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 75 of 127 Research Studies DisplayedPalmer JA, Parker VA, Barre LR
Understanding implementation fidelity in a pragmatic randomized clinical trial in the nursing home setting:a mixed-methods examination.
This randomized clinical trial called Pragmatic Trial of Video Education in Nursing Homes (PROVEN) was one of the largest trials to be conducted in nursing homes on education of residents in Advanced Care Planning (ACP). The trial used videos with champions promoting ACP education across two large health-care systems. The trial length was 18 months, with champions offering video education to the residents every six months. At the end of the study 28 interviews involving 33 champions were analyzed. The researchers found different patterns between high- and low-adherence nursing homes. High-adherence nursing homes had more family and patient willingness to engage in the program and champions were better at recruitment. Champions also supplemented the video with ACP conversations.
AHRQ-funded; HS000011.
Citation: Palmer JA, Parker VA, Barre LR .
Understanding implementation fidelity in a pragmatic randomized clinical trial in the nursing home setting:a mixed-methods examination.
Trials 2019 Nov 28;20(1):656. doi: 10.1186/s13063-019-3725-5..
Keywords: Nursing Homes, Long-Term Care, Education: Patient and Caregiver, Health Literacy, Patient and Family Engagement, Elderly
Rice WS, Stringer KL, Sohail M
Accessing pre-exposure prophylaxis (PrEP): perceptions of current and potential prEP users in Birmingham, Alabama.
Limited studies to date assess barriers to and facilitators of pre-exposure prophylaxis (PrEP) uptake and utilization using a patient-centered access to care framework, among diverse socio-demographic groups, or in the U.S. Deep South, an area with disproportionate HIV burden. In this study, the investigators examine perceptions of PrEP access in qualitative interviews with 44 current and potential PrEP users in Birmingham, Alabama.
AHRQ-funded; HS013852.
Citation: Rice WS, Stringer KL, Sohail M .
Accessing pre-exposure prophylaxis (PrEP): perceptions of current and potential prEP users in Birmingham, Alabama.
AIDS Behav 2019 Nov;23(11):2966-79. doi: 10.1007/s10461-019-02591-9..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Healthcare Utilization, Patient-Centered Healthcare, Racial and Ethnic Minorities, Health Literacy, Education: Patient and Caregiver, Access to Care, Health Promotion
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
Glick AF, Brach C, Yin HS
AHRQ Author: Brach C
Health literacy in the inpatient setting: implications for patient care and patient safety.
This article considers how health literacy plays a part in events that lead up to children's hospitalizations both during hospital admission and after discharge. The authors discussed interventions that incorporate health-literacy-informed strategies and that target patients, families, and health care systems that should be implemented to improve patient outcomes and patient-centered and family-centered care.
AHRQ-authored.
Citation: Glick AF, Brach C, Yin HS .
Health literacy in the inpatient setting: implications for patient care and patient safety.
Pediatr Clin North Am 2019 Aug;66(4):805-26. doi: 10.1016/j.pcl.2019.03.007..
Keywords: Children/Adolescents, Health Literacy, Hospital Discharge, Hospitalization, Hospitals, Inpatient Care, Patient Safety
Brega AG, Hamer MK, Albright K
AHRQ Author: Brach C
Organizational health literacy: quality improvement measures with expert consensus.
The investigators sought to identify and evaluate existing organizational health literacy (OHL)-related quality improvement (QI) measures. They identified 22 OHL-related QI measures that have the support of experts in the field, and recommended additional measure development and testing. However, they note that their Consensus OHL QI Measures are appropriate for immediate use.
AHRQ-authored; AHRQ-funded; 233201500025I.
Citation: Brega AG, Hamer MK, Albright K .
Organizational health literacy: quality improvement measures with expert consensus.
Health Lit Res Pract 2019 Jul 1;3(2):e127-e46. doi: 10.3928/24748307-20190503-01..
Keywords: Health Literacy, Quality of Care, Quality Improvement, Quality Indicators (QIs), Quality Measures
Tieu L, Hobbs A, Sarkar U
Adapting patient experience data collection processes for lower literacy patient populations using tablets at the point of care.
This study compared the acceptability of low-literacy tablet-based and traditional paper-based patient experience surveys in English and Spanish. The Consumer Assessment of Healthcare Providers & Systems Clinician & Group Survey (CG-CAHPS) was adapted for a pilot survey using low-literacy questions in Spanish and English. The majority of interview participants preferred the tablet version over the traditional paper-based survey. This was especially true for the younger and Latino respondents.
