than the completion rate at 3.3 percent in the control group.
AHRQ-funded; HS022911.
Citation: MacLaughlin KL, Kessler ME, Komandur Elayavilli R .
Impact of patient reminders on Papanicolaou test completion for high-risk patients identified by a clinical decision support system.
J Womens Health 2018 May;27(5):569-74. doi: 10.1089/jwh.2017.6667.
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Keywords: Cancer, Clinical Decision Support (CDS), Guidelines, Health Information Technology (HIT)
Bowen ME, Bhat D, Fish J
Improving performance on preventive health quality measures using clinical decision support to capture care done elsewhere and patient exceptions.
This before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement.
AHRQ-funded; HS022418.
Citation: Bowen ME, Bhat D, Fish J .
Improving performance on preventive health quality measures using clinical decision support to capture care done elsewhere and patient exceptions.
Am J Med Qual 2018 May/Jun;33(3):237-45. doi: 10.1177/1062860617732830..
Keywords: Clinical Decision Support (CDS), Prevention, Provider Performance, Quality Improvement, Quality Measures, Quality Measures
Nanji KC, Seger DL, Slight SP
Medication-related clinical decision support alert overrides in inpatients.
This study examined the use of medical-related clinical decision support alert overrides by clinicians in hospital inpatient settings. Overall, almost three-quarters of alerts were overridden, with 40% of them not being appropriate. The majority of overrides dealing with duplicate drug, patient allergy or formulary substitution alerts were appropriate but very few for renal- or age-based were. The authors concluded that research should be done to optimize alert types and frequencies to reduce alarm fatigue.
AHRQ-funded; HS024764.
Citation: Nanji KC, Seger DL, Slight SP .
Medication-related clinical decision support alert overrides in inpatients.
J Am Med Inform Assoc 2018 May;25(5):476-81. doi: 10.1093/jamia/ocx115..
Keywords: Clinical Decision Support (CDS), Decision Making, Health Information Technology (HIT), Inpatient Care, Medication
Wey A, Salkowski N, Kremers WK
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
The researchers developed a kidney offer acceptance decision tool to predict the probability of graft survival and patient survival for first-time kidney-alone candidates after an offer is accepted or declined, and they characterized the effect of restricting the donor pool with a maximum acceptable kidney donor profile index (KDPI). Donor pool restrictions were associated with worse 3-year outcomes, especially for candidates with high allocation priority.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kremers WK .
A kidney offer acceptance decision tool to inform the decision to accept an offer or wait for a better kidney.
Am J Transplant 2018 Apr;18(4):897-906. doi: 10.1111/ajt.14506.
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Keywords: Clinical Decision Support (CDS), Decision Making, Kidney Disease and Health, Medical Expenditure Panel Survey (MEPS), Transplantation
Grout RW, Cheng ER, Carroll AE
A six-year repeated evaluation of computerized clinical decision support system user acceptability.
This study examined user acceptance patterns over six years of a continuous computerized clinical decision support system (CDSS) integration and updated a long-term, repeated follow-up of user acceptability of a CDSS. It found that favorable opinions of the CDSS were more likely in frequent users, physicians and advanced practitioners, and full-time workers.
AHRQ-funded; HS017939; HS018453; HS020640.
Citation: Grout RW, Cheng ER, Carroll AE .
A six-year repeated evaluation of computerized clinical decision support system user acceptability.
Int J Med Inform 2018 Apr;112:74-81. doi: 10.1016/j.ijmedinf.2018.01.011.
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Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Provider: Health Personnel, Health Information Technology (HIT), Quality Improvement
Aldina S, Goldhaber-Fiebert SN, Hannenberg AA
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
This study examined organizational context and implementation process factors influencing the use of cognitive aids for OR crises. It found that small facility size was associated with a fourfold increase in the odds of a facility reporting more successful implementation. Completing more implementation steps was also significantly associated with more successful implementation.
AHRQ-funded; HS024235.
Citation: Aldina S, Goldhaber-Fiebert SN, Hannenberg AA .
Factors associated with the use of cognitive aids in operating room crises: a cross-sectional study of US hospitals and ambulatory surgical centers.
Implement Sci 2018 Mar 26;13(1):50. doi: 10.1186/s13012-018-0739-4.
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Keywords: Adverse Events, Ambulatory Care and Surgery, Patient Safety, Quality Improvement, Quality of Care, Hospitals, Decision Making, Clinical Decision Support (CDS)
Wong A, Seger DL, Slight SP
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
The aim of this study was to determine the rate of anaphylaxis overrides, the reasons for these overrides, whether the overrides were appropriate, and if harm occurred from overrides. Overrides of 'definite' anaphylaxis drug-allergy interactions were common and often appropriate. Most overrides were due to desensitizations.
AHRQ-funded; HS021094.
Citation: Wong A, Seger DL, Slight SP .
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
Drug Saf 2018 Mar;41(3):297-302. doi: 10.1007/s40264-017-0615-1.
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Keywords: Adverse Drug Events (ADE), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Medication: Safety, Medication
Etter DJ, McCord A, Ouyang F
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. The authors concluded that incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care was feasible and well utilized by providers.
AHRQ-funded; HS022681.
Citation: Etter DJ, McCord A, Ouyang F .
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
J Adolesc Health 2018 Feb;62(2):191-97. doi: 10.1016/j.jadohealth.2017.08.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Decision Making, Depression, Behavioral Health, Primary Care, Screening