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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 299 Research Studies DisplayedJones AE, King JB, Kim K
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.
The objective of this study was to describe direct oral anticoagulant (DOAC) management in patients who were and were not managed by an anticoagulation management service (AMS). Subjects were patients with atrial fibrillation at the University of Utah Health (UUH) who received DOAC therapy. Results showed that patients managed by AMS providers were more complex and had more frequent encounters regarding their DOAC therapy than those managed by non-AMS providers. However, there was evidence of duplicative DOAC therapy management efforts. No difference between AMS and non-AMS groups in the composite clinical endpoint was detected.
AHRQ-funded; HS026156.
Citation: Jones AE, King JB, Kim K .
The role of clinical pharmacy anticoagulation services in direct oral anticoagulant monitoring.
J Thromb Thrombolysis 2020 Oct;50(3):739-45. doi: 10.1007/s11239-020-02064-0..
Keywords: Blood Thinners, Medication, Provider: Pharmacist, Provider, Care Management, Healthcare Delivery
Temkin-Greener H, Cen X, Li Y
Nursing home staff turnover and perceived patient safety culture: results from a national survey.
In this study, the investigators examined the association between turnover of registered nurses (RNs) and certified nurse assistants (CNAs) and perceived patient safety culture (PSC) in nursing homes (NHs). The investigators suggest that the effect of turnover on PSC depends on who leaves and to a lesser extent on the organizational characteristics. In NHs, improvements in PSC may depend on the ability to retain a well-trained and skilled nursing staff.
AHRQ-funded; HS024923.
Citation: Temkin-Greener H, Cen X, Li Y .
Nursing home staff turnover and perceived patient safety culture: results from a national survey.
Gerontologist 2020 Sep 15;60(7):1303-11. doi: 10.1093/geront/gnaa015..
Keywords: Nursing Homes, Long-Term Care, Surveys on Patient Safety Culture, Patient Safety, Provider: Nurse, Provider
Vitous CA, Jafri SM, Seven C
Exploration of surgeon motivations in management of abdominal wall hernias: a qualitative study.
Although evidence-based guidelines designed to minimize health care variation and promote effective care are widely accepted, creating guidelines alone does not often lead to the desired practice change. Such knowledge-to-practice gaps are well-recognized in the management of patients with abdominal wall hernia. The purpose of this study was to evaluate the systematic application of the Theoretical Domains Framework (TDF) to explore motivations and behaviors associated with surgical decision-making in abdominal wall hernia practice to help inform the future design of theory-based interventions for desired practice and behavior change.
AHRQ-funded; HS025778.
Citation: Vitous CA, Jafri SM, Seven C .
Exploration of surgeon motivations in management of abdominal wall hernias: a qualitative study.
JAMA Netw Open 2020 Sep;3(9):e2015916. doi: 10.1001/jamanetworkopen.2020.15916..
Keywords: Surgery, Digestive Disease and Health, Provider: Physician, Provider
Lozada MJ, Raji MA, Goodwin JS
Opioid prescribing by primary care providers: a cross-sectional analysis of nurse practitioner, physician assistant, and physician prescribing patterns.
The purpose of this study was to identify prescription opioid over-prescribers by comparing prescribing patterns of primary care physicians (MDs), nurse practitioners (NPs), and physician assistants (PAs). Participants were a national sample of 2015 Medicare Part D enrollees. Findings showed that most NPs/PAs prescribed opioids in a pattern similar to MDs, but NPs/PAs had more outliers who prescribed high-frequency, high-dose opioids than did MDs. Recommendations included efforts to reduce opioid overprescribing including targeted provider education, risk stratification, and state legislation.
AHRQ-funded; HS020642.
Citation: Lozada MJ, Raji MA, Goodwin JS .
Opioid prescribing by primary care providers: a cross-sectional analysis of nurse practitioner, physician assistant, and physician prescribing patterns.
J Gen Intern Med 2020 Sep;35(9):2584-92. doi: 10.1007/s11606-020-05823-0..
