National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 56 Research Studies DisplayedParikh K, Hall M, Tieder JS
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
A retrospective cohort study using the 2019 Kids' Inpatient Database found disparities in pediatric safety events. Black and Hispanic children had significantly higher odds in 5 of 7 safety indicators compared to white children, especially in postoperative sepsis and respiratory failure. Medicaid-covered children also showed higher odds in 4 of 7 indicators compared to privately insured children, highlighting the need for targeted interventions to enhance hospital patient safety, particularly among minority and Medicaid-covered populations.
AHRQ-funded; HS028484.
Citation: Parikh K, Hall M, Tieder JS .
Disparities in racial, ethnic, and payer groups for pediatric safety events in US hospitals.
Pediatrics 2024 Mar; 153(3):e2023063714. doi: 10.1542/peds.2023-063714.
Keywords: Healthcare Cost and Utilization Project (HCUP), Disparities, Racial and Ethnic Minorities, Children/Adolescents, Patient Safety, Hospitals
Hsieh N
Unpacking intersectional inequities in flu vaccination by sexuality, gender, and race-ethnicity in the United States.
This study examined influenza vaccination inequities at the intersection of sexuality, gender, and race-ethnicity using data from the 2013 to 2018 National Health Interview Survey (N = 166,908). It found that White gay men had the highest vaccination rate (56%), while Black bisexual women had the lowest rate (23%). Sexual minority women (Black or Hispanic) had lower vaccination rates than heterosexual women, but sexual minority men had higher or similar vaccination rates than heterosexual men. While economic enabling, noneconomic enabling, and need-based factors all help to explain a substantial portion of these gaps, they cannot explain all the disadvantages faced by Black lesbian, bisexual, heterosexual women, and Black heterosexual men.
AHRQ-funded; HS029329.
Citation: Hsieh N .
Unpacking intersectional inequities in flu vaccination by sexuality, gender, and race-ethnicity in the United States.
J Health Soc Behav 2024 Mar; 65(1):38-59. doi: 10.1177/00221465231199276.
Keywords: Influenza, Vaccination, Disparities
Barwise AK, Curtis S, Diedrich DA
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
The objectives of this planned qualitative study were to use machine learning predictive analytics to identify patients with language barriers and complex medical needs in order to prioritize them for in-person interpreters. The authors conducted semi-structured interviews with clinicians, interpreters, and staff involved in caring for patients or organizing interpreters to understand perceived risks and benefits of artificial intelligence (AI) in this domain. Perceived risks included concerns about transparency, accuracy, redundancy, privacy, stigmatization among patients, alert fatigue, and supply-demand issues; perceived benefits included increased awareness of in-person interpreters, improved standard of care, and prioritization for interpreter utilization. They concluded that the use of AI to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.
AHRQ-funded; HS028475.
Citation: Barwise AK, Curtis S, Diedrich DA .
Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives.
J Am Med Inform Assoc 2024 Feb 16; 31(3):611-21. doi: 10.1093/jamia/ocad224.
Keywords: Health Information Technology (HIT), Disparities, Communication, Clinician-Patient Communication
Patel MD, Lin P, Cheng Q
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
The purpose of this multi-site retrospective study was to assess differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, factoring in age, clinical factors, and ED operating conditions. The study assessed differences in the assignment of Emergency Severity Index (ESI) by patient sex and race/ethnicity, accounting for age, clinical factors, and ED operating conditions. For the study outcome, ESI levels were grouped into three categories: 1-2 (highest acuity), 3, and 4-5 (lowest acuity). The researchers analyzed patient-level data from three EDs affiliated with a large Southeastern United States health system. The study found 186,840 eligible ED visits with 56,417 from an academic ED, 69,698 from a metropolitan community ED, and 60,725 from a rural community ED. The majority of patients were assigned ESI 3 in the academic and metropolitan community EDs (61% and 62%, respectively) whereas 47% were assigned ESI 3 in the rural community ED. In adjusted analyses, White females had a lower likelihood of being assigned ESI 1-2 compared to White males although both groups were roughly comparable in the assignment of ESI 4-5. Non-White and Hispanic females were generally least likely to be assigned ESI 1-2 in all EDs. Interactions between ED wait time and race/ethnicity-sex were not statistically significant.
AHRQ-funded; HS029078.
Citation: Patel MD, Lin P, Cheng Q .
Patient sex, racial and ethnic disparities in emergency department triage: a multi-site retrospective study.
Am J Emerg Med 2024 Feb; 76:29-35. doi: 10.1016/j.ajem.2023.11.008..
