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Agency for Healthcare Research Quality

Organization and Delivery

Accelerating Change and Transformation in Organizations and Networks (ACTION): Field Partnerships for Applied Research
Informed Decisions Toolbox: Finding and Using Management Research EvidenceNew
Integrated Delivery System Research Network (IDSRN)
Strengthening Managed Care

Workshop Summaries

Integrated Delivery Systems In Managed Care: Challenges to State Oversight
Workshop Brief, March 1997
Structuring Health Insurance Markets: Protecting Consumers and Promoting Competition
Workshop Brief, May 1998
Understanding the Alphabet Soup of Managed Care Integrated Delivery Systems
Workshop Brief, October 1998

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Research Findings

Agency Press Releases

Date   Title
3/13/08 AHRQ Awards $5 Million To Help Integrate Clinical Decision Support Technologies into Health Care Delivery

Research Activities, August 2008:
Studies elaborate on the potential use of health information technology to improve care delivery
Long-term use of antibiotics appears safe to treat a large-scale exposure to anthrax in a bioterrorism attack
An antimicrobial stewardship program improves appropriate antimicrobial use among hospitalized children
Education campaign reduces antibiotic prescribing by emergency department physicians for upper respiratory tract infections

Research Activities, July 2008:
Doctors are willing to report and learn from medical mistakes, but find error-reporting systems inadequate
Quality of care for patients with coronary heart disease is not strongly influenced by medical practice characteristics
Emergency departments vary in their approach to psychiatric emergencies, underscoring the need for standards

Research Activities, June 2008:
Community-wide interventions prove modestly successful in reducing antibiotic use among Medicaid-insured children
Use of dementia treatments is similar in community and long-term care settings
Telepsychiatrists and in-person therapists deliver similar therapy to veterans suffering from posttraumatic stress disorder
A collaborative approach to diabetes care in community health centers can cost-effectively improve that care
Use of quality improvement strategies by home care agencies may reduce hospitalizations of home patients

Research Activities, May 2008:
AHRQ's 2007 State Snapshots provide broader portraits of State-by-State health care performance
American Indian health advocates can learn to develop multimedia health projects for rural communities
Telepsychiatry can help veterans with combat-related posttraumatic stress disorder
AHRQ awards $5 million to help integrate clinical decision support technologies into health care delivery

Research Activities, April 2008:
Conference on assisted living reveals its evolution, dearth of research, and quality of life for residents
Patients with depression who receive mental health treatment and are involved in therapeutic decisions are more satisfied with their care

Research Activities, March 2008:
Collaboration between hospital and community palliative care services can improve care for dying children
Studies examine emergency communication, use of defibrillators, and benefit of ED pharmacists
More than half a million patients visit the emergency department for severe sepsis each year
Limiting out-of-hospital endotracheal intubation to experienced rescuers would limit the practice
Hospitalists can reduce hospital stays and costs for children with common pediatric conditions like asthma
Crash site data along with pelvic x-rays may aid triage of motor vehicle crash victims with pelvic fractures

Research Activities, February 2008:
Children with special health care needs seem to benefit from Medicaid managed care programs with case managers
Studies examine the impact of nurse staffing on complications, mortality, and length of hospital stay
Staffing levels and turnover are influenced by nursing home expenditure patterns
Hospitals serving the uninsured and underserved need help with public reporting and pay-for-performance measures

Research Activities, January 2008:
Elderly cancer patients who live in minority communities use hospice care less than their counterparts in white communities
For patients with melanoma, longer distance to a provider means later stage of diagnosis
Possible problematic drug interactions are not always reported in medical records

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Research Activities, December 2007:
Many underinsured U.S. children are not getting needed vaccines due to the current vaccine financing system
Family-centered, high quality primary care is linked to fewer nonurgent emergency department visits by children
Many errors by medical residents are caused by teamwork breakdowns and lack of supervision
Hospital CEOs need more research relevant to the challenges they face in the health care system
Pilot study suggests that after-hours telephone medical consultations may pose risks to patient safety
Women leaving the hospital against medical advice after delivering a baby should be targeted for more services
Studies suggest ways to improve the hospital discharge process to reduce postdischarge adverse events and rehospitalizations
Primary care practices face competing demands, not clinical inertia, in providing quality care to patients with diabetes
Patients with HIV who share treatment decisions with their doctor have better outcomes
Studies explore the challenges and complexities faced by paramedics performing out-of-hospital endotracheal intubation

Research Activities, October 2007:
Primary care practice-based research networks are a young diverse group vital to translating research into practice
Studies examine dispensing of sample medications and preventing medication errors in primary care practices
Strategies to improve health literacy for diverse populations should address literacy, language, and cultural barriers
Barriers to timely diagnosis and treatment of prostate cancer in black men arise from lower socioeconomic status
Studies examine medication adherence and group medical visits among persons with high blood pressure
Educational outreach to individual physicians to improve antihypertensive drug prescribing can reduce drug costs

Research Activities, September 2007:
Children with complex chronic conditions are more likely to die in their homes than in the hospital
Hospitals that operate at or over capacity are more likely to have patient safety problems
Nurses and physicians have different perspectives and roles in medical decisions affecting nursing home residents
Physicians seem to manage potential conflicts with managed care financial arrangements to retain patient trust
Physicians have positive attitudes about pay-for-quality programs, but are ambivalent about certain program features

Research Activities, August 2007:
Connecticut midwife practices vary greatly in compensation and employment structures
Few of the safeguards routinely used for intravenous chemotherapy have been adopted for oral chemotherapy at U.S. cancer centers

Research Activities, July 2007:
Mandatory limits on medical resident work hours may constrain hospital house staff and affect patient outcomes and resource use

