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Topics
- Cancer (7)
- Cancer: Skin Cancer (1)
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- (-) Palliative Care (14)
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- Provider: Nurse (1)
- Provider: Physician (1)
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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 14 of 14 Research Studies DisplayedWu A, Ugiliweneza B, Wang D
Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a seer-Medicare retrospective study.
This study investigates differences in palliative care (PC) timing on outcomes for patients with glioblastoma (GBM) using Surveillance, Epidemiology, and End Results (SEER) Medicare data. Findings showed that, despite an overall increase in PC consultations, only a minority of GBM patients receive PC. Patients with late PC had the longest survival times and had greater hospice use in the last month of life compared to other subgroups.
AHRQ-funded; HS028747.
Citation: Wu A, Ugiliweneza B, Wang D .
Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a seer-Medicare retrospective study.
Neurooncol Pract 2022 Aug;9(4):299-309. doi: 10.1093/nop/npac026.
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Keywords: Palliative Care, Cancer, Quality of Life, Healthcare Costs
Jin MC, Hsin G, Ratliff J
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
This study analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities and access and utilization of palliative care and supportive services. The authors introduced a novel construct, “provider patient racial diversity index” (provider pRDI) which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider's patient demographics and suggest a provider's cultural sensitivity and exposure to diversity. Their analysis demonstrated low rates of palliative care, home health, and social work services among racial minority patients, with Hispanics having the lowest likelihood of engagement with all three categories of supportive services. Patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses.
AHRQ-funded; HS028747.
Citation: Jin MC, Hsin G, Ratliff J .
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
Cancers 2022 May 23;14(10). doi: 10.3390/cancers14102567..
Keywords: Palliative Care, Disparities, Cancer
Temkin-Greener H, Guo W, Hua Y
End-of-life care in assisted living communities: race and ethnicity, dual enrollment status, and state regulations.
The purpose of this study was to evaluate the relationships between death at home and home hospice care with race, ethnicity, community characteristics, strictness of state-level regulations for assisted living facilities, dual Medicare-Medicaid enrollment, and other individual characteristics. The researchers found that almost 60% of the 100,783 fee-for-service Medicare beneficiaries residing in 16,560 assisted living communities who died in 2018-2019, died at home. Of those individuals, 84% were with home hospice care. Dual Medicare-Medicaid enrollment was a more important predictor of death at home than race or ethnicity; yet race was a stronger predictor than dual enrollment for hospice care at death. In states with lower regulatory strictness for assisted living communities, residents were less likely to die at home. The study concludes that these results imply an important role for state regulation of assisted living facilities and can help guide efforts to ensure equitable access to the individual’s preference for end-of-life-care.
Citation: Temkin-Greener H, Guo W, Hua Y .
End-of-life care in assisted living communities: race and ethnicity, dual enrollment status, and state regulations.
Health Aff 2022 May;41(5):654-62. doi: 10.1377/hlthaff.2021.01677..
Keywords: Elderly, Palliative Care, Long-Term Care, Racial and Ethnic Minorities
Washington KT, Kukulka K, Govindarjan R
Engaging specialist palliative care in the management of amyotrophic lateral sclerosis: a patient-, family-, and provider-based approach.
Investigators sought to describe key stakeholders' perspectives on specialist palliative care and its integration into the management of amyotrophic lateral sclerosis (ALS). Individual interviews were conducted with 42 stakeholders; the interview transcriptions were analyzed using inductive thematic analysis techniques. The investigators found that stakeholders expressed limited or inaccurate understandings of palliative care's definition and purpose. Stakeholders generally supported the integration of specialist palliative care into ALS management and recognized the value of early integration of palliative services in both the community and the clinical setting.
AHRQ-funded; HS022140.
Citation: Washington KT, Kukulka K, Govindarjan R .
Engaging specialist palliative care in the management of amyotrophic lateral sclerosis: a patient-, family-, and provider-based approach.
J Palliat Care 2022 Apr;37(2):170-76. doi: 10.1177/0825859719895827..
Keywords: Palliative Care, Neurological Disorders
Gray NA, