National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Adverse Drug Events (ADE) (16)
- Adverse Events (9)
- Alcohol Use (1)
- Cancer: Breast Cancer (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (2)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- Data (1)
- Diagnostic Safety and Quality (1)
- Elderly (3)
- Electronic Health Records (EHRs) (7)
- Emergency Department (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (9)
- Hospital Discharge (1)
- Hospitalization (1)
- Hospitals (3)
- Long-Term Care (1)
- Medical Errors (7)
- Medication (24)
- (-) Medication: Safety (24)
- Neurological Disorders (1)
- Nursing Homes (1)
- Opioids (1)
- Patient-Centered Healthcare (1)
- Patient and Family Engagement (1)
- Patient Safety (20)
- Prevention (2)
- Provider: Pharmacist (1)
- Quality Improvement (1)
- Quality of Care (1)
- Research Methodologies (1)
- Risk (1)
- Transitions of Care (1)
- Vulnerable Populations (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 24 of 24 Research Studies DisplayedSchnipper JL, Mixon A, Stein J
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study.
The authors of this paper conducted a pragmatic quality improvement (QI) study at five US hospitals, two of which included concurrent controls. The investigators found that a mentored implementation of a multifaceted medication reconciliation QI initiative was associated with a reduction in total, but not potentially harmful, medication discrepancies. They suggest that the effect of EHR implementation on medication discrepancies warrants further study.
AHRQ-funded; HS019598.
Citation: Schnipper JL, Mixon A, Stein J .
Effects of a multifaceted medication reconciliation quality improvement intervention on patient safety: final results of the MARQUIS study.
BMJ Qual Saf 2018 Dec;27(12):954-64. doi: 10.1136/bmjqs-2018-008233..
Keywords: Hospitals, Medication, Medication: Safety, Patient Safety, Quality Improvement
Gray SL, Marcum ZA, Schmader KE
Update on medication use quality and safety in older adults, 2017.
Improving the quality of medication use and medication safety in older adults is an important public health priority and is of paramount importance for clinicians who care for them. In this paper, the investigators selected four important articles (from 2017), that address these issues, to annotate and critique. In addition, they discuss the broader implications for optimizing medication use.
AHRQ-funded; HS023779; HS022982.
Citation: Gray SL, Marcum ZA, Schmader KE .
Update on medication use quality and safety in older adults, 2017.
J Am Geriatr Soc 2018 Dec;66(12):2254-58. doi: 10.1111/jgs.15665..
Keywords: Elderly, Quality of Care, Medication, Medication: Safety, Patient Safety
Schiff G, Mirica MM, Dhavle AA
A prescription for enhancing electronic prescribing safety.
The authors review six areas in which electronic prescribing areas can be improved to transform medication ordering quality and safety. They recommend incorporating medication indications into electronic prescribing, establishing a single shared online medication list, implementing an electronic cancellation mechanism for pharmacies, implementing standardized structured and codified prescription instruction, reengineering clinical decision support, and redesigning electronic prescribing to facilitate ordering of nondrug alternatives.
AHRQ-funded; HS023694.
Citation: Schiff G, Mirica MM, Dhavle AA .
A prescription for enhancing electronic prescribing safety.
Health Aff 2018 Nov;37(11):1877-83. doi: 10.1377/hlthaff.2018.0725..
Keywords: Adverse Drug Events (ADE), Adverse Events, Health Information Technology (HIT), Healthcare Delivery, Medical Errors, Medication, Medication: Safety, Patient Safety
Wang SV, Maro JC, Baro E
Data mining for adverse drug events with a propensity score-matched tree-based scan statistic.
In this study, the investigators propose a method that combines tree-based scan statistics with propensity score-matched analysis of new initiator cohorts, a robust design for investigations of drug safety. They subsequently conducted plasmode simulations to evaluate performance. The authors suggest that TreeScan with propensity score matching shows promise as a method for screening and prioritization of potential adverse events.
AHRQ-funded; HS022193.
Citation: Wang SV, Maro JC, Baro E .
Data mining for adverse drug events with a propensity score-matched tree-based scan statistic.
Epidemiology 2018 Nov;29(6):895-903. doi: 10.1097/ede.0000000000000907..
