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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 467 Research Studies Displayed
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
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
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
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
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
Quigley DD, Qureshi N, AlMasarweh L
Using CAHPS patient experience data for patient-centered medical home transformation.
The purpose of this study was to examine how primary care practices used the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and its patient-centered medical home (PCMH) items during their PCMH transition. The investigators concluded that CAHPS surveys were considered actionable for PCMH transformation and used in standardizing and coordinating care. The CAHPS PCMH items were considered integral to the continuous QI needed for moving beyond formal PCMH recognition and maximizing transformation.
AHRQ-funded; HS016980; HS025920.
Citation:
Quigley DD, Qureshi N, AlMasarweh L .
Using CAHPS patient experience data for patient-centered medical home transformation.
Am J Manag Care 2021 Sep;27(9):e322-e29. doi: 10.37765/ajmc.2021.88745..
Keywords:
Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Patient-Centered Healthcare, Primary Care, Practice Improvement, Healthcare Delivery, Quality Improvement, Quality of Care
Chen H, Upadhyay N, Lyu N
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
This study’s objective was to examine whether linkage with mental health (MH) treatment differed across 3 different integrated care agreements (ICAs) following diagnosis for Attention Deficit Hyperactive Disorder (ADHD) or Major Depressive Disorder (MDD) given by primary care providers (PCPs) in the pediatric setting. The ICAs were categorized as PCPs who practiced alone (non-co-located); PCPs practiced with specialist outside the practice but co-located at the practice site; and employed specialists who were co-located. A total of 4203 incident ADHD and 298 incident MDD diagnoses were identified, of which 74% of ADHD cases and 67% of MDD cases received treatment within 90 days of diagnosis. Children with ADHD were twice as likely to receive treatment if they were diagnosed by non-co-located or co-affiliated PCPs than those diagnosed by non-co-located PCPs. Those treated children were also 2 times more likely to receive guideline recommended psychotherapy and treated at the diagnosing site versus elsewhere.
AHRQ-funded; HS025251.
Citation:
Chen H, Upadhyay N, Lyu N .
Association of primary and behavioral health integrated care upon pediatric mental disorder treatment.
Acad Pediatr 2021 Sep-Oct;21(7):1187-94. doi: 10.1016/j.acap.2021.05.021..
Keywords:
Children/Adolescents, Behavioral Health, Patient-Centered Healthcare, Primary Care, Healthcare Delivery, Depression, Attention Deficit Hyperactivity Disorder (ADHD)
Quigley DD, Slaughter M, Qureshi N
Practices and changes associated with patient-centered medical home transformation.
Knowing which patient-centered medical home (PCMH) care delivery changes and quality improvement (QI) practices further PCMH implementation is essential. In this study, the investigators used the 2008-2017 National Committee of Quality Assurance (NCQA) PCMH directory of 15,188 primary care practices that received Level 1, 2, or 3 NCQA PCMH recognition to: 1.) construct a stratified national sample of 105 practices engaged in PCMH transformation and 2.) examine their QI practices and PCMH changes associated with PCMH transformation.
AHRQ-funded; HS016980; HS025920.
Citation:
Quigley DD, Slaughter M, Qureshi N .
Practices and changes associated with patient-centered medical home transformation.
Am J Manag Care 2021 Sep;27(9):386-93. doi: 10.37765/ajmc.2021.88740..
Keywords:
Patient-Centered Healthcare, Primary Care, Practice Improvement, Healthcare Delivery, Quality Improvement, Quality of Care
Angier H, Giebultowicz S, Kaufmann J
Creation of a linked cohort of children and their parents in a large, national electronic health record dataset.
Researchers sought to identify a national cohort of children that link to at least one parent in the same electronic health record dataset and describe their demographics. They were able to link 33% of children to a parent in electronic health record data from a large network of community health centers across the United States. They stated that further analyses utilizing these linkages will allow examination of the multi-level factors that impact a child's receipt of recommended health care.
