National Healthcare Quality and Disparities Report
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Topics
- Ambulatory Care and Surgery (2)
- Cancer (2)
- Caregiving (2)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Children/Adolescents (3)
- Chronic Conditions (1)
- Clinician-Patient Communication (5)
- (-) Communication (20)
- Cultural Competence (2)
- Decision Making (2)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (1)
- Electronic Health Records (EHRs) (2)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (2)
- Evidence-Based Practice (1)
- Guidelines (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Delivery (3)
- Health Information Technology (HIT) (2)
- Health Literacy (1)
- Home Healthcare (1)
- Hospitals (1)
- Implementation (1)
- Inpatient Care (1)
- Intensive Care Unit (ICU) (1)
- Medication (4)
- Medication: Safety (3)
- Nursing (1)
- Opioids (2)
- Patient Adherence/Compliance (1)
- Patient Safety (7)
- Policy (1)
- Primary Care (2)
- (-) Provider (20)
- Provider: Clinician (5)
- Provider: Nurse (5)
- Provider: Pharmacist (1)
- Provider: Physician (8)
- Quality Improvement (2)
- Quality of Care (4)
- Risk (1)
- Simulation (1)
- Substance Abuse (1)
- Surgery (4)
- Teams (3)
- Tools & Toolkits (1)
- Training (1)
- Transitions of Care (1)
- Trauma (1)
- Treatments (1)
- Urinary Tract Infection (UTI) (1)
- Workflow (1)
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
1 to 20 of 20 Research Studies DisplayedLinks 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.
AHRQ-funded; HS022932.
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
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
Friese CR, Mendelsohn-Victor K, Medvec BR
Factors associated with job satisfaction in medical oncology practices: results from a multisite survey.
This is a job satisfaction survey of clinicians from 29 ambulatory medical oncology practices conducted in 2017. The survey also examined clinician-to-clinician communication, and perceptions of patient safety. Of the 280 clinicians who responded, 85% reported that they were very satisfied or satisfied with their current position. Patient safety and accuracy of clinician communication were positively associated with job satisfaction.
AHRQ-funded; HS024914.
Citation: Friese CR, Mendelsohn-Victor K, Medvec BR .
Factors associated with job satisfaction in medical oncology practices: results from a multisite survey.
J Nurs Adm 2021 Apr;51(4):200-05. doi: 10.1097/nna.0000000000000998..
Keywords: Provider: Clinician, Provider: Physician, Provider: Nurse, Provider, Communication
Gerchow L, Burka LR, Miner S
Language barriers between nurses and patients: a scoping review.
This systematic review explored how research has examined the nursing workforce with respect to language barriers and identifies gaps for further research. Four databases were used to identify 48 studies representing 16 countries. Most studies were qualitative, with the inpatient setting most commonly studied. Studies were coded for data analysis. Coding produced four themes: interpreter use/misuse, barriers to and facilitators of quality care, cultural competence, and interventions. Regardless of setting, country, or language, nurses noted like experiences and applied similar strategies.
AHRQ-funded; HS023593.
Citation: Gerchow L, Burka LR, Miner S .
Language barriers between nurses and patients: a scoping review.
Patient Educ Couns 2021 Mar;104(3):534-53. doi: 10.1016/j.pec.2020.09.017..
Keywords: Cultural Competence, Communication, Provider: Nurse, Provider
Alley L, Novak K, Havlin T
Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists
The authors developed the Resources Encouraging Safe Prescription Opioid and Naloxone Dispensing (RESPOND) Toolkit to enhance community pharmacists' understanding of their role in addressing opioid safety; to improve integration of prescription drug monitoring program (PDMP) into daily workflow; and to enhance communication between pharmacists, prescribers, and patients. In this paper, they described the development of the RESPOND Toolkit and summarized their findings from initial pilot testing. They concluded that the RESPOND Toolkit has promise as an effective and scalable approach to providing community pharmacist-tailored training to promote behavioral shifts supporting opioid safety for patients.
AHRQ-funded; HS024227.
Citation: Alley L, Novak K, Havlin T .
Development and pilot of a prescription drug monitoring program and communication intervention for pharmacists
Res Social Adm Pharm 2020 Oct;16(10):1422-30. doi: 10.1016/j.sapharm.2019.12.023..