Keywords: Emergency Department, Disparities, Racial and Ethnic Minorities
Jindal M, Barnert E, Chomilo N
AHRQ Author: Mistry KB
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
This partly AHRQ-authored paper is part of a series on Racism and Child Health in the USA, which builds on Paper 1's summary of existing disparities in health-care delivery and highlights policies within multiple sectors that can be modified and supported to improve health equity, and, in so doing, improves the health of racially and ethnically minoritized children. The authors discuss current and historical policy approaches across housing, employment, health insurance, immigration, and criminal which have the potential to affect child health equity. They commented that these policies must be considered with a focus on structural racism to understand which have the potential to eliminate or at least attenuate disparities. If these policy efforts do not directly address structural racism, they will not achieve equity and instead worsen gaps and existing disparities in access and quality-thereby continuing to perpetuate a two-tier system dictated by racism.
AHRQ-authored.
Citation: Jindal M, Barnert E, Chomilo N .
Policy solutions to eliminate racial and ethnic child health disparities in the USA.
Lancet Child Adolesc Health 2024 Feb; 8(2):159-74. doi: 10.1016/s2352-4642(23)00262-6..
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Policy
Nash KA, Weerahandi H, Yu H
Measuring equity in readmission as a distinct assessment of hospital performance.
This study examined the measure of equitable readmissions in hospitals as developed by the Centers for Medicare & Medicaid Services (CMS). Objectives were to define a measure of equitable readmissions; identify hospitals with equitable readmissions by insurance (dual eligible vs non-dual eligible) or patient race (Black vs White); and compare hospitals with and without equitable readmissions by hospital characteristics and performance on accountability measures (quality, cost, and value). The authors used data from a cross-section of hospitals who were eligible for the CMS Hospital-Wide Readmission measure using Medicare data from July 2018 through June 2019. Of 4638 hospitals, they found that 74% served a sufficient number of dual-eligible patients, and 42% served a sufficient number of Black patients to apply CMS Disparity Methods by insurance and race. Of these eligible hospitals, 17% had equitable readmission rates by insurance and 30% by race. Hospitals with equitable readmissions by insurance or race cared for a lower percentage of Black patients (insurance, 1.9% vs 3.3%, race, 7.6% vs 9.3%), and differed from nonequitable hospitals in multiple domains (teaching status, geography, size. In examining equity by insurance, hospitals with low costs were more likely to have equitable readmissions, and there was no relationship between quality and value, and equity. In examining equity by race, hospitals with high overall quality were more likely to have equitable readmissions, and there was no relationship between cost and value, and equity.
AHRQ-funded; HS022882.
Citation: Nash KA, Weerahandi H, Yu H .
Measuring equity in readmission as a distinct assessment of hospital performance.
JAMA 2024 Jan 9; 331(2):111-23. doi: 10.1001/jama.2023.24874..
Keywords: Hospital Readmissions, Hospitals, Provider Performance, Disparities
Wolf RM, Hall M, Williams DJ
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
This retrospective cohort study examined associations between pharmacologic restraint use and race and ethnicity among children (aged 5-≤18 years) admitted for mental health conditions to acute care nonpsychiatric children's hospitals. Study period was 2018 to 2022 and was conducted at 41 US children’s hospitals and included a cohort of 61,503 hospitalizations. Compared with non-Hispanic Black children, children of non-Hispanic White (adjusted odds ratio [aOR], 0.81), Asian (aOR, 0.82), or other race and ethnicity (aOR, 0.68) were less likely to receive pharmacologic restraint, with no significant difference with Hispanic children. When stratified by sex, racial/ethnic differences were magnified in males, except for Hispanic males, and not found in females. Sensitivity analysis revealed amplified disparities for all racial/ethnic groups, including Hispanic youth.
AHRQ-funded; HS026122.
Citation: Wolf RM, Hall M, Williams DJ .
Disparities in pharmacologic restraint for children hospitalized in mental health crisis.
Pediatrics 2024 Jan; 153(1). doi: 10.1542/peds.2023-061353..
Keywords: Disparities, Children/Adolescents, Behavioral Health, Inpatient Care, Hospitals, Medication
Cron DC, Braun HJ, Ascher NL
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
The objective of this study was to determine association of sex with access to liver transplantation among candidates with the highest possible model for end-stage liver disease score (MELD 40). Using national transplant registry data, researchers compared liver offer acceptance and waitlist outcomes by sex for waitlisted liver transplant candidates who reached MELD 40. Results showed that even among candidates with high disease severity and equally high MELD scores, women have reduced access to liver transplantation and worse outcomes compared with men. The researchers concluded that policies addressing this disparity should consider factors beyond MELD score adjustments.