AHRQ-funded; HS025962.
Citation:
Angier H, Giebultowicz S, Kaufmann J .
Creation of a linked cohort of children and their parents in a large, national electronic health record dataset.
Medicine 2021 Aug 13;100(32):e26950. doi: 10.1097/md.0000000000026950..
Keywords:
Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery
Kandel ZK, Rittenhouse DR, Bibi S
The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices.
The Centers for Medicare and Medicaid Services' (CMS) State Innovation Models (SIMs) initiative funded 17 states to implement health care payment and delivery system reforms to improve health system performance. The authors investigated whether SIM improved health information technology (HIT) and care management capabilities of physician practices. They found that the CMS SIM Initiative did not accelerate the adoption of ten foundational physician practice capabilities beyond national trends.
AHRQ-funded; HS024075.
Citation:
Kandel ZK, Rittenhouse DR, Bibi S .
The CMS State Innovation Models Initiative and improved health information technology and care management capabilities of physician practices.
Med Care Res Rev 2021 Aug;78(4):350-60. doi: 10.1177/1077558719901217..
Keywords:
Health Information Technology (HIT), Healthcare Delivery, Payment, Healthcare Systems, Innovations and Emerging Issues
Parmasad V, Keating JA, Carayon P
Physical distancing for care delivery in health care settings: considerations and consequences.
Physical distancing in high complexity systems such as health care is particularly challenging and may benefit from a human factors and systems engineering perspective. In this paper the investigators discussed challenges to implementing and maintaining physical distancing in health care settings and presented possible solutions from a human factors and systems engineering perspective.
AHRQ-funded; HS026226.
Citation:
Parmasad V, Keating JA, Carayon P .
Physical distancing for care delivery in health care settings: considerations and consequences.
Am J Infect Control 2021 Aug;49(8):1085-88. doi: 10.1016/j.ajic.2020.12.014..
Keywords:
COVID-19, Healthcare Delivery, Patient Safety
Clair K, Ijadi-Maghsoodi R, Nazinyan M
Veteran perspectives on adaptations to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic.
This paper looks at veterans’ perspectives on adaptations made to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic. Adaptations to services are described within a large residential rehabilitation program for under-resourced veterans; reports veterans’ experiences; and outlines successes and challenges encountered. Data was collected from two focus groups with nine veterans in the program. The groups highlighted experiences of inconsistent communication about residential policies, interruptions to medical and addiction services, and feelings of confinement and social isolation.
AHRQ-funded; HS026407.
Citation:
Clair K, Ijadi-Maghsoodi R, Nazinyan M .
Veteran perspectives on adaptations to a VA residential rehabilitation program for substance use disorders during the novel coronavirus pandemic.
Community Ment Health J 2021 Jul;57(5):801-07. doi: 10.1007/s10597-021-00810-z..
Keywords:
Veterans, Substance Abuse, Rehabilitation, COVID-19, Healthcare Delivery, Access to Care, Patient Experience
Kemp MT, Williams AM, Brown CS
Practical guidance for early identification of barriers in surgical telehealth clinics.
The authors provide advice on early identification of and response to barriers in telehealth settings in order to help patients receive optimal care. Their focus is on standardizing expectations, assessing technological knowledge and resource access, evaluating understanding and comfort with telehealth, and assessing social support.
AHRQ-funded; HS000053.
Citation:
Kemp MT, Williams AM, Brown CS .
Practical guidance for early identification of barriers in surgical telehealth clinics.
Ann Surg 2021 Jun;273(6):e268-e70. doi: 10.1097/sla.0000000000004633..
Keywords:
Surgery, Telehealth, Health Information Technology (HIT), Healthcare Delivery, Access to Care
Hofstetter AM, Schaffer S
Childhood and adolescent vaccination in alternative settings.
