Digital healthcare knowledge and tools can enhance the efforts of patients, clinicians, and health systems working to improve healthcare quality and safety. AHRQ’s DHR program funds research to create actionable findings on what and how digital healthcare works best for these critical stakeholders in healthcare.
Now more than ever, the DHR program is focused on supporting crucial research that identifies how the various components of the ever evolving digital healthcare ecosystem can best come together to positively influence healthcare delivery and create value for its key stakeholders: patients, clinicians, and health systems. This ecosystem includes clinical, contextual, and patient-generated health data as well as the tools used to manage and apply these data, such as advanced analytics and data visualizations. The application of these data can result in new knowledge, which can take the form of computable clinical guidelines and decision support. The DHR program continues to fund research on how these ecosystem elements and the actors who create and use them can best support the quality and safety of healthcare.
Research Themes
The DHR program funds research to identify and generate knowledge and tools on how digital healthcare solutions can be designed and implemented to improve patient safety, care, and shared decision making without placing excessive burden on users, including patients, physicians, and other members of care teams.
Research in this summary is broken down by completed research and newly funded (i.e., emerging) research.
- Completed research: 21 grants and contracts recently completed
- Emerging research: 25 grants and contracts recently awarded
Within each stakeholder theme, we share significant findings and impact to the field for completed research and for emerging research, we share its potential significance.
In 2021, the DHR program supported 104 grants and nine research contracts across the three main stakeholder themes:
Engaging and Empowering Patients
Engaging and empowering patients in their own healthcare leads to improvements in safety, quality, and satisfaction of care. Digital healthcare tools can facilitate patient engagement through the use of patient portals, smartphones, and tracking vitals or symptoms with wearable technology or mobile apps. Digital healthcare tools also empower patients to participate more actively in their own health self-management, chronic care management, and wellness at various points of interaction with the healthcare system, including during care transitions when patients may be especially vulnerable.
In 2021, several DHR-funded research projects focused on patients, including studying how digital healthcare tools can: empower patients and their families to improve patient-centered care; support chronic disease management; and improve care transitions.
Research Stories by Subtheme
Below are research stories told in the investigator’s own words organized by subtheme.
The Clinical Decision Support Innovation Collaborative will integrate perspectives from diverse stakeholders, including patients and caregivers, clinicians, researchers, clinical decision support developers, informaticians, payers, and policymakers to produce resources and evidence to make clinical decision support more valuable and meaningful to patients, clinicians, and healthcare systems.
Using health information exchange to identify high-need patients during care transitions can facilitate cross-sector communication, improve care continuity, and reduce rehospitalizations and other acute care.
Virtual visits with members of a pharmacy team can support patients recently discharged from the hospital with their medication use and improve outcomes among chronic obstructive pulmonary disease patients at high risk for readmission.
Many people with depression who do not have upcoming medical appointments go undiagnosed. An online questionnaire can help get them into treatment.
A wearable digital healthcare intervention to promote selfregulation among children with attention deficit hyperactivity disorder and their parents is a promising method to support adherence to treatment.
Other Research by Subtheme
The research stories highlighted in this report are only a subset of the work that AHRQ funds. The following table includes additional research that was either completed or newly awarded in 2021. To search the entire portfolio of research, please visit AHRQ Funded Projects.
The use of BedsideNotes—a new capability within an existing inpatient portal to share physicians’ inpatient notes with families at the bedside—will support parent engagement in the care of their hospitalized children, to improve patient care and prevent harm.
Publicly available, standards-based, interoperable clinical decision support (CDS) for chronic pain management, which is both patient- and clinician-facing, can provide end-to-end support for shared decision-making in real-world settings.
Integration of an electronic pediatric organ transplant quality-of-life tool into routine care has the potential to improve medication adherence and outcomes in this patient population.