AHRQ-funded; HS022408.
Citation: Tieu L, Hobbs A, Sarkar U .
Adapting patient experience data collection processes for lower literacy patient populations using tablets at the point of care.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S140-s48. doi: 10.1097/mlr.0000000000001030..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Information Technology (HIT), Health Literacy, Patient Experience, Primary Care, Quality of Care, Quality Improvement, Racial and Ethnic Minorities, Urban Health
Lor M, Koleck TA, Bakken S
Association between health literacy and medication adherence among Hispanics with hypertension.
This study examined the association between health literacy and medication adherence among Hispanic adults with hypertension. A cross-sectional survey of 1355 Hispanic adults, mostly Dominicans who self-report hypertension was conducted. After controlling for age, sex, birth country, education level, recruitment location, depression, anxiety, and sleep disturbance inadequate health literacy was associated with a lower adherence score.
AHRQ-funded; HS019853; HS022961.
Citation: Lor M, Koleck TA, Bakken S .
Association between health literacy and medication adherence among Hispanics with hypertension.
J Racial Ethn Health Disparities 2019 Jun;6(3):517-24. doi: 10.1007/s40615-018-00550-z..
Keywords: Blood Pressure, Health Literacy, Patient Adherence/Compliance, Medication, Racial and Ethnic Minorities
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
Khoong EC, Cherian R, Matta GY
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
The goal of this study was to understand how safety-net patients, including those with limited English proficiency, view clinician electronic health record (EHR) use. Through focus groups in English, Spanish, and Cantonese, results showed that linguistically diverse patients accepted the value of EHR use during outpatient visits but desired more eye contact, verbal warnings before EHR use, and screen-sharing. Support for clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients is recommended.
AHRQ-funded; HS022561; HS023558; HS022408.
Citation: Khoong EC, Cherian R, Matta GY .
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
J Med Internet Res 2019 May 22;21(5):e13131. doi: 10.2196/13131..
Keywords: Cultural Competence, Racial and Ethnic Minorities, Patient Experience, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication, Health Literacy, Communication
Hirsh J, Wood P, Keniston A
Limited health literacy and patient confusion about rheumatoid arthritis patient global assessments and model disease states.
The objective of this study was to understand the perspectives of vulnerable patients regarding patient global assessment visual analog scales (PGA-VAS) and model disease states. The investigators found that vulnerable patients perceived difficulty with PGA-VAS and did not reliably rate a model disease state VAS. The authors suggest that these patients are potentially at risk for disease activity misclassification because of literacy and other barriers in completing VAS.
AHRQ-funded.
Citation: Hirsh J, Wood P, Keniston A .
Limited health literacy and patient confusion about rheumatoid arthritis patient global assessments and model disease states.
Arthritis Care Res 2019 May;71(5):611-19. doi: 10.1002/acr.23692..
Keywords: Arthritis, Health Literacy
Armstrong MJ, Rastgardani T, Gagliardi AR
Barriers and facilitators of communication about off periods in Parkinson's disease: qualitative analysis of patient, carepartner, and physician Interviews.
This article discusses barriers and facilitators of communication with Parkinson’s disease patients, care partners, and their physicians specifically during off periods. Twenty persons with Parkinson’s and their care partners, and 20 physicians participated in interviews using a semi-structured questionnaire. Communication barrier levels were identified as patient-level, caregiver-level, and physician-level. For patients cognitive impairment and reluctance to discuss symptoms was the largest barrier. Caregiver absence was also a barrier. For physicians barriers were distraction by technology and lack of appreciation of off period burdens. Various tools such as home diaries, questionnaires and mobile phone videos can be used to aid communication regarding off periods. Patients and their caregivers stressed the need for more formal educational materials and improved educational tools.
AHRQ-funded; HS024159.
Citation: Armstrong MJ, Rastgardani T, Gagliardi AR .
Barriers and facilitators of communication about off periods in Parkinson's disease: qualitative analysis of patient, carepartner, and physician Interviews.
PLoS One 2019 Apr 18;14(4):e0215384. doi: 10.1371/journal.pone.0215384..