This article reviews the unique advantages, challenges, and experiences regarding vaccine delivery in alternative settings, such as schools, emergency rooms, hospitals, and pharmacies. It describes the key components that each setting must possess as well as other important factors to consider when assessing the ability of each to deliver vaccines to the children and adolescents they serve. It is important to emphasize that these settings should not replace the medical home as the primary location for vaccination, but rather serve as a critical safety net for high-risk individuals and communities and in situations where access to traditional locations may be limited, such as during the COVID-19 pandemic.
AHRQ-funded; HS025470.
Citation:
Hofstetter AM, Schaffer S .
Childhood and adolescent vaccination in alternative settings.
Acad Pediatr 2021 May-Jun;21(4s):S50-s56. doi: 10.1016/j.acap.2021.02.001..
Keywords:
Children/Adolescents, Vaccination, Healthcare Delivery, Public Health
Hollingsworth JM, Yu X, Yan PL
Provider care team segregation and operative mortality following coronary artery bypass grafting.
The purpose of this study was to examine whether provider care team segregation within hospitals contributes to the higher mortality rate of Black patients following coronary artery bypass grafting compared to their White counterparts. Using national Medicare data, findings showed that Black patients who undergo coronary artery bypass grafting at a hospital with a higher level of provider care team segregation die more frequently after surgery than Black patients treated at a hospital with a lower level.
AHRQ-funded; HS026908.
Citation:
Hollingsworth JM, Yu X, Yan PL .
Provider care team segregation and operative mortality following coronary artery bypass grafting.
Circ Cardiovasc Qual Outcomes 2021 May;14(5):e007778. doi: 10.1161/circoutcomes.120.007778..
Keywords:
Surgery, Heart Disease and Health, Cardiovascular Conditions, Mortality, Teams, Healthcare Delivery, Racial / Ethnic Minorities
Linke SE, Kallenberg GR, Kronick R
Integrating "Exercise Is Medicine" into primary care workflow: a study protocol.
As a major contributor to the burden of most chronic diseases, insufficient physical activity (PA) creates a significant financial burden on the health care system. Exercise Is Medicine (EIM) is a global health initiative committed to the belief that PA is integral to the prevention and treatment of diseases and should be routinely assessed as a vital sign and treated in the health care setting. This paper described an in-progress embedded quality improvement (QI) project that integrated EIM into routine clinical practice.
AHRQ-funded; HS026517.
Citation:
Linke SE, Kallenberg GR, Kronick R .
Integrating "Exercise Is Medicine" into primary care workflow: a study protocol.
Transl Behav Med 2021 Apr 26;11(4):921-29. doi: 10.1093/tbm/ibaa088..
Keywords:
Primary Care, Lifestyle Changes, Workflow, Healthcare Delivery
Peahl AF, Powell A, Berlin H
Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic.
The authors evaluated institutional-level adoption and patient and provider experiences with a coronavirus disease 2019 prenatal care model. They found that reduced visit schedules and virtual visits were rapidly integrated into real-world care, with positive experiences for many patients and providers. They recommended future research to understand the health outcomes and care experience associated with alternative approaches to prenatal care delivery across more diverse patient populations outside of the coronavirus disease 2019 pandemic to inform broader health policy decisions.
AHRQ-funded; HS025465.
Citation:
Peahl AF, Powell A, Berlin H .
Patient and provider perspectives of a new prenatal care model introduced in response to the coronavirus disease 2019 pandemic.
Am J Obstet Gynecol 2021 Apr;224(4):384.e1-84.e11. doi: 10.1016/j.ajog.2020.10.008..
Keywords:
Maternal Care, Pregnancy, Patient-Centered Healthcare, Telehealth, Health Information Technology (HIT), Healthcare Delivery, COVID-19
Kuo YF, Agrawal P, Chou LN
Assessing association between team structure and health outcome and cost by social network analysis.
