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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.
Results1 to 25 of 337 Research Studies Displayed
Crist K, Lafferty M, Umberfield E
Which factors promote shared understanding between physicians and nurses in inpatient oncology care settings?: A qualitative exploration.
This qualitative secondary analysis was conducted to identify factors that contribute to shared understanding between physicians and nurses from video-recorded conversations that occurred between them during inpatient rounds on oncology units. Four factors emerged as contributors to shared understanding: engagement, clarification, confirmation, and resolution. These factors occurred in sequence with engagement occurring first and resolution occurring last, as the closure of a communication exchange. A greater awareness of body language and positioning at the start of a communication exchange may increase the effectiveness of nurse-physician communication.
Citation: Crist K, Lafferty M, Umberfield E . Which factors promote shared understanding between physicians and nurses in inpatient oncology care settings?: A qualitative exploration. Cancer Nurs 2022 Mar-Apr;45(2):E338-E44. doi: 10.1097/ncc.0000000000000959..
Keywords: Communication, Provider: Physician, Provider: Nurse
Meisel ZF, Shofer F, Dolan A
AHRQ Author: Rhodes KV
A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain.
The purpose of this trial was to compare the effectiveness of three approaches for communicating opioid risk during an emergency department visit for a common painful condition. Participants were adult patients with kidney stone or musculoskeletal back pain, randomly assigned to one of three risk communication strategies: a personalized probabilistic risk visual aid, a visual aid and video narrative, or general risk information. Findings showed that an emergency medicine communication tool incorporating probabilistic risk and patient narratives was more effective than general information in mitigating preferences for opioids in the treatment of pain but was not more effective with respect to opioid use or risk recall.
Citation: Meisel ZF, Shofer F, Dolan A . A multicentered randomized controlled trial comparing the effectiveness of pain treatment communication tools in emergency department patients with back or kidney stone pain. Am J Public Health 2022 Feb;112(S1):S45-s55. doi: 10.2105/ajph.2021.306511..
Keywords: Pain, Emergency Department, Education: Patient and Caregiver, Opioids, Comparative Effectiveness, Clinician-Patient Communication, Communication
Gutman CK, Lion KC, Fisher CL
Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care.
The authors discuss the issue of individuals with limited English proficiency (LEP) and the high risk for adverse outcomes in the US health care system, especially in the emergency department. They point out that, although professional language interpretation improves the quality of care for these patients, it remains underused. They find few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP and urge further high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
Citation: Gutman CK, Lion KC, Fisher CL . Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care. J Am Coll Emerg Physicians Open 2022 Feb;3(1):e12639. doi: .
Keywords: Communication, Emergency Department, Cultural Competence, Clinician-Patient Communication
Squires A, Ma C, Miner S
Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis.
In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. The objective of this retrospective cross-sectional study was to determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge.
Citation: Squires A, Ma C, Miner S . Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis. Int J Nurs Stud 2022 Jan;125:104093. doi: 10.1016/j.ijnurstu.2021.104093..
Keywords: Cultural Competence, Home Healthcare, Hospital Readmissions, Risk, Communication
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
Ejem D, Steinhauser K, Dionne-Odom JN
Exploring culturally responsive religious and spirituality health care communications among African Americans with advanced heart failure, their family caregivers, and clinicians.
This study explored how religion and spirituality (R/S) impacts the ways that African Americans (AAs) cope with serious illness. In particular, this study looks at AAs with advanced heart failure and their family caregivers’ (FCGs) preferences about R/S in patient-clinician communication. Transcribed interviews were analyzed to identify emergent themes. AA patient participants (n = 15) were a mean age of 62, 40% female, and 87% had >high school diploma/GED. AA FCGs (n = 14) were a mean age of 58, 93% female, 93% had >high school diploma/GED, and 86% were unemployed. Most caregivers were patients’ spouses/partners. All participants were Protestants. Patients and FCGs perspectives differed in relation to inclusion of R/S in health care communication. Patients felt that R/S should not be discussed in clinical encounters and discussed only if patient initiated. FCGs felt that clinicians’ R/S communication is not a priority, but clinicians should openly acknowledge patients’ R/S beliefs and should engage in R/S conversations with patients.
