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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 491 Research Studies Displayed
Kranz AM, Steiner ED, Mitchell JM
School-based health services in Virginia and the COVID-19 pandemic.
The purpose of this study was to examine how the COVID-19 pandemic may have impacted the provision of school health services and related student needs. In May 2021, all 1178 Virginia public elementary schools received a web-based survey regarding the impact of the pandemic on school-based health services, with 65% of schools responding (N=767). Schools reported providing fewer school-based health services during the pandemic than before, with dental screenings declining the most (51% before vs 15% after). The study also reported that mental health as a top concern for students increased from 15% before the pandemic to 27% during the pandemic. The study concluded that schools reported providing fewer health services to students during pandemic in the 2020-2021 school year and increased concern about students' mental health.
AHRQ-funded; HS025430.
Citation:
Kranz AM, Steiner ED, Mitchell JM .
School-based health services in Virginia and the COVID-19 pandemic.
J Sch Health 2022 May;92(5):436-44. doi: 10.1111/josh.13147..
Keywords:
COVID-19, Children/Adolescents, Public Health, Healthcare Delivery, Community-Based Practice
Kenney MK, Chanlongbutra A, Fanflick PL
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
The purpose of the study was to compare Children and Youth with Special Health Care Needs (CYSHCN) with non-CYSHCN in the likelihood of experiencing Adverse Childhood Events (ACEs), and then document the differences in receiving recommended and needed health care services among CYSHCS with and without ACEs. The researchers studied a sample of 16,304 CYSHCN from the 2016 and 2017 National Survey of Children’s Health (N=71,181). The study found that CYHSCN had a greater likelihood of having each of the measured Adverse Childhood Events, and greater likelihood of experiencing aggregated levels of ACE’s than non-CYSHCN. In addition, an increase in ACEs was related to a decrease in the likelihood of a CYSHCN having a medical home with family-centered and coordinated care. Having one or greater ACEs increased the likelihood of having unmet mental health care needs. The study concluded that the researcher’s findings extend the current understanding of the relationship between CYSHCN and ACEs, and that the need for additional work to establish care systems for this vulnerable population continues.
AHRQ-authored.
Citation:
Kenney MK, Chanlongbutra A, Fanflick PL .
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
Disabil Health J 2022 Apr;15(2):101226. doi: 10.1016/j.dhjo.2021.101226..
Keywords:
Children/Adolescents, Disabilities, Healthcare Delivery, Vulnerable Populations
Bergman ZR, Usher M, Olson A
Comparison of outcomes and process of care for patients treated at hospitals dedicated for COVID-19 care vs other hospitals.
The purpose of this study was to analyze the mortality rate and complications associated with treatment at the COVID-19-dedicated hospitals. Findings showed that, in this cohort study, COVID-19-dedicated hospitals in Minnesota had multiple benefits, including providing high-volume repetitive treatment and isolating patients with the infection. This experience suggests improved in-hospital mortality for patients treated at dedicated hospitals.
AHRQ-funded; HS026732; HS026379.
Citation:
Bergman ZR, Usher M, Olson A .
Comparison of outcomes and process of care for patients treated at hospitals dedicated for COVID-19 care vs other hospitals.
JAMA Netw Open 2022 Mar;5(3):e220873. doi: 10.1001/jamanetworkopen.2022.0873..
Keywords:
COVID-19, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes, Healthcare Delivery, Hospitals
Brajcich BC, Benson AB, Gantt G
Management of colorectal cancer during the COVID-19 pandemic: recommendations from a statewide multidisciplinary cancer collaborative.
J Surg Oncol 2022 Mar;125(4):560-63. doi: 10.1002/jso.26758.
AHRQ-funded; HS026385.
Citation:
Brajcich BC, Benson AB, Gantt G .
Management of colorectal cancer during the COVID-19 pandemic: recommendations from a statewide multidisciplinary cancer collaborative.
J Surg Oncol 2022 Mar;125(4):560-63. doi: 10.1002/jso.26758..
Keywords:
COVID-19, Cancer: Colorectal Cancer, Cancer, Guidelines, Evidence-Based Practice, Healthcare Delivery
Hays RD, Skootsky SA
Patient experience with in-person and telehealth visits before and during the COVID-19 pandemic at a large integrated health system in the United States.