Researchers sought to assess the impact of team structure composition and degree of collaboration among various providers on process and outcomes of primary care. Their findings showed that highly connected primary care practices with high collaborative care and less top-down MD-centered authority have lower odds of hospitalization, fewer emergency room admissions, and lower total spending. They concluded that these findings likely reflect better communication and more coordinated care of older patients.
AHRQ-funded; HS020642.
Citation:
Kuo YF, Agrawal P, Chou LN .
Assessing association between team structure and health outcome and cost by social network analysis.
J Am Geriatr Soc 2021 Apr;69(4):946-54. doi: 10.1111/jgs.16962..
Keywords:
Elderly, Teams, Healthcare Delivery, Primary Care, Primary Care: Models of Care, Care Coordination
Li KY, Zhu Z, Ng S
Direct-to-consumer telemedicine visits for acute respiratory infections linked to more downstream visits.
The authors compared downstream care utilization data from a large, commercial payer for the period 2016-19. They found that the telemedicine cohort had fewer emergency department visits but more subsequent office, urgent care, and telemedicine visits. These findings suggest that potential savings from shifting initial care to a direct-to-consumer telemedicine setting should be balanced against the potential for higher spending on downstream care.
AHRQ-funded; HS027632.
Citation:
Li KY, Zhu Z, Ng S .
Direct-to-consumer telemedicine visits for acute respiratory infections linked to more downstream visits.
Health Affairs 2021 Apr;40(4):596-602. doi: 10.1377/hlthaff.2020.01741..
Keywords:
Telehealth, Health Information Technology (HIT), Respiratory Conditions, Healthcare Delivery
Peahl AF, Smith RD, Moniz MN
Prenatal care redesign: creating flexible maternity care models through virtual care.
Each year, over 98% of the almost 4 million pregnant patients in the United States receive prenatal care-a crucial preventive service to improve outcomes for moms and babies. In this paper, the authors outline their experience rapidly transitioning prenatal care to a new model with 4 in-person visits, 1 ultrasound visit, and 4 virtual visits (the 4-1-4 prenatal plan). They then explore how lessons from this implementation can inform patient-centered prenatal care redesign during and beyond the COVID-19 pandemic.
AHRQ-funded; HS025465.
Citation:
Peahl AF, Smith RD, Moniz MN .
Prenatal care redesign: creating flexible maternity care models through virtual care.
Am J Obstet Gynecol 2020 Sep;223(3):389.e1-89.e10. doi: 10.1016/j.ajog.2020.05.029..
Keywords:
Maternal Care, Telehealth, Health Information Technology (HIT), Pregnancy, Women, Healthcare Delivery, Patient-Centered Healthcare
Anderson KE, Shugarman LR, Davenport K
Regulation of provider networks in response to COVID-19.
The authors anticipate that the coronavirus disease 2019 pandemic will have 3 main effects on provider networks and their regulation: enrollment changes, changes to the provider landscape, and changes to care delivery. They suggested that telehealth will have a larger role in care delivery than in the pre-pandemic period, and that regulators will need to adapt network standards to accommodate in-person and virtual care delivery.
AHRQ-funded; HS000029.
Citation:
Anderson KE, Shugarman LR, Davenport K .
Regulation of provider networks in response to COVID-19.
Am J Manag Care 2021 Apr;27(4):e101-e04. doi: 10.37765/ajmc.2021.88614..
Keywords:
Health Insurance, Policy, Access to Care, Healthcare Delivery, COVID-19
Grove LR, Gertner AK, Swietek KE
Effect of enhanced primary care for people with serious mental illness on service use and screening.
This retrospective cohort study compared healthcare use and screening receipt of people with serious mental illness (SMI) newly receiving enhanced primary care to people with SMI newly receiving usual primary care. Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and dates, and recommended screenings 18 months after the initial visit. Enhanced primary care was associated with an increase of 1.2 primary care visits in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient days and 3.0 non-psychiatric inpatient days. There was no significant effect on psychiatric service and ED visits. Enhanced primary care increased the probability of preventive screenings such as glucose and HIV, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening.