Citation: Ejem D, Steinhauser K, Dionne-Odom JN . Exploring culturally responsive religious and spirituality health care communications among African Americans with advanced heart failure, their family caregivers, and clinicians. J Palliat Med 2021 Dec;24(12):1798-806. doi: 10.1089/jpm.2021.0044..
Keywords: Racial / Ethnic Minorities, Communication, Heart Disease and Health, Cardiovascular Conditions, Caregiving
Duffy B, Miller J, Vitous CA
Intersystem medical error discovery: a document analysis of ethical guidelines.
The authors conducted a document analysis of ethical guidelines concerning how providers should respond to other providers' errors, especially when they occur outside the provider's facility or system (intersystem medical error discovery [IMED]). They found that ethics codes provided little guidance on communication regarding IMED scenarios, and in some cases, the guidance was internally conflicting.
Citation: Duffy B, Miller J, Vitous CA . Intersystem medical error discovery: a document analysis of ethical guidelines. J Patient Saf 2021 Dec 1;17(8):e1765-e73. doi: 10.1097/pts.0000000000000625..
Keywords: Medical Errors, Patient Safety, Provider: Health Personnel, Communication
Aronson PL, Schaeffer P, Niccolai LM
Parents' perspectives on communication and shared decision making for febrile infants ≤60 days old.
This study examined parents’ perceptions of receiving and understanding information in the emergency department (ED) and their perspectives on shared decision making (SDM) in the management of febrile infants 60 days of age or less. The authors conducted semistructured interviews with 23 parents of febrile infants ≤60 days old evaluated in the pediatric ED at an urban, academic medical center. Themes for parents’ perspectives on SDM included: 1) giving parents the opportunity to express their opinions and concerns builds confidence in the decision making process, 2) parents’ preferences for participation in decision making vary considerably, and 3) different perceptions about risk influence parents’ preferences about having their infant undergo a lumbar puncture (LP). Parents valued risk and benefits of having their infant undergo an LP differently, which influences their preferences.
Citation: Aronson PL, Schaeffer P, Niccolai LM . Parents' perspectives on communication and shared decision making for febrile infants ≤60 days old. Pediatr Emerg Care 2021 Dec;37(12):e1213-e19. doi: 10.1097/pec.0000000000001977..
Keywords: Newborns/Infants, Clinician-Patient Communication, Communication, Decision Making, Emergency Department
Lafferty M, Harrod M, Krein S
It's like sending a message in a bottle: a qualitative study of the consequences of one-way communication technologies in hospitals.
Researchers examined how physicians and nurses use available communication technologies and identify the implications for communication and patient care based on the theory of workarounds. They found that one-way communication technologies created an environment where workarounds could flourish. By placing results within the context of the theory of workarounds, they extended what is known about why and how workarounds develop, and they offered strategies to minimize workarounds' adverse effects. They concluded that two-way communication technologies could minimize workarounds and gaps in information exchange and could reduce unnecessary interruptions and the potential for adverse events.
J Am Med Inform Assoc 2021 Nov 25;28(12):2601-07. doi: 10.1093/jamia/ocab191.
Citation: Lafferty M, Harrod M, Krein S . It's like sending a message in a bottle: a qualitative study of the consequences of one-way communication technologies in hospitals. AHRQ-funded; HS022305..
Keywords: Hospitals, Communication, Health Information Technology (HIT), Provider: Physician
Hsueh L, Huang J, Millman AK
Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic.
The authors hypothesized that limited English proficiency (LEP) would be associated with lower video use compared with telephone, especially among patients without prior video visit experience. They found that one-third of patients with LEP scheduled a visit by video instead of telephone. Patients with LEP chose video less often than patients without LEP, even after adjusting for technology factors. However, among patients with prior video visit experience, no significant difference in video visit use by LEP was found.
Citation: Hsueh L, Huang J, Millman AK . Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic. JAMA Netw Open 2021 Nov;4(11):e2133129. doi: 10.1001/jamanetworkopen.2021.33129..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Disparities, Communication
Bowles EJA, O'Neill SC, Li T
Effect of a randomized trial of a web-based intervention on patient-provider communication about breast density.
