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Topics
- Ambulatory Care and Surgery (1)
- Blood Pressure (2)
- Cancer (1)
- Cardiovascular Conditions (1)
- Caregiving (3)
- Children/Adolescents (2)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (3)
- Clinician-Patient Communication (3)
- Communication (3)
- Dementia (1)
- Diabetes (1)
- Diagnostic Safety and Quality (3)
- Education: Continuing Medical Education (1)
- Education: Patient and Caregiver (1)
- Elderly (3)
- Electronic Health Records (EHRs) (1)
- Emergency Department (3)
- Evidence-Based Practice (4)
- Guidelines (3)
- Health Information Technology (HIT) (1)
- Imaging (2)
- Kidney Disease and Health (1)
- Medication (2)
- Neurological Disorders (1)
- Newborns/Infants (3)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (3)
- Patient Safety (1)
- Practice Patterns (2)
- Pregnancy (1)
- Primary Care (2)
- Provider (13)
- Provider: Clinician (3)
- Provider: Nurse (2)
- (-) Provider: Physician (22)
- Respiratory Conditions (1)
- (-) Shared Decision Making (22)
- Surgery (7)
- Women (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 22 of 22 Research Studies DisplayedSchuttner L, Lee JR, Hockett Sherlock S
Primary care physician perspectives on the influence of patient values, health priorities, and preferences on clinical decision-making for complex patients with multimorbidity: a qualitative study.
The purpose of this study was to explore primary care physician (PCP) perspectives on the influence of patients' values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and higher psychosocial complexity. Between May and July 2020 the researchers utilized semi-structured telephone interviews with 23 PCPs in patient-centered medical home teams in a nationally integrated health system in the United States. The study found three major themes: (1) The personal values of patients were rarely directly discussed in routine clinical encounters but informed more typically discussed constructs of patient preferences, goals, and priorities; (2) Patient preferences, goals, and priorities were sources of conflicting perspectives about care plans between healthcare teams, patients, and families; (3) Physicians used direct strategies to communicate and negotiate about patient preferences, goals, and priorities when developing care plans. The researchers concluded that during clinical decision-making for complex patients with multimorbidity, primary care physicians perceive patient values, preferences, health priorities and goals as influential.
AHRQ-funded; HS026369.
Citation: Schuttner L, Lee JR, Hockett Sherlock S .
Primary care physician perspectives on the influence of patient values, health priorities, and preferences on clinical decision-making for complex patients with multimorbidity: a qualitative study.
Risk Manag Healthc Policy 2022 Nov 16; 15:2135-46. doi: 10.2147/rmhp.S380021..
Keywords: Primary Care, Provider: Physician, Shared Decision Making, Chronic Conditions
Dorr DA, Richardson JE, Bobo M
Provider perspectives on patient- and provider-facing high blood pressure clinical decision support.
This study tried to partly address the challenge of developing a patient-facing clinician decision support (CDS) for persistent high blood pressure (HBP). The authors sought to understand provider variations and rationales related to HBP guideline recommendations and perceptions regarding patient role and use of digital tools. They implemented a pilot and final survey for hypertension experts and primary care physicians. Five clinical cases were presented that queried clinicians' attitudes related to actions; variations; prioritization; patient input; importance; and barriers for HBP diagnosis, monitoring, and treatment. Fifteen hypertension experts and 14 providers took the pilot and final versions of the survey. The majority (over 80%) of providers felt the recommendations were important yet found them difficult to follow-up to 90% of the time. Provider perceptions of relative amounts of patient input and patient work for effective HBP management ranged from 22 to 100%. Reasons for variation provided included adverse effects of treatment, patient comorbidities, shared decision-making, and health care cost and access issues. Respondents were generally positive toward patient use of electronic CDS applications but worried about access to health care, nuance of recommendations, and patient understanding of the tools.
AHRQ-funded; HS26849.
Citation: Dorr DA, Richardson JE, Bobo M .
Provider perspectives on patient- and provider-facing high blood pressure clinical decision support.
Appl Clin Inform 2022 Oct;13(5):1131-40. doi: 10.1055/a-1926-0199..
Keywords: Blood Pressure, Clinical Decision Support (CDS), Shared Decision Making, Provider: Physician
Miller-Rosales C, Lewis VA, Shortell SM
Adoption of patient engagement strategies by physician practices in the United States.
Researchers analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. They found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. They noted that risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.
AHRQ-funded; HS024075.
Citation: Miller-Rosales C, Lewis VA, Shortell SM .
Adoption of patient engagement strategies by physician practices in the United States.
Med Care 2022 Sep;60(9):691-99. doi: 10.1097/mlr.0000000000001748..
