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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
151 to 175 of 299 Research Studies DisplayedArmstrong MJ, Gronseth GS, Day GS
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Patient and caregiver perspectives on amyloid positron emission tomography (PET) use are largely unexplored, particularly as compared with clinician views. In this study, the investigators surveyed clinicians, patients, caregivers, and dementia advocates on topics relating to an evidence-based guideline on amyloid PET use. They found that patients and caregivers emphasized the importance of having a dementia diagnosis and placed more value on testing and outcomes for asymptomatic populations than clinicians.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Gronseth GS, Day GS .
Patient stakeholder versus physician preferences regarding amyloid PET testing.
Alzheimer Dis Assoc Disord 2019 Jul-Sep;33(3):246-53. doi: 10.1097/wad.0000000000000311..
Keywords: Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Ranganathan K, Kochkodan JM, Baker MK
Variation in the desire for cleft revision surgery among children, caregivers, and surgeons.
This study examined the differences in perception between children, caregivers, and their surgeons for the need for cleft revision surgery. A sample of 100 children with cleft lip and/or cleft palate and their caregivers (n=100) were surveyed on satisfaction with appearance using the Cleft Evaluation Profile. Ten surgeons and ten control observers then rated photographs of these children using questions analogous to the Profile. The children generally reported greater satisfaction in appearance across all domains compared with surgeons. Children and caregivers had similar degrees of satisfaction in appearance of the lip and maxilla. The authors concluded that more care must be given to children’s perception before moving forward with further revision surgery.
AHRQ-funded; HS023313.
Citation: Ranganathan K, Kochkodan JM, Baker MK .
Variation in the desire for cleft revision surgery among children, caregivers, and surgeons.
Plast Reconstr Surg 2019 Jul;144(1):171-78. doi: 10.1097/prs.0000000000005722..
Keywords: Caregiving, Children/Adolescents, Surgery, Provider, Provider: Physician
Linzer M, Poplau S, Prasad K
Characteristics of health care organizations associated with clinician trust: results from the healthy work place study.
This study examined clinician trust among clinicians in private practices using retrospective cohort data from the Healthy Work Place randomized clinical trial. Thirty-four primary care practices in the Upper Midwest and East Coast were sampled. The study included 165 clinicians with most being physicians, and some advanced practice clinicians (nurse practitioners and physician assistants). Measures of clinician trust included belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need. The population surveyed were 87.7% physicians and 52.1% women. Most (63.6%) worked in family medicine and the rest in internal medicine. Greater work control was associated with higher levels of trust. Men were more likely to express loyalty and high trust. Higher trust was associated with greater work satisfaction and leads to better staff retention and lower stress levels.
AHRQ-funded.
Citation: Linzer M, Poplau S, Prasad K .
Characteristics of health care organizations associated with clinician trust: results from the healthy work place study.
JAMA Netw Open 2019 Jun 5;2(6):e196201. doi: 10.1001/jamanetworkopen.2019.6201..
Keywords: Primary Care, Provider, Provider: Clinician, Provider: Nurse, Provider: Physician
Mitchell AP, Rotter JS, Patel E
Association between reimbursement incentives and physician practice in oncology: a systematic review.
Investigators sought to evaluate whether the financial incentives presented by oncology reimbursement policies affect physician practice patterns. Following a literature search, 18 observational cohort studies were included, most with moderate risk of bias. The findings suggested that some oncologists may, in certain circumstances, alter treatment recommendations based on personal revenue considerations. The authors concluded that an implication of this finding is that value-based reimbursement policies may be a useful tool to better align physician incentives with patient need and increase the value of oncology care.
AHRQ-funded; HS000032.
Citation: Mitchell AP, Rotter JS, Patel E .
Association between reimbursement incentives and physician practice in oncology: a systematic review.
JAMA Oncol 2019 Jun;5(6):893-99. doi: 10.1001/jamaoncol.2018.6196..
Keywords: Practice Patterns, Payment, Provider: Physician, Provider
Anton NE, Mizota T, Whiteside JA
Mental skills training limits the decay in operative technical skill under stressful conditions: results of a multisite, randomized controlled study.