Keywords: Adverse Drug Events (ADE), Adverse Events, Patient Safety, Medication, Medication: Safety, Data, Research Methodologies
Prey JE, Polubriaginof F, Grossman LV
Engaging hospital patients in the medication reconciliation process using tablet computers.
Researchers conducted a pilot study to determine whether patients’ use of an electronic home medication review tool on a table computer could improve medication safety before or after hospitalization. Patients were randomized to the tool and out of 76 patients approached, 65 participated. About three-quarters (74%) made changes to their home medication list. Out of that total, 74% of the changes identified had a significant or greater potential severity, and 49% had a greater than 50-50 chance of harm. This medication reconciliation tool showed great potential to improve medication safety during and after hospitalization.
AHRQ-funded; HS021816.
Citation: Prey JE, Polubriaginof F, Grossman LV .
Engaging hospital patients in the medication reconciliation process using tablet computers.
J Am Med Inform Assoc 2018 Nov;25(11):1460-69. doi: 10.1093/jamia/ocy115..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitalization, Hospitals, Medication, Medication: Safety, Patient and Family Engagement, Patient Safety, Prevention
Ratwani RM, Savage E, Will A
Identifying electronic health record usability and safety challenges in pediatric settings.
To understand specific usability issues and medication errors in the care of children, the investigators analyzed 9,000 patient safety reports, made in the period 2012-17, from three different health care institutions that were likely related to EHR use. They found: the general pattern of usability challenges and medication errors were the same across the three sites; the most common usability challenges were associated with system feedback and the visual display; and the most common medication error was improper dosing.
AHRQ-funded; HS023701.
Citation: Ratwani RM, Savage E, Will A .
Identifying electronic health record usability and safety challenges in pediatric settings.
Health Aff 2018 Nov;37(11):1752-59. doi: 10.1377/hlthaff.2018.0699..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Children/Adolescents
Bates DW, Singh H
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
This paper comments on the progress made in improving patient safety since the 1999 report from The Institute of Medicine titled “To Err is Human” was published. This landmark report highlighted problem areas, and since then there has been a number of effective interventions to prevent hospital-acquired infections and improve medication safety. Additional areas for improvement have also been identified in the past two decades, including outpatient care, diagnostic, errors and the use of health information technology. The authors believe that electronic data developments can help increase patient safety even further.
AHRQ-funded; HS022087; HS017820.
Citation: Bates DW, Singh H .
Two decades since To Err Is Human: an assessment of progress and emerging priorities in patient safety.
Health Aff 2018 Nov;37(11):1736-43. doi: 10.1377/hlthaff.2018.0738..
Keywords: Adverse Drug Events (ADE), Adverse Events, Diagnostic Safety and Quality, Electronic Health Records (EHRs), Health Information Technology (HIT), Medical Errors, Medication, Medication: Safety, Patient Safety, Prevention
Weitzman ER, Magane KM, Wisk LE
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Information about the prevalence of alcohol use among youth with chronic medical conditions (YCMCs) who take alcohol-interactive (AI) medications is scant. This study attempts to address gaps and inform interventions by quantifying simultaneous exposure to alcohol use and AI medications among YCMCs. Participants were adolescents with a variety of chronic conditions: type 1 diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention-deficit/hyperactivity disorder, inflammatory bowel disease. Participants completed an electronic survey designed to measure prevalence of exposure to AI medications and associations with alcohol usage in the past year. Many of the participants reported alcohol use, but drinking was less likely among those who took AI medications. The authors conclude that perceptions about alcohol-medication interference mediated the association between drinking and AI medication exposure.
AHRQ-funded; HS022986.
Citation: Weitzman ER, Magane KM, Wisk LE .
Alcohol use and alcohol-interactive medications among medically vulnerable youth.
Pediatrics 2018 Oct;142(4). doi: 10.1542/peds.2017-4026..
Keywords: Alcohol Use, Children/Adolescents, Chronic Conditions, Medication, Medication: Safety, Patient Safety, Vulnerable Populations
Hartung DM, Hall J, Haverly SN
Pharmacists' role in opioid safety: a focus group investigation.
