National Healthcare Quality and Disparities Report
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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (1)
- Adverse Events (2)
- Caregiving (1)
- Clinical Decision Support (CDS) (2)
- Clinician-Patient Communication (1)
- Communication (1)
- Critical Care (1)
- Diagnostic Safety and Quality (1)
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- Electronic Health Records (EHRs) (4)
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- (-) Health Information Technology (HIT) (10)
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- Intensive Care Unit (ICU) (4)
- Medical Errors (1)
- Medication (1)
- Medication: Safety (1)
- Neonatal Intensive Care Unit (NICU) (2)
- (-) Newborns/Infants (10)
- Nutrition (1)
- Patient and Family Engagement (1)
- Patient Safety (2)
- Respiratory Conditions (3)
- Shared Decision Making (1)
- Workflow (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 10 of 10 Research Studies DisplayedGephart SM, Tolentino DA, Quinn MC
Neonatal intensive care workflow analysis informing NEC-Zero clinical decision support design.
The aim of this qualitative descriptive study was to explore the current clinical workflow and sociotechnical processes of clinicians for necrotizing enterocolitis risk awareness, timely discovery of symptoms, and treatment to guide decision support design. The researchers conducted 11 focus groups in two neonatal ICUs. The study found that workflow processes were different for nurses (who observe the signs of necrotizing enterocolitis and inform providers to order diagnostic tests and treatments) and providers (who receive notification of necrotizing enterocolitis concern and then decide what actions to take). The researchers reported that clinicians wanted a necrotizing enterocolitis-relevant dashboard with: 1) nutrition tracking and recognition of necrotizing enterocolitis; 2) features to support decision-making; 3) breast milk tracking and feeding clinical decision support; 4) tools for necrotizing enterocolitis surveillance and quality reporting; and 5) general electronic health records improvements to enhance user experience.
AHRQ-funded; HS022908.
Citation: Gephart SM, Tolentino DA, Quinn MC .
Neonatal intensive care workflow analysis informing NEC-Zero clinical decision support design.
Comput Inform Nurs 2023 Feb; 41(2):94-101. doi: 10.1097/cin.0000000000000929..
Keywords: Newborns/Infants, Clinical Decision Support (CDS), Intensive Care Unit (ICU), Workflow, Health Information Technology (HIT)
Shafer GJ, Singh H, Thomas EJ
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
The objective of this study was to determine the frequency and etiology of diagnostic errors during the first 7 days of admission for inborn neonatal intensive care unit (NICU) patients. The "Safer Dx NICU Instrument" was used to review electronic health records. The reviewers discovered that the frequency of diagnostic error in inborn NICU patients during the first 7 days of admission was 6.2%.
AHRQ-funded; HS027363.
Citation: Shafer GJ, Singh H, Thomas EJ .
Frequency of diagnostic errors in the neonatal intensive care unit: a retrospective cohort study.
J Perinatol 2022 Oct;42(10):1312-18. doi: 10.1038/s41372-022-01359-9..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Diagnostic Safety and Quality, Medical Errors, Adverse Events, Patient Safety, Electronic Health Records (EHRs), Health Information Technology (HIT)
Kern-Goldberger AS, Rasooly IR, Luo B
EHR-integrated monitor data to measure pulse oximetry use in bronchiolitis.
This study’s objective was to determine if electronic health record (EHR) data can accurately estimate the extent of actual oxygen saturation monitoring use in bronchiolitis. The study included infants aged 8 weeks through 23 months who were hospitalized with bronchiolitis. Findings showed that EHR-integrated monitor data were a valid measure of actual oxygen saturation monitoring use that may help hospitals more efficiently identify opportunities to de-implement guideline-inconsistent use.
AHRQ-funded; HS026620.
Citation: Kern-Goldberger AS, Rasooly IR, Luo B .
EHR-integrated monitor data to measure pulse oximetry use in bronchiolitis.
Hosp Pediatr 2021 Oct;11(10):1073-82. doi: 10.1542/hpeds.2021-005894..
Keywords: Newborns/Infants, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Beam KS, Lee M, Hirst K
Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.
This study analyzed the accuracy of International Classification of Diseases (ICD) codes to identify bronchopulmonary dysplasia (BPD) in newborns. A retrospective cohort study in a single-center NICU (n=166) was conducted to evaluate sensitivity and specificity of ICD-10 codes for BPD diagnosis. The sensitivity of any BPD-related codes ranged from 0.82 to 0.95, while specificity range was 0.25 to 0.36. The most common date of BPD diagnosis was the day of birth, which is inconsistent with the clinical definition. The authors conclude that the ICD codes for BPD are unlikely to accurately reflect the current clinical definition and should be interpreted with caution.
AHRQ-funded; HS000063.
Citation: Beam KS, Lee M, Hirst K .
Specificity of International Classification of Diseases codes for bronchopulmonary dysplasia: an investigation using electronic health record data and a large insurance database.
J Perinatol 2021 Apr;41(4):764-71. doi: 10.1038/s41372-021-00965-3..
Keywords: Newborns/Infants, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Aronson PL, Politi MC, Schaeffer P
Development of an app to facilitate communication and shared decision-making with parents of febrile infants ≤ 60 days old.
This study’s aim was to develop and test a tool to engage parents of febrile infants 60 days or less of age evaluated in the emergency department (ED). The tool was designed to improve communication between parents and healthcare providers and to support shared decision-making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age. The authors conducted a multi-phase development and testing process including individual, semi-structured interviews with parents and clinicians; design of a “storyboard” of the tool with design impression testing; development of a software application prototype called e-Care; and usability testing of e-Care using qualitative assessment and the System Usability Scale (SUS). The authors interviewed 27 parents and 23 clinicians. After the interviews, they developed separate versions of e-Care for infants aged 28 days or less and 29 to 60 days of age in both English and Spanish. e-Care is divided into 4 sections: 1) homepage; 2) why testing is done; 3) what tests are done; and 4) what happens after testing. The mean SUS score given by parents and clinicians was 90.3 representing “excellent” usability.