Research Activities, May 2007:
Case management may improve adherence to antiviral therapy as well as outcomes of HIV-infected homeless persons
Transfer of health care funding from California State to counties maintained commitment to social service spending for the indigent
Studies examine effect of physician practice size and opening of specialty cardiac hospitals on treatment of heart attack patients
Regionalizing stroke care to high-volume hospitals may not improve stroke outcomes or lower costs for some regions

Research Activities, April 2007:
Visits to pediatric practice-based research network offices are representative of national pediatric outpatient visits
Community health centers provide poorer quality of care to the uninsured with chronic disease
Clinic-based and community-based strategies can promote the use of key preventive services by Latina women

Research Activities, January 2007:
Health systems dedicated to improving patient safety are beginning their journey and need a roadmap to prioritize initiatives
Overprescribing of lipid-lowering agents is associated with several physician and practice characteristics

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Research Activities, December 2006:
Journal supplement reviews evidence for the efficacy of telemedicine and telecare

Research Activities, October 2006:
Learning collaboratives are a potentially effective way to improve the quality of care delivered by pediatric practices

Research Activities, September 2006:
Children's hospitals are much more likely than general hospitals to diagnose child abuse in severely injured infants
Nurse-led care improves functioning for patients with heart failure in minority communities
Hospitals could be better linked with other community response teams to manage public health emergencies

Research Activities, July 2006:
High-quality/low-cost hospital performance is linked to organizational characteristics and market forces
Studies examine Federal support and ways to measure available resources for emergency medical services in rural areas
Physicians who are dissatisfied with their profession are two to three times more likely to leave medicine than satisfied doctors
Collaboration of hospitalists/attending physicians and nurse practitioners can reduce hospital stays and increase profit

Research Activities, June 2006:
Primary care physician and health care system characteristics influence the likelihood of referral to specialists
Communication between primary care patients and their doctors does not necessarily result in shared decisionmaking

Research Activities, May 2006
Nurse-anchored practice-based research centers help address health disparities

Research Activities, April 2006
Patient responses to medical errors depend on the timeliness and quality of the physician's communication about the event
Geographic access to most types of doctors has improved, but some smaller specialties have not spread to the most rural areas
Increasing specialization of generalist surgeons confounds workforce projections

Research Activities, March 2006
Computerized medication alert systems may need to be more specific for home health care patients

Research Activities, February 2006:
Changes in the delivery of care are needed to reduce the burden of diabetes among ethnic minorities
Regional strategies to prepare for public health disasters in Texas offer lessons about community resource allocation

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Research Activities, September 2005:
Guidance is available to help communities reopen former hospitals to care for survivors of Hurricane Katrina
Acculturation plays a pivotal role in the health status and behaviors of Latinos in the United States
Studies highlight the importance of providing interpreter and translating services for minorities
Studies reveal variations in preventive care and parental guidance among pediatric and family medicine practices
Survey reveals shortage of radiologists and certified mammography technologists at U.S. community mammography facilities

Research Activities, July 2005:
Stem cell transplant centers that have greater physician involvement in patient care have better patient outcomes
National advisory committee on children and terrorism makes first recommendations for preparedness

Research Activities, June 2005:
Physician supply increases in States with caps on malpractice lawsuit awards, with the greatest impact in rural areas
Despite predictions of the end of managed care, enrollment in HMO plans has stayed relatively constant in recent years

Research Activities, May 2005:
Researchers examine effects of quality improvement on depression care for adolescents and adults

Research Activities, April 2005:
Postoperative functioning, age, obesity, and social support influence where patients go after total hip replacement
Being organized as a group/staff HMO generally has a stronger impact on care access and quality than capitation
Costs of rehabilitative care can be reduced to reimbursement levels with little effect on patient function

Research Activities, February 2005:
Adding a breakfast portion to home-delivered meals can improve the lives of frail, homebound older adults
Studies offer guidance to help physical therapists identify and refer patients at risk of deep vein thrombosis
Organizational research can help clinicians make decisions about staff and IT systems

Research Activities, January 2005:
Substantial barriers prevent cancer patients from obtaining optimal care at the end of life
Nursing homes that employ physician extenders and provide training for nurses' aides have fewer hospitalizations

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Research Activities, December 2004:
Researchers compare receipt of health care from public and private providers serving one North Carolina Indian tribe

Research Activities, November 2004:
Structured health programs can greatly help frail older adults and their family caregivers
Volume and intensity of physicians' services used by FFS Medicare enrollees jumped over 30 percent in the mid-1990s

Research Activities, October 2004:
Very little of the variation in quality of diabetes care is explained by practice factors

Research Activities, September 2004:
Expanded Medicaid eligibility reduced the risk of inadequate prenatal care in California during the 1990s
Individuals are unlikely to recommend an insurance plan if they do not like the provider choices or preventive services covered

Research Activities, August 2004:
Teaching anesthesia during surgery may be a distraction that reduces the vigilance of anesthesia care
Trade-offs and individual preferences should be emphasized when advising patients about dialysis choices
Patients of general internists and hospitalists tend to have shorter hospital stays
Researchers examine disparities in receipt of preventive care

Research Activities, May 2004:
Deaf and hearing-impaired patients suggest ways doctors can improve communication to improve care quality and safety

Research Activities, April 2004:
Physicians should give patients with kidney failure more information about the option of peritoneal dialysis
Hospitals with low mortality rates for coronary bypass surgery also perform well in valve replacement

Research Activities, March 2004:
Researchers find SCHIP and Medicaid networks compete for physicians in some markets
Study shows the culture of medical group practice changes as practices become larger and more complex

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AHRQ Advancing Excellence in Health Care