The Digital Healthcare Research Program at AHRQ continues to fund foundational research to identify and generate digital healthcare knowledge and tools that are shareable, standards-based, publicly available, and whole-person oriented. Funded research focuses on how digital healthcare solutions can be designed and implemented to improve quality and safety without placing excessive burden on users, including patients, physicians, and other members of care teams. In 2019, AHRQ funded 28 new research projects to address the priority areas described below. The importance of several recently funded research projects is highlighted below, including the research goals and the anticipated outcomes or future application of the work. Click on a Principal Investigator’s name for more information on the individual’s research.
Improving Care: Extending Evidence-Based Clinical Decision Support Across Systems
CDS helps clinicians, patients, and others in the care team by delivering the right information at the right time so they can make the best care decisions. When well developed and implemented, CDS uses patient-specific data and is guided by evidence-based findings to improve health and yield the best possible outcomes. A snapshot of new AHRQ-funded CDS research includes the following:
Dr. Fahd Ahmad and fellow investigators at Washington University in St. Louis will adapt and implement the Electronic Sexually Transmitted Infection (STI) Risk Assessment (E-STIRA), a tool enabling adolescents to self-report their sexual history using an electronic questionnaire. The tool provides STI testing recommendations to the provider and patient. With STI rates on the rise, the study aims to assess changes in STI testing and treatment in four primary care settings, with the goal of reducing adolescent STI rates.
Although screening for lung cancer using low-dose computed tomography (LDCT) is effective for the early detection of lung cancer among individuals with a history of heavy smoking, less than five percent of those at risk are screened. Dr. Kensaku Kawamoto of the University of Utah will investigate Decision Precision+, a tool for pulling patient risk data from EHRs to determine patient eligibility for lung cancer screening. The tool prompts providers to initiate a risk-benefit discussion based on the patient’s profile. The research aims to enable widespread implementation of Decision Precision+ to increase lung cancer LDCT screenings and prevent lung cancer deaths.
Dr. Daniel Malone and his research team are studying the use of CDS to help providers identify patients at risk for developing the life-threatening cardiac arrhythmia referred to as torsades des pointes (TdP). The team will evaluate the effectiveness of this CDS on outcomes such as shortened hospital stays and reduced sudden cardiac deaths. The implementation will occur across seven State regional hospitals serving disadvantaged populations.
Dr. Mary Politi and her research team at Washington University are investigating the effectiveness of their CDS tool, the Breast Reconstruction Education and Support Tool, called BREASTChoice. This tool will provide breast cancer patients and surgeons with individually tailored risk predictions related to mastectomy and breast reconstruction surgery. The researchers will evaluate the decision quality and treatment choice generated by BREASTChoice in a randomized controlled trial in three hospitals. The aim of the trial is to decrease surgery complication rates and improve patient-centered decision making.
Dr. Ann Vandenberg and her research team from Emory University are scaling and disseminating a proven CDS tool to decrease the number of potentially inappropriate medications (PIMs) prescribed to older adults upon discharge from an ED. The Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) CDS tool, which addresses guidelines for prescribing and monthly audits and feedback for providers, has been shown to decrease PIMs. The widespread implementation of EQUIPPED aims to reduce PIMs and provide appropriate feedback to prescribers.
Dr. Brian Wells and his research team are studying a CDS tool to identify patients at risk of type 2 diabetes in the EHR of the Department of Family Medicine at Wake Forest University Health Systems. During this pilot study, high-risk patients identified via EHRs will be contacted by text message and offered testing. This mobile text message intervention seeks to improve the early detection of those at risk of type 2 diabetes, employing technological preventive methods to improve healthcare quality.
