The impact of AHRQ-funded research goes beyond the studies themselves, as the dissemination of research findings from the DHR program is critical to the transfer of successful digital healthcare knowledge, tools, and strategies that improve healthcare delivery, optimize clinician decision making, and engage patients and caregivers.
Throughout the year, DHR-funded researchers and staff share and showcase their research findings in several ways that include publishing in peer-reviewed journals, presenting at health- and informatics-focused conferences, and during AHRQ webinars. These activities highlight the importance of DHR program funding in advancing digital healthcare.
AHRQ-Funded Researchers Disseminate Findings in High-Impact Journals
In 2021, AHRQ-funded researchers published over 100 research articles in peer-reviewed journals and book chapters, including the following:
In the article, Dr. Evan Ornstein outlines his study seeking to understand if a clinical decision support (CDS) strategy is associated with improved influenza vaccination rates before discharge among eligible hospitalized children. In the quality improvement study, the combination of a default-checked influenza vaccine order in admission order sets for eligible patients with a nursing script using a presumptive strategy to offer the vaccine was associated with significantly higher odds of the hospitalized child receiving the influenza vaccine compared with concurrent and historical controls. This study suggests that a user-centered CDS strategy may improve vaccination rates among vulnerable, hospitalized children.
In the publication, Drs. Kevin Bozic and Joel Tsevat describe how an artificial intelligence (AI)–enabled decision aid generated using PRO measurements compares with education only on decision quality, patient satisfaction, and functional outcomes among individuals with knee osteoarthritis considering total knee replacement. The randomized clinical trial of 129 patients demonstrated statistically significant improvement in decision quality, level of shared decision making, patient satisfaction, and functional outcomes in patients using an AI-enabled decision aid. These findings suggest that AI-enabled decision aids incorporating PRO measurement data provide a personalized, data-driven approach to shared decision making for the surgical management of knee osteoarthritis.
In the article, Dr. Mary Reed examines if rates of treatment or followup office or emergency visits differ in patient-scheduled primary care video or telephone visits compared with in-person visits. In the cohort study of more than 1 million patients, adjusted rates of prescribing and nonmedication orders were significantly lower for telemedicine visits than for clinic visits, with slightly higher rates of followup office visits after telemedicine visits but no significant difference in rates of 7-day emergency visits or hospitalizations. The findings suggest that video or telephone visits may offer a convenient way to address some primary care needs within ongoing patient-physician relationships, without substantially higher rates of followup office visits or health events emergency department visits or hospitalizations.
Reaching the Research Community Through National Webinars
The DHR program convenes national webinars to highlight recent developments and disseminate the impact of innovative DHR. These conferences allow DHR-funded researchers to showcase and explain their work to a broad and interested audience from around the world.
The July 1, 2021 national webinar featured the following research:
- Dr. Jerome Osheroff showcased the work of the ACTS COVID-19 Evidence to Guidance to Action Collaborative. He described the challenges and opportunities to improve the evidence to guidance to action to data to evidence Learning Health System cycle with digital healthcare approaches and tools—especially related to putting rapidly evolving evidence and guidance into practice for novel infectious diseases, using COVID-19 as an example.
- Dr. Alexander Krist described a model for engaging patients in care planning to facilitate decision making, and discussed facilitators and barriers to implementing patient care planning. This work builds on previously AHRQ-funded research on patient portals, with the current focus on how to make them standards based, and thus able to be more broadly shared.
- Dr. Robert Rudin presented on how his team updated a mobile application that collects patient-reported outcomes (PROs) on asthma, developed as part of a previous AHRQ-funded grant, and quickly adapted it to face the needs presented by the pandemic.
The October 19, 2021 national webinar featured the following research:
- Dr. Zach Hettinger showcased research on how he applied cognitive systems engineering to understand and support complex cognition and work activities in the emergency department (ED) to support clinical decision making and reduce cognitive burden of clinicians. Findings from the research were then used to iteratively develop several tools and prototypes to better support clinicians to carry out their work effectively and safely.
- Dr. Anping Xie presented on how he used a sociotechnical systems approach and a user-centered design method to guide development of an electronic health record (EHR)-embedded clinical decision support (CDS) tool that draws upon the strengths of analytical and naturalistic decision making. Findings from the study found the use of the tool reduced unnecessary blood culture utilization for infants in the pediatric intensive care unit.
- Dr. Yalini Senathirajah highlighted her work on developing and testing an application called MedWISER (Medical Widget-based Information Sharing Environment), which uses a distinctive interaction style in which the user can “compose” or assemble desired information together on the same screen. By allowing clinicians to customize the information in the EHR display, the use of MedWISER reduced the cognitive burden on clinicians, saved time, and supported clinical decision making in high-stress situations.
Disseminating Knowledge and Research Findings at Conferences
AHRQ DHR-funded researchers and staff presented research findings at a variety of digital healthcare, health services research, medical, and other conferences. These included the Annual Symposium for the American Medical Informatics Association (AMIA), AcademyHealth’s Annual Research Meeting, the Human Factors and Ergonomics in Health Care Annual Symposium, the American Telemedicine Association Annual Meeting, the Society of Medical Decision Making, and the Health Information Management Systems Society’s Global Conference and Exhibition.
At the 2021 AMIA Annual Symposium alone, AHRQ-funded research was highlighted in seven sessions and demonstrations. Click on the links below in Table 1 to learn more about this research.
AHRQ-Funded Research Results Noted as Most Relevant, Interesting, or Innovative of the Year
A special event held during the virtual 2021 AMIA Annual Symposium featured the year’s most noteworthy publications. This popular Biomedical and Health Informatics Year in Review session is informed by AMIA’s 20 Working Groups. These groups identified papers representing the most influential biomedical and health informatics work published over the past year. Three of the papers presented the results of DHR research.
Consumer and Preventative Health Informatics Working Group
Dr. Anne Turner’s paper in the Journal of the American Medical Informatics Association, “Personal health information management among healthy older adults: varying needs and approaches,” received an honorable mention in the Consumer and Preventative Health Informatics group. The paper described the research team’s ecological approach to investigate personal health information management (PHIM) needs and practices of older adults in different residential settings. They found that there are five primary PHIM activities that older adults engage in: seeking, tracking, organizing, sharing health information, and emergency planning. The paper outlines the three major themes influencing older adults’ practice of PHIM: (1) older adults are most concerned with maintaining health and preventing illness, (2) older adults frequently involve others in PHIM activities, and (3) older adults’ approach to PHIM is situational and context-dependent. The key takeaway of the paper is that older adults’ approaches to PHIM are dynamic and sensitive to changes in health, social networks, personal habits, motivations, and goals.
Evaluation, People, and Organizational Issues Working Group
Wanda Pratt’s paper, “Different roles with different goals: designing to support shared situational awareness between patients and clinicians in the hospital,” received an honorable mention in the Evaluation, People, and Organization Issues group. The paper describes their research on studying team-based situational awareness from the perspective of patients and their caregivers and how it can help to ensure high-quality care and prevent errors in the complex hospital environment. The key message of the study is that elevating patients and caregivers from passive recipients to equal contributors and members of the healthcare team will improve situational awareness and ensure the best possible outcomes.
Visual Analytics Working Group
The final AHRQ-funded work highlighted during AMIA’s Year in Review session was Dr. Robert Rudin’s paper, “User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care.” The paper outlined how Dr. Rudin conducted a user-centered design process involving English- and Spanish-speaking patients and providers to identify user and electronic health record (EHR) integration requirements for a scalable remote symptom monitoring intervention for asthma patients and their providers.