The authors hypothesize that surgery residents trained on mental skills would outperform controls under increased stress conditions in the simulated operating room. They find that their comprehensive mental skills curriculum implemented with surgery residents at two institutions was effective at minimizing the deterioration of resident technical performance under stressful conditions compared with controls. They conclude that their results provide further evidence for the effectiveness of mental skills training to optimize surgery trainees' technical performance during challenging clinical situations.
AHRQ-funded; R18 HS022080.
Citation: Anton NE, Mizota T, Whiteside JA .
Mental skills training limits the decay in operative technical skill under stressful conditions: results of a multisite, randomized controlled study.
Surgery 2019 Jun;165(6):1059-64. doi: 10.1016/j.surg.2019.01.011..
Keywords: Surgery, Education: Continuing Medical Education, Stress, Provider Performance, Training, Provider: Physician, Provider
Martin JR, Anton N, Timsina L
Performance variability during training on simulators is associated with skill transfer.
Researchers looked at performance variability during training on simulators for performing laparoscopic surgery. Their hypothesis was that participants (surgery residents and medical students) who had consistent scores were most likely to have the most expertise and be capable of training others. The trainees first used the Fundamentals of Laparoscopic Surgery (FLS) simulator to learn laparoscopic suturing and then were transfer tested on a live, anesthetized porcine model. Their hypothesis was proven true and those with decreased practice variability was associated with greater scores in posttests and transfer tests.
AHRQ-funded; R18 HS022080.
Citation: Martin JR, Anton N, Timsina L .
Performance variability during training on simulators is associated with skill transfer.
Surgery 2019 Jun;165(6):1065-68. doi: 10.1016/j.surg.2019.01.013..
Keywords: Simulation, Training, Surgery, Education: Continuing Medical Education, Provider Performance, Provider: Physician, Provider
Aronson PL, Schaeffer P, Fraenkel L
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
This paper discusses the reasons for wide variation in the decision to perform lumbar punctures (LPs) in febrile infants 8 weeks or less. Semi-structured interviews were conducted with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Five themes emerged from the interviews that included: age of the infant, the physician’s clinical experience, physician’s use of research findings, the physician’s values, and the role of the primary care pediatrician.
AHRQ-funded; HS026006.
Citation: Aronson PL, Schaeffer P, Fraenkel L .
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
Hosp Pediatr 2019 Jun;9(6):405-14. doi: 10.1542/hpeds.2019-0002..
Keywords: Newborns/Infants, Decision Making, Provider: Physician, Provider: Nurse, Provider: Clinician, Provider, Emergency Department, Diagnostic Safety and Quality
Simpson KR, Lyndon A, Spetz J
Adherence to the AWHONN staffing guidelines as perceived by labor nurses.
Labor and delivery nurses were surveyed to determine if their units adhere to Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) staffing guidelines. Labor nurses in selected hospitals in California, Michigan and New Jersey were invited via email to participate in the study. Their nurse leaders facilitated the invitations. A total of 615 labor nurses from 67 hospitals participated. Most nurses did report that staffing guidelines were adhered to. The hospitals with smaller annual birth volumes (500-999 range) were significantly more like to be perceived as compliant than hospitals with 2,500 or more annual births.
AHRQ-funded; HS025715.
Citation: Simpson KR, Lyndon A, Spetz J .
Adherence to the AWHONN staffing guidelines as perceived by labor nurses.
Nurs Womens Health 2019 Jun;23(3):217-23. doi: 10.1016/j.nwh.2019.03.003..
Keywords: Care Management, Guidelines, Labor and Delivery, Maternal Care, Patient Safety, Pregnancy, Provider, Provider: Nurse, Women
Donovan E, Case P, Bratberg JP
Beliefs associated with pharmacy-based naloxone: a qualitative study of pharmacy-based naloxone purchasers and people at risk for opioid overdose.
The purpose of this study was to understand factors that impact the likelihood of obtaining pharmacy-based naloxone. Results showed that several themes emerged from the interview data: individual, interpersonal, pharmacy, community, and societal, suggesting that these factors can be used to inform interventions seeking to increase the provision of pharmacy-based naloxone.
AHRQ-funded; HS024021.
Citation: Donovan E, Case P, Bratberg JP .
Beliefs associated with pharmacy-based naloxone: a qualitative study of pharmacy-based naloxone purchasers and people at risk for opioid overdose.
J Urban Health 2019 Jun;96(3):367-78. doi: 10.1007/s11524-019-00349-1..
Keywords: Medication, Provider, Provider: Pharmacist, Opioids, Risk, Substance Abuse
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
Mueller SK, Schnipper JL
Physician perspectives on interhospital transfers.
This study examined physician perspectives of the common problems that occur during acute care hospital interhospital transfers. The process tends to be nonstandardized which creates a number of issues. These issues include: patients sometimes, frequently, or always arriving without required specialized care (56% of the time), arriving with unrealistic expectations of care (77.2% of responses), arrived more than 24 hours after accepted transfer in 80.1% of responses, and arrived without necessary transfer records 86.9% of the time. The last issue and also time of day of arrival many physicians felt posed a risk to the transferred patients.
AHRQ-funded; HS023331.
Citation: Mueller SK, Schnipper JL .
Physician perspectives on interhospital transfers.
J Patient Saf 2019 Jun;15(2):86-89. doi: 10.1097/pts.0000000000000312..
Keywords: Healthcare Delivery, Hospitals, Patient Safety, Provider, Provider: Physician, Transitions of Care
Kamal AH, Wolf SP, Troy J
Policy changes key to promoting sustainability and growth of the specialty palliative care workforce.
The authors used 2018 clinician survey data to model risk factors associated with palliative care clinicians leaving the field early. Their modeling revealed an impending "workforce valley." They recommended policies that support high-value, team-based palliative care through expansion in all segments of the specialty palliative care workforce, combined with payment reform to encourage the deployment of sustainable teams.
AHRQ-funded; HS023681.
Citation: Kamal AH, Wolf SP, Troy J .
Policy changes key to promoting sustainability and growth of the specialty palliative care workforce.
Health Aff 2019 Jun;38(6):910-18. doi: 10.1377/hlthaff.2019.00018..
Keywords: Palliative Care, Policy, Provider, Teams, Workforce
Nocon RS, Fairchild PC, Gao Y
Provider and staff morale, job satisfaction, and burnout over a 4-year medical home intervention.
This study examined the impact of adopting the patient-centered medical home (PCMH) on clinicians and staff at primary care practices. A longitudinal study was done comparing baseline (201) and post-intervention (2013-2014) survey results. Five-hundred thirty-six providers and staff at baseline and 589 were surveyed post-intervention. Almost half of all clinics reported improved better job morale, job satisfaction, and freedom from burnout. However, there were some clinics that saw a decrease in the percentage of providers reporting high job satisfaction and freedom from burnout. Control clinics were not used in this study, so it is impossible to know if results were similar in non-PCMH primary care practices.
AHRQ-funded; HS000084.
Citation: Nocon RS, Fairchild PC, Gao Y .
Provider and staff morale, job satisfaction, and burnout over a 4-year medical home intervention.
J Gen Intern Med 2019 Jun;34(6):952-59. doi: 10.1007/s11606-019-04893-z..
Keywords: Burnout, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Provider, Provider: Clinician, Stress
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
Suda KJ, Durkin MJ, Calip GS
Comparison of opioid prescribing by dentists in the United States and England.
The goal of this cross-sectional study was to compare opioid prescribing rates by dentists in the US and England, using data on prescriptions dispensed from outpatient pharmacies and health care settings in 2016 by dentists in both countries. Findings show that the proportion of prescriptions for opioids written by US dentists was 37 times greater than the proportion written by English dentists. US dentists also had a higher number of opioid prescriptions per 1000 population and number of prescriptions per dentist. Dihydrocodeine was the only opioid prescribed by English dentists, while US dentists prescribed a range of opioids containing hydrocodone, codeine, oxycodone, and tramadol, as well as long-acting opioids. The researchers conclude that US dentists adopt measures similar to those used in England to reduce dental opioid prescribing in the United States.
AHRQ-funded; HS025177.
Citation: Suda KJ, Durkin MJ, Calip GS .
Comparison of opioid prescribing by dentists in the United States and England.
JAMA Netw Open 2019 May 3;2(5):e194303. doi: 10.1001/jamanetworkopen.2019.4303..
Keywords: Dental and Oral Health, Medication, Opioids, Pain, Practice Patterns, Provider
Hultman GM, Marquard JL, Lindemann E
Challenges and opportunities to improve the clinician experience reviewing electronic progress notes.
There is a need to understand better how clinicians review electronic notes and how note structure variability may impact clinicians' note-reviewing experiences. This article aimed to understand how physicians review electronic clinical notes and what impact section order has on note-reviewing patterns. The investigators indicated that their findings support the need to improve EHR note design and presentation to support optimal note review patterns for clinicians.
AHRQ-funded; HS022085.
Citation: Hultman GM, Marquard JL, Lindemann E .
Challenges and opportunities to improve the clinician experience reviewing electronic progress notes.
Appl Clin Inform 2019 May;10(3):446-53. doi: 10.1055/s-0039-1692164..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Mitchell AP, Winn AN, Lund JL
Evaluating the strength of the association between industry payments and prescribing practices in oncology.
Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown. This study evaluated physician use of orally administered cancer drugs for four cancers and whether practice setting at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict-of-interest policies were associated with the strength of the payment-prescribing association.
AHRQ-funded; HS000032.
Citation: Mitchell AP, Winn AN, Lund JL .
Evaluating the strength of the association between industry payments and prescribing practices in oncology.
Oncologist 2019 May;24(5):632-39. doi: 10.1634/theoncologist.2018-0423..
Keywords: Cancer, Medication, Provider: Physician, Provider
Tawfik DS, Shanafelt TD, Dyrbye LN
Personal and professional factors associated with work-life integration among US physicians.
Poor work-life integration (WLI) occurs when career and personal responsibilities come in conflict and may contribute to the ongoing high rates of physician burnout. The characteristics associated with WLI are poorly understood. The objective of this study was to identify personal and professional factors associated with WLI in physicians and identify factors that modify the association between gender and WLI.
AHRQ-funded; HS027837.
Citation: Tawfik DS, Shanafelt TD, Dyrbye LN .
Personal and professional factors associated with work-life integration among US physicians.
JAMA Netw Open 2021 May;4(5):e2111575. doi: 10.1001/jamanetworkopen.2021.11575..
Keywords: Burnout, Provider: Physician, Provider
Sharp B, Johnson J, Hamedani AG
What are we measuring? Evaluating physician-specific satisfaction scores between emergency departments.
The goals of this study were to determine whether Press Ganey ED satisfaction scores for emergency physicians working at two different sites were consistent between sites, and to identify factors contributing to any variation. The investigators found that Press Ganey satisfaction scores for the same group of emergency physicians varied significantly between sites. They indicated that this suggests these scores are more dependent on site-specific factors, such as wait times, than a true representation of the quality of care provided by the physician.
AHRQ-funded; HS024558.
Citation: Sharp B, Johnson J, Hamedani AG .
What are we measuring? Evaluating physician-specific satisfaction scores between emergency departments.
West J Emerg Med 2019 May;20(3):454-59. doi: 10.5811/westjem.2019.4.41040..
Keywords: Emergency Department, Patient Experience, Provider: Physician, Provider
Woodard JA, Leekha S, Jackson SS
Beyond entry and exit: Hand hygiene at the bedside.
This study assessed compliance with, knowledge of, and attitudes toward the World Health Organization (WHO) 5 moments for hand hygiene (HH) using a modified WHO HH observation form and a survey that assessed health care personnel (HCP) knowledge, opinions, and barriers to HH. Of the 218 HCPs who completed the survey, less than one-third were familiar with the WHO 5 moments and only 21& of that group could recall the 5 moments. 302 HH opportunities in 104 unique HCP-patient interactions were observed, but with infrequent compliance. The researchers conclude that lack of recognition of opportunities at the bedside and for glove use may contribute to low compliance.
AHRQ-funded; HS024108.
Citation: Woodard JA, Leekha S, Jackson SS .
Beyond entry and exit: Hand hygiene at the bedside.
Am J Infect Control 2019 May;47(5):487-91. doi: 10.1016/j.ajic.2018.10.026..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Prevention, Provider, Public Health
St Hilaire MA, Anderson C, Anwar J
Brief (<4 hour) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts.
This study examines the impact of reinstating extended duration (24-28) work shifts (EDWS) for postgraduate year 1 resident physicians. The performance of residents was studied for 23 male residents between 2002-2004 during a three-week on-call rotation schedule at the Medical and Intensive Care Units at Brigham and Women’s Hospital in Boston. If the sleep episodes were four hours or less then the odds of >1 attentional failure was 2.72 times higher during post-call compared to matched sessions during non-EDWS.
AHRQ-funded; HS012032.
Citation: St Hilaire MA, Anderson C, Anwar J .
Brief (<4 hour) sleep episodes are insufficient for restoring performance in first-year resident physicians working overnight extended-duration work shifts.
Sleep 2019 May;42(5):pii: zsz041. doi: 10.1093/sleep/zsz041..
Keywords: Adverse Events, Education: Continuing Medical Education, Medical Errors, Patient Safety, Provider, Provider: Physician, Quality of Care, Sleep Problems, Training
Trent SA, Havranek EP, Ginde AA
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
This study examined the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for patients with severe sepsis. A quasi-experiment was conducted with attending physicians randomized into 6 clusters at a single urban safety net hospital. Feedback with blinded peer comparison significantly improved guideline adherence from 52% to 65% with feedback.
AHRQ-funded; HS022400.
Citation: Trent SA, Havranek EP, Ginde AA .
Effect of audit and feedback on physician adherence to clinical practice guidelines for pneumonia and sepsis.
Am J Med Qual 2019 May/Jun;34(3):217-25. doi: 10.1177/1062860618796947..
Keywords: Antibiotics, Emergency Department, Guidelines, Infectious Diseases, Inpatient Care, Medication, Pneumonia, Provider, Provider: Physician, Sepsis
de Cordova PB, Rogowski J, Riman KA
Effects of public reporting legislation of nurse staffing: a trend analysis.
The authors examined nurse staffing trends after the New Jersey enactment of P.L.1971, c.136 (C.26:2 H-13) on January 24, 2005, mandating that all health care facilities compile, post, and report staffing information. They found that the number of patients per registered nurse decreased for ten specialties, and conclude that this indicates the importance of public reporting in improving patient safety.
AHRQ-funded; HS024339.
Citation: de Cordova PB, Rogowski J, Riman KA .
Effects of public reporting legislation of nurse staffing: a trend analysis.
Policy Polit Nurs Pract 2019 May;20(2):92-104. doi: 10.1177/1527154419832112..
Keywords: Hospitals, Patient Safety, Workforce, Policy, Provider, Provider: Nurse
Baloh J, Thom KA, Perencevich E
Hand hygiene before donning nonsterile gloves: healthcareworkers' beliefs and practices.
The purpose of this study was to examine the practices and beliefs of health care workers related to the use of nonsterile gloves and associated hand hygiene (HH) before gloving. Gloving and HH practices of health care workers at three large academic hospitals were observed as they entered patient rooms, and interviews were conducted with providers, nurses, and nursing assistants to elicit their beliefs and perceptions of these hygiene practices. While interviewed health care workers reported 100% HH compliance before gloving, observed HH compliance was only 42% and observed gloving before entering contact precaution rooms was 78%. Most health care workers described glove use more often than was necessary, and generally used gloves for their own safety, and sanitized their hands before gloving for patient safety. The authors conclude that HH and glove use are intertwined in clinical practice and should be considered jointly to improve infection prevention improvement efforts.
AHRQ-funded; HS024108.
Citation: Baloh J, Thom KA, Perencevich E .
Hand hygiene before donning nonsterile gloves: healthcareworkers' beliefs and practices.
Am J Infect Control 2019 May;47(5):492-97. doi: 10.1016/j.ajic.2018.11.015..
Keywords: Provider: Clinician, Provider, Provider: Health Personnel, Patient Safety, Prevention