National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 66 of 66 Research Studies DisplayedCalvitti A, Hochheiser H, Ashfaq S
Physician activity during outpatient visits and subjective workload.
The researchers describe methods for capturing and analyzing EHR use and clinical workflow of physicians during outpatient encounters and relating activity to physicians' self-reported workload. They found that visit activity was highly variable across individual physicians, and the observed activity metrics ranged widely as correlates to subjective workload.
AHRQ-funded; HS021290.
Citation: Calvitti A, Hochheiser H, Ashfaq S .
Physician activity during outpatient visits and subjective workload.
J Biomed Inform 2017 May;69:135-49. doi: 10.1016/j.jbi.2017.03.011.
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Keywords: Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow, Ambulatory Care and Surgery
Hanauer DA, Branford GL, Greenberg G
Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
This report describes a 2-year prospective, longitudinal survey of attending physicians in 3 clinical areas (family medicine, general pediatrics, internal medicine) who experienced a transition from a homegrown electronic health record (EHR) to a vendor EHR. The primary goal was to determine if perceptions followed a J-curve pattern in which they initially dropped but eventually surpassed baseline measures. A J-curve was not found for any measures, including workflow, safety, communication, and satisfaction.
AHRQ-funded; HS023613.
Citation: Hanauer DA, Branford GL, Greenberg G .
Two-year longitudinal assessment of physicians' perceptions after replacement of a longstanding homegrown electronic health record: does a J-curve of satisfaction really exist?
J Am Med Inform Assoc 2017 Apr 1;24(e1):e157-e65. doi: 10.1093/jamia/ocw077.
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Keywords: Electronic Health Records (EHRs), Provider: Health Personnel, Ambulatory Care and Surgery, Patient Safety, Workflow
Narayanan J, Dobrin S, Choi J
Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.
The researchers describe a stepwise process for building structured clinical documentation support tools in the electronic medical record (EMR) that define best practices in epilepsy, and describe how they incorporated these toolkits into their clinical workflow. These tools write notes and capture hundreds of fields of data including several score tests. They also summarize brain imaging, blood laboratory, and electroencephalography results, and document neuromodulation treatments.
AHRQ-funded; HS024057.
Citation: Narayanan J, Dobrin S, Choi J .
Structured clinical documentation in the electronic medical record to improve quality and to support practice-based research in epilepsy.
Epilepsia 2017 Jan;58(1):68-76. doi: 10.1111/epi.13607.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Neurological Disorders, Quality of Care, Quality Improvement, Tools & Toolkits, Workflow
Fong A, Hoffman DJ, Zachary Hettinger A
Identifying visual search patterns in eye gaze data; gaining insights into physician visual workflow.
The authors propose an algorithmic approach to identify different visual search patterns. They demonstrate this approach by identifying common physician visual search patterns using a simulated prototype emergency department patient tracking system. They then discuss the benefits and limitations as well as insights from this initial evaluation.
AHRQ-funded; HS020433.
Citation: Fong A, Hoffman DJ, Zachary Hettinger A .
Identifying visual search patterns in eye gaze data; gaining insights into physician visual workflow.
J Am Med Inform Assoc 2016 Nov;23(6):1180-84. doi: 10.1093/jamia/ocv196.
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Keywords: Healthcare Delivery, Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow
Valdez RS, Holden RJ
Health care human factors/ergonomics fieldwork in home and community settings.
The researchers offered several strategies that human factors and ergonomics professionals can use before, during, and after home and community site visits to optimize fieldwork and mitigate challenges in these settings.
AHRQ-funded; HS022930; HS018809.
Citation: Valdez RS, Holden RJ .
Health care human factors/ergonomics fieldwork in home and community settings.
Ergon Des 2016 Oct;24(4):4-9. doi: 10.1177/1064804615622111.
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Keywords: Caregiving, Community-Based Practice, Home Healthcare, Workflow
Menon S, Murphy DR, SIngh H
Workarounds and test results follow-up in electronic health record-based primary care.
This study sought to understand why primary care practitioners use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management. It concluded that workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs.
AHRQ-funded; HS022901; HS022087.
Citation: Menon S, Murphy DR, SIngh H .
Workarounds and test results follow-up in electronic health record-based primary care.