Keywords: Communication, Clinician-Patient Communication, Neurological Disorders, Caregiving, Education: Patient and Caregiver, Health Literacy, Patient and Family Engagement
Russell AM, Patel DA, Curtis LM
Test-retest reliability of the Newest Vital Sign health literacy instrument: in-person and remote administration.
The objective of this study was to determine the reliability of the Newest Vital Sign (NVS) by examining test-retest properties of the measure. The NVS assessment was conducted in-person at baseline, and in-person or via telephone at follow-up. Intraclass correlation coefficients were employed to assess the test-retest reliability by using raw NVS scores categorized by mode of administration of the second NVS assessment. The findings indicated that the test-retest properties of the NVS are similar by mode of administration. The authors conclude that their data suggests the NVS measure can be reliably administered by telephone.
AHRQ-funded; HS023459.
Citation: Russell AM, Patel DA, Curtis LM .
Test-retest reliability of the Newest Vital Sign health literacy instrument: in-person and remote administration.
Patient Educ Couns 2019 Apr;102(4):749-52. doi: 10.1016/j.pec.2018.11.016..
Keywords: Education: Patient and Caregiver, Health Literacy
Lyles CR, Tieu L, Sarkar U
A randomized trial to train vulnerable primary care patients to use a patient portal.
This study examined the use of patient care portals in primary care practices with vulnerable patients such as those with lower socioeconomic status or limited health literacy (LHL). A randomized control trial was created with 93 English-speaking patients with 1+ chronic diseases. The patients were provided with either an 1) in-person tutorial with a research assistant, or 2) a link to view the videos on their own. A third arm of the trial were control patients with just normal access to get to the portal. There was a higher rate of access (21%) after the trial was over with the two intervention groups as compared with 9% for the usual care patients.
AHRQ-funded; HS022408; HS022561; HS023558.
Citation: Lyles CR, Tieu L, Sarkar U .
A randomized trial to train vulnerable primary care patients to use a patient portal.
J Am Board Fam Med 2019 Mar-Apr;32(2):248-58. doi: 10.3122/jabfm.2019.02.180263..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Literacy, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Vulnerable Populations
Hero JO, Sinaiko AD, Kingsdale J
Decision-making experiences of consumers choosing individual-market health insurance plans.
This study researched the experiences of consumers choosing individual-market health insurance plans using either Marketplaces established by the Affordable Care Act (ACA) or directly through an insurance carrier. Consumers in 2017 reported that they had an easier overall experience using Marketplace than those who enrolled directly. Consumers with low health literacy had poor experiences with either method.
AHRQ-funded; HS024700.
Citation: Hero JO, Sinaiko AD, Kingsdale J .
Decision-making experiences of consumers choosing individual-market health insurance plans.
Health Aff 2019 Mar;38(3):464-72. doi: 10.1377/hlthaff.2018.05036..
Keywords: Shared Decision Making, Health Insurance, Health Literacy
Warsame F, Haugen CE, Ying H
Limited health literacy and adverse outcomes among kidney transplant candidates.
More than one-third of US adults have limited health literacy, putting them at risk of adverse clinical outcomes. In this study the investigators evaluated the prevalence of limited health literacy among 1578 adult kidney transplant (KT) candidates (May 2014-November 2017) and examined its association with listing for transplant and waitlist mortality in this pilot study. The investigators concluded that limited health literacy may be a salient mechanism in access to KT; programs to aid candidates with limited health literacy may improve outcomes and reduce disparities.
AHRQ-funded; HS024600.
Citation: Warsame F, Haugen CE, Ying H .
Limited health literacy and adverse outcomes among kidney transplant candidates.
Am J Transplant 2019 Feb;19(2):457-65. doi: 10.1111/ajt.14994..
Keywords: Health Literacy, Transplantation, Adverse Events, Patient-Centered Outcomes Research, Outcomes, Surgery, Mortality, Kidney Disease and Health
Egan M, Yin HS, Greenhawt M
Low caregiver health literacy among pediatric food-allergic patients is associated with poorer food allergy management knowledge.
In this paper, the authors discuss how lower health literacy in caregivers of children with food allergies is associated with deficiencies in demonstrating correct use of an epinephrine autoinjector, increased reactions to foods in the past 12 months, and knowledge gaps on treatment of allergic reactions.
AHRQ-funded; HS024599.
Citation: Egan M, Yin HS, Greenhawt M .