Using Patient-Reported Outcomes to Improve Patient Care
PROs, the status of a patient’s health condition that comes directly from the patient, are imperative to obtaining the highest quality of care in clinical settings. Including PRO measures in healthcare practices helps to guide healthcare providers’ decisions related to prevention, diagnosis, treatment, and long-term care. AHRQ is leading the way by funding advanced research on electronic methods for capturing and visualizing PROs. The following are newly funded research efforts involving PROs:
Dr. Heidi Crane and Dr. William Lober from the University of Washington are leading a research study to improve the use of PROs in tailored clinical care for individuals with HIV who have multiple chronic conditions. HIV providers routinely prioritize and address multiple chronic conditions in the context of a time-constrained clinic visit. Through randomized trials, the research team will investigate innovative strategies to improve the collection and use of person-specific PRO measures. The aim is to minimize the negative impact of collecting and using PROs on clinical workflow and improve determination of clinical priorities.
The dissemination of actionable PRO data is essential to improving clinical outcomes, especially for complicated cases. Drs. Heather Gold and Enrico Bertini at the New York University School of Medicine and their research team are working to develop and test PRO visual presentations in EHRs. The goal is for clinicians to illustrate and communicate complex clinical data to patients through visual explanations. Housed at NYU Langone Medical Center, the study will evaluate the usefulness and acceptability of such visualizations for improving patient outcomes by increasing clinicians’ ability to communicate patients’ complex data for clinical management.
Dr. Clifford Ko and the research team at the American College of Surgeons are researching the dissemination of an effective health IT PRO implementation for surgical quality improvement. The infrastructure of the National Surgical Quality Improvement Program (NSQIP), a nationally validated outcomes-based program to improve the quality of surgical care, provides access to NSQIP’s expansive registry network, the first surgical clinical registry in the U.S. to measure PROs. The study will explore best practices to promote health IT PRO implementation.
Dr. Ida Sim from the University of California San Francisco is implementing The Mobile Patient-Reported Outcomes for Value and Effectiveness (mPROVE) study to advance outcomes for those with multiple chronic conditions. Researchers will test the ability of mPROVE, a patient-facing mobile app in numerous languages, to collect information through PRO surveys and visual PROs. A provider-facing dashboard for shared decision making will be available in the EHR. The research team will evaluate the implementation of the app, its integration into UCSF’s EHR, and how workflows for shared decision making can be optimized for those with multiple chronic conditions.
Adhering to a prescribed medication schedule is difficult for some individuals for reasons including forgetfulness, affordability, and side-effect avoidance. To improve adherence, Dr. Margie Snyder and her research team are implementing PatientToc, an existing mobile app to collect PROs. PatientToc, available in numerous languages, is accessible to those with low literacy. The app, never implemented in pharmacies, will capture information on medication adherence, enabling pharmacists to use the data to inform patient counseling. The research aims to identify best practices for improving medication adherence and for evaluating the quality of care in community pharmacies.
Using Telehealth and Telemedicine to Improve Health and Healthcare
While telehealth and telemedicine have long been practiced in rural settings and for hard-to-access specialties, their widespread adoption has been limited by reimbursement, broadband connectivity, and other technology challenges. In situations where face-to-face healthcare is impractical or inconvenient, telemedicine and telehealth facilitate the remote delivery of health services, enabling long-distance patient care, education, and monitoring. The following are 2019 examples of AHRQ-funded telehealth and telemedicine research initiatives:
Dr. Janet Bull with Four Seasons Compassion for Life, a community-based palliative care service, piloted the implementation of an app that enables rural patients to connect with their providers remotely. Based on patients’ positive experiences in the pilot, the research team will incorporate a pharmacy services platform. The team will evaluate the feasibility of using the app to provide patients with a virtual pharmacist, and will explore the effects of virtual pharmacy consultations.
Timely diagnosis for stroke patients is critical in reducing adverse outcomes such as physical and mental disabilities. Using ambulance transit time to conduct stroke neurology consultations improves the speed of diagnosis. Emergency Medical Services in Georgetown County, South Carolina, partnered with the Medical University of South Carolina Center for Telehealth to pilot such a service. Prior to expansion of this approach, the researchers identified the need to evaluate the use of such consultations in the stressful, physically constrained environment of an ambulance. Dr. Kapil Chalil Madathil from Clemson University is leading the overall evaluation of the pilot and refinement of the guidelines and recommendations for broader implementation.