Researchers sought to compare patient experience by visit type and before and during the pandemic. Using CAHPS® data, they found that patient experience with telehealth visits was as positive as or more positive than that with traditional office-based visits. Doctor communication on telehealth visits was viewed as slightly more positive than that of in-office or telephone visits. Telehealth visits were also slightly more positive than in-office visits for care coordination, overall rating of the doctor, and willingness to recommend to family and friends. Office staff were viewed less positively on the telephone than telehealth or in-office visits. Further, patient experience was similar before and during the COVID-19 pandemic.
AHRQ-funded; HS025920.
Citation:
Hays RD, Skootsky SA .
Patient experience with in-person and telehealth visits before and during the COVID-19 pandemic at a large integrated health system in the United States.
J Gen Intern Med 2022 Mar;37(4):847-52. doi: 10.1007/s11606-021-07196-4..
Keywords:
COVID-19, Telehealth, Health Information Technology (HIT), Patient Experience, Healthcare Delivery
Bierman AS, Tong ST, McNellis RJ
Realizing the dream: the future of primary care research.
In this article, the authors discussed the primary care research central to successful primary care transformation and to realizing the vision of a high-performing US health system to serve effectively all Americans and their communities while advancing health equity.
AHRQ-authored.
Citation:
Bierman AS, Tong ST, McNellis RJ .
Realizing the dream: the future of primary care research.
Ann Fam Med 2022 Mar-Apr;20(2):170-74. doi: 10.1370/afm.2788..
Keywords:
Primary Care, Healthcare Delivery, Evidence-Based Practice, Healthcare Systems, Learning Health Systems, Patient-Centered Healthcare
Rikin S, Perez HR, Zhang C
Changes in outpatient opioid prescribing during the COVID-19 pandemic: an interrupted time series analysis.
Changes in health care delivery during the COVID-19 pandemic may have impacted opioid prescribing. This study evaluated the impact of restrictions on in-person care on opioid prescribing in the outpatient setting. The hypothesis was that after restrictions to in-person care were implemented, there would be a reduction in the number of chronic and non-chronic opioid prescriptions.
AHRQ-funded; HS026396.
Citation:
Rikin S, Perez HR, Zhang C .
Changes in outpatient opioid prescribing during the COVID-19 pandemic: an interrupted time series analysis.
J Prim Care Community Health 2022 Jan-Dec;13:21501319221076926. doi: 10.1177/21501319221076926..
Keywords:
COVID-19, Opioids, Medication, Practice Patterns, Healthcare Delivery
Adler-Milstein J, Linden A, Bernstein S
Longitudinal participation in delivery and payment reform programs among US primary care organizations.
The purpose of this retrospective, observational study was to assess longitudinal primary care organization participation patterns in large-scale reform programs and to identify organizational characteristics associated with multiprogram participation. Medicare claims were used to identify organizations that delivered primary care services. Findings showed that no program achieved more than 50% participation; 36% of organizations did not participate in any program; 50% participated in one; 13% in two; and 1% in all three. Larger organizations, those with younger providers, those with more primary care providers, and those with larger Medicare patient panels were more likely to participate in more programs.
AHRQ-funded; HS025165.
Citation:
Adler-Milstein J, Linden A, Bernstein S .
Longitudinal participation in delivery and payment reform programs among US primary care organizations.
Health Serv Res 2022 Feb;57(1):47-55. doi: 10.1111/1475-6773.13646..
Keywords:
Primary Care, Medicare, Healthcare Delivery
Lai LY, Kaufman SR, Modi PK
Impact of advanced practice provider integration into multispecialty group practices on outcomes following major surgery.
Researchers examined the impact of advanced practice provider (APP) integration into multispecialty group practices on outcomes after major surgery. Using Medicare data, they found that integration of APPs into multispecialty group practices was associated with improved postoperative outcomes after major surgery. They recommended that future research identify the mechanisms by which APPs improve outcomes to inform optimal utilization.
AHRQ-funded; HS025707.
Citation:
Lai LY, Kaufman SR, Modi PK .
Impact of advanced practice provider integration into multispecialty group practices on outcomes following major surgery.
Surg Innov 2022 Feb;29(1):111-17. doi: 10.1177/15533506211013150..
Keywords:
Surgery, Healthcare Delivery
Zimmerman S, Carder P, Schwartz L
The imperative to reimagine assisted living.
Assisted living (AL) has existed in the United States for decades, evolving in response to older adults' need for supportive care and distaste for nursing homes and older models of congregate care. AL is state-regulated, provides at least 2 meals a day, around-the-clock supervision, and help with personal care, but is not licensed as a nursing home. This article presents the background regarding those tensions, as well as potential solutions that have been borne out, paving the path to a better future of assisted living.
AHRQ-funded; HS026893.