Keywords: Patient and Family Engagement, Provider: Physician, Shared Decision Making
Damberg CL, Tom A, Reid RO
Physician organizations' use of behavioral nudges to influence physician behavior.
The purpose of this mixed-methods study design study was to examine the adoption of behavioral nudges by health system-affiliated physician organizations (POs), determine the types of nudges being used, assess PO leader perceptions of nudge effectiveness, and explore implementation challenges. The researchers collected data from a purposive sample of 30 health system-affiliated POs from 4 states between October 2017 and June 2019. A initial survey asked PO leaders to report their organization's use of 5 categories of nudges to influence primary and specialty physicians' actions. Semi structured phone interviews were then conducted to confirm survey responses, obtain examples of the nudges that POs reported utilizing, explore how nudges were structured, and identify challenges to implementation. The study found that almost all study POs reported utilizing nudges. The types of nudges most typically used were clinical templates, patient action lists, and altered order entry. PO leaders reported that the utilization of nudges was limited, not widespread across the organization, and structured in the form of suggestions and not default actions or hard stops. The researchers concluded that the utilization of nudges continues to be limited in practice.
AHRQ-funded; HS024067.
Citation: Damberg CL, Tom A, Reid RO .
Physician organizations' use of behavioral nudges to influence physician behavior.
Am J Manag Care 2022 Sep;28(9):473-76. doi: 10.37765/ajmc.2022.89223..
Keywords: Provider: Physician, Shared Decision Making
Links AR, Callon W, Wasserman C
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. In this study, the authors characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. The investigators concluded that clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions.
AHRQ-funded; HS022932.
Citation: Links AR, Callon W, Wasserman C .
Treatment recommendations to parents during pediatric tonsillectomy consultations: a mixed methods analysis of surgeon language.
Patient Educ Couns 2021 Jun;104(6):1371-79. doi: 10.1016/j.pec.2020.11.015..
Keywords: Children/Adolescents, Surgery, Caregiving, Shared Decision Making, Clinician-Patient Communication, Communication, Provider: Physician, Provider
Vemulakonda VM, Kempe A A, Hamer MK
Physician perspectives on discussions with parents of infants with suspected ureteropelvic junction obstruction.
The purpose of this study was to understand pediatric urologists' perceived role of patient characteristics on discussions about treatment of infants with suspected UPJ obstruction. The investigators found that physicians recognized a gap in data to guide surgical decisions and utilized personal experience to augment this gap. Physicians also recognized the influence of educational and language barriers on discussions with families and considered risk of loss to follow up when making recommendations, suggesting an implicit consideration of demographics.
AHRQ-funded; HS024597.
Citation: Vemulakonda VM, Kempe A A, Hamer MK .
Physician perspectives on discussions with parents of infants with suspected ureteropelvic junction obstruction.
J Pediatr Surg 2021 Mar;56(3):620-25. doi: 10.1016/j.jpedsurg.2020.04.016..
Keywords: Newborns/Infants, Surgery, Shared Decision Making, Provider: Physician
Rutkowski RA, Salwei M, Barton H
Physician perceptions of disposition decision-making for older adults in the emergency department: a preliminary analysis.
Disposition decision-making in the emergency department (ED) is critical to patient safety and quality of care. Disposition decision-making has particularly important implications for older adults who comprise a significant portion of ED visits annually and are vulnerable to suboptimal outcomes throughout ED care transitions. In this study, the investigators conducted a secondary inductive content analysis of interviews with ED physicians to explore their perceptions of who they involve in disposition decision-making and what information they use to make disposition decisions for older adults.
AHRQ-funded; HS026624.
Citation: Rutkowski RA, Salwei M, Barton H .
Physician perceptions of disposition decision-making for older adults in the emergency department: a preliminary analysis.
Proc Hum Factors Ergon Soc Annu Meet 2020 Dec;64(1):648-52. doi: 10.1177/1071181320641148..
Keywords: Elderly, Shared Decision Making, Emergency Department, Provider: Physician
Ehlers AP, Vitous CA, Sales A
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
Investigators explored factors associated with surgeon choice of approach (minimally invasive vs open) in inguinal hernia repair as a tool to gain an understanding of guideline-discordant care. They found that decision-making for the approach to inguinal hernia repair was largely influenced by surgeon preference and access to resources rather than patient factors. Although a one-size-fits-all approach is not recommended, the operative approach should ideally be informed by patient factors, including hernia characteristics. They recommended addressing surgeon preference and available resources with a clinician-facing decision aid to provide an opportunity to optimize care for patients undergoing inguinal hernia repair.
AHRQ-funded; HS025778.
