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Research Studies is a compilation of published research articles funded by ÂÜÀòÊÓƵor authored by ÂÜÀòÊÓƵresearchers.

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1 to 12 of 12 Research Studies Displayed
Salwei ME, Hoonakker PLT, Pulia M
Retrospective analysis of the human-centered design process used to develop a clinical decision support in the emergency department: PE Dx Study Part 2.
With the growing implementation and use of health IT such as Clinical Decision Support (CDS), there is increasing attention on the potential negative impact of these technologies on patients (e.g., medication errors) and clinicians (e.g., increased workload, decreased job satisfaction, burnout). Human-Centered Design (HCD) and Human Factors (HF) principles are recommended to improve the usability of health IT and reduce its negative impact on patients and clinicians; however, challenges persist. The purpose of this study was to examine how a Human-Centered Design (HCD) process impacts the usability of health IT. The researchers conducted a systematic retrospective analysis of the HCD process utilized in the design of a Clinical Decision Support (CDS) for pulmonary embolism diagnosis in the emergency department (ED). The study identified gaps in the current HCD process, 7 design outcomes of the HCD process, and the need for a continuous health IT design process.
AHRQ-funded; HS026395; HS029042; HS024558; HS022086.
Citation: Salwei ME, Hoonakker PLT, Pulia M . Retrospective analysis of the human-centered design process used to develop a clinical decision support in the emergency department: PE Dx Study Part 2. Hum Factors Health 2023 Dec; 4:100055. doi: 10.1016/j.hfh.2023.100055..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Emergency Department
Watterson TL, Steege LM, Mott DA
Sociotechnical work system approach to occupational fatigue.
The impact of occupational fatigue has been researched in fields outside of health care such as transportation and industry. Studies with health care professionals such as physicians, medical residents, and nurses has highlighted the potential for occupational fatigue to affect patient, employee, and organizational outcomes. The researchers advise that a conceptual framework of occupational fatigue that is informed by a sociotechnical systems approach is needed. The purpose of this paper was to outline the health care professional occupational fatigue conceptual framework by following the Systems Engineering Initiative for Patient Safety (SEIPS) model and adapting the Conceptual Model of Occupational Fatigue in Nursing.
AHRQ-funded; HS027766.
Citation: Watterson TL, Steege LM, Mott DA . Sociotechnical work system approach to occupational fatigue. Jt Comm J Qual Patient Saf 2023 Sep; 49(9):485-93. doi: 10.1016/j.jcjq.2023.05.007..
Keywords: Provider: Health Personnel, Burnout
Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW
Documentation dynamics: note composition, burden, and physician efficiency.
This study’s objective was to analyze how physician clinical note length and composition relate to electronic health record (EHR)-based measures of burden and efficiency that have been tied to burnout. This cross-sectional study examined EHR metadata capturing physician-level measures from 203,728 US-based ambulatory physicians using the Epic Systems EHR between September 2020 and May 2021. The authors calculated physician-level averages for four measures of interest and assigned physicians to overall note length deciles and note composition deciles from six sources, including templated text, manual text, and copy/paste text. They found that physicians in the top decile of note length demonstrated greater burden and lower efficiency than physicians in the median decile level, spending 39% more time in the EHR after hours and closing 5.6 percentage points fewer visits on the same day. Copy/paste use demonstrated a similar dose/response relationship, with top-decile copy/paste users closing 6.8 percentage points fewer visits on the same day and spending more time in the EHR after hours and on days off. Templated text such as Epic’s SmartTools demonstrated a non-linear relationship with burden and efficiency, with very low and very high levels of use associated with increased EHR burden and decreased efficiency.
AHRQ-funded; HS026116.
Citation: Apathy NC, Rotenstein L, Bates DW NC, Rotenstein L, Bates DW . Documentation dynamics: note composition, burden, and physician efficiency. Health Serv Res 2023 Jun; 58(3):674-85. doi: 10.1111/1475-6773.14097..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Watterson TL, Chui MA
Subjective perceptions of occupational fatigue in community pharmacists.
The objective of this study was to describe subjective perceptions of occupational fatigue in community pharmacists. Wisconsin pharmacists who were eligible to participate completed a demographic questionnaire, a Pharmacist Fatigue Instrument, and semi-structured interview. Interview results were separated into overarching themes that included mental fatigue, physical fatigue, active fatigue, and passive fatigue. The researchers concluded that interventions aimed at improving occupational fatigue in community pharmacies should consider key themes of fatigue that pharmacists experience.
AHRQ-funded; HS027766.
Citation: Watterson TL, Chui MA . Subjective perceptions of occupational fatigue in community pharmacists. Pharmacy 2023 May 9; 11(3):84. doi: 10.3390/pharmacy11030084..
Keywords: Provider: Pharmacist, Burnout
Quigley DD, Slaughter ME, Qureshi N
Associations of pediatric nurse burnout with involvement in quality improvement.