Appl Clin Inform 2016 Jun 22;7(2):543-59. doi: 10.4338/aci-2015-10-ra-0135.
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Keywords: Communication, Electronic Health Records (EHRs), Primary Care, Workflow
Gray CP, Harrison MI, Hung D
AHRQ Author: Harrison MI
Medical assistants as flow managers in primary care: challenges and recommendations.
Drawing on an empirical study of a large, multispecialty delivery system engaged in reconfiguration of primary care, the authors found that using medical assistants (Mas) as flow managers required overcoming several challenges. These included entrenched social and occupational hierarchies between physicians and MAs, a lack of adequate training and mentorship, and difficulty attracting and retaining talented MAs.
AHRQ-authored; AHRQ-funded; 2902010000221.
Citation: Gray CP, Harrison MI, Hung D .
Medical assistants as flow managers in primary care: challenges and recommendations.
J Healthc Manag 2016 May-Jun;61(3):181-91.
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Keywords: Primary Care, Organizational Change, Practice Improvement, Quality Improvement, Quality of Care, Workflow, Provider
Abraham J, Kannampallil T, Brenner C
Characterizing the structure and content of nurse handoffs: a Sequential Conversational Analysis approach.
This paper describes Sequential Conversational Analysis (SCA) - a mixed-method approach integrating qualitative conversational analysis with quantitative sequential pattern analysis. This approach allows characterization of the nature of nurse handoff communication, highlighting the relationships underlying verbal content. The authors also discuss how SCA can help in understanding the dynamics of communication in other settings.
AHRQ-funded; HS017586.
Citation: Abraham J, Kannampallil T, Brenner C .
Characterizing the structure and content of nurse handoffs: a Sequential Conversational Analysis approach.
J Biomed Inform 2016 Feb;59:76-88. doi: 10.1016/j.jbi.2015.11.009.
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Keywords: Communication, Quality of Care, Intensive Care Unit (ICU), Nursing, Workflow
Acharya S, Fischer-Valuck BW, Kashani R
Online magnetic resonance image guided adaptive radiation therapy: first clinical applications.
The authors demonstrated the feasibility of online adaptive magnetic resonance (MR) image guided radiation therapy (MR-IGRT) with five patients with abdominopelvic malignancies. They successfully implemented online adaptive MR-IGRT with planning and quality assurance workflow suitable for routine clinical application. Clinical trials are in development to formally evaluate adaptive treatments for a variety of disease sites.
AHRQ-funded; HS022888.
Citation: Acharya S, Fischer-Valuck BW, Kashani R .
Online magnetic resonance image guided adaptive radiation therapy: first clinical applications.
Int J Radiat Oncol Biol Phys 2016 Feb;94(2):394-403. doi: 10.1016/j.ijrobp.2015.10.015.
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Keywords: Cancer, Cancer: Colorectal Cancer, Imaging, Workflow
Holman GT, Beasley JW, Karsh BT
The myth of standardized workflow in primary care.
This analysis evaluates workflow variation in terms of the sequence of tasks performed during patient visits. It concluded that the prevalence of specific tasks shifts significantly as primary care visits progress to their conclusion but, notably, PCPs collect patient information throughout the visit.
AHRQ-funded; HS017115; HS017014.
Citation: Holman GT, Beasley JW, Karsh BT .
The myth of standardized workflow in primary care.
J Am Med Inform Assoc 2016 Jan;23(1):29-37. doi: 10.1093/jamia/ocv107.
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Keywords: Primary Care, Workflow
Starmer AJ, Destino L, Yoon CS
Intern and resident workflow patterns on pediatric inpatient units: a multicenter time-motion study.
The researchers sought to quantify the proportion of time spent by residents in direct care, indirect care activities, and education across 9 pediatric institutions. They found that across all sites and levels of training, trainees spent more time in interprofessional communication (34.7 percent), and at the computer (20.5 percent), and less time in contact with patients and families (12.0 percent) and in educational activities (4.7 percent).
AHRQ-funded; HS019456.
Citation: Starmer AJ, Destino L, Yoon CS .
Intern and resident workflow patterns on pediatric inpatient units: a multicenter time-motion study.
JAMA Pediatr 2015 Dec;169(12):1175-7. doi: 10.1001/jamapediatrics.2015.2471..