Keywords: Opioids, Substance Abuse, Medication, Medication: Safety, Patient Safety, Tools & Toolkits, Communication, Provider: Pharmacist, Provider, Training
Lafferty M, Fauer A, Wright N
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care. The authors identified four primary themes from the analysis that affect delays. They suggest future investigations to examine nurses' communication practices in the context of timely chemotherapy administration since communication and documentation technologies within healthcare settings continuously evolve.
AHRQ-funded; HS024914.
Citation: Lafferty M, Fauer A, Wright N .
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
Oncol Nurs Forum 2020 Jul 1;47(4):417-27. doi: 10.1188/20.Onf.417-427..
Keywords: Treatments, Cancer, Ambulatory Care and Surgery, Quality of Care, Clinician-Patient Communication, Communication, Provider: Nurse, Provider, Nursing, Chronic Conditions
Lee YSH, King MD, Anderson D
The how matters: how primary care provider communication with team relates to patients' disease management.
This study examined how primary care provider (PCP)-team communication relates to patients’ disease management. A longitudinal study was conducted of how 3 aspects of PCP-care team communication including participation, time spent listening, an uninterrupted speaking length relate to disease management of patients with hypertension or diabetes. The study recruited 27 PCPs and 98 team members serving 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites. Data was collected using sociometric sensors worn by PCPs and team members, surveys on patient-PCP communication, and electronic records which extracted PCP and patient characteristics. Results showed that PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. Greater PCP participation, listening, and length of uninterrupted time speaking were associated with significantly higher odds that their patients had controlled hypertension and diabetes.
AHRQ-funded; HS016978.
Citation: Lee YSH, King MD, Anderson D .
The how matters: how primary care provider communication with team relates to patients' disease management.
Med Care 2020 Jul;58(7):643-50. doi: 10.1097/mlr.0000000000001342..
Keywords: Primary Care, Communication, Teams, Provider, Quality of Care
McHugh M, Brown T, Walunas TL
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
The authors sought to identify patterns of contrasting perspectives on implementation issues between practice leaders and their practice facilitators as well as factors that may contribute to them. Through individual interviews, they found that turnover of staff was frequently reported in dyads with contrasting perspectives. They recommended that planners of quality improvement initiatives using practice facilitation consider taking steps to minimize contrasting perspectives by addressing turnover challenges and encouraging opportunities to share perspectives.
AHRQ-funded; HS023921.
Citation: McHugh M, Brown T, Walunas TL .
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
J Healthc Qual 2020 May/Jun;42(3):e32-e38. doi: 10.1097/jhq.0000000000000223..
Keywords: Primary Care, Quality Improvement, Quality of Care, Implementation, Communication, Provider
Manojlovich M, Harrod M, Hofer TP
Using qualitative methods to explore communication practices in the context of patient care rounds on general care units.
This study examined communication practices between nurses and physicians in general care units at 4 Midwestern hospitals. A total of 163 physicians, registered nurses, and nurse practitioners participated. The researchers observed and shadowed clinicians during rounds and other times during a 2 week period as well as conducting interviews and holding focus groups. Workflow differences affected rounds and subsequently communication practices. Good rapport between physicians and nurses contributed to nurse participation during rounds. Lower rapport made some nurses feel uncomfortable accompanying physicians during rounds unless invited.
AHRQ-funded; HS022305.
Citation: Manojlovich M, Harrod M, Hofer TP .
Using qualitative methods to explore communication practices in the context of patient care rounds on general care units.
J Gen Intern Med 2020 Mar;35(3):839-45. doi: 10.1007/s11606-019-05580-9..
Keywords: Communication, Provider: Physician, Provider: Nurse, Provider, Hospitals, Teams, Inpatient Care, Healthcare Delivery
McCarthy DM, Powell RE, Cameron KA
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial.
The purpose of this study was to evaluate the effectiveness of the Uncertainty Communication Education Module (UCEM) in improving physician communications. Patients' understanding of the care they received has implications for care quality, safety, and patient satisfaction, especially when they are discharged without a definitive diagnosis. Developing a patient-centered diagnostic uncertainty communication strategy will improve safety of acute care discharges. This trial has been designed to have a low-resource, scalable intervention that would allow for widespread dissemination and uptake.