AHRQ-funded; HS028476.
Citation: Cron DC, Braun HJ, Ascher NL .
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
Ann Surg 2024 Jan; 279(1):112-18. doi: 10.1097/sla.0000000000005933..
Keywords: Disparities, Access to Care, Sex Factors, Transplantation
Song Zhang, Zhang X, Patterson LJ
Racial and ethnic disparities in hospitalization outcomes among Medicare beneficiaries during the COVID-19 pandemic.
This study assessed assess racial and ethnic differences in hospitalization outcomes during the COVID-19 pandemic among Medicare beneficiaries. Medicare claims from the Social Security Administration was used to determine in-hospital mortality and mortality inclusive of discharges to hospice and discharges to postacute care. Over 31 million Medicare recipients in the database were analyzed with over 14 million hospitalizations from January 2019 to February 2021. There was a decline in non-COVID-19 and an emergence of COVID-19 hospitalizations among beneficiaries of different racial and ethnic minority groups through February 2021. In-hospital mortality was not significantly different among Black patients relative to White patients but was 3.5 percentage points higher among Hispanic patients and other racial and ethnic minority groups. There were disparities in discharges to hospice and postacute care as well.
AHRQ-funded; HS024072.
Citation: Song Zhang, Zhang X, Patterson LJ .
Racial and ethnic disparities in hospitalization outcomes among Medicare beneficiaries during the COVID-19 pandemic.
JAMA Health Forum 2021 Dec 23;2(12):e214223. doi: 10.1001/jamahealthforum.2021.4223..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Medicare, Hospitalization, Outcomes, Mortality
Lin JS, Hoffman L, Bean SI
Addressing racism in preventive services: methods report to support the US Preventive Services Task Force.
The purpose of this report was to articulate the definitional and conceptual issues around racism and health inequity and to describe how racism and health inequities are currently addressed in preventive health. An audit was conducted assessing published literature on policy and position statements addressing racism, a subset of cancer and cardiovascular topics in USPSTF reports, recent systematic reviews on interventions to reduce health inequities, and societies, organizations, agencies, and funding bodies to gather information about how they address racism and health equity. Findings showed that racism is complex and pervasive, operates at multiple interrelated levels, and exerts negative effects on other social determinants and health and well-being through multiple pathways. The most directly relevant and immediately useful guidance identified is that from the GRADE (Grading of Recommendations Assessment, Development and Evaluation) working group.
AHRQ-funded; 290201600006C.
Citation: Lin JS, Hoffman L, Bean SI .
Addressing racism in preventive services: methods report to support the US Preventive Services Task Force.
JAMA 2021 Dec 21;326(23):2412-20. doi: 10.1001/jama.2021.17579..
Keywords: U.S. Preventive Services Task Force (USPSTF), Social Determinants of Health, Racial and Ethnic Minorities, Disparities, Research Methodologies, Prevention, Evidence-Based Practice
Steenland MW, Wilson IB, Matteson KA
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
This study’s objective was to measure the association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities. A total of 60,990 childbirths were reviewed from January 1, 2014 on with a total of 72.3% paid for by Medicaid and 27.7% paid for by a commercial payer. The mean age of the birthing person was 27; with 67% White, 22% Black, and 7% Hispanic. Medicaid expansion in Arkansas was associated with a 27.8 percentage point increase in continuous insurance coverage and an increase in outpatient visits of 0.9 during the first 6 months postpartum, representing relative increases of 54.9% and 75.0%, respectively. Racial disparities in postpartum coverage decreased from 6.3 percentage points before expansion to -2.0 after. However, disparities in outpatient care after expansion persisted between Black and White individuals.
AHRQ-funded; HS027464.
Citation: Steenland MW, Wilson IB, Matteson KA .
Association of Medicaid expansion in Arkansas with postpartum coverage, outpatient care, and racial disparities.
JAMA Health Forum 2021 Dec;2(12):e214167. doi: 10.1001/jamahealthforum.2021.4167..
Keywords: Medicaid, Maternal Care, Pregnancy, Racial and Ethnic Minorities, Disparities, Policy, Women, Access to Care
Vervoort D, Canner JK, Haut ER
Racial disparities associated with reinterventions after elective endovascular aortic aneurysm repair.