This study evaluated a personalized web-based intervention between women and their providers designed to improve breast cancer risk communication. This randomized trial included women aged 40-69 years with 504 women in the control group and 492 women who used the intervention website. The website included information about breast density, personalized breast cancer risk, chemoprevention, and magnetic resonance imaging. Participants self-reported their communication about density with providers at 6 weeks and 12 months. Women in the intervention arm were 2.39 times more likely to report density communication at 6 weeks than the control arm. This effect persisted at 12 months. At 6 weeks the effect was only significant among women who reported versus those who did not report any previous density discussions. A quarter of women in each arm did not have a density conversation at any point during the study.
Citation: Bowles EJA, O'Neill SC, Li T . Effect of a randomized trial of a web-based intervention on patient-provider communication about breast density. J Womens Health 2021 Nov;30(11):1529-37. doi: 10.1089/jwh.2021.0053.
Keywords: Communication, Women, Cancer: Breast Cancer, Cancer, Health Information Technology (HIT)
Choe AY, Schondelmeyer AC, Thomson J
Improving discharge instructions for hospitalized children with limited english proficiency.
Research was conducted on an intervention for patients with limited English proficiency (LEP) who are discharged from the hospital without instructions in their preferred language. The objective was to increase the percentage of patients with LEP on the hospital medicine service who received translated discharge instructions from 12% to 80%. During the 18-month study period 540 patients with LEP were discharged. Spanish was the preferred language of 66% of these patients. The percentage of patients who received translated discharge instructions increased from 12% to 50% in 3 months, and to 77% in 18 months. For Spanish-language patients, the percentage increased to 96% by 18 months.
AHRQ-funded; HS026763; HS025138.
Citation: Choe AY, Schondelmeyer AC, Thomson J . Improving discharge instructions for hospitalized children with limited english proficiency. Hosp Pediatr 2021 Nov;11(11):1213-22. doi: 10.1542/hpeds.2021-005981.
AHRQ-funded; HS026763; HS025138..
AHRQ-funded; HS026763; HS025138..
Keywords: Children/Adolescents, Hospital Discharge, Clinician-Patient Communication, Cultural Competence, Communication
Stransky ML, Oshita JY, Morris MA
Receipt of treatment among a nationally representative sample of US adults with communication disorders.
A robust body of literature exists on clinical research outcomes for persons with communication disorders (CD). Comparatively few studies have examined population-based health service outcomes for CD-related services, which capture persons with CDs who may not be part of clinical or administrative data. The investigators addressed this gap, describing four CD-related healthcare outcomes among adults reporting problems with communication (voice, speech, and language): (1) utilization, (2) utilization determinants, (3) professionals providing CD care, and (4) patient-reported service-related outcomes.
Citation: Stransky ML, Oshita JY, Morris MA . Receipt of treatment among a nationally representative sample of US adults with communication disorders. J Commun Disord 2021 Nov-Dec;94:106148. doi: 10.1016/j.jcomdis.2021.106148..
Fauer A, Wright N, Lafferty M
Influences of physical layout and space on patient safety and communication in ambulatory oncology practices: a multisite, mixed method investigation.
Researchers examined how physical layouts and space in ambulatory oncology practices influence patient safety and clinician communication. They found that the physical layout affected communication around chemotherapy infusion and ultimately patient safety. Two themes emerged: visibility of patients during infusion and proximity of clinicians in the infusion center to clinicians in the clinic where providers see patients. They concluded that their findings informed efforts to construct new and to modify existing infusion centers to enhance patient safety and clinician communication.
Citation: Fauer A, Wright N, Lafferty M . Influences of physical layout and space on patient safety and communication in ambulatory oncology practices: a multisite, mixed method investigation. HERD 2021 Oct;14(4):270-86. doi: 10.1177/19375867211027498..
Keywords: Patient Safety, Communication
Hofstetter AM, Opel DJ, Stockwell MS
Associations between health care professional communication practices and influenza vaccination of hospitalized children.
The objective of this study was to describe the communication of health care professionals (HCPs) with parents of hospitalized children concerning the influenza vaccine. A survey was conducted online or via telephone with English- and Spanish-speaking parents of influenza vaccine-eligible children hospitalized at a pediatric hospital after discharge. Findings showed that a parent-reported HCP conversation and recommendation were associated with influenza vaccination during hospitalization.