The purpose of this study was to explore the relationships of inpatient pediatric nurse burnout with their perceptions on the importance of quality at the hospital, and with patient experience measurement, quality improvement (QI), unit culture, and staffing. The researchers implemented a cross-sectional study at an urban children's hospital and surveyed pediatric nurses about their perceptions including the Maslach Burnout Inventory. The study found that 27% of pediatric nurses reported burnout. Nurses who possessed greater confidence in patient experience measurement, received frequent patient experience performance reports, felt included in QI, and experienced QI efforts as integrated into patient care reported not being burned out when compared to those reporting burnout. Higher levels of open communication among nurses and unit-level teamwork were also related with lack of burnout, and a higher QI workload was related with burnout.
AHRQ-funded; HS025920.
Citation: Quigley DD, Slaughter ME, Qureshi N . Associations of pediatric nurse burnout with involvement in quality improvement. J Pediatr Nurs 2023 May-Jun; 70:e9-e16. doi: 10.1016/j.pedn.2022.11.001..
Keywords: Children/Adolescents, Burnout, Provider: Nurse, Quality Improvement, Quality of Care
Casalino LP, Jung HY, Bodenheimer T
The association of teamlets and teams with physician burnout and patient outcomes.
This cross-sectional observational study’s goal was to determine the prevalence and performance of primary care teamlets and teams. Survey participants included 688 general internists and family physicians. Physicians were assigned to one of four teamlet/team categories (e.g., teamlet/no team) and, in secondary analyses, to one of eight teamlet/team categories that classified teamlets into high, medium, and low collaboration as perceived by the physician (e.g., teamlet perceived-high collaboration/no team) based on their responses. The majority of physicians (77.4%) practiced in teamlets; 36.7% in teams. The four categories were divided as follows: 49.1% practiced in the teamlet/no team category; 28.3% in the teamlet/team category; 8.4% in no teamlet/team; 14.1% in no teamlet/no team. Results showed that 15.7%, 47.4%, and 14.4% of physicians practiced in perceived high-, medium-, and low-collaboration teamlets. Physicians who did not practice in a teamlet or team had significantly lower rate of burnout compared to the three teamlet/team categories. There were no significant differences in outcomes or Medicare spending by teamlet/team or teamlet perceived-collaboration/team categories compared to no teamlet/no team, for Medicare beneficiaries in general, or for dual-eligible beneficiaries.
AHRQ-funded; HS025716.
Citation: Casalino LP, Jung HY, Bodenheimer T . The association of teamlets and teams with physician burnout and patient outcomes. J Gen Intern Med 2023 May; 38(6):1384-92. doi: 10.1007/s11606-022-07894-7..
Keywords: Teams, Burnout, Primary Care, Provider: Physician
Barger LK, Weaver MD, Sullivan JP
Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study.
The purpose of this study was to determine if long weekly work hours and shifts of extended duration are associated with adverse patient and physician safety outcomes. The criteria included work hours and shifts (≥24 hours) and for senior resident physicians (postgraduate year 2 and above; PGY2+). This study was conducted in the U.S. and spanned eight academic years. The analysis concluded that working 48 hours per week or longer, and extended shifts endanger even experienced (ie, PGY2+) resident physicians and their patients. It recommends lowering weekly work hour limits, as the European Union has done, and eliminating shifts of extended duration to protect the more than 150 000 physicians training in the US and their patients.
AHRQ-funded; HS012032.
Citation: Barger LK, Weaver MD, Sullivan JP . Impact of work schedules of senior resident physicians on patient and resident physician safety: nationwide, prospective cohort study. BMJ Med 2023; 2(1):e000320. doi: 10.1136/bmjmed-2022-000320..
Keywords: Provider: Physician, Burnout, Patient Safety
Tawfik DS, Adair KC, Palassof S
Leadership behavior associations with domains of safety culture, engagement, and health care worker well-being.
This study evaluated health care worker leadership behaviors in relation to burnout, safety culture, and engagement using the Local Leadership scale of the Safety, Communication, Operational Reliability, and Engagement (SCORE) survey. The SCORE survey was administered to 31 Midwestern hospitals with domains including Local Leadership, Emotional Exhaustion/Burnout, Safety Climate, and Engagement. Out of 23,853 distributed surveys, 70.4% were returned. Local leadership scores averaged 68.8 ± 29.1, with 44.2% reporting emotional exhaustion, 55.9% reporting concerning safety climate, 68.4% reporting concerning teamwork climate, 47.5% reporting high workload, and 20.7% reporting intentions to leave. Each 10-point increase in local leadership score was associated with odds ratios of 0.72 for burnout, 0.48 for concerning safety climate, 0.64 for concerning teamwork climate, 0.90 for high workload, and 0.80 for intentions to leave, after adjustment for unit and provider characteristics.