Citation: Ehlers AP, Vitous CA, Sales A .
Exploration of factors associated with surgeon deviation from practice guidelines for management of inguinal hernias.
JAMA Netw Open 2020 Nov 2;3(11):e2023684. doi: 10.1001/jamanetworkopen.2020.23684..
Keywords: Surgery, Guidelines, Provider: Physician, Provider, Shared Decision Making, Evidence-Based Practice
Lim H, Raffel KE, Harrison JD
Decisions in the dark: an educational intervention to promote reflection and feedback on night float rotations.
An educational intervention was created for medical residents during night float rotations where they admit patients to the hospital. The intervention was designed to provide feedback on their diagnostic and management reasoning using feedback solicitation and chart review. Second- and third-year internal medicine residents on a 1-month night float rotation were recruited. Residents performed chart review of a subset of patients they admitted and completed reflection worksheets detailing patients’ clinical courses. Sixty-eight of 82 eligible residents participated in the intervention. The authors evaluated 248 reflection worksheets using content analysis. Major themes that emerged from chart review included residents’ identification of reasoning gaps and evaluation of resident-provider interactions.
AHRQ-funded; HS026383.
Citation: Lim H, Raffel KE, Harrison JD .
Decisions in the dark: an educational intervention to promote reflection and feedback on night float rotations.
J Gen Intern Med 2020 Nov;35(11):3363-67. doi: 10.1007/s11606-020-05913-z..
Keywords: Provider: Physician, Provider, Education: Continuing Medical Education, Shared Decision Making
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
AHRQ-funded; HS025701.
Citation: Westafer LM, Kunz A, Bugajska P .
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Shared Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Jafri SM, Vitous CA, Dossett LA
Surgeon attitudes and beliefs toward abdominal wall hernia repair in female patients of childbearing age.
This qualitative study examined surgeons’ thoughts on decision-making in repairing an abdominal wall hernia in a woman or girl of childbearing age.
AHRQ-funded; HS026030.
Citation: Jafri SM, Vitous CA, Dossett LA .
Surgeon attitudes and beliefs toward abdominal wall hernia repair in female patients of childbearing age.
JAMA Surg 2020 Jun;155(6):528-30. doi: 10.1001/jamasurg.2020.0099..
Keywords: Provider: Physician, Provider, Surgery, Women, Pregnancy, Shared Decision Making
Ganguli I, Simpkin AL, Colla CH
Why do physicians pursue cascades of care after incidental findings? A national survey.
This study was a survey of physicians on their decision-making about care after incidental findings in a patient. The researchers developed a survey instrument for physicians after looking at prior literature and cognitive interviews as well as items on respondent characteristics. They administered a web-based survey to a stratified random sample of American College of Physicians (ACP) members between January 22 and March 3, 2019. They created two vignette-based questions on two theoretical patients who had incidental findings from a test. They asked them if they would follow clinical guidelines and do no further action, order more tests, refer the patient to a specialist, or make a decision after consulting with a specialist. The response rate was 44.7%. Of these, 57.6% of physicians would follow a specialist’s recommendations over guidelines, and 62.4% would do further testing in the absence of other guidelines. US medical graduates and less cost-conscious physicians were more likely to pursue follow-up and 58.6% of those respondents felt it seemed “clinically important”. Some physicians were also driven by fear of a lawsuit, especially if they had been sued before.
AHRQ-funded; HS023812.
Citation: Ganguli I, Simpkin AL, Colla CH .
Why do physicians pursue cascades of care after incidental findings? A national survey.
J Gen Intern Med 2020 Apr;35(4):1352-54. doi: 10.1007/s11606-019-05213-1..
Keywords: Shared Decision Making, Provider: Physician, Provider
Goyal P, Anderson TS, Bernacki GM
Physician perspectives on deprescribing cardiovascular medications for older adults.
Investigators sought to characterize and compare clinician perspectives regarding deprescribing cardiovascular medications for older adults across three specialties. Within each specialty, 750 physicians were surveyed. The investigators found that, while barriers to deprescribing cardiovascular medications were shared across specialties, reasons for deprescribing, especially in the setting of limited life expectancy, varied. They concluded that implementing deprescribing will require improved processes for both physician-physician and physician-patient communication.
AHRQ-funded; HS022982.
Citation: Goyal P, Anderson TS, Bernacki GM .
Physician perspectives on deprescribing cardiovascular medications for older adults.
J Am Geriatr Soc 2020 Jan;68(1):78-86. doi: 10.1111/jgs.16157..