A Fast Healthcare Interoperability Resources (FHIR)-enabled digital personal health record mobile app has the potential to enhance care coordination for families of children and youth with special healthcare needs and to inform improvements in family-centered care coordination that will be highly impactful for populations of patients with complex health needs across the age spectrum.
Using real-time patient-reported outcomes of hospitalized patients has the potential to reduce adverse events during care transitions by improving the identification of at-risk patients with multiple chronic conditions.
Engaging cancer patients to communicate medication-related experiences and concerns with their healthcare team via an electronic patient safety event reporting platform has the potential to reduce adverse medication events during hospital-to-home transitions of care.
Development and integration of tools to support pharmacological and behavioral treatment for children with attention deficit hyperactivity disorder may lead to improvement in behavioral outcomes.
Telehealth Education for Asthma Connecting Hospital and Home (TEACHH) is an innovative intervention that integrates active engagement of children and caregivers, patient-centered educational support with medication labeling, and in-home smartphone teleconferencing followup with the potential to reduce overall morbidity for children at the highest risk of poor outcomes and use of costly acute healthcare services.
By adapting WiseApp for Spanish-speaking patients living with HIV, this research has the potential to improve medication adherence, potentially slowing progression of HIV and decreasing premature deaths.
Depression-specific enhancements of patient portals increase patient activation and improve the ability of patients and providers to communicate.
Optimizing Care Delivery for Clinicians
The DHR program funds research to support clinicians and other healthcare professionals in maximizing their ability to provide high-quality and safe healthcare to patients. This includes research to optimize clinical decision making by delivering the right information to the right people at the right times, so that clinicians can make the best care decisions, all the while ensuring that technology is designed and information is available to support cognitive work while reducing provider burden.
In 2021, the DHR program funded research projects that focused on optimizing care delivery for clinicians including research on: making CDS interventions more shareable and interoperable; improving healthcare technology design to advance patient safety; identifying risk with artificial intelligence (AI) and other machine learning digital tools; and optimizing data visualization to improve care.
Research Stories by Subtheme
Below are research stories told in the investigator’s own words organized by subtheme.
Translating hypertension guidelines into a patient-facing clinical decision support tool can engage patients in blood pressure management.
The tailored and scaled implementation and evaluation of AHRQ’s interoperable clinical decision support tools, MyPAIN and PainManager, have the potential to expand upon the shared decision-making processes used in chronic pain management to improve patient care and obtain optimal patient outcomes.
Analysis of patient safety event reports showed an association between electronic health record (EHR) usability and patient safety in both adults and children and led to development of an EHR assessment tool that healthcare facilities can use to identify usability and safety issues.
Giving clinicians the ability to customize the patient electronic health record display reduces cognitive burden, saves time, and supports decision making in busy clinical environments.
Simple and informative graphic displays in emergency department trauma bays can streamline and expedite information sharing across caregiver roles to improve patient care and safety.
Pandemics put extraordinary demands on healthcare capacity and studying hospital resilience can increase our preparedness for future pandemics.
A clinical decision support tool helps patients and physicians use at-home measured blood pressure data to better understand hypertension control and inform shared treatment decisions.
Adaptation of a digital mental health intervention has the potential to improve the coordination of and access to mental health services in ambulatory care settings.
Using predictive modeling and clinical decision support tools to identify people with unmet social needs has the potential to increase referrals to social services.
Other Research by Subtheme
The research stories highlighted in this report are only a subset of the work that AHRQ funds. The following table includes additional research that was either completed or newly awarded in 2021. To search the entire portfolio of research, please visit AHRQ Funded Projects.
A Pharmacogenomics (PGx) clinical decision support alert program has a role in improving outcomes and represents a wholistic approach to care when a PGx Testing program is combined with a CDS alert program.
Use of DDInteract resulted in patients favoring pain treatments with less risk of gastrointestinal bleeding, with this tool having broad applicability to other therapeutic interventions that would benefit from this model of shared decision making.
The issue of communication errors during intensive care unit interprofessional patient rounds can be improved with the use of real-time simultaneous review of patient data by all members of the rounding team.