Citation:
Zimmerman S, Carder P, Schwartz L .
The imperative to reimagine assisted living.
J Am Med Dir Assoc 2022 Feb;23(2):225-34. doi: 10.1016/j.jamda.2021.12.004..
Keywords:
Elderly, Long-Term Care, Healthcare Delivery, Workforce, Quality of Care, Quality of Life, Healthcare Costs
Staiger B
Disruptions to the patient-provider relationship and patient utilization and outcomes: evidence from Medicaid managed care.
The patient-provider relationship is considered a cornerstone to delivering high-value healthcare. However, in Medicaid managed care settings, disruptions to this relationship are disproportionately common. In this paper, the researcher evaluated the impact of a primary provider's exit from a Medicaid managed care plan on adult beneficiary healthcare utilization and outcomes.
AHRQ-funded; HS026128.
Citation:
Staiger B .
Disruptions to the patient-provider relationship and patient utilization and outcomes: evidence from Medicaid managed care.
J Health Econ 2022 Jan;81:102574. doi: 10.1016/j.jhealeco.2021.102574..
Keywords:
Medicaid, Clinician-Patient Communication, Healthcare Delivery, Chronic Conditions
Manojlovich M, Hofer TP, Krein SL
Advancing patient safety through the clinical application of a framework focused on communication.
The purpose of this review article was to describe a conceptual framework of communication drawn from multiple academic disciplines and to apply it to health care, specifically for examining communication between providers about the clinical care of their patients. Findings showed that poor communication remained a stubborn problem in health care in part because of a narrow theoretical and definitional approach to resolving it. The proposed conceptual framework suggested ways to build relationships and trust, addressed hierarchical differences between communicators, and illuminated the role of technology in communication.
AHRQ-funded; HS022305; HS024760.
Citation:
Manojlovich M, Hofer TP, Krein SL .
Advancing patient safety through the clinical application of a framework focused on communication.
J Patient Saf 2021 Dec 1;17(8):e732-e37. doi: 10.1097/pts.0000000000000547..
Keywords:
Patient Safety, Communication, Healthcare Delivery
Lee DJ, Shelton JB, Brendel P
Impact of the COVID-19 pandemic on urological care delivery in the United States.
This study examined changes in urological care delivery in the US due to the COVID-19 pandemic. Real-world data was analyzed from the American Urological Association Quality (AQUA) Registry from 157 outpatient urological practices and 3,165 providers across 58 states and territories, including over 3.2 million unique patients, over 12 million outpatient visits and over 2 million procedures. Primary outcome measured was the number of outpatient visits and procedures performed from January 2019 to February 2021. The largest decline (>50%) was from March to April 2020 across all patient demographic groups and states. Nonurgent outpatient visits decreased more across various nonurgent procedures (49-59%) than for potentially urgent diagnoses (38-52%). Medicare-insured patients had the steepest declines (55%), while those on Medicaid and government insurance had the lowest percentage of care recovery to baseline. African American patients also had slower recoveries back to baseline.
AHRQ-funded; HS026372.
Citation:
Lee DJ, Shelton JB, Brendel P .
Impact of the COVID-19 pandemic on urological care delivery in the United States.
J Urol 2021 Dec;206(6):1469-79. doi: 10.1097/ju.0000000000002145..
Keywords:
COVID-19, Healthcare Delivery
Henriksen K, Rodrick D, Grace EN
Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment.
This article describes a grant initiative undertaken by AHRQ that brings design, systems engineering, and health care delivery research together to test new ideas that could make health care safer. Based on feedback received from project teams, lessons learned are emerging that find considerable variation among project teams in deploying the methodology and a longer-than-anticipated amount of time in bringing team members from different disciplines together where they learn to communicate and function as a team. Three narratives are generated in terms of what success might look like.
AHRQ-authored.
Citation:
Henriksen K, Rodrick D, Grace EN .
Pursuing patient safety at the intersection of design, systems engineering, and health care delivery research: an ongoing assessment.
J Patient Saf 2021 Dec 1;17(8):e1685-e90. doi: 10.1097/pts.0000000000000577..
Keywords:
Patient Safety, Healthcare Delivery, Learning Health Systems, Healthcare Systems
Prabhakaran S, Khorzad R, Parnianpour Z
Door-in-door-out process times at primary stroke centers in Chicago.