Keywords: Elderly, Medication, Cardiovascular Conditions, Shared Decision Making, Provider: Physician, Provider
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, Shared Decision Making, Surgery, Kidney Disease and Health, Caregiving, Provider: Physician, Provider, Patient and Family Engagement
Armstrong 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: Shared Decision Making, Dementia, Diagnostic Safety and Quality, Evidence-Based Practice, Guidelines, Imaging, Neurological Disorders, Patient-Centered Outcomes Research, Provider, Provider: Physician
Johnston FM, Beckman M
Navigating difficult conversations.
In this paper, the authors discussed breaking bad news and navigating difficult conversations in surgical oncology practice. They note that mounting evidence supports a patient-centered communication approach and models of shared decisionmaking. Physician training in patient-centered cancer communication also continues to evolve.
AHRQ-funded; HS024736.
Citation: Johnston FM, Beckman M .
Navigating difficult conversations.
J Surg Oncol 2019 Jul;120(1):23-29. doi: 10.1002/jso.25472..
Keywords: Cancer, Clinician-Patient Communication, Communication, Shared Decision Making, Patient-Centered Healthcare, Patient and Family Engagement, Provider: Physician, Surgery
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, Shared Decision Making, Provider: Physician, Provider: Nurse, Provider: Clinician, Provider, Emergency Department, Diagnostic Safety and Quality
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, Shared Decision Making, Education: Patient and Caregiver, Provider, Provider: Physician
Morris RS, Ruck JM, Conca-Cheng AM
Shared decision-making in acute surgical illness: the surgeon's perspective.
The authors sought to learn more about surgeons’ perceptions of shared decision-making in settings in which surgical patients have more comorbidities and are of an older age. In this article, they discussed the 6 majors themes that emerged (responsibility for the decision to operate, perceived futility, surgeon judgment, surgeon introspection, pressure to operate, and costs of the operation).
AHRQ-funded; HS024736.
Citation: Morris RS, Ruck JM, Conca-Cheng AM .
Shared decision-making in acute surgical illness: the surgeon's perspective.
J Am Coll Surg 2018 May;226(5):784-95. doi: 10.1016/j.jamcollsurg.2018.01.008.
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Keywords: Shared Decision Making, Provider: Physician, Surgery
McCreedy EM, Kane RL, Gollust SE
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
Clinicians strive to deliver individualized, patient-centered care. However, these intentions are understudied. This research explored how patient characteristics associated with a high risk-to-benefit ratio with hypoglycemia medications affected decision making by primary care clinicians. The investigators found that primary care clinicians often chose to intensify glycemic control despite individual patient factors that warranted higher glycemic targets based on existing guidelines.
AHRQ-funded; HS000011.
Citation: McCreedy EM, Kane RL, Gollust SE .
Patient-centered guidelines for geriatric diabetes care: potential missed opportunities to avoid harm.
J Am Board Fam Med 2018 Mar-Apr;31(2):192-200. doi: 10.3122/jabfm.2018.02.170141..
Keywords: Diabetes, Elderly, Patient-Centered Healthcare, Guidelines, Evidence-Based Practice, Shared Decision Making, Medication, Primary Care, Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Ancker JS, Edwards A, Nosal S
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
In this study, the investigators tested hypotheses arising from two possible alert fatigue mechanisms: (A) cognitive overload associated with amount of work, complexity of work, and effort distinguishing informative from uninformative alerts, and (B) desensitization from repeated exposure to the same alert over time. The investigators found that clinicians became less likely to accept alerts as they received more of them, particularly more repeated alerts. There was no evidence of an effect of workload per se, or of desensitization over time for a newly deployed alert.
AHRQ-funded; HS021531.
Citation: Ancker JS, Edwards A, Nosal S .
Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system.
BMC Med Inform Decis Mak 2017 Apr 10;17(1):1-9. doi: 10.1186/s12911-017-0430-8..
Keywords: Clinical Decision Support (CDS), Shared Decision Making, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Provider, Provider: Nurse, Provider: Physician
Brody A, Twiner M, Kumar A
Survey of emergency physician approaches to management of asymptomatic hypertension.
The objective of this study was to define emergency physician (EP) approaches to management of asymptomatic uncontrolled hypertension (HTN) and assess adherence to the American College of Emergency Physician clinical policies. It found that wide variability exists in EP approaches to patients with asymptomatic HTN. Treatment decisions were impacted by patient history of chronic HTN, referral from primary care providers, and magnitude of BP elevation.
AHRQ-funded; HS000011.
Citation: Brody A, Twiner M, Kumar A .
Survey of emergency physician approaches to management of asymptomatic hypertension.
J Clin Hypertens 2017 Mar;19(3):265-69. doi: 10.1111/jch.12921.
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Keywords: Blood Pressure, Emergency Department, Provider: Physician, Shared Decision Making