This qualitative study explores the pharmacist's role in promoting opioid safety from the perspective of pharmacists and patients. Using focus groups, results showed that pharmacists expressed discomfort filling potentially high-risk opioid prescriptions and noted barriers such as lack of clinical information and discomfort policing high-risk prescribing; and that patients were concerned about pharmacists potentially overstepping their professional responsibilities by interfering with prescribers' clinical decisions.
AHRQ-funded; HS024227.
AHRQ-funded; HS024227.
AHRQ-funded; HS024227.
Citation: Hartung DM, Hall J, Haverly SN .
Pharmacists' role in opioid safety: a focus group investigation.
Pain Med 2018 Sep;19(9):1799-806. doi: 10.1093/pm/pnx139..
Keywords: Provider: Pharmacist, Opioids, Medication: Safety, Medication, Patient Safety
Wong A, Plasek JM, Montecalvo SP
Natural language processing and its implications for the future of medication safety: a narrative review of recent advances and challenges.
This review illustrates the fundamentals of natural language processing (NLP) and discusses the application the NLPs to medication safety in four data sources: electronic health records, Internet-based data, published literature, and reporting systems. The benefit of NLP is its time-saving features in association with the automation of medication safety tasks, as well as the potential for near real-time identification of adverse events, such as incidents posted on social media that might otherwise go unanalyzed. However, NLP is limited by a lack of data sharing between health care organizations, which inhibits wider adverse event monitoring across populations. The authors anticipate that future work on NLPs will focus on integrating of data sources from different domains to more quickly identify potential adverse events and to improve clinical decision support regarding patients’ estimated risks for specific adverse events.
AHRQ-funded; HS022728; HS024264; HS025375.
Citation: Wong A, Plasek JM, Montecalvo SP .
Natural language processing and its implications for the future of medication safety: a narrative review of recent advances and challenges.
Pharmacotherapy 2018 Aug;38(8):822-41. doi: 10.1002/phar.2151..
Keywords: Adverse Drug Events (ADE), Adverse Events, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety, Patient Safety
Trivedi LU, Alvarez CA, Mansi IA
Association of statin therapy with risk of epilepsy in 2 propensity score-matched cohorts.
The objective of this study was to examine the association between statin use and epilepsy risk in a general population and in a healthy population (individuals with no severe comorbidities). The study did not demonstrate a significant beneficial or deleterious effect of statin use on risk of being diagnosed with epilepsy. The authors assert that clinicians should not withhold statins, whenever indicated, in patients with epilepsy.
AHRQ-funded; HS022418.
Citation: Trivedi LU, Alvarez CA, Mansi IA .
Association of statin therapy with risk of epilepsy in 2 propensity score-matched cohorts.
Ann Pharmacother 2018 Jun;52(6):546-53. doi: 10.1177/1060028018756650..
Keywords: Medication, Medication: Safety, Adverse Drug Events (ADE), Adverse Events, Cardiovascular Conditions, Neurological Disorders, Risk
Wang J, Ali E, Gong Y
An information enhanced framework for reporting medication events.
In this article, the authors describe a proposed framework to discover supportive information from the FDA Adverse Event Reporting System (FAERS), an open data source, to enhance the reporting of insulin-use events. The framework represents a paradigm for developing an information enhanced electronic reporting system.
AHRQ-funded; HS022895.
Citation: Wang J, Ali E, Gong Y .
An information enhanced framework for reporting medication events.
Stud Health Technol Inform 2018;250:169-73..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medical Errors, Medication, Medication: Safety, Patient Safety
Kannampallil TG, Manning JD, Chestek DW
Effect of number of open charts on intercepted wrong-patient medication orders in an emergency department.
The authors examined the effect of number of open charts on intercepted wrong-patient medication orders in an emergency department using an interrupted time series analysis of intercepted wrong-patient medication orders in an emergency department during 2010-2016.
AHRQ-funded; HS024945.
Citation: Kannampallil TG, Manning JD, Chestek DW .
Effect of number of open charts on intercepted wrong-patient medication orders in an emergency department.
J Am Med Inform Assoc 2018 Jun;25(6):739-43. doi: 10.1093/jamia/ocx099..