Integrating prescription drug monitoring programs into existing electronic health record systems may improve provider use and accessibility, reduce high-risk opioid prescribing practices, and improve opioid-related overdose outcomes.
Novel wearable technologies and modes of interaction may improve prehospital care coordination while allowing emergency care professionals to have their hands free of technology and allow them to better focus on the patient, ultimately improving outcomes.
The use of a shared decision making tool resulted in patients with atrial fibrillation having more confidence in choosing to use oral anticoagulants to prevent stroke.
The use of a novel screening tool has the potential to identify patients at highest risk of emergency department return and associated severe disease and decompensation from COVID-19, prompting earlier hospital admission and higher levels of care in the disease course, which may reduce morbidity and mortality.
Clinical decision support tools that incorporate patient and caregiver preferences may promote the uptake of alternative acute care models, such as providing hospital-level care at home, which can reduce healthcare costs and mitigate morbidity and mortality risks associated with in-hospital admission.
The use of an automated method to screen for HIV risk among hospitalized patients with substance misuse has the potential to increase the identification of those at risk to afford them access to testing, prevention, and intervention.
By validating the use of computable social factor phenotypes to generate an assessment of social factors using readily available data, there is the potential to increase their collection, act on them, and reduce healthcare utilization and costs.
Supporting Health Systems in Advancing Care Delivery
DHR-funded research focuses on supporting health systems in advancing care delivery at the health systems or organizational level. Efforts to promote interoperability and leverage data and technologies to strengthen the quality of services delivered can support health systems in advancing care delivery.
In 2021, the DHR program also funded research projects focused on health systems, including research on: leveraging telehealth to improve health systems; integrating patient-generated health data; and advancing the digital health equity agenda.
Research Stories by Subtheme
Below are research stories told in the investigator’s own words organized by subtheme.
Including virtual pharmacists in palliative care teams can reduce adverse drug interactions and increase the quality of life for people who are very ill.
Evaluation of the rapid transition to telehealth due to the COVID-19 pandemic will inform patient care post-COVID-19 to ensure equal access and high-quality care.
A framework and guide to help creators and users of healthcare solutions that involve digital technologies ensure that their solutions are equitable.
Governance, integration, and reporting are key systems-level principles that support incorporation of electronic patient-reported outcomes into clinical practice.
Other Research by Subtheme
The research stories highlighted in this report are only a subset of the work that AHRQ funds. The following table includes additional research that was either completed or newly awarded in 2021. To search the entire portfolio of research, please visit AHRQ Funded Projects.
The ability to assess a patient for stroke while being transported in an ambulance has the potential to improve prehospital risk assessment of stroke during the critical window that reduces adverse consequences from strokes.
Bringing together telehealth and emergency medicine leaders with the goal to develop a national research agenda to support telehealth in emergency medicine supports efforts to improve healthcare access and health outcomes, and reduce disparities for patients seeking emergency care.
Providing a forum to bring together a broad range of stakeholders among academia, government, and industry on the trends and knowledge gaps in HIT+A facilitates collaboration and promotes the opportunity for these stakeholders to understand critical issues in practice, and the most pressing policy agenda items that are in need of rigorous scientific research.
A new patient-generated health data (PGHD) guide supports ambulatory care settings of all types in the design and implementation of successful PGHD programs that can improve patient outcomes.
Optimizing PRO data visualization with clinicians’ and patients’ input will improve clinicians’ ability to effectively synthesize and communicate complex data to provide patient-centered clinical management.
Facilitating data exchange between public health and clinical care information technology systems and across information systems within public health has the potential to improve data-informed decision making and surveillance of vaccinepreventable diseases, including COVID-19.
By directly engaging Medicaid medical directors and clinician thought leaders to identify Medicaid challenges amenable to technology solutions, the likelihood that technology investments will be made in areas of potential benefit to beneficiaries and programs will increase.