In this study, the authors’ goal was to examine racial disparities associated with reinterventions following elective endovascular abdominal aortic aneurysm repair (EVAR) in a real-world cohort. Using the Vascular Quality Initiative EVAR dataset, they found that Black patients requiring reintervention were more frequently female, more frequently current or former smokers, and less frequently insured by Medicare/Medicaid. After adjusting for baseline differences, the risk of reintervention after elective EVAR was significantly lower for Black versus White patients, and all-cause mortality was comparable between groups. The authors recommended further investigation.
AHRQ-funded; HS024547.
Citation: Vervoort D, Canner JK, Haut ER .
Racial disparities associated with reinterventions after elective endovascular aortic aneurysm repair.
J Surg Res 2021 Dec;268:381-88. doi: 10.1016/j.jss.2021.07.010..
Keywords: Racial and Ethnic Minorities, Disparities, Outcomes
Krissberg JR, Kaufmann MB, Gupta A
Racial disparities in pediatric kidney transplantation under the new Kidney Allocation System in the United States.
This study aimed to assess how implementation of the 2014 Kidney Allocation System (KAS) affected racial and ethnic disparities in pediatric kidney transplantation access and related outcomes. The authors performed a retrospective cohort study of children <18 years of age active on the kidney transplant list from 2008 to 2019 using the Scientific Registry of Transplant Recipients. Results found that all children experienced longer wait times from activation to transplantation post-KAS. Although they found that Black and Hispanic children and other children of color experienced longer times from activation to transplant compared with White children in both eras; this finding was largely attenuated after multivariable analysis. Multivariable analysis also showed that racial and ethnic disparities in time from dialysis initiation to transplantation in the pre-KAS era were lessened in the post-KAS era. No disparities were found in odds of delayed graft function, however Black and Hispanic children experienced longer times with a functioning graft in the post-KAS era.
AHRQ-funded; HS026128.
Citation: Krissberg JR, Kaufmann MB, Gupta A .
Racial disparities in pediatric kidney transplantation under the new Kidney Allocation System in the United States.
Clin J Am Soc Nephrol 2021 Dec; 16(12):1862-71. doi: 10.2215/cjn.06740521..
Keywords: Disparities, Racial and Ethnic Minorities, Kidney Disease and Health, Transplantation
Parikh K, Hall M, Kaiser SV
Development of a health disparities index: proof of concept with chest radiography in asthma.
The objective of this study was to develop a tool for quantifying health disparity (Health Disparity Index[HDI]) and explore hospital variation measured by this index using chest radiography (CXR) in asthma as the proof of concept. The investigators concluded that the HDI provided a practical measure of disparity. They suggested that to improve equity in healthcare, metrics are needed that are intuitive, accurate, usable, and actionable.
AHRQ-funded; HS016418.
Citation: Parikh K, Hall M, Kaiser SV .
Development of a health disparities index: proof of concept with chest radiography in asthma.
J Pediatr 2021 Nov;238:290-95.e1. doi: 10.1016/j.jpeds.2021.07.022..
Keywords: Asthma, Respiratory Conditions, Disparities
Hsueh L, Huang J, Millman AK
Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic.
The authors hypothesized that limited English proficiency (LEP) would be associated with lower video use compared with telephone, especially among patients without prior video visit experience. They found that one-third of patients with LEP scheduled a visit by video instead of telephone. Patients with LEP chose video less often than patients without LEP, even after adjusting for technology factors. However, among patients with prior video visit experience, no significant difference in video visit use by LEP was found.
AHRQ-funded; HS025189.
Citation: Hsueh L, Huang J, Millman AK .
Disparities in use of video telemedicine among patients with limited English proficiency during the COVID-19 pandemic.
JAMA Netw Open 2021 Nov;4(11):e2133129. doi: 10.1001/jamanetworkopen.2021.33129..
Keywords: COVID-19, Telehealth, Health Information Technology (HIT), Disparities, Communication
Gorman DC, Ham SA, Staab EM
Medical assistant protocol improves disparities in depression screening rates.
This study examined the impacts of a medical assistant screening protocol on the rates of depression screening, overall and by sociodemographic groups, in a primary care setting. Findings showed that implementation of a medical assistant protocol in a primary care setting may significantly increase depression screening rates while mitigating or removing sociodemographic disparities.
AHRQ-funded; HS026151.
Citation: Gorman DC, Ham SA, Staab EM .
Medical assistant protocol improves disparities in depression screening rates.
Am J Prev Med 2021 Nov;61(5):692-700. doi: 10.1016/j.amepre.2021.05.010..
