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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
126 to 150 of 299 Research Studies DisplayedMurphy DR, Giardina TD, Satterly T
An exploration of barriers, facilitators, and suggestions for improving electronic health record inbox-related usability: a qualitative analysis.
The purpose of this study was to determine barriers, facilitators, and suggestions associated with electronic health record (EHR) inbox-related usability. The study included cognitive walkthroughs of EHR inbox management with 25 physicians at six large health care organizations using four different EHR systems. Results showed that usability of the EHR inbox is often suboptimal and variable across sites, suggesting lack of shared best practices related to information management. Development of regional or national consortia to support collaborative sharing and implementation of EHR system best practices across EHR developers and health care organizations could improve safety and efficiency and reduce physician burnout.
AHRQ-funded; HS022901.
Citation: Murphy DR, Giardina TD, Satterly T .
An exploration of barriers, facilitators, and suggestions for improving electronic health record inbox-related usability: a qualitative analysis.
JAMA Netw Open 2019 Oct 2;2(10):e1912638. doi: 10.1001/jamanetworkopen.2019.12638..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider
Ganguli I, Simpkin AL, Lupo C
Cascades of care after incidental findings in a US national survey of physicians.
The objective of this study was to estimate the national frequency and consequences of cascades of care after incidental findings using a national survey of US physicians. 991 practicing U.S. internists in a research panel representative of American College of Physicians national membership participated in the survey. Survey findings indicated that almost all respondents had experienced cascades after incidental findings that did not lead to clinically meaningful outcomes yet caused harm to patients and themselves. Recommendations included encouraging policy makers and health care leaders to address cascades after incidental findings as part of efforts to improve health care value and reduce physician burnout.
AHRQ-funded; HS023812.
Citation: Ganguli I, Simpkin AL, Lupo C .
Cascades of care after incidental findings in a US national survey of physicians.
JAMA Netw Open 2019 Oct 2;2(10):e1913325. doi: 10.1001/jamanetworkopen.2019.13325..
Keywords: Chronic Conditions, Provider: Physician, Provider
Childers CP, Hofer IS, Cheng DS
Evaluating surgeons on intraoperative disposable supply costs: details matter.
Cost report cards have demonstrated variation in intraoperative supply costs and may allow comparisons between surgeons. However, cost data are complex and, if not properly vetted, may be inaccurate. In this study, a retrospective assessment of intraoperative supply costs for consecutive laparoscopic cholecystectomies (2013-2017) at a 4-facility academic center was performed. The investigators concluded that evaluating surgeons based on intraoperative supply costs was sensitive to analytic methods.
AHRQ-funded; HS025079.
Citation: Childers CP, Hofer IS, Cheng DS .
Evaluating surgeons on intraoperative disposable supply costs: details matter.
J Gastrointest Surg 2019 Oct;23(10):2054-62. doi: 10.1007/s11605-018-3889-4..
Keywords: Healthcare Costs, Provider, Provider: Physician, Surgery
Everson J, Richards MR, Buntin MB
Horizontal and vertical integration's role in meaningful use attestation over time.
This study examined rates of attestation and attrition from the meaningful use (MU) program by independent, horizontally integrated, and vertically integrated physicians. The goal was to determine if MU created pressure for independent physicians to join integrated organizations. They compared attestation rates using secondary data from SK&A and Medicare MU Files from 2011-2016 with office-based physicians. The sample size was 291,234 physicians. Forty-nine percent of physicians that remained independent during the period attested to MU at least once during the program, compared with 70% that remained horizontally or vertically integrated. There was also significantly more attrition among independent physicians than those physicians who were integrated.
AHRQ-funded; HS026395.
Citation: Everson J, Richards MR, Buntin MB .
Horizontal and vertical integration's role in meaningful use attestation over time.
Health Serv Res 2019 Oct;54(5):1075-83. doi: 10.1111/1475-6773.13193..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workforce, Provider: Physician, Provider, Medicare
Kelly LA, McHugh MD, Aiken LH
Nurse Outcomes in Magnet(R) and non-magnet hospitals.
The goal of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. Results demonstrated superior nurse work environments in Magnet hospitals compared with non-Magnet hospitals, with better work environments being associated with lower nurse job dissatisfaction and burnout. Three decades of evidence showing superior outcomes for Magnet hospitals place this organizational innovation into a class all of its own as best practice, deserving the attention of hospital leaders, nurses, and the public.
AHRQ-funded; HS017551.
Citation: Kelly LA, McHugh MD, Aiken LH .
Nurse Outcomes in Magnet(R) and non-magnet hospitals.
J Nurs Adm 2019 Oct;49(10S Suppl):S19-s24. doi: 10.1097/nna.0000000000000801..
Keywords: Burnout, Hospitals, Provider, Provider: Nurse, Workforce
Zikmund-Fisher BJ, Solomon JB, Scherer AM
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
Patient portals of electronic health record systems currently present patients with tables of laboratory test results, but visual displays can increase patient understanding and sensitivity to result variations. In this study, the investigators sought to assess physician preferences and concerns about visual display designs as potential motivators or barriers to their implementation.
Citation: Zikmund-Fisher BJ, Solomon JB, Scherer AM .
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
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Keywords: Primary Care, Electronic Health Records (EHRs), Education: Patient and Caregiver, Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Read JM, Weiler DT, Satterly T
Provider preference in exam room layout design and computing.
This study examined the impact of electronic health records (EHRs) on exam room design which would make it easier for providers to promote flexibility, mobility, and body orientation directed towards the patient. Semistructured interviews with 28 providers was conducted and the interviews were audio recorded and transcribed for analysis. Flexibility in sharing the computer screen with patients was an important theme as well as exam room layout, exam room computing and provider workflow.
AHRQ-funded; HS024488.
Citation: Read JM, Weiler DT, Satterly T .
Provider preference in exam room layout design and computing.
Appl Clin Inform 2019 Oct;10(5):972-80. doi: 10.1055/s-0039-3401813..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workflow, Primary Care, Provider
White EM, Aiken LH, McHugh MD
Registered nurse burnout, job dissatisfaction, and missed care in nursing homes.
The purpose of this article was to examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes. The investigators concluded that missed nursing care due to inadequate time or resources is common in nursing homes and is associated with RN burnout and job dissatisfaction; they indicated that improved work environments with sufficient staff hold promise for improving care and nurse retention.
AHRQ-funded; HS000011.
Citation: White EM, Aiken LH, McHugh MD .
Registered nurse burnout, job dissatisfaction, and missed care in nursing homes.
J Am Geriatr Soc 2019 Oct;67(10):2065-71. doi: 10.1111/jgs.16051..
Keywords: Provider: Nurse, Provider, Burnout, Nursing Homes, Long-Term Care, Workforce
Vemulakonda VM, Hamer MK, Kempe A
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
Although there are significant demographic and clinical variations in treatment decisions for infants with high-grade hydronephrosis concerning for ureteropelvic junction obstruction (UPJO), there has been little research on the roles of parents and surgeons in the surgical decision-making (DM) process. The purpose of this study was to understand parents' and surgeons' perceived roles in the surgical DM process for infants with high-grade hydronephrosis.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM, Hamer MK, Kempe A .
Surgical decision-making in infants with suspected UPJ obstruction: stakeholder perspectives.
J Pediatr Urol 2019 Oct;15(5):469.e1-69.e9. doi: 10.1016/j.jpurol.2019.05.027..
Keywords: Newborns/Infants, Decision Making, Surgery, Kidney Disease and Health, Caregiving, Provider: Physician, Provider, Patient and Family Engagement
Oslock WM, Paredes AZ, Baselice HE
Women surgeons and the emergence of acute care surgery programs.