Low caregiver health literacy among pediatric food-allergic patients is associated with poorer food allergy management knowledge.
J Allergy Clin Immunol Pract 2019 Feb;7(2):655-58. doi: 10.1016/j.jaip.2018.05.021..
Keywords: Caregiving, Health Literacy, Children/Adolescents, Education: Patient and Caregiver
De Oliveira GS, Errea M, Bialek J
The impact of health literacy on shared decision making before elective surgery: a propensity matched case control analysis.
The primary aim of this study was to evaluate a possible association between health literacy and decision conflict in surgical patients. Patients undergoing a diverse number of elective surgeries were enrolled in the study. Health literacy was measured using the Newest Vital Sign instrument and decision conflict using the low literacy version of the Decision Conflict Scale. The investigators found that poor health literacy is associated with greater decision conflict in patients undergoing elective surgical procedures.
AHRQ-funded; HS024158.
Citation: De Oliveira GS, Errea M, Bialek J .
The impact of health literacy on shared decision making before elective surgery: a propensity matched case control analysis.
BMC Health Serv Res 2018 Dec 12;18(1):958. doi: 10.1186/s12913-018-3755-9..
Keywords: Shared Decision Making, Education: Patient and Caregiver, Health Literacy, Surgery
Turner AM, Osterhage KP, Taylor JO, et al.
A closer look at health information seeking by older adults and involved family and friends: design considerations for health information technologies.
Older adults are the largest consumers of healthcare. As part of a broader study of personal health information management (PHIM), the investigators interviewed older adults in King County, Washington, and their involved family and friends (FF), regarding health information (HI) sources they seek and utilize. The authors indicated that design considerations include: facilitating access to quality provider-vetted HI, incorporating older adults and FF in the design process, and creating shared spaces for communication of HI among older adults, FF, and providers.
AHRQ-funded; HS022106.
Citation: Turner AM, Osterhage KP, Taylor JO, et al..
A closer look at health information seeking by older adults and involved family and friends: design considerations for health information technologies.
AMIA Annu Symp Proc 2018 Dec 5;2018:1036-45..
Keywords: Elderly, Health Information Technology (HIT), Caregiving, Education: Patient and Caregiver, Health Literacy
Fisher KA, Tan ASL, Matlock DD
Keeping the patient in the center: common challenges in the practice of shared decision making.
This study examines the practice of shared-decision making (SDM) to achieve patient-centered decisions. It was determined that not all circumstances make it possible for that to happen and there have to be some basic elements present. Those elements include the patients’ health literacy, their emotional state, their relationship with the clinician and the nature of the decision.
AHRQ-funded; HS024596.
Citation: Fisher KA, Tan ASL, Matlock DD .
Keeping the patient in the center: common challenges in the practice of shared decision making.
Patient Educ Couns 2018 Dec;101(12):2195-201. doi: 10.1016/j.pec.2018.08.007..
Keywords: Clinician-Patient Communication, Shared Decision Making, Health Literacy, Patient-Centered Healthcare, Patient and Family Engagement
Zuckerman KE, Chavez AE, Regalado Murillo C
Disparities in familiarity with developmental disabilities among low-income parents.
Parent knowledge about developmental disabilities (DDs) may facilitate access to DD care; however, parents may vary in their knowledge and familiarity with common DDs. The objective of this study was to assess racial/ethnic and language differences in low-income families' familiarity, knowledge, and personal experience with DDs. The investigators concluded that low-income Latino-LEP and other race parents have less familiarity or personal experience with DDs and are less aware of early signs of DDs compared to low-income white parents.
AHRQ-funded; HS000063.
Citation: Zuckerman KE, Chavez AE, Regalado Murillo C .
Disparities in familiarity with developmental disabilities among low-income parents.
Acad Pediatr 2018 Nov - Dec;18(8):944-51. doi: 10.1016/j.acap.2018.06.011..
Keywords: Disabilities, Children/Adolescents, Caregiving, Health Literacy, Low-Income, Vulnerable Populations, Racial and Ethnic Minorities
Guo M, Quensell M, Chang A
Understanding of key obstetric quality terminology by Asian and Pacific Islander subgroups: implications for patient engagement and health equity.