Keywords: Children/Adolescents, Education: Continuing Medical Education, Inpatient Care, Provider, Training, Workflow
Cutting EM, Overby CL, Banchero M
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
The researchers used information gained from focus groups in order to illustrate the current process of delivering genetic test results to clinicians. They proposed a business process model and notation (BPMN) representation of this process for a Translational Pharmacogenomics Project being implemented at the University of Maryland Medical Center. They found that the current process could be improved to reduce input errors, better inform and notify clinicians about the implications of certain genetic tests, and make results more easily understood. They demonstrated theiruse of BPMN to improve this important clinical process for CYP2C19 genetic testing.
AHRQ-funded; HS023390.
Citation: Cutting EM, Overby CL, Banchero M .
Using workflow modeling to identify areas to improve genetic test processes in the University of Maryland Translational Pharmacogenomics Project.
AMIA Annu Symp Proc 2015 Nov 5;2015:466-74.
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Keywords: Genetics, Diagnostic Safety and Quality, Medication, Workflow, Quality Improvement, Quality of Care, Organizational Change
Gephart S, Carrington JM, Finley B
A systematic review of nurses' experiences with unintended consequences when using the electronic health record.
The purpose of this article is to present the state of the science on nurses' experiences with unintended consequences of electronic health records (EHRs). Findings demonstrate that nurses experience changes to workflow, must continually adapt to meet patient's needs in the context of imperfect EHR systems, and have difficulty accessing the information they need to make patient care decisions. Implications for nurse administrators include the need for continual engagement with nurses along the continuum of EHR design, as well as the need to encourage nurses to speak up and acknowledge workflow changes that threaten patient safety or do not support work efficiency.
AHRQ-funded; HS021074.
Citation: Gephart S, Carrington JM, Finley B .
A systematic review of nurses' experiences with unintended consequences when using the electronic health record.
Nurs Adm Q 2015 Oct-Dec;39(4):345-56. doi: 10.1097/naq.0000000000000119.
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Keywords: Adverse Events, Clinical Decision Support (CDS), Electronic Health Records (EHRs), Nursing, Workflow
Linzer M, Poplau S, Grossman E
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
This study aimed to assess if improvements in work conditions reduce clinician stress and burnout. It found that burnout was more likely to improve with workflow interventions and with targeted QI projects than in controls. Also, interventions in communication or workflow led to greater improvements in clinician satisfaction.
AHRQ-funded; HS018160.
Citation: Linzer M, Poplau S, Grossman E .
A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study.
J Gen Intern Med 2015 Aug;30(8):1105-11. doi: 10.1007/s11606-015-3235-4..
Keywords: Burnout, Stress, Primary Care, Workflow, Quality Improvement, Quality of Care, Communication
Butler KA, Mercer E, Bahrami A
Model checking for verification of interactive health IT systems.
The authors proposed to formalize the relationship between HIT and the conceptual work that increasingly typifies modern care. They demonstrated the method on a patient contact system to show that model checking is effective for interactive systems and that much of it can be automated.
AHRQ-funded; HS021233.
Citation: Butler KA, Mercer E, Bahrami A .
Model checking for verification of interactive health IT systems.
AMIA Annu Symp Proc 2015;2015:349-58.
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Keywords: Decision Making, Health Information Technology (HIT), Health Information Technology (HIT), Patient Safety, Workflow
Zai AH, Kim S, Kamis A
Applying operations research to optimize a novel population management system for cancer screening.
The objective of this paper is to optimize a new visit-independent, population-based cancer screening system (TopCare) by using operations research techniques to simulate changes in patient outreach staffing levels (delegates, navigators), modifications to user workflow within the information technology (IT) system, and changes in cancer screening recommendations. Results showed that simulating the impact of changes in staffing, system parameters, and clinical inputs on the effectiveness and efficiency of care can inform the allocation of limited resources in population management.
AHRQ-funded; HS018161.
Citation: Zai AH, Kim S, Kamis A .
Applying operations research to optimize a novel population management system for cancer screening.
J Am Med Inform Assoc 2014 Feb;21(e1):e129-35. doi: 10.1136/amiajnl-2013-001681.
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Keywords: Cancer, Health Information Technology (HIT), Prevention, Screening, Workflow