The authors sought to examine predictors of women surgeons in emergency general surgery (EGS) generally, and in acute care surgery (ACS) particularly. They found that 50.4% of hospitals studied had zero women surgeons. Women were more likely to be among EGS surgeons at hospitals with ACS models. They concluded that their study highlighted the dearth of women representation within EGS hospitals nationally and illuminated some of the underlying characteristics of ACS that may draw women: urban, academic, and staffed by more recently trained surgeons.
AHRQ-funded; HS022694.
Citation: Oslock WM, Paredes AZ, Baselice HE .
Women surgeons and the emergence of acute care surgery programs.
Am J Surg 2019 Oct;218(4):803-08. doi: 10.1016/j.amjsurg.2019.07.008..
Keywords: Surgery, Provider: Physician, Provider, Emergency Department
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
Bach P, Hartung D
Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders.
This narrative review explores the literature describing novel programs designed to capitalize on the role of the community pharmacist in helping to reduce opioid-related harms, as well as evaluations of existing practices already in place in the US and elsewhere around the world. Specific approaches examined include strategies to facilitate pharmacist monitoring for problematic opioid use, to increase pharmacy-based harm reduction efforts (including naloxone distribution and needle exchange programs), and to involve community pharmacists in the dispensation of opioid agonist therapy.
AHRQ-funded; HS024227; 2902015000091.
Citation: Bach P, Hartung D .
Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders.
Addict Sci Clin Pract 2019 Sep 2;14(1):30. doi: 10.1186/s13722-019-0158-0..
Keywords: Medication, Opioids, Provider, Provider: Pharmacist, Substance Abuse
McCarthy DM, Russell AM , Effler MR
Implementation fidelity of patient-centered prescription label to promote opioid safe use.
The authors assessed implementation of a patient-centered "PRN" (as needed) label entitled "Take-Wait-Stop" (TWS) with three deconstructed steps replacing traditional wording. They found that exact intervention adherence was not achieved in the majority of cases, limiting impact, but that community pharmacies were responsive to new instructions, with higher implementation reliability requiring additional supports.
AHRQ-funded; HS023459.
Citation: McCarthy DM, Russell AM , Effler MR .
Implementation fidelity of patient-centered prescription label to promote opioid safe use.
Pharmacoepidemiol Drug Saf 2019 Sep;28(9):1251-57. doi: 10.1002/pds.4795..
Keywords: Opioids, Patient Safety, Health Literacy, Medication, Provider: Pharmacist, Provider
Bernstein A, Rogers KM, Possin KL
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
The prevalence of dementia, a neurocognitive disorder (NCD), is expected to triple in the next 30 years. In this study, the investigators surveyed a national sample of primary care physicians to characterize their attitudes and practices with respect to the evaluation and management of NCDs.
AHRQ-funded; HS022241.
Citation: Bernstein A, Rogers KM, Possin KL .
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
J Gen Intern Med 2019 Sep;34(9):1691-92. doi: 10.1007/s11606-019-05013-7..
Keywords: Dementia, Neurological Disorders, Provider: Physician, Provider: Clinician, Provider, Primary Care
Ike B, Baldwin LM, Sutton S
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
The authors assessed the impact of implementing the Six Building Blocks on the work-life of primary care providers and staff. Six rural and rural-serving primary care organizations implemented the Six Building Blocks, with assistance from practice facilitators, clinical experts, and informatics specialists. The authors found that clinicians and staff reported improvement in their work-life after implementing the Six Building Blocks Program to improve opioid medication management and recommended further research on patient experiences specific to practice redesign programs.
AHRQ-funded; HS023750.
Citation: Ike B, Baldwin LM, Sutton S .
Staff and clinician work-life perceptions after implementing systems-based improvements to opioid management.
J Am Board Fam Med 2019 Sep-Oct;32(5):715-23. doi: 10.3122/jabfm.2019.05.190027.