AHRQ-funded; HS026006.
Citation: Aronson PL, Politi MC, Schaeffer P .
Development of an app to facilitate communication and shared decision-making with parents of febrile infants ≤ 60 days old.
Acad Emerg Med 2021 Jan;28(1):46-59. doi: 10.1111/acem.14082..
Keywords: Clinician-Patient Communication, Communication, Newborns/Infants, Caregiving, Shared Decision Making, Patient and Family Engagement, Emergency Department, Health Information Technology (HIT)
Brady PW, Schondelmeyer AC, Landrigan CP
Validity of continuous pulse oximetry orders for identification of actual monitoring status in bronchiolitis.
Investigators used direct bedside observation to determine continuous pulse oximetry monitor use in infants with bronchiolitis and then assessed if an active continuous monitoring order was present in the electronic health record. They found that most monitored infants did not have an active monitoring order. The positive predictive value of a monitoring order was 77%, and the negative predictive value was 69%. They recommended that teams intending to measure continuous pulse oximetry use understand the limitations of using electronic health record orders as a stand-alone measure.
AHRQ-funded; HS023827; HS026763.
Citation: Brady PW, Schondelmeyer AC, Landrigan CP .
Validity of continuous pulse oximetry orders for identification of actual monitoring status in bronchiolitis.
J Hosp Med 2020 Nov;15(11):665-68. doi: 10.12788/jhm.3443..
Keywords: Newborns/Infants, Electronic Health Records (EHRs), Health Information Technology (HIT), Hospitals
Rossol SL, Yang JK, Toney-Noland C
Non-contact video-based neonatal respiratory monitoring.
Respiratory rate (RR) has been shown to be a reliable predictor of cardio-pulmonary deterioration, but standard RR monitoring methods in the neonatal intensive care units (NICU) with contact leads have been related to iatrogenic complications. This iterative design study developed a novel algorithm that produced RR from footage analyzed from stable NICU patients in open cribs with corrected gestational ages ranging from 33 to 40 weeks. The final algorithm used a proprietary technique of micromotion and stationarity detection to model background noise to be able to amplify and record respiratory motions.
AHRQ-funded; HS023506.
Citation: Rossol SL, Yang JK, Toney-Noland C .
Non-contact video-based neonatal respiratory monitoring.
Children 2020 Oct 6;7(10). doi: 10.3390/children7100171..
Keywords: Newborns/Infants, Health Information Technology (HIT), Respiratory Conditions, Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU)
Adelman JS, Applebaum JR, Southern WN
Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units of 2 integrated health care systems.
Researchers assessed the risk of wrong-patient orders among multiple-birth infants and singletons receiving care in the NICU and examined the proportion of wrong-patient orders between multiple-birth infants and siblings (intrafamilial errors) and between multiple-birth infants and nonsiblings (extrafamilial errors). They found that multiple-birth status in the NICU is associated with significantly increased risk of wrong-patient orders compared with singleton-birth status. Strategies to reduce this risk include using given names at birth, changing from temporary to given names when available, and encouraging parents to select names for multiple births before they are born when acceptable to families.
AHRQ-funded; HS024538.
Citation: Adelman JS, Applebaum JR, Southern WN .
Risk of wrong-patient orders among multiple vs singleton births in the neonatal intensive care units of 2 integrated health care systems.
JAMA Pediatr 2019 Oct 10;173(10):979-85. doi: 10.1001/jamapediatrics.2019.2733..
Keywords: Newborns/Infants, Intensive Care Unit (ICU), Adverse Drug Events (ADE), Adverse Events, Medication: Safety, Medication, Patient Safety, Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Garfield CF, Lee YS, Kim HN
Supporting parents of premature infants transitioning from the NICU to home: a pilot randomized control trial of a smartphone application.
This study determined whether parents of Very Low Birth Weight (VLBW) infants in the Neonatal Intensive Care Unit (NICU) transitioning home with the NICU-2-Home smartphone application have greater parenting self-efficacy, are better prepared for discharge and have shorter length of stay (LOS) than control parents. It found that a smartphone application can improve parenting self-efficacy, discharge preparedness, and LOS with improved benefits based on usage.
AHRQ-funded; HS020316.
Citation: Garfield CF, Lee YS, Kim HN .
Supporting parents of premature infants transitioning from the NICU to home: a pilot randomized control trial of a smartphone application.
Internet Interv 2016 May;4(Pt 2):131-37. doi: 10.1016/j.invent.2016.05.004.
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Keywords: Newborns/Infants, Neonatal Intensive Care Unit (NICU), Health Information Technology (HIT), Home Healthcare, Hospital Discharge
Bennett WE, Jr., Hendrix KS, Thompson-Fleming RT
Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
The researchers used a novel computerized decision support system to gather data from multiple general pediatrics offices.They found an association between the introduction of cow's milk before 1 year of age and the rate of delayed developmental milestones after 1 year of age, adding strength to the recommendations from the AAP and IOM to delay cow's milk introduction until after 1 year of age.
AHRQ-funded; HS017939; HS018453; HS020640.
Citation: Bennett WE, Jr., Hendrix KS, Thompson-Fleming RT .
Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
Eur J Pediatr 2014 Jul;173(7):887-92. doi: 10.1007/s00431-014-2265-y.
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Keywords: Clinical Decision Support (CDS), Disabilities, Health Information Technology (HIT), Newborns/Infants, Nutrition