This study sought to identify modifiable predictors of door-in-door-out times for transfer of acute stroke patients from primary stroke centers to comprehensive stroke centers using 3 Chicago-region primary stroke centers as a model. A retrospective analysis of consecutive patients with acute stroke from February 2018 to January 2020 who required transfer from 1 of 3 primary stroke centers to 1 of 3 affiliated comprehensive stroke centers was conducted. Of 191 total patients, 67.9% arrived by emergency medical services and 57.4% during off-hours. Telestroke was performed in 84.2% of patients, 30.5% received alteplase, and 48.4% underwent a computed tomography (CT) at the primary stroke center. The median door-in-door-out time was 148.5 minutes. The largest contributors to longer door-in-door-out times were CT to CT angiography time, transfer center contact to ambulance request time, ambulance request to arrive time, and transfer ambulance at primary stroke center. Other factors included CT angiography performed at the primary stroke center, walk-in arrival mode, administration of intravenous alteplase request by primary stroke center, and ambulance request by the primary stroke center.
AHRQ-funded; HS025359.
Citation:
Prabhakaran S, Khorzad R, Parnianpour Z .
Door-in-door-out process times at primary stroke centers in Chicago.
Ann Emerg Med 2021 Nov;78(5):674-81. doi: 10.1016/j.annemergmed.2021.06.018..
Keywords:
Stroke, Cardiovascular Conditions, Healthcare Delivery, Emergency Department
Vranas KC, Golden SE, Mathews KS
The influence of the COVID-19 pandemic on ICU organization, care processes, and frontline clinician experiences: a qualitative study.
The COVID-19 pandemic resulted in unprecedented adjustments to intensive care unit (ICU) organization and care processes globally. The investigators examined if hospital emergency responses to the COVID-19 pandemic differed depending on hospital setting and explored which strategies worked well to mitigate strain as perceived by intensivists. The investigators concluded that their study demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
AHRQ-funded; HS028038.
Citation:
Vranas KC, Golden SE, Mathews KS .
The influence of the COVID-19 pandemic on ICU organization, care processes, and frontline clinician experiences: a qualitative study.
Chest 2021 Nov;160(5):1714-28. doi: 10.1016/j.chest.2021.05.041..
Keywords:
COVID-19, Intensive Care Unit (ICU), Critical Care, Healthcare Delivery, Workforce, Public Health
Bayramzadeh S, Anthony MK, Sterling M
The role of the physical environment in shaping interruptions and disruptions in complex health care settings: a scoping review.
This scoping review investigated the impact of the physical environment on interruptions and disruptions and the associated outcomes in complex environments, as they relate to the components of the Systems Engineering Initiative for Patient Safety. Findings showed that poor layout configurations, tripping hazards, and technology integration were common examples of compromised workflow and safety issues due to the physical environment's characteristics.
AHRQ-funded; HS027261.
Citation:
Bayramzadeh S, Anthony MK, Sterling M .
The role of the physical environment in shaping interruptions and disruptions in complex health care settings: a scoping review.
Am J Med Qual 2021 Nov-Dec;36(6):449-58. doi: 10.1097/jmq.0000000000000005..
Keywords:
Healthcare Delivery, Patient Safety
Capo-Lugo CE, Askew RL, Boebel M
A comparative approach to quantifying provision of acute therapy services.
This study’s objective was to compare delivery of acute rehabilitation therapy using metrics reflecting distinct aspects of rehabilitation therapy services. Seven general medical-surgical hospitals in Illinois and Indiana prospectively collected de-identified rehabilitation therapy data. The data looked at 35,449 patients who received any type of acute rehabilitation therapy. Metrics recorded by therapists included therapy types, total minutes, and minutes per day (intensity). Extended hospital stay was defined as length of stay (LOS) longer than Medicare’s geometric mean LOS. The odds of an extended hospital stay increased with increased number of minutes, increased number of therapy types, and decreased with increased rehabilitation intensity.
AHRQ-funded; HS000078.
Citation:
Capo-Lugo CE, Askew RL, Boebel M .
A comparative approach to quantifying provision of acute therapy services.
Medicine 2021 Oct 8;100(40):e27377. doi: 10.1097/md.0000000000027377.
AHRQ-funded; HS000078..
AHRQ-funded; HS000078..
Keywords:
Rehabilitation, Healthcare Delivery
Zachrison KS, Yan Z, Schwamm LH
Changes in virtual and in-person health care utilization in a large health system during the COVID-19 pandemic.
This cross-sectional study evaluates how the growth of virtual care has impacted health care utilization in an integrated delivery network.
AHRQ-funded; HS024561.
Citation:
Zachrison KS, Yan Z, Schwamm LH .
Changes in virtual and in-person health care utilization in a large health system during the COVID-19 pandemic.
