AHRQ Studies in Health Affairs Examine Child Health Coverage, Medicaid Readmissions, Bundled Payments

Electronic Newsletter, Issue 435

AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.

August 5, 2014


AHRQ Stats

Private-sector employees enrolled in an employer-sponsored health plan with deductibles had an average single deductible of $1,167 and an average family deductible of $2,322 in 2012. (Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey Statistical Brief #427:Co-pays, Deductibles, and Coinsurance Percentages for Employer-Sponsored Health Insurance in the Private Sector, by Firm Size, 2012.)

Today's Headlines

  1. AHRQ Studies in Health Affairs Examine Child Health Coverage, Medicaid Readmissions, Bundled Payments.
  2. AHRQ Report and Videos Show How to Successfully Implement CDS Into Clinical Workflows.
  3. Patients at Federal Health Centers Get More Preventive Care in Fewer Visits, Study Finds.
  4. Continuing-Education Video Addresses Children Exposed to Trauma and Interventions for Maltreatment.
  5. National Quality Strategy Priorities in Action Features Nationally Recognized Center that Promotes Person- and Family-Centered Care.
  6. CHIPRA Quality Demonstration States Look To Expand Use of Care Coordinators in Medical Homes Serving Children and Adolescents.
  7. AHRQ in the Professional Literature.

1. AHRQ Studies in Health Affairs Examine Child Health Coverage, Medicaid Readmissions, Bundled Payments

AHRQ-funded studies appearing in the August 4 issue of Health Affairs examine an array of health care issues. Open-access abstracts for the studies are available online. The study, "Children's Health Insurance Program Premiums Adversely Affect Enrollment, Especially Among Lower-Income Children" shows how the relationship between premiums and coverage varies considerably by income level and parental access to employer-sponsored insurance. Another study, "Medicaid Admissions and Readmissions: Understanding the Prevalence, Payments, and Most Common Diagnoses," found that Medicaid readmissions in 19 states were widespread (averaging 9.4 percent of all admissions), costly ($77 million per state) and represented 12.5 percent of Medicaid payments for all hospitalizations. A third study, "Bundled Payment Fails To Gain a Foothold in California: The Experience of the IHA Bundled Payment Demonstration," found that the pilot on bundled payment for orthopedic procedures drew few participants due to factors such as administrative burden, state regulatory uncertainty and disagreements about bundle definition.

2. AHRQ Report and Videos Show How to Successfully Implement CDS Into Clinical Workflows

A new report and accompanying videos from AHRQ, "Findings and Lessons from AHRQ's Clinical Decision Support Demonstration Projects," show how organizations can successfully develop, implement and evaluate the best methods and approaches for incorporating clinical decision support (CDS) into clinical workflows. The report and accompanying videos show the approaches Brigham and Women's Hospital and the Yale School of Medicine took toward creating processes and tools for translating clinical knowledge and narrative guidelines into formats that can be used by multiple electronic health record systems and for implementing CDS across a range of care settings. For more information on this initiative, including the report and videos, please visit the AHRQ Health Information Technology Web site.

3. Patients at Federal Health Centers Get More Preventive Care in Fewer Visits, Study Finds

In a recent AHRQ-funded study, researchers found that patients who received most of their care at federally funded health centers had fewer office and hospital outpatient visits, fewer prescriptions and fewer hospital stays. The researchers also found that these patients were more likely to receive breast cancer screening. Data from AHRQ's 2004–2008 Medical Expenditure Panel Survey were used to compare health care usage and preventive care between patients at federal health centers and patients in other settings. Federal health centers provide socially and medically disadvantaged patients with care that results in lower systemwide utilization and valuable preventive care, the authors concluded. The article and abstract "Health Care Utilization and Receipt of Preventive Care for Patients Seen at Federally Funded Health Centers Compared to Other Sites in Primary Care" were published online April 30 in Health Services Research. AHRQ's James Kirby, Ph.D., and Quyen Ngo-Metzger, M.D., M.P.H., are co-authors of the article.