AHRQ-funded; HS027837.
Citation: Tawfik DS, Adair KC, Palassof S . Leadership behavior associations with domains of safety culture, engagement, and health care worker well-being. Jt Comm J Qual Patient Saf 2023 Mar; 49(3):156-65. doi: 10.1016/j.jcjq.2022.12.006..
Keywords: Burnout, Provider: Health Personnel
Giordano NA, Swan BA, Johnson TM
Scalable and sustainable approaches to address the well-being of healthcare personnel.
This article discusses current research that stemmed from a HRSA grant to implement interventions to reduce burnout and optimize behavioral health in the healthcare workforce as part of their Health and Public Safety Workforce Resilient Training Program. A total of 34 awards were made, with the common focus on implementing individual-level mindfulness and compassion-based interventions. The authors are one of the awardees and discuss their efforts to implement a program called Atlanta’s Resiliency Resource fOr frontline Workers (ARROW). This program offers comprehensive resources for resiliency enrichment, mindfulness training and professional development for clinicians and staff working within metropolitan Atlanta healthcare systems. The authors hope to address concerns regarding the paucity of long-term data following participation in mindfulness training, the use of heterogenous and unscalable interventions and restricted enrollment that hinders generalizability.
AHRQ-funded; HS026232.
Citation: Giordano NA, Swan BA, Johnson TM . Scalable and sustainable approaches to address the well-being of healthcare personnel. J Adv Nurs 2023 Feb; 79(2):e12-e15. doi: 10.1111/jan.15505..
Keywords: Burnout, Provider: Health Personnel, Stress
Tierney WM, Henning JM, Altillo BS
User-centered design of a clinical tool for shared decision-making about diet in primary care.
This study described how the authors engaged primary care clinicians and their patients in an iterative design process for a software application to enhance clinician-patient diet discussions. The goal is to help prevent clinician burnout and career dissatisfaction brought on by poorly designed health information technology. Individual clinician and patient interviews were conducted to detail the desired informational content of the screens displayed followed by iterative reviews of intermediate and final versions of the program and its outputs. Participants were primary care clinicians practicing in an urban federally qualified health center and two academic primary care clinics, and their patients who were overweight or obese with diet-sensitive conditions. Three iterations of design and review were conducted with substantial evolution of the program’s content, format, and flow of information. The amount of information was fine-tuned so it would be just the right amount displayed to facilitate shared dietary goal setting.
AHRQ-funded; HS027660.
Citation: Tierney WM, Henning JM, Altillo BS . User-centered design of a clinical tool for shared decision-making about diet in primary care. J Gen Intern Med 2023 Feb; 38(3):715-26. doi: 10.1007/s11606-022-07804-x..
Keywords: Patient-Centered Healthcare, Shared Decision Making, Primary Care
Apathy NC, Hare AJ, Fendrich S
I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes.
The authors analyzed observed reductions in physicians’ note length and documentation time, both of which contribute to EHR burden and burnout. Their study used EHR metadata for ambulatory physician Epic users and examined changes in note composition of physicians who decreased note length and/or documentation time. Their findings showed that note length decreases were primarily attributable to reductions in copy/paste text and templated text, while note time decreases were primarily attributable to reductions in manual text. They concluded that future research should explore scalable burden-reduction initiatives that are responsive to both note bloat and documentation time.
AHRQ-funded; HS026116.
Citation: Apathy NC, Hare AJ, Fendrich S . I had not time to make it shorter: an exploratory analysis of how physicians reduce note length and time in notes. J Am Med Inform Assoc 2023 Jan18; 30(2):355-60. doi: 10.1093/jamia/ocac211..
Keywords: Provider: Physician, Burnout, Electronic Health Records (EHRs), Health Information Technology (HIT)
Aiken LH, Sloane DM, McHugh MD
A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action
The goal of this cross-sectional study was to establish whether hospital nursing care shortages are primarily due to the COVID pandemic, and therefore likely to subside, or if shortages are due to understaffing and poor working conditions that predated the pandemic. The study considered registered nurses in New York and Illinois, and a subset of staff nurses employed in 357 hospitals, before and during the pandemic. While no evidence was found to show that large numbers of nurses left in the first 18 months of the pandemic, the study’s findings indicate that nurses in hospitals with better staffing and more favorable work environments prior to the pandemic reported significantly better outcomes. The authors concluded that policies that prevent chronic understaffing have the most potential to stabilize the hospital nurse workforce.
AHRQ-funded; HS028978.
Citation: Aiken LH, Sloane DM, McHugh MD . A repeated cross-sectional study of nurses immediately before and during the COVID-19 pandemic: Implications for action Nurs Outlook 2023 Jan-Feb; 71(1):101903. doi: 10.1016/j.outlook.2022.11.007..
Keywords: COVID-19, Provider: Nurse, Workforce, Burnout

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