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 Evidence
Integrated Delivery System Research Network (IDSRN)
Strengthening Managed Care

Top of Page

Research Findings

Research Activities, July 2009:
More comprehensive American Indian and Alaska Native diabetes education programs are linked to better diabetes care
Fewer than half of patients with diabetes are referred for lifestyle counseling, nutrition, and exercise
Electronic medication administration records improve communication and decisionmaking in nursing homes Several practices of hospital governing boards are linked to improved quality of care
Examining processes, not outcomes, improves patient safety in hospitals
Study underscores the positive impact of patient-centered care delivered by nurses on cancer patient outcomes
Patients who are connected to their doctors tend to receive care that adheres to guidelines

Research Activities, June 2009:
Clinician interviews are the best method to determine whether patients with kidney failure are also depressed
Women with cardiac symptoms are more likely than men to experience delays in emergency care
Weekly telephone calls help patients with limited English proficiency and literacy self-manage diabetes
Nurse-led disease management of heart failure is cost-effective in ethnically diverse urban communities
Minority children from disadvantaged families use more urgent care and less preventive care for their asthma
Health information systems need to address pediatric needs

Research Activities, April 2009:
A novel system lets rural hospitals obtain a remote pharmacist's review of medication orders around-the-clock
The chronic care model improves care delivery and patient outcomes, but practices need better tools to implement it
Hospital outpatient department and office-based provider visits for high cholesterol and other conditions soared in a decade

Research Activities, March 2009:
Strategies are needed to improve immunization rates among adolescents, especially those with high-risk conditions
Available resources, not competition, drive nursing homes to advertise
Impact of direct-to-consumer advertising on drug use varies depending on the drug, scope of advertising, and culture

Research Activities, February 2009:
Social support did not yield better health results in study of patients with diabetes
Telephone coaching following hospitalization for acute coronary syndrome adds little to in-hospital counseling
Most office-based psychiatrists are providing medication rather than psychotherapy to their patients
Mental health counseling remains persistently low from adolescence into young adulthood

Research Activities, January 2009:
Integrated mental and physical health services may help people with depression

Research Activities, December 2008:
Hospital processes are the usual causes for workarounds to medication barcode scanning systems
Changing criteria in a definition of high-risk asthma may help pinpoint those who will need the most care
A nursing home's strategic orientation influences how it reacts to publication of its care quality scores

Research Activities, November 2008:
Organizational style influences clinical departmental differences in dealing with patient safety
Studies examine ways to improve delivery of colorectal cancer screening in primary care practice
Most Federal health centers are not integrated in their community's emergency preparedness plans

Research Activities, October 2008:
Education by mail is as effective as in-class training for Korean-Americans with high blood pressure
Automated E-mail system helps identify adverse drug events
Clinical distractions and care continuity affect antihypertensive treatment for patients with diabetes and hypertension
Medical clinic structure influences use of mental health and substance abuse care by persons with HIV disease

Research Activities, September 2008:
Direct-to-patient mailings increase adherence to beta-blocker therapy after heart attack
Having medical, not dental insurance, leads to dental appointments
Native Americans, nonurban residents, and people living in the South travel further for specialized cancer care
Reducing community contacts by half within 7 days may allow for local control of a flu pandemic

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

Top of Page

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

Top of Page

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

Top of Page

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

Top of Page