4. Continuing-Education Video Addresses Children Exposed to Trauma and Interventions for Maltreatment

According to a new continuing education video by AHRQ, an urgent need currently exists to augment the evidence base on interventions addressing child maltreatment. Several interventions show promise in improving child well-being and child welfare outcomes, including a home-visiting approach with maltreating parents called SafeCare® and a foster-parent training program called Keeping Foster Parents Trained and Supported (KEEP). However, the video, based on the 2013 comparative effectiveness review "Child Exposure to Trauma: Comparative Effectiveness of Interventions Addressing Maltreatment," explores major research gaps and highlights the need for collaborative clinical trials supported by a multisite research network. The video is available for continuing education credit from AHRQ.

5. National Quality Strategy Priorities in Action Features Nationally Recognized Center that Promotes Person- and Family-Centered Care

This month's National Quality Strategy (NQS) Priorities in Action features the Oregon Health Care Quality Corporation, an independent nonprofit organization dedicated to improving the quality and affordability of health care in Oregon by leading community collaborations and producing unbiased public reporting information. The organization's work helped to reduce avoidable emergency department visits for children and adults. As a percentage of total emergency department visits, avoidable emergency department visits declined from 16.8 percent to 13.9 percent among children and from 11.0 percent to 10.1 percent among adults. Oregon Health Care Quality Corporation promotes effective communication and coordination of care by using the NQS levers of Public Reporting, Measurement and Feedback, and Health Information Technology. Review the complete list of NQS levers, which represents core business functions, resources or actions that stakeholders can use to align their work with this national strategy.

6. CHIPRA Quality Demonstration States Look To Expand Use of Care Coordinators in Medical Homes Serving Children and Adolescents

AHRQ has published the ninth Evaluation Highlight from the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program, now available on the national evaluation Web site. This Highlight focuses on how six states—Alaska, Idaho, Massachusetts, Oregon, Utah and West Virginia—are using grant funds to support the use of care coordinators as practices implement patient-centered medical home models. These experiences may be helpful to other states that are seeking to use care coordinators as an integral part of their strategy for achieving the functions of care coordination in primary care practices serving children and adolescents. AHRQ is leading the national evaluation of the CHIPRA Quality Demonstration Grant Program. The Centers for Medicare & Medicaid Services funds the evaluation. If you have questions or comments, please contact the national evaluation team via Email.

7. AHRQ in the Professional Literature

Rangachari P, Madaio M, Rethemeyer RK. Role of communication content and frequency in enabling evidence-based practices. Qual Manag Health Care 2014 Jan-Mar;23(1):43-58. Select to access the abstract on PubMed®.

Liss DT, Fishman PA, Rutter CM, et al. Specialty use among patients with treated hypertension in a patient-centered medical home. J Gen Intern Med 2014 May;29(5):732-40. Select to access the abstract on PubMed®.

Laws MB, Lee Y, Rogers WH, et al. Provider-patient communication about adherence to anti-retroviral regimens differs by patient race and ethnicity. AIDS Behav 2014 Jul;18(7):1279-87. Select to access the abstract on PubMed®.

Bleser WK, Miller-Day M, Naughton D. Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home. Ann Fam Med 2014 Jan-Feb;12(1):37-45. Select to access the abstract on PubMed®.

Ferrer RL, Cruz I, Burge S, et al. Measuring capability for healthy diet and physical activity. Ann Fam Med 2014 Jan-Feb;12(1):46-56. Select to access the abstract on PubMed®.

Abdus S, Zuvekas SH. Racial/Ethnic differences in the relationship between obesity and depression treatment. J Behav Health Serv Res. Epub 25 Jan 2014. Select to access the abstract on PubMed®.

Southern WN, Drainoni ML, Smith BD, et al. Physician nonadherence with a hepatitis C screening program. Qual Manag Health Care 2014 Jan-Mar;23(1):1-9. Select to access the abstract on PubMed®.

Regenstein M, Andres E. Reducing hospital readmissions among Medicaid patients: a review of the literature. Qual Manag Health Care 2014 Jan-Mar;23(1):20-42. Select to access the abstract on PubMed®. 


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Current as of August 2014
Internet Citation: AHRQ Studies in Health Affairs Examine Child Health Coverage, Medicaid Readmissions, Bundled Payments: Electronic Newsletter, Issue 435. August 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/435.html