In this study, women in Oahu, Hawai'i with a recent delivery were interviewed about their understanding of ten common obstetric terms. Health literacy was assessed by the rapid estimate of adult literacy in medicine (REALM). Multivariable models predicted total terms comprehended by demographic factors. The investigators found that participants were unfamiliar with common obstetrics terminology. Comprehension struggles were more common among populations with maternal health disparities, including Asian and Pacific Islander subgroups, and those with low health literacy.
AHRQ-funded; HS021903.
Citation: Guo M, Quensell M, Chang A .
Understanding of key obstetric quality terminology by Asian and Pacific Islander subgroups: implications for patient engagement and health equity.
Matern Child Health J 2018 Nov;22(11):1543-49. doi: 10.1007/s10995-018-2597-8..
Keywords: Health Literacy, Patient and Family Engagement, Pregnancy, Women
Abutaleb A, Buchwald A, Chudy-Onwugaje K
Inflammatory bowel disease telemedicine clinical trial: impact of educational text messages on disease-specific knowledge over 1 year.
The authors aimed to determine if delivery of educational messages through a telemedicine system improves inflammatory bowel disease (IBD) knowledge. They found that, although telemedicine improves IBD-specific knowledge through text messaging, telemedicine is not superior to education given through standard visits at referral centers.
AHRQ-funded; HS018975.
Citation: Abutaleb A, Buchwald A, Chudy-Onwugaje K .
Inflammatory bowel disease telemedicine clinical trial: impact of educational text messages on disease-specific knowledge over 1 year.
Inflamm Bowel Dis 2018 Sep 15;24(10):2191-97. doi: 10.1093/ibd/izy149..
Keywords: Telehealth, Health Information Technology (HIT), Digestive Disease and Health, Education: Patient and Caregiver, Health Literacy, Quality of Life
Phillippi JC, Doersam JK, Neal JL
Electronic informed consent to facilitate recruitment of pregnant women into research.
This study examined the use of electronic informed consent to increase the participation of racially and geographically diverse pregnant women in prospective research. They evaluated the feasibility and utility of e-consent in the first year of a multiyear clinical trial involving pregnant women. Out of 86 women screened, 71 were eligible, 65 agreed to review the e-consent form, and 61 completed the process. Even those women who reported low health literacy were able to complete the form and may expedite enrollment of a representative sample.
AHRQ-funded; HS024733.
Citation: Phillippi JC, Doersam JK, Neal JL .
Electronic informed consent to facilitate recruitment of pregnant women into research.
J Obstet Gynecol Neonatal Nurs 2018 Jul;47(4):529-34. doi: 10.1016/j.jogn.2018.04.134.
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Keywords: Women, Pregnancy, Health Literacy
Burgette JM, Preisser JS, Weinberger M
Absence of a moderating effect of parent health literacy on Early Head Start enrollment and dental use.
The purpose of the study was to examine the moderating effect of parents' health literacy (HL) on the effectiveness of North Carolina Early Head Start (EHS) in improving children's dental use. The investigators found that parents in EHS had a higher prevalence of low HL compared to non-EHS parents. Parents' HL did not moderate the relationship between EHS and child dental use, suggesting that EHS results in similar improvements in dental use regardless of parent's HL levels.
AHRQ-funded; HS000032.
Citation: Burgette JM, Preisser JS, Weinberger M .
Absence of a moderating effect of parent health literacy on Early Head Start enrollment and dental use.
J Public Health Dent 2018 Jun;78(3):257-65. doi: 10.1111/jphd.12269..
Keywords: Caregiving, Children/Adolescents, Dental and Oral Health, Health Literacy
Fredericksen RJ, Gibbons L, Brown S
Medication understanding among patients living with multiple chronic conditions: implications for patient-reported measures of adherence.
The purpose of this study was to assess knowledge of names and purposes of prescribed medications among patients with multiple chronic conditions. The investigators found that many patients demonstrated difficulty identifying the name and purpose of prescribed medications; this did not differ by demographic group or medication storage type. They suggest that patients may benefit from routine review of medications with their provider in order to improve health literacy, outcomes, and patient-reported adherence measurement.
AHRQ-funded; HS022242.
Citation: Fredericksen RJ, Gibbons L, Brown S .
Medication understanding among patients living with multiple chronic conditions: implications for patient-reported measures of adherence.
Res Social Adm Pharm 2018 Jun;14(6):540-44. doi: 10.1016/j.sapharm.2017.06.009..
Keywords: Chronic Conditions, Health Literacy, Medication, Patient Adherence/Compliance