JAMA Netw Open 2021 Oct;4(10):e2129973. doi: 10.1001/jamanetworkopen.2021.29973.
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Keywords:
COVID-19, Telehealth, Health Information Technology (HIT), Healthcare Delivery
Portney DS, Zhu Z, Chen EM
COVID-19 and use of teleophthalmology (CUT Group): trends and diagnoses.
The coronavirus disease 2019 (COVID-19) pandemic altered how clinicians care for patients. Ophthalmologists saw an estimated 81% drop in volume, the most of any specialty during the initial pandemic and public health restrictions. This study demonstrates the characteristics of telehealth use in ophthalmology on a large scale with primary data before and during the COVID-19 pandemic.
AHRQ-funded; HS027632.
Citation:
Portney DS, Zhu Z, Chen EM .
COVID-19 and use of teleophthalmology (CUT Group): trends and diagnoses.
Ophthalmology 2021 Oct;128(10):1483-85. doi: 10.1016/j.ophtha.2021.02.010..
Keywords:
COVID-19, Telehealth, Health Information Technology (HIT), Healthcare Delivery
Werner NE, Rutkowski RA, Krause S
Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility.
Care transitions that occur across healthcare system boundaries represent a unique challenge for maintaining high quality care and patient safety, as these systems are typically not aligned to perform the care transition process. In this article, the investigators explored healthcare professionals' mental models of older adults' transitions between the emergency department (ED) and skilled nursing facility (SNF).
AHRQ-funded; HS026624.
Citation:
Werner NE, Rutkowski RA, Krause S .
Disparate perspectives: exploring healthcare professionals' misaligned mental models of older adults' transitions of care between the emergency department and skilled nursing facility.
Appl Ergon 2021 Oct;96:103509. doi: 10.1016/j.apergo.2021.103509..
Keywords:
Elderly, Transitions of Care, Emergency Department, Nursing Homes, Healthcare Delivery
Samal L, Fu HN, Camara DS
Health information technology to improve care for people with multiple chronic conditions.
The objective of this study was to review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps. The investigators concluded that the body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.
AHRQ-authored; AHRQ-funded; HS026849; 290201600001B.
Citation:
Samal L, Fu HN, Camara DS .
Health information technology to improve care for people with multiple chronic conditions.
Health Serv Res 2021 Oct;56(Suppl 1):1006-36. doi: 10.1111/1475-6773.13860..
Keywords:
Chronic Conditions, Health Information Technology (HIT), Evidence-Based Practice, Decision Making, Healthcare Delivery
Benneyan JC, White T, Nehls N
Systems analysis of a dedicated ambulatory respiratory unit for seeing and ensuring follow-up of patients with COVID-19 symptoms.
This paper is a systems analysis of a dedicated ambulatory respiratory unit for patients with COVID-19 symptoms. Workflow redesigns were necessitated by COVID and included new ambulatory workflows to handle surge volumes, protect patients and staff, and ensure timely reliable care. The workflow innovations observed can possibly be used to benefit routine care. Observations found that more than 85% of follow-ups were completed within 24 hours, and no staff or patient infections were associated with unit operations. Identified issues included role confusion, staffing and gatekeeping bottlenecks, and patient reluctance to visit in person or discuss concerns on the phone.
AHRQ-funded; HS027282.
Citation:
Benneyan JC, White T, Nehls N .
Systems analysis of a dedicated ambulatory respiratory unit for seeing and ensuring follow-up of patients with COVID-19 symptoms.
J Ambul Care Manage 2021 Oct-Dec;44(4):293-303. doi: 10.1097/jac.0000000000000390..
Keywords:
COVID-19, Ambulatory Care and Surgery, Respiratory Conditions, Workflow, Healthcare Delivery
Anesi GL, Kerlin MP
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Researchers discuss the impact of resource limitations on care delivery and outcomes. They conclude that the interaction between resource limitation and care delivery and outcomes is complex and incompletely understood. Further, the COVID-19 pandemic provides a learning opportunity for strain response during both pandemic and non-pandemic times.
AHRQ-funded; HS026372.
Citation:
Anesi GL, Kerlin MP .
The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage.
Curr Opin Crit Care 2021 Oct 1;27(5):513-19. doi: 10.1097/mcc.0000000000000859..
Keywords:
COVID-19, Public Health, Healthcare Delivery, Intensive Care Unit (ICU), Outcomes
Bierman AS, Wang J, O'Malley PG
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
AHRQ-authored.
Citation:
Bierman AS, Wang J, O'Malley PG .
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords:
Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