AHRQ-funded; HS025651.
Citation: McCarthy DM, Powell RE, Cameron KA .
Simulation-based mastery learning compared to standard education for discussing diagnostic uncertainty with patients in the emergency department: a randomized controlled trial.
BMC Med Educ 2020 Feb 19;20(1):49. doi: 10.1186/s12909-020-1926-y..
Keywords: Education: Continuing Medical Education, Clinician-Patient Communication, Communication, Emergency Department, Simulation, Provider: Physician, Provider
Squires A, Miner S, Liang E
How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data.
Increasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting. The objective of this study was to explore home health care professionals' perspectives about how workload changes from managing language barriers influence quality and safety in home health care.
AHRQ-funded; HS023593.
Citation: Squires A, Miner S, Liang E .
How language barriers influence provider workload for home health care professionals: A secondary analysis of interview data.
Int J Nurs Stud 2019 Nov;99:103394. doi: 10.1016/j.ijnurstu.2019.103394..
Keywords: Home Healthcare, Cultural Competence, Communication, Provider, Healthcare Delivery
Manojlovich M, Ameling JM, Forman J
Contextual barriers to communication between physicians and nurses about appropriate catheter use.
This study identified contextual barriers to communication between physicians and nurses that contribute to inappropriate use of catheters and increased risk of health care-associated infections. The researchers conducted individual and small-group semistructured interviewed with physicians and nurses in a progressive care unit of an academic hospital. Common barriers included workflow misalignment between clinicians, issues with electronic medical records and pagers, and strained relationships between clinicians.
AHRQ-funded; HS024385.
Citation: Manojlovich M, Ameling JM, Forman J .
Contextual barriers to communication between physicians and nurses about appropriate catheter use.
Am J Crit Care 2019 Jul;28(4):290-98. doi: 10.4037/ajcc2019372..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Communication, Healthcare-Associated Infections (HAIs), Patient Safety, Provider, Provider: Nurse, Provider: Physician, Urinary Tract Infection (UTI), Workflow
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
Patel MR, Friese CR, Mendelsohn-Victor K
Clinician perspectives on electronic health records, communication, and patient safety across diverse medical oncology practices.
This study examined the effects of electronic health records (EHRs) on communication and patient safety in oncology practices. The authors conducted a survey of 297 oncology nurses and prescribers in a statewide collaborative. They found there was an inverse relationship between reliance on EHRs and safety.
AHRQ-funded; HS024914.
Citation: Patel MR, Friese CR, Mendelsohn-Victor K .
Clinician perspectives on electronic health records, communication, and patient safety across diverse medical oncology practices.
J Oncol Pract 2019 Jun;15(6):e529-e36. doi: 10.1200/jop.18.00507..
Keywords: Cancer, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Provider, Provider: Clinician
Pack AP, Golin CE, Hill LM
Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data.
This study looked into the value of using graphical display prototypes of hypothetical daily drug concentrations measured in hair for patients to assess their medication adherence. Investigators surveyed 30 HIV-positive patients and 29 clinicians to assess their preferences for three different prototypes. Patients and clinicians generally found the prototypes acceptable, but clinicians largely preferred daily drug concentrations in bar graph display. Patients with lower health literacy had trouble understanding the link between medication-taking and drug concentrations in hair and also preferred pictographs over bar or line graphs.
AHRQ-funded; HS000032.
Citation: Pack AP, Golin CE, Hill LM .
Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data.
Patient Educ Couns 2019 Jun;102(6):1090-97. doi: 10.1016/j.pec.2018.12.029..
Keywords: Clinician-Patient Communication, Communication, Health Literacy, Medication, Patient Adherence/Compliance, Provider, Provider: Clinician
Links AR, Callon W, Wasserman C
Surgeon use of medical jargon with parents in the outpatient setting.
This study analyzed the use of unexplained medical jargon with parents whose children have sleep-disordered breathing and their consultations with otolaryngologists in a pediatric surgical setting. Participants (64 parents and 8 otolaryngologists) completed questionnaires that evaluated demographics, clinical features and parental role in decision-making. Unexplained medical jargon was commonly used by physicians (mean total utterances per visit = 28.9) while parents used jargon a mean of 4.3 times. Clinicians used more jargon when they felt that parents had greater involvement in decision-making or when parents used more jargon themselves. These results will be incorporated into communication training for clinicians.