Keywords: Opioids, Medication, Primary Care, Practice Patterns, Medication: Safety, Provider: Nurse, Provider: Physician, Provider: Physician Assistant, Provider
Blackley SV, Schubert VD, Goss FR
Physician use of speech recognition versus typing in clinical documentation: a controlled observational study.
Researchers studied the usability and quality of documentation with speech recognition (SR) versus typing; participants were ten physicians at Brigham and Women's Hospital, Boston, who had used SR for at least six months. The researchers found that participants felt that SR saved them time, increased their efficiency, and allowed them to quickly document more relevant details. Quality analysis supported the perception that SR allowed for more detailed notes, but whether dictation was objectively faster than typing remains unclear, and participants described some scenarios where typing was still preferred. They concluded that dictation can be effective for creating comprehensive documentation, especially when physicians like and feel comfortable using SR.
AHRQ-funded; HS024264.
Citation: Blackley SV, Schubert VD, Goss FR .
Physician use of speech recognition versus typing in clinical documentation: a controlled observational study.
Int J Med Inform 2020 Sep;141:104178. doi: 10.1016/j.ijmedinf.2020.104178.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider
Cotter JM, Tyler A, Reese J
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
This study looked at pediatric emergency department (ED) inpatient use of dexamethasone versus prednisone by providers for asthma treatment. A survey was distributed to providers who care for inpatient asthmatics. Ninety-two providers completed the survey. When patients received dexamethasone in the ED, 44% continued dexamethasone, 14% switched to prednisone, 2% stopped steroid use, and 40% said it depended on the circumstances. Hospitalists were significantly more likely to continue dexamethasone than pulmonologists (61% versus 15%). Switching to prednisone included factors such as severity of exacerbation (73%) and asthma history (47%). Just over half of providers (5f1%) felt uncomfortable using dexamethasone because of “minimal data to support [its] use inpatient.”
AHRQ-funded; HS026512.
Citation: Cotter JM, Tyler A, Reese J .
Steroid variability in pediatric inpatient asthmatics: survey on provider preferences of dexamethasone versus prednisone.
J Asthma 2020 Sep;57(9):942-48. doi: 10.1080/02770903.2019.1622713..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Medication, Inpatient Care, Care Management, Hospitalization, Emergency Department, Practice Patterns, Provider: Physician, Provider
Du S, Wiegmann D, Beasley J
Defining team membership in primary care: qualitative analysis.
This study explored the question: "How do healthcare professionals in primary care clinics define who is on their team?" Participants had very different perspectives on how their teams were defined, and multiple themes emerged. This study can inform healthcare professionals and administrators, as well as health IT designers, consultants, architects, and researchers interested in primary care teams and how they function in a clinic environment.
AHRQ-funded; HS022505.
Citation: Du S, Wiegmann D, Beasley J .
Defining team membership in primary care: qualitative analysis.
IISE Trans Healthc Syst Eng 2020;10(4):251-60. doi: 10.1080/24725579.2020.1800869..
Keywords: Primary Care: Models of Care, Primary Care, Teams, Provider
Thomas GW, Long S, Tatum M
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
In this paper, a vision is presented to elevate community orthopedic practice and improve patient safety by advancing the use of simulators for training and assessing surgical skills. Key elements of this vision included 1) methods for the objective and rigorous assessment of the performance of practicing surgeons now exist, 2) simulators are sufficiently mature and sophisticated that practicing surgeons will use them, and 3) practicing surgeons can improve their performance with appropriate feedback and coaching.
AHRQ-funded; HS022077; HS025353.
Citation: Thomas GW, Long S, Tatum M .
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
Iowa Orthop J 2020;40(1):25-34..
Keywords: Orthopedics, Surgery, Simulation, Training, Provider: Physician, Provider
Rhee TG, Olfson M, Nierenberg AA
20-year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings.
Pharmacological options for treating bipolar disorder have increased over the past 20 years, with several second-generation antipsychotics receiving regulatory approval in the 1990s. In this study the authors describe trends in use of pharmacological agents in the outpatient management of bipolar disorder. The authors concluded that substantial changes occurred in the treatment of bipolar disorder over the past 20 years, with second-generation antipsychotics in large measure supplanting traditional mood stabilizers.