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Keywords: Opioids, Pain, Chronic Conditions, Primary Care: Models of Care, Primary Care, Care Management, Ambulatory Care and Surgery, Quality Improvement, Medication, Provider, Clinician-Patient Communication
Cook JM, Newman E, Simiola V
Trauma training: competencies, initiatives, and resources.
Traumatic stress is currently not a required component of the standard curricula in graduate-level education in clinical and counseling psychology. However, due to the high prevalence of trauma and its potentially deleterious physical and mental health effects in the general and clinical populations, it is imperative that psychology graduate students and practitioners understand the relevance of trauma in their clients' lives and its impact in clinical research. This paper discusses competencies, initiatives and resources related to trauma training.
AHRQ-funded; HS021602.
Citation: Cook JM, Newman E, Simiola V .
Trauma training: competencies, initiatives, and resources.
Psychotherapy 2019 Sep;56(3):409-21. doi: 10.1037/pst0000233..
Keywords: Education: Continuing Medical Education, Behavioral Health, Provider, Stress, Training, Trauma
Sockolow PS, Bass EJ, Ynag Y
Availability and quality of information used by nurses while admitting patients to a rural home health care agency.
This study investigated the availability and quality of information used by nurses in a rural home health care agency during patient admission. Twelve in-home admissions were observed and the nurses were interviewed before and after the admissions process. Content and quality of documents available to the nurses was analyzed and needed documents were not uniformly present. They rarely received visit pattern or medication management information. These results show the need for a high quality electronic health record system.
AHRQ-funded; HS024537.
Citation: Sockolow PS, Bass EJ, Ynag Y .
Availability and quality of information used by nurses while admitting patients to a rural home health care agency.
Stud Health Technol Inform 2019 Aug 21;264:798-802. doi: 10.3233/shti190333..
Keywords: Rural Health, Home Healthcare, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Nurse, Provider
Hultman GM, Marquard JL, Kandaswamy S
Electronic progress note reading patterns: an eye tracking analysis.
This study used eye-tracking to understand how the order of note sections influences the way physicians read electronic progress notes. Results showed no relationship between time spent reading a section and section origin of verbal summaries.
AHRQ-funded; HS022085.
Citation: Hultman GM, Marquard JL, Kandaswamy S .
Electronic progress note reading patterns: an eye tracking analysis.
Stud Health Technol Inform 2019 Aug 21;264:1684-85. doi: 10.3233/shti190596..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider, Provider: Physician
Rogers ES, Cuthel AM, Berry CA
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
This study examined the effectiveness of practice facilitation to improve cardiovascular disease in 257 small independent primary care practices (SIPs) enrolled in the AHRQ-funded EvidenceNOW initiative called HealthyHearts. These SIPs were enrolled in HealthyHearts NYC in New York City. Interviews were conducted with SIPs with 3 or fewer office staff and their answers were compared with interviews with practices with more than 3 office staff. Three facilitation benefits were found to the most important, including 1. Creating awareness of quality gaps; 2. Connecting practices to information, resources, and strategies, and; 3. Optimizing the HER for QI goals.
AHRQ-funded; HS023922.
Citation: Rogers ES, Cuthel AM, Berry CA .
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S17-s23. doi: 10.1370/afm.2427..
Keywords: Primary Care, Provider: Clinician, Provider: Physician, Provider, Quality Improvement, Quality of Care, Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Brunsberg KA, Landrigan CP, Garcia BM
Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services.
The objective of this paper was to determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians. Results of this prospective cohort study showed that resident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors, indicating the importance of determining what interventions might mitigate the patient safety risk.
AHRQ-funded; HS019456.
Citation: Brunsberg KA, Landrigan CP, Garcia BM .
Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services.
Acad Med 2019 Aug;94(8):1150-56. doi: 10.1097/acm.0000000000002778..
