AHRQ-funded research aims to improve the delivery of health services at the health systems or organizational level. Efforts to share health information across different technologies and healthcare environments, and leveraging data and technologies to strengthen the quality of services delivered were key aspects of research projects focused on health systems.
Interoperability allows information to flow from one information system to another with the goal of improving health outcomes, quality of care, safety, cost-effectiveness, and access to health services. AHRQ funded the following research to develop interoperable systems in support of population health.
Dr. Brian Dixon leveraged a health information exchange (HIE) to improve public health reporting in primary care settings. A decision support intervention delivered pre-populated case reporting forms through the HIE when laboratory results for reportable diseases were positive. As a result, reporting rates and completeness of the forms significantly improved, and feedback from providers and public health professionals was positive.
Dr. Jason Shapiro used real-time data from an HIE to validate quality measures of potentially avoidable visits to the ED. Compared to data from EHRs, data from the HIE increased the identification of early return visits and frequent ED users, thereby improving the accuracy of the quality measures. Future application of this work has the potential to reduce data fragmentation by increasing providers’ access to information across the health system.
With funding from AHRQ, the MITRE Corporation launched CDS Connect to facilitate translation of evidence-based care into clinical practice with interoperable CDS. CDS Connect includes an online repository of CDS artifacts—various types of evidence-based medical knowledge, such as clinical guidelines that may be used to create prototypes for sharing CDS across health settings and technologies. This work provides the framework for improving healthcare outcomes via CDS creation, discovery, integration, and implementation using evidence-based interoperable CDS artifacts. The repository of CDS artifacts is available here on the AHRQ website.
Dr. Kathleen Cartmell tested an interactive voice recognition (IVR) tobacco dependence treatment service for inpatients that linked an EHR, tobacco cessation program, and statewide healthcare utilization data. At 30 days after discharge, smokers using the IVR service were significantly less likely to be readmitted compared to those who did not use the service. Their healthcare charges were also, on average, $7,299 lower.
Quality Improvement, often implemented iteratively, is the process of attaining a higher level of performance or quality compared to previous levels. In the healthcare environment, quality improvement efforts may focus on strengthening health services delivery to serve the ultimate goal of improving patients’ health and experiences with the health system. The following two AHRQ-funded research projects, both conducted in pediatrics, used data in the EHR with the shared goal of improving quality.
Dr. Elizabeth Alpern developed an emergency care data registry for pediatric patients using EHRs. The registry contains data from more than two million ED visits representing more than 900,000 patients. Data from the registry have been used for quality improvement audits and feedback, as well as health services research.
Dr. Naomi Bardach created and pilot tested FIQS, the Family Input to Quality and Safety tool, which allows pediatric patients and their caregivers to provide safety reports regarding their inpatient care. Participants had a positive experience using the tool. Additionally, they endorsed its continued use, thereby demonstrating the feasibility of collecting real-time safety reports from patient and family members so that health systems can readily take action based on these data.