AHRQ-funded; HS023000.
Citation: Rhee TG, Olfson M, Nierenberg AA .
20-year trends in the pharmacologic treatment of bipolar disorder by psychiatrists in outpatient care settings.
Am J Psychiatry 2020 Aug;177(8):706-15. doi: 10.1176/appi.ajp.2020.19091000..
Keywords: Behavioral Health, Medication, Practice Patterns, Ambulatory Care and Surgery, Provider: Physician, Provider
Furukawa MF, Kimmey L, Jones DJ
AHRQ Author: Furukawa MF, Guo J
Consolidation of providers into health systems increased substantially, 2016-18.
This article reports that provider consolidation into vertically-integrated health systems increased from 2016 to 2018. More than half of US physicians and 72 percent of hospitals were affiliated with one of 637 health systems in 2018. For-profit and church-operated systems had the largest increases in system size, driven in part by a large number of system mergers and acquisitions.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Furukawa MF, Kimmey L, Jones DJ .
Consolidation of providers into health systems increased substantially, 2016-18.
Health Aff 2020 Aug;39(8):1321-25. doi: 10.1377/hlthaff.2020.00017..
Keywords: Health Systems, Provider
Womack DM, Hribar MR, Steege LM
Registered nurse strain detection using ambient data: an exploratory study of underutilized operational data streams in the hospital workplace.
Registered nurses (RNs) regularly adapt their work to ever-changing situations but routine adaptation transforms into RN strain when service demand exceeds staff capacity and patients are at risk of missed or delayed care. The purpose of this study was to assess the utility of ambient workplace data, defined as time-stamped transaction records and log file data produced by non-electronic health record care delivery tools (e.g., nurse call systems, communication devices), as an information channel for automated sensing of RN strain.
AHRQ-funded; HS026370.
Citation: Womack DM, Hribar MR, Steege LM .
Registered nurse strain detection using ambient data: an exploratory study of underutilized operational data streams in the hospital workplace.
Appl Clin Inform 2020 Aug;11(4):598-605. doi: 10.1055/s-0040-1715829..
Keywords: Provider: Nurse, Provider, Health Information Technology (HIT), Workforce, Burnout
Zetts RM, Stoesz A, Garcia AM
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.
Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts.
AHRQ-funded; HS026506; HS024930; 233201500020I.
Citation: Zetts RM, Stoesz A, Garcia AM .
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.
BMJ Open 2020 Jul 14;10(7):e034983. doi: 10.1136/bmjopen-2019-034983..
Keywords: Primary Care, Antimicrobial Stewardship, Antibiotics, Medication, Provider: Physician, Provider
Lafferty M, Fauer A, Wright N
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
The purpose of this study was to examine the causes and consequences of chemotherapy treatment delays and possible solutions to improve quality of care. The authors identified four primary themes from the analysis that affect delays. They suggest future investigations to examine nurses' communication practices in the context of timely chemotherapy administration since communication and documentation technologies within healthcare settings continuously evolve.
AHRQ-funded; HS024914.
Citation: Lafferty M, Fauer A, Wright N .
Causes and consequences of chemotherapy delays in ambulatory oncology practices: a multisite qualitative study.
Oncol Nurs Forum 2020 Jul 1;47(4):417-27. doi: 10.1188/20.Onf.417-427..
Keywords: Treatments, Cancer, Ambulatory Care and Surgery, Quality of Care, Clinician-Patient Communication, Communication, Provider: Nurse, Provider, Nursing, Chronic Conditions
Rhee TG, Wilkinson ST
Exploring the psychiatrist-industry financial relationship: insight from the open payment data of Centers for Medicare and Medicaid Services.
The Physician Payments Sunshine Act (PPSA) requires reporting of financial payments by pharmaceutical and medical device companies to teaching hospitals and individual physicians in the United States. In this study, industry payments made to psychiatrists were quantified. The investigators found that over half of active psychiatrists (55.7%) received some form of payments from pharmaceutical manufacturers.