Keywords: Children/Adolescents, Provider: Physician, Provider, Medical Errors, Adverse Events, Burnout, Patient Safety, Depression, Behavioral Health
Barbash IJ, Pilewski JM, McVerry BJ
Closing the loop: engaging leaders and front-line physicians to promote physician wellness.
The authors describe their experience with linking buy-in from organizational leaders with a process of engaging frontline physicians to identify and drive changes designed to improve physician wellness in an academic pulmonary and critical care medicine division. They conclude that, with support from local leaders, empowered physicians can improve their work environments in ways that allow them to focus on the essential missions of academic medicine—discovery, teaching, and patient care.
AHRQ-funded; HS025455.
Citation: Barbash IJ, Pilewski JM, McVerry BJ .
Closing the loop: engaging leaders and front-line physicians to promote physician wellness.
Ann Am Thorac Soc 2019 Aug;16(8):970-73. doi: 10.1513/AnnalsATS.201812-866PS.
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Keywords: Burnout, Provider: Physician, Provider
Poghosyan L, Ghaffari A, Shaffer J
Nurse practitioner primary care organizational climate questionnaire: item response theory and differential item functioning.
This study evaluated the Nurse Practitioner Primary Care Organization Climate Questionnaire (NP-PCOCQ) and the items on the questionnaire using item response theory (IRT) and also conducted differential item functioning (DIF) analysis. The questionnaire was sent to 278 primary nurse practitioners (NPs) in New York State, and 314 NPs in Massachusetts. Data was collected online in NY and a mail survey was used in MA in 2012. Out of 29 items on the questionnaire, only 5 exhibited DIF. Out of these results, a shortened 24-item questionnaire was developed.
AHRQ-funded; HS020999.
Citation: Poghosyan L, Ghaffari A, Shaffer J .
Nurse practitioner primary care organizational climate questionnaire: item response theory and differential item functioning.
J Clin Nurs 2019 Aug;28(15-16):2934-45. doi: 10.1111/jocn.14895..
Keywords: Primary Care, Provider: Clinician, Provider: Nurse, Provider
Sklar M, Hatch MR, Aarons GA
A climate for evidence-based practice implementation in the patient-centred medical home.
This paper discusses variations in climate for evidence-based practice (EBP) implementation in patient-centered medical homes (PCMHs) in the United States. The study compared two Rhode Island PCMHs, one a Family Care Center (FCC), and the other an Internal Medicine Clinic (IMC). The FCC staff had more positive attitudes towards EBP than IMC staff. They also reported greater educational support for EBPs than IMC staff and physicians. The importance of removing barriers to EBP implementation was emphasized.
AHRQ-funded; HS024192.
Citation: Sklar M, Hatch MR, Aarons GA .
A climate for evidence-based practice implementation in the patient-centred medical home.
J Eval Clin Pract 2019 Aug;25(4):637-47. doi: 10.1111/jep.13050..
Keywords: Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Provider
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
Snyder ME, Jaynes H, Gernant SA
Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation.
This study evaluated the effectiveness of alerts for community pharmacist-provided medication therapy management (MTM). The alerts come in five categories: indication, effectiveness, safety, adherence, and cost-containment. The heuristic evaluation used the Instrument for Evaluating Human-Factors Principles in Medication-Related Decision Support Alerts (I-MeDeSA). Four analysts’ individual ratings were summed for each alert, and a mean score on the modified I-MeDeSA was computed. The analysts’ scores were similar. The scores indicated opportunities for improvement across all MTM alert categories including principles of alert prioritization; text-based information; alarm philosophy; and corrective actions.
AHRQ-funded; HS025005.
Citation: Snyder ME, Jaynes H, Gernant SA .
Alerts for community pharmacist-provided medication therapy management: recommendations from a heuristic evaluation.
BMC Med Inform Decis Mak 2019 Jul 16;19(1):135. doi: 10.1186/s12911-019-0866-0..
Keywords: Decision Making, Health Information Technology (HIT), Medication, Provider, Provider: Pharmacist