AHRQ-funded; HS000032.
Citation:
Grove LR, Gertner AK, Swietek KE .
Effect of enhanced primary care for people with serious mental illness on service use and screening.
J Gen Intern Med 2021 Apr;36(4):970-77. doi: 10.1007/s11606-020-06429-2..
Keywords:
Behavioral Health, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Screening, Healthcare Utilization, Healthcare Delivery
Etherton MR, Zachrison KS, Yan Z
Regional changes in patterns of stroke presentation during the COVID-19 pandemic.
The authors sought to determine the effect of the coronavirus pandemic on patterns of stroke patient presentation and quality of care. They analyzed data from 25 New England hospitals: one urban, academic, comprehensive stroke center and telestroke hub, and 24 spoke hospitals in the same telestroke network. They included all telestroke consultations from the 24 spokes, and stroke admissions to the comprehensive stroke center hub from November 2019 through April 2020. They compared rates of presentation, timeliness presentation, and quality of care pre- versus post-March 2020. They also examined trends in patient demographics, stroke severity, timeliness, diagnosis including large vessel occlusion, alteplase use, and endovascular thrombectomy among eligible subjects. Among 1248 patient presentations, telestroke consultations and ischemic stroke patient admissions decreased through the hub and spoke network. Age and stroke severity were unchanged during the study period. However, rates of adherence for the quality measures dysphagia screening, early antithrombotic initiation, and early venous thromboembolism prophylaxis were reduced during the pandemic.
AHRQ-funded; HS024561.
Citation:
Etherton MR, Zachrison KS, Yan Z .
Regional changes in patterns of stroke presentation during the COVID-19 pandemic.
Stroke 2021 Apr;52(4):1398-406. doi: 10.1161/strokeaha.120.031300..
Keywords:
Stroke, Cardiovascular Conditions, COVID-19, Telehealth, Health Information Technology (HIT), Healthcare Delivery
Olmos-Ochoa TT, Miake-Lye IM, Glenn BA
Sustaining successful clinical-community partnerships in medically underserved urban areas: a qualitative case study.
This qualitative case study examines the Faith Community Health Partnership, which is a collaboration between faith-community nurses and community organizations sustained over 25 years. Factors supporting partnership sustainability were identified through semi-structured interviews with 18 FHCP partners. Factors include maintaining partners’ commitment over time; strategic resource-sharing; facilitating engagement; and preserving partnership flexibility.
AHRQ-funded; HS000046.
Citation:
Olmos-Ochoa TT, Miake-Lye IM, Glenn BA .
Sustaining successful clinical-community partnerships in medically underserved urban areas: a qualitative case study.
J Community Health Nurs 2021 Jan-Mar;38(1):1-12. doi: 10.1080/07370016.2021.1869423.
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Keywords:
Community Partnerships, Community-Based Practice, Vulnerable Populations, Urban Health, Case Study, Access to Care, Healthcare Delivery
Desai SM, Shambhu S, Mehrotra A
Online advertising increased New Hampshire residents' use of provider price tool but not use of lower-price providers.
This study looked at the results of an online advertising campaign to increase consumers’ awareness about insurer-specific negotiated price information available on New Hampshire’s public price transparency website. The campaign led to a more than 600% increase in visits to the website, but it did not translate to increased use of lower-price providers. The authors concluded that the findings imply that the limited success is driven by structural factors that limit consumers’ ability to use health care price information as opposed to only a lack of awareness about price transparency tools.
AHRQ-funded; HS026980.
Citation:
Desai SM, Shambhu S, Mehrotra A .
Online advertising increased New Hampshire residents' use of provider price tool but not use of lower-price providers.
Health Aff 2021 Mar;40(3):521-28. doi: 10.1377/hlthaff.2020.01039..
Keywords:
Healthcare Costs, Healthcare Delivery