AHRQ-funded; HS023000.
Citation: Rhee TG, Wilkinson ST .
Exploring the psychiatrist-industry financial relationship: insight from the open payment data of Centers for Medicare and Medicaid Services.
Adm Policy Ment Health 2020 Jul;47(4):526-30. doi: 10.1007/s10488-020-01009-2.
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Keywords: Provider: Physician, Provider, Behavioral Health, Payment, Policy
Poghosyan L, Ghaffari A, Liu J
Organizational support for nurse practitioners in primary care and workforce outcomes.
Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. In this study, the researchers investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. The investigators concluded that nurse practitioners from primary care practices with higher levels of organizational support were more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Organizational support for nurse practitioners in primary care and workforce outcomes.
Nurs Res 2020 Jul/Aug;69(4):280-88. doi: 10.1097/nnr.0000000000000425..
Keywords: Provider: Clinician, Provider, Primary Care, Burnout, Stress, Workforce, Organizational Change
McClellan C, Flottemesch TJ, Ali MM
AHRQ Author: McClellan C
Physician networks and potentially inappropriate opioid prescriptions.
The authors examined associations between care networks defined by shared patients and problematic opioid prescribing using four behaviors defined by the CDC guidelines. They found that greater provider integration was associated with a lower risk of a provider's patients repeatedly having potentially inappropriate prescription fills; however, the association with a provider having any potentially problematic prescription was more ambiguous.
AHRQ-authored.
Citation: McClellan C, Flottemesch TJ, Ali MM .
Physician networks and potentially inappropriate opioid prescriptions.
J Addict Dis 2020 Jul-Sep;38(3):301-10. doi: 10.1080/10550887.2020.1760655..
Keywords: Opioids, Medication, Medication: Safety, Substance Abuse, Patient Safety, Provider
Lee YSH, King MD, Anderson D
The how matters: how primary care provider communication with team relates to patients' disease management.
This study examined how primary care provider (PCP)-team communication relates to patients’ disease management. A longitudinal study was conducted of how 3 aspects of PCP-care team communication including participation, time spent listening, an uninterrupted speaking length relate to disease management of patients with hypertension or diabetes. The study recruited 27 PCPs and 98 team members serving 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites. Data was collected using sociometric sensors worn by PCPs and team members, surveys on patient-PCP communication, and electronic records which extracted PCP and patient characteristics. Results showed that PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. Greater PCP participation, listening, and length of uninterrupted time speaking were associated with significantly higher odds that their patients had controlled hypertension and diabetes.
AHRQ-funded; HS016978.
Citation: Lee YSH, King MD, Anderson D .
The how matters: how primary care provider communication with team relates to patients' disease management.
Med Care 2020 Jul;58(7):643-50. doi: 10.1097/mlr.0000000000001342..
Keywords: Primary Care, Communication, Teams, Provider, Quality of Care
Pruitt LCC, Skarda DE, Barnhart DC
Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.
The effect of the consolidation of neonatal pediatric surgical cases to limited surgeons within a hospital is unknown. In this retrospective cohort study, the authors elected to model the distribution of complex neonatal procedures using an economic measure of market concentration, the Herfindahl-Hirschmann Index (HHI), and study its effect on outcomes of index pediatric surgical operations.
AHRQ-funded; HS025776.
Citation: Pruitt LCC, Skarda DE, Barnhart DC .
Impact of consolidation of cases on post-operative outcomes for index pediatric surgery cases.
J Pediatr Surg 2020 Jun;55(6):1048-52. doi: 10.1016/j.jpedsurg.2020.02.044..
Keywords: Newborns/Infants, Surgery, Hospitals, Provider: Physician, Provider
Tubbs-Cooley HL, Riddle SW, Gold JM
Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period.
The purpose of this study was to describe paediatric postdischarge concerns manifesting in the first 96 hr after hospital discharge. The investigators analysed home visit records of 651 children (age <18) hospitalized at a large Midwestern children's hospital in 2015 and 2016 who were enrolled in the trial. Registered nurses documented concerns in structured fields and free-text notes in visit records. Descriptive statistics were used to summarize visit documentation. Free-text visit notes were reviewed and exemplars illustrative of quantitative findings were selected.