Citation: Hofstetter AM, Opel DJ, Stockwell MS . Associations between health care professional communication practices and influenza vaccination of hospitalized children. Acad Pediatr 2021 Sep-Oct;21(7):1142-50. doi: 10.1016/j.acap.2021.06.014..
Keywords: Children/Adolescents, Influenza, Vaccination, Communication, Health Promotion, Clinician-Patient Communication
Manojlovich M, Harrod M, Hofer T
Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study.
How quickly physicians respond to communications from bedside nurses is important for the delivery of safe inpatient care. Delays in physician responsiveness can impede care or contribute to patient harm. Understanding contributory factors to physician responsiveness can provide insights to promote timely physician response, possibly improving communication to ensure safe patient care. The purpose of this study was to describe the factors contributing to physician responsiveness to text or numeric pages, telephone calls and face-to-face messages delivered by nurses on adult general care units.
Citation: Manojlovich M, Harrod M, Hofer T . Factors influencing physician responsiveness to nurse-initiated communication: a qualitative study. BMJ Qual Saf 2021 Sep;30(9):747-54. doi: 10.1136/bmjqs-2020-011441..
Keywords: Provider: Physician, Provider: Nurse, Communication, Inpatient Care
Schulson L, Lin MY, Paasche-Orlow MK
Limited English proficient patient visits and emergency department admission rates for ambulatory care sensitive conditions in California: a retrospective cohort study.
Little is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients. The objective of this study was to estimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates varied at hospitals with a high versus low proportion of LEP patients.
Citation: Schulson L, Lin MY, Paasche-Orlow MK . Limited English proficient patient visits and emergency department admission rates for ambulatory care sensitive conditions in California: a retrospective cohort study. J Gen Intern Med 2021 Sep;36(9):2683-91. doi: 10.1007/s11606-020-06523-5..
Keywords: Emergency Department, Vulnerable Populations, Communication
Calabrese SK, Lane SB, Caldwell A
Electronic dissemination of a web-based video promotes PrEP contemplation and conversation among US women engaged in care at Planned Parenthood.
This study evaluated the acceptability and impact of a web-based PrEP educational video among women (n = 126) by comparing two Planned Parenthood centers: one using a Web Video and the other using standard education tools. Most women reported the video helped them understand better what PrEP is (92%), how it works (93%), and how to take PrEP (92%). One month post-intervention, more women in the Web Video group reported a high level of comfort discussing PrEP with a provider (82% vs 48%) and commonly thinking about PrEP (36.% vs. 4%).
Citation: Calabrese SK, Lane SB, Caldwell A . Electronic dissemination of a web-based video promotes PrEP contemplation and conversation among US women engaged in care at Planned Parenthood. AIDS Behav 2021 Aug;25(8):2483-500. doi: 10.1007/s10461-021-03210-2..
Keywords: Human Immunodeficiency Virus (HIV), Sexual Health, Education: Patient and Caregiver, Health Promotion, Prevention, Health Information Technology (HIT), Communication, Women
Chilakamarri P, Finn EB, Sather J
Failure mode and effect analysis: engineering safer neurocritical care transitions.
Investigators presented failure mode and effect analysis (FMEA) as a systems-engineering methodology to be applied to neurocritical care transitions to reduce failures in communication and improve patient safety. They described their local implementation of FMEA to improve the safety of inter-hospital transfer for patients with intracerebral and subarachnoid hemorrhage as evidence of success. They found that application of the FMEA approach yielded meaningful and sustained process change for patients with neurocritical care needs.
Citation: Chilakamarri P, Finn EB, Sather J . Failure mode and effect analysis: engineering safer neurocritical care transitions. Neurocrit Care 2021 Aug;35(1):232-40. doi: 10.1007/s12028-020-01160-6..
Keywords: Patient Safety, Transitions of Care, Critical Care, Communication, Quality Improvement, Quality of Care
Stolldorf DP, Ridner SH, Vogus TJ
Implementation strategies in the context of medication reconciliation: a qualitative study.
Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. Yet, the implementation and sustainability of MedRec interventions have been challenging due to contextual barriers like the lack of interprofessional communication (among pharmacists, nurses, and providers) and limited organizational capacity. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy, the authors report the differing strategies hospital implementation teams used to implement an evidence-based MedRec Toolkit (the MARQUIS Toolkit).
Citation: Stolldorf DP, Ridner SH, Vogus TJ . Implementation strategies in the context of medication reconciliation: a qualitative study. Implement Sci Commun 2021 Jun 10;2(1):63. doi: 10.1186/s43058-021-00162-5..
Keywords: Medication: Safety, Medication, Adverse Drug Events (ADE), Medical Errors, Adverse Events, Patient Safety, Implementation, Communication
Cifra Cifra, CL Dukes, KC Ayres, et al.
Referral communication for pediatric intensive care unit admission and the diagnosis of critically ill children: a pilot ethnography.
This pilot study’s goal was to determine the feasibility of using focused ethnography to understand the relationship between referral communication and the diagnostic process for critically ill children. Findings showed that focused ethnography in the pediatric intensive care unit is feasible to investigate relationships between clinician referral communication and the diagnostic process for critically ill children.
Citation: Cifra Cifra, CL Dukes, KC Ayres, et al.. Referral communication for pediatric intensive care unit admission and the diagnosis of critically ill children: a pilot ethnography. J Crit Care 2021 Jun;63:246-49. doi: 10.1016/j.jcrc.2020.09.011..
Keywords: Children/Adolescents, Communication, Critical Care, Intensive Care Unit (ICU), Diagnostic Safety and Quality
Links AR, Callon W, Wasserman C
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. In this study, the authors characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. The investigators concluded that clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions.
Citation: Links AR, Callon W, Wasserman C . Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language. Patient Educ Couns 2021 Jun;104(6):1371-79. doi: 10.1016/j.pec.2020.11.015..
Keywords: Children/Adolescents, Surgery, Caregiving, Decision Making, Clinician-Patient Communication, Communication, Provider: Physician, Provider
Zellmer BM, Nacht CL, Coller RJ
BedsideNotes: sharing physicians' notes with parents during hospitalization.
Physicians increasingly share ambulatory visit notes with patients to meet new federal requirements, and evidence suggests patient experiences improve without overburdening physicians. Whether sharing inpatient notes with parents of hospitalized children yields similar outcomes is unknown. In this pilot study, the investigators evaluated parent and physician perceptions of sharing notes with parents during hospitalization. The investigators concluded that parents all valued having access to physicians' notes during their child's hospital stay; however, some physicians remained concerned about the potential negative consequences of sharing.
Citation: Zellmer BM, Nacht CL, Coller RJ . BedsideNotes: sharing physicians' notes with parents during hospitalization. Hosp Pediatr 2021 May;11(5):503-08. doi: 10.1542/hpeds.2020-005447..
Keywords: Children/Adolescents, Clinician-Patient Communication, Communication, Caregiving, Hospitalization
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
Patel M, Cadzinski AJ, Bell AM
Interprofessional consultations (eConsults) in urology.
This study examined the implementation of an asynchronous form of telehealth called eConsult which is used by primary care providers to consult with a specialist in place of an in-person consultation. The use of eConsult in the practice of urology was analyzed at four academic institutions: University of Michigan, University of California-San Francisco, University of Washington, and Montefiore Medical Center. Data looked at was eConsult conversion rate (to an in-person consultation), response time, completion time, and diagnosis categories. Out of a total of 462 urological eConsults requested, 36% were converted to a traditional in-person visit. Among resolved eConsults, 53.8% were addressed in less than 1 day; 28.6% in 1 day, 8.4% in 2 days, 3.4% in 3 days; 3.4% in 4 days, 1.7% in 5 days, and 0.8% in 6 days or more. Half were completed in 1-10 minutes; 46.7% in 11-20 minutes, 2.8% in 21-39 minutes, and less than 1% in 31 minutes or more.
Citation: Patel M, Cadzinski AJ, Bell AM . Interprofessional consultations (eConsults) in urology. Urol Pract 2021 May;8(3):321-27. doi: 10.1097/upj.0000000000000209..
Keywords: Telehealth, Health Information Technology (HIT), Clinician-Patient Communication, Communication, Implementation