Keywords: Disparities, Depression, Behavioral Health, Screening, Racial and Ethnic Minorities
Ingraham NE, Purcell LN, Karam BS
Racial and ethnic disparities in hospital admissions from COVID-19: determining the impact of neighborhood deprivation and primary language.
This retrospective cohort study evaluated neighborhood-level deprivation and English language proficiency effects on disproportionate outcomes seen in racial and ethnic minorities diagnosed with COVID-19. Health records of 12 Midwest hospitals and 60 clinics in Minnesota between March 4 and August 19, 2020 were used. COVID-19 hospitalization rates were evaluated against the patient’s Area Deprivation Index (ADI) and primary language. A total of 5577 individuals were included, with 866 hospitalized within 45 days of diagnosis. Hospitalized patients were older, and more likely to be male. Minority/race ethnicity was associated with COVID-19 severity, but ADI was not associated with increased hospitalization. Non-English speaking significantly increased odds of hospital admission across and within minority groups.
AHRQ-funded; HS024532; HS26732; HS026379.
Citation: Ingraham NE, Purcell LN, Karam BS .
Racial and ethnic disparities in hospital admissions from COVID-19: determining the impact of neighborhood deprivation and primary language.
J Gen Intern Med 2021 Nov;36(11):3462-70. doi: 10.1007/s11606-021-06790-w..
Keywords: COVID-19, Hospitalization, Racial and Ethnic Minorities, Disparities
Herb J, Staley BS, Roberson M
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
The investigators’ objective was to determine national usage and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism among insured older adults. Data was obtained using Medicare claims. They found that parathyroidectomy was underused and recommended that quality improvement efforts, rooted in equitable care, be undertaken to increase access to parathyroidectomy for this disease.
AHRQ-funded; HS000032.
Citation: Herb J, Staley BS, Roberson M .
Use and disparities in parathyroidectomy for symptomatic primary hyperparathyroidism in the Medicare population.
Surgery 2021 Nov;170(5):1376-82. doi: 10.1016/j.surg.2021.05.026..
Keywords: Elderly, Disparities, Medicare, Surgery, Racial and Ethnic Minorities
Grafova IB, Jarrín OF
Beyond Black and White: mapping misclassification of Medicare beneficiaries race and ethnicity.
This study examined state-level variation in racial/ethnic misclassification of race and ethnicity in the Centers for Medicare and Medicaid Services administrative database using the enrollment database (EDB) beneficiary race code and the Research Triangle Institute (RTI) race code. The cohort included 4,231,370 Medicare beneficiaries who utilized home health care services in 2015. The authors found substantial variation between states in misclassification of self-identified Hispanic, Asian American/Pacific Islander, and American Indian/Alaska Native beneficiaries.
AHRQ-funded; HS022406.
Citation: Grafova IB, Jarrín OF .
Beyond Black and White: mapping misclassification of Medicare beneficiaries race and ethnicity.
Med Care Res Rev 2021 Oct;78(5):616-26. doi: 10.1177/1077558720935733..
Keywords: Medicare, Racial and Ethnic Minorities, Disparities
Nguyen KH, Thorsness R, Hayes S
Evaluation of racial, ethnic, and socioeconomic disparities in initiation of kidney failure treatment during the first 4 months of the COVID-19 pandemic.
This study examined the impact of COVID-19 on initiation of kidney failure treatment during the first 4 months of the pandemic with a focus on racial, ethnic, and socioeconomic disparities. The study population included 127,149 patients with incident kidney failure between January 2018 and June 2020. The mean age of patients was 62.8 years, and were 41.7% female, 25.9% non-Hispanic Black and 15.6% Hispanic/Latino. There were significant decreases in the proportion of patients with incident kidney failure receiving preemptive transplantation and initiating hemodialysis treatment with an arteriovenous fistula during the first 4 months of the pandemic compared to the pre-COVID-19 period. These decreases were most significant among non-Hispanic Black patients. There were also significant decreases in patients residing in counties in the highest quintile of COVID-19 mortality rates, but not for patients residing in other counties. Treatment initiation was approximately 30% lower than projected in April 2020.
AHRQ-funded; HS028285.
Citation: Nguyen KH, Thorsness R, Hayes S .
Evaluation of racial, ethnic, and socioeconomic disparities in initiation of kidney failure treatment during the first 4 months of the COVID-19 pandemic.
JAMA Netw Open 2021 Oct;4(10):e2127369. doi: 10.1001/jamanetworkopen.2021.27369..