AHRQ-funded; HS022932.
Citation: Links AR, Callon W, Wasserman C .
Surgeon use of medical jargon with parents in the outpatient setting.
Patient Educ Couns 2019 Jun;102(6):1111-18. doi: 10.1016/j.pec.2019.02.002..
Keywords: Ambulatory Care and Surgery, Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Decision Making, Education: Patient and Caregiver, Provider, Provider: Physician
Xie A, Woods-Hill CZ, Berenholtz SM
Use of human factors and ergonomics to disseminate health care quality improvement programs.
Human factors and ergonomics (HFE) is recognized as a key systems engineering approach to improve health care quality and safety. In this article, the authors suggest that HFE can play an important role in the dissemination of quality improvement programs across diverse health care settings. They suggest that to achieve this, health care organizations need to build capacity by leveraging HFE expertise and develop tools that guide local adaptation of interventions developed for large-scale quality initiatives.
AHRQ-funded; HS025642; HS025238.
Citation: Xie A, Woods-Hill CZ, Berenholtz SM .
Use of human factors and ergonomics to disseminate health care quality improvement programs.
Qual Manag Health Care 2019 Apr/Jun;28(2):117-18. doi: 10.1097/qmh.0000000000000211..
Keywords: Quality Improvement, Quality of Care, Communication, Provider
Frasier LL, Pavuluri Quamme SR, Ma Y
Familiarity and communication in the operating room.
Researchers sought to evaluate the relationship between familiarity, communication rates, and communication ineffectiveness of health care providers in the operating room. They found that team members do not compensate for unfamiliarity by increasing their verbal communication, and dyad familiarity is not protective against ineffective communication. Cross-disciplinary communication remains vulnerable in the operating room, suggesting poor crosstalk across disciplines in the operative setting. They recommended further investigation to explore these relationships and identify effective interventions, ensuring that all team members have the necessary information to optimize their performance.
AHRQ-funded; HS022403.
Citation: Frasier LL, Pavuluri Quamme SR, Ma Y .
Familiarity and communication in the operating room.
J Surg Res 2019 Mar;235:395-403. doi: 10.1016/j.jss.2018.09.079..
Keywords: Communication, Patient Safety, Surgery, Teams, Provider: Physician, Provider
Meisel ZF, Metlay JP, Sinnenberg L
A randomized trial testing the effect of narrative vignettes versus guideline summaries on provider response to a professional organization clinical policy for safe opioid prescribing.
The authors compared whether narrative vignettes embedded in the American College of Emergency Physicians (ACEP) daily e-newsletter improved dissemination of the clinical policy to ACEP members, and engagement of members with the clinical policy, compared with traditional summary text. They found that the vignettes outperformed traditional guideline text in promoting engagement with an evidence-based clinical guideline related to opioid prescriptions.
AHRQ-funded; HS021956.
Citation: Meisel ZF, Metlay JP, Sinnenberg L .
A randomized trial testing the effect of narrative vignettes versus guideline summaries on provider response to a professional organization clinical policy for safe opioid prescribing.
Ann Emerg Med 2016 Dec;68(6):719-28. doi: 10.1016/j.annemergmed.2016.03.007.
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Keywords: Communication, Evidence-Based Practice, Guidelines, Opioids, Medication, Medication: Safety, Policy, Provider
Jones LK, Jennings BM, Goelz RM
An ethogram to quantify operating room behavior.
The researchers adopted a method from the field of ethology for observing and quantifying the interpersonal interactions of operating room (OR) team members. They found that the ethogram's high interobserver reliability indicates its utility for yielding largely objective, descriptive, quantitative data on OR behavior.
AHRQ-funded; HS023403.
Citation: Jones LK, Jennings BM, Goelz RM .
An ethogram to quantify operating room behavior.
Ann Behav Med 2016 Aug;50(4):487-96. doi: 10.1007/s12160-016-9773-0.
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Keywords: Communication, Provider: Physician, Provider, Surgery, Patient Safety