AHRQ-funded; HS024735.
Citation: Tubbs-Cooley HL, Riddle SW, Gold JM .
Paediatric clinical and social concerns identified by home visit nurses in the immediate postdischarge period.
J Adv Nurs 2020 Jun;76(6):1394-403. doi: 10.1111/jan.14341..
Keywords: Children/Adolescents, Home Healthcare, Hospital Discharge, Provider: Nurse, Provider
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
Yuan CT, Nembhard IM, Kane GC
The influence of peer beliefs on nurses' use of new health information technology: a social network analysis.
Implementation of health information technology fails at an alarming rate because intended users often choose not to use it. In this study, the investigators examined the relationship between an individual's system use and the beliefs of his or her peers. The investigators concluded that their findings indicated a significant role of social networks in implementation, and specifically that shared beliefs between an individual and his or her peer network may be critical to implementation success, more so than the beliefs across the entire peer group.
AHRQ-funded; HS022201.
Citation: Yuan CT, Nembhard IM, Kane GC .
The influence of peer beliefs on nurses' use of new health information technology: a social network analysis.
Soc Sci Med 2020 Jun;255:113002. doi: 10.1016/j.socscimed.2020.113002..
Keywords: Health Information Technology (HIT), Provider: Nurse, Provider
Toledo P, Lewis CR, Lange EMS
Women and underrepresented minorities in academic anesthesiology.
The demographics of the United States is changing with 51% of the population being female, and 32% of the population identifying as an underrepresented minority (URM, ie, African American/black, Hispanic/Latino, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). This article provides an overview of the current status of women and URM faculty in academic anesthesiology and provides a framework for academic advancement.
AHRQ-funded; HS025267; HS026169.
Citation: Toledo P, Lewis CR, Lange EMS .
Women and underrepresented minorities in academic anesthesiology.
Anesthesiol Clin 2020 Jun;38(2):449-57. doi: 10.1016/j.anclin.2020.01.004..
Keywords: Provider: Physician, Provider, Workforce, Women, Racial and Ethnic Minorities, Education: Academic
Gernant SA, Adeoye-Olatunde OA, Murawski MM
Experiences applying technology to overcome common challenges in pharmacy practice-based research in the United States.
Despite the importance of pharmacy practice-based research in generating knowledge that results in better outcomes for patients, health systems and society alike, common challenges to PPBR persist. In this paper, the authors described PPBR challenges their research teams have encountered, and their experiences using technology-driven solutions to overcome such challenges. The authors describe the technology driven solutions they have used to address PPBR challenges.
AHRQ-funded; HS025943.
Citation: Gernant SA, Adeoye-Olatunde OA, Murawski MM .
Experiences applying technology to overcome common challenges in pharmacy practice-based research in the United States.
Pharmacy 2020 May 30;8(2):93. doi: 10.3390/pharmacy8020093..
Keywords: Provider: Pharmacist, Provider, Health Information Technology (HIT), Patient-Centered Outcomes Research, Evidence-Based Practice, Health Services Research (HSR)
McHugh M, Brown T, Walunas TL
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
The authors sought to identify patterns of contrasting perspectives on implementation issues between practice leaders and their practice facilitators as well as factors that may contribute to them. Through individual interviews, they found that turnover of staff was frequently reported in dyads with contrasting perspectives. They recommended that planners of quality improvement initiatives using practice facilitation consider taking steps to minimize contrasting perspectives by addressing turnover challenges and encouraging opportunities to share perspectives.
AHRQ-funded; HS023921.
Citation: McHugh M, Brown T, Walunas TL .
Contrasting perspectives of practice leaders and practice facilitators may be common in quality improvement initiatives.
J Healthc Qual 2020 May/Jun;42(3):e32-e38. doi: 10.1097/jhq.0000000000000223..
Keywords: Primary Care, Quality Improvement, Quality of Care, Implementation, Communication, Provider