Keywords: Adverse Drug Events (ADE), Emergency Department, Medical Errors, Medication, Medication: Safety, Patient Safety
Kron K, Myers S, Volk L
Incorporating medication indications into the prescribing process.
Investigators looked into the challenges of incorporating patient-specific drug indications into a computerized prescriber order-entry (CPOE) system. Six expert stakeholder panels were convened to provide input. Findings are summarized including rationale, literature findings, potential benefits, and challenges of incorporating indications into the prescribing process. The findings have identified design requirements for a new CPOE interface and workflow.
AHRQ-funded; HS023694.
Citation: Kron K, Myers S, Volk L .
Incorporating medication indications into the prescribing process.
Am J Health Syst Pharm 2018 Jun 1;75(11):774-83. doi: 10.2146/ajhp170346..
Keywords: Health Information Technology (HIT), Medication, Medication: Safety
Lee JL, Dy SM, Gurses AP
Towards a more patient-centered approach to medication safety.
In this perspective, the authors focus their discussion on a patient-centered approach to measurement and describe commonly used health system–oriented medication safety measures for evaluating interventions. They also discuss measures that reflect patient-centeredness in medication safety.
AHRQ-funded; HS024436.
Citation: Lee JL, Dy SM, Gurses AP .
Towards a more patient-centered approach to medication safety.
J Patient Exp 2018 Jun;5(2):83-87. doi: 10.1177/2374373517727532..
Keywords: Adverse Drug Events (ADE), Patient-Centered Healthcare, Patient Safety, Medication: Safety, Medication
Zhou S, Kang H, Yao B
Unveiling originated stages of medication errors: an automated pipeline approach.
Medication error reports collected by Patient Safety Organizations provide an opportunity to analyze and learn from previous cases. However, the current process of analyzing the reports is labor-intensive and time-consuming. To improve the efficiency, the investigators used automated text classification techniques to develop a pipeline for medication error report pre-analysis.
AHRQ-funded; HS022895.
Citation: Zhou S, Kang H, Yao B .
Unveiling originated stages of medication errors: an automated pipeline approach.
Stud Health Technol Inform 2018;250:182-86..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medical Errors, Medication, Medication: Safety, Patient Safety
Smith JC, Chen Q, Denny JC
Evaluation of a novel system to enhance clinicians' recognition of preadmission adverse drug reactions.
This study evaluated whether an automated system, the Adverse Drug Effect Recognizer (ADER), could assist clinicians in detecting and addressing inpatients' ongoing preadmission adverse drug reactions (ADRs). The investigators found that their results indicated that ADER helped physicians recognize ADRs and reduced ordering of suspected ADR-causing medications. They suggest that in hospitals using EHRs, ADER-like systems could improve clinicians' recognition and elimination of ongoing ADRs.
AHRQ-funded; HS023485.
Citation: Smith JC, Chen Q, Denny JC .
Evaluation of a novel system to enhance clinicians' recognition of preadmission adverse drug reactions.
Appl Clin Inform 2018 Apr;9(2):313-25. doi: 10.1055/s-0038-1646963..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Patient Safety, Health Information Technology (HIT)
Rangachari P, Dellsperger KC, Fallaw D
Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.
Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from "limited use" of EHR Medication Reconciliation (MedRec) Technology, to "meaningful use." Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. The purpose of this paper is to describe the methods and results of Phase 1.
AHRQ-funded; HS024335.
Citation: Rangachari P, Dellsperger KC, Fallaw D .
Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.
J Hosp Adm 2018 Apr;7(2):36-49. doi: 10.5430/jha.v7n2p36.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication: Safety, Medication, Patient Safety
Wong A, Seger DL, Slight SP
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
The aim of this study was to determine the rate of anaphylaxis overrides, the reasons for these overrides, whether the overrides were appropriate, and if harm occurred from overrides. Overrides of 'definite' anaphylaxis drug-allergy interactions were common and often appropriate. Most overrides were due to desensitizations.
AHRQ-funded; HS021094.
Citation: Wong A, Seger DL, Slight SP .
Evaluation of 'definite' anaphylaxis drug allergy alert overrides in inpatient and outpatient settings.