Keywords: COVID-19, Kidney Disease and Health, Racial and Ethnic Minorities, Disparities
O'Kane M, Agrawal S, Binder L
AHRQ Author: Meyers D
An equity agenda for the field of health care quality improvement.
The authors of this paper assert that the U.S. health system must take action to centralize equity, particularly racial equity (including ethnicity), in discussions of quality. In this discussion paper, the authors provide an analysis and delineation of the key elements of their racial equity agenda for the field of health care quality improvement.
AHRQ-authored.
Citation: O'Kane M, Agrawal S, Binder L .
An equity agenda for the field of health care quality improvement.
NAM Perspect 2021 Sep 15;2021. doi: 10.31478/202109b..
Keywords: Quality Improvement, Quality of Care, Racial and Ethnic Minorities, Disparities, Social Determinants of Health
Curry CW, Felt D, Kan K
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
Researchers sought to examine adjusted odds of non-remitting asthma by sexual identity, race/ethnicity, and their intersections, along with their relationship with traditional non-remitting asthma risk factors and victimization. Using data from the Youth Risk Behavior Survey, they found that, at the intersections, 8 sexual minority and racial/ethnic minority subpopulations were significantly more likely to have non-remitting asthma compared with White heterosexual sex-matched peers. They concluded that the evidence suggests that traditional non-remitting asthma risk factors and victimization may partly explain disparities in non-remitting asthma.
AHRQ-funded; HS026385.
Citation: Curry CW, Felt D, Kan K .
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
J Allergy Clin Immunol Pract 2021 Sep;9(9):3396-406. doi: 10.1016/j.jaip.2021.04.046..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Disparities
Trent SA, George N, Havranek EP
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Evidence-based guidelines are often cited as a means of ensuring high-quality care for all patients. The objective of this study was to assess whether emergency department (ED) adherence to core evidence-based guidelines differed by patient sex and race/ethnicity and to assess the effect of ED guideline adherence on patient outcomes by sex and race/ethnicity. The investigators concluded that longstanding, nationally reported evidence-based guidelines can help eliminate sex and race/ethnicity disparities in quality of care.
AHRQ-funded; HS022400.
Citation: Trent SA, George N, Havranek EP .
Established evidence-based treatment guidelines help mitigate disparities in quality of emergency care.
Acad Emerg Med 2021 Sep;28(9):1051-60. doi: 10.1111/acem.14235..
Keywords: Evidence-Based Practice, Guidelines, Emergency Department, Disparities, Quality of Care
Markovitz AA, Ayanian JZ, Warrier A
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Using national data for 2008-18, investigators found that double bonuses were not associated with either improvements in plan quality or increased Medicare Advantage enrollment. Additionally, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. These findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. This study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Warrier A .
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Health Aff 2021 Sep;40(9):1411-19. doi: 10.1377/hlthaff.2021.00349..
Keywords: Medicare, Health Insurance, Payment, Quality Improvement, Quality of Care, Disparities, Racial and Ethnic Minorities
Goyal MK, Chamberlain JM, Webb M
Racial and ethnic disparities in the delayed diagnosis of appendicitis among children.
The objective of this 3-year multicenter retrospective cohort study of children was to determine if there are race/ethnicity differences in rates of appendiceal perforation, delayed diagnosis of appendicitis, and diagnostic imaging during prior visit(s). Delayed diagnosis was defined as having at least one emergency department (ED) visit within 7 days preceding the appendicitis diagnosis. Out of 7,298 patients diagnosed with appendicitis and documented race/ethnicity, 2,567 had appendiceal perforation. Non-Hispanic (NH) Black children had a higher likelihood of perforation (36.5% versus 34.9%) then non-Hispanic whites. They also were over twice as likely to have delayed diagnosis (4.7% versus 2.0%). Eighty-nine patients (43.2%) patients with delayed diagnosis had abdominal imaging during the prior visits. However, NH-Black children were less likely to have any imaging (28.2% versus 46.2%) or definitive imaging (10.3% versus 35.9%).
Acad Emerg Med 2021 Sep;28(9):949-56. doi: 10.1111/acem.14142.
Citation: Goyal MK, Chamberlain JM, Webb M .
Racial and ethnic disparities in the delayed diagnosis of appendicitis among children.
Acad Emerg Med 2021 Sep;28(9):949-56. doi: 10.1111/acem.14142..
Keywords: Children/Adolescents, Racial and Ethnic Minorities, Disparities, Diagnostic Safety and Quality