Drug Saf 2018 Mar;41(3):297-302. doi: 10.1007/s40264-017-0615-1.
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Keywords: Adverse Drug Events (ADE), Clinical Decision Support (CDS), Electronic Health Records (EHRs), Medication: Safety, Medication
Cornu P, Phansalkar S, Seger DL
High-priority and low-priority drug-drug interactions in different international electronic health record systems: a comparative study.
The purpose of this comparative retrospective study was to investigate whether alert warnings for high-priority and low-priority drug-drug interactions were present in five international electronic health record systems, to compare and contrast the severity level assigned to them, and to establish the proportion of alerts that were overridden.
AHRQ-funded; HS021094.
Citation: Cornu P, Phansalkar S, Seger DL .
High-priority and low-priority drug-drug interactions in different international electronic health record systems: a comparative study.
Int J Med Inform 2018 Mar;111:165-71. doi: 10.1016/j.ijmedinf.2017.12.027..
Keywords: Adverse Drug Events (ADE), Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety
Kerstenetzky L, Birschbach MJ, Beach KF
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
The authors of this study report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to skilled nurse facilities and long term care pharmacy staff.
AHRQ-funded; HS021984.
Citation: Kerstenetzky L, Birschbach MJ, Beach KF .
Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: a targeted needs assessment using the Intervention Mapping framework.
Res Social Adm Pharm 2018 Feb;14(2):138-45. doi: 10.1016/j.sapharm.2016.12.013..
Keywords: Adverse Drug Events (ADE), Hospital Discharge, Hospitals, Long-Term Care, Medical Errors, Medication, Medication: Safety, Nursing Homes, Patient Safety, Transitions of Care
Gray SL, Hart LA, Perera S
Meta-analysis of interventions to reduce adverse drug reactions in older adults.
This review examined the effect of interventions to optimize medication use on adverse drug reactions (ADRs) in older adults. Thirteen randomized controlled trials involving 6,198 older adults were included in the review. It concluded that interventions designed to optimize medication use reduced the risk of any and serious ADRs in older adults.
AHRQ-funded; HS023779.
Citation: Gray SL, Hart LA, Perera S .
Meta-analysis of interventions to reduce adverse drug reactions in older adults.
J Am Geriatr Soc 2018 Feb;66(2):282-88. doi: 10.1111/jgs.15195.
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Keywords: Adverse Drug Events (ADE), Elderly, Medication: Safety, Medication, Patient Safety
Zullo AR, Gray SL, Holmes HM
Screening for medication appropriateness in older adults.
Older adults are at high risk for inappropriate medication use given their myriad medical conditions and medications. Screening efforts may seem overwhelming, but starting with a focused approach and leveraging a team-based strategy can help practicing clinicians gain initial momentum. Future research is needed to strengthen the evidence base for medication use in older adults and to elucidate effective and scalable interventions to improve medication safety.
AHRQ-funded; HS022998.
Citation: Zullo AR, Gray SL, Holmes HM .
Screening for medication appropriateness in older adults.
Clin Geriatr Med 2018 Feb;34(1):39-54. doi: 10.1016/j.cger.2017.09.003.
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Keywords: Elderly, Medication: Safety, Medication, Patient Safety
Sun D, Sarda G, Skube SJ
Phenotyping and visualizing infusion-related reactions for breast cancer patients.
Researchers developed and evaluated a phenotyping algorithm to detect Infusion-related reactions (IRRs) for breast cancer patients. They also designed a visualization prototype to render IRR patients' medications, lab tests and vital signs over time. By comparing with the 42 randomly selected doses that are manually labeled by a domain expert, the sensitivity, positive predictive value, specificity, and negative predictive value of the algorithms are 69 percent, 60 percent, 79 percent, and 85 percent, respectively.
AHRQ-funded; HS022085.
Citation: Sun D, Sarda G, Skube SJ .
Phenotyping and visualizing infusion-related reactions for breast cancer patients.
Stud Health Technol Inform 2017;245:599-603.
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Keywords: Adverse Drug Events (ADE), Cancer: Breast Cancer, Medication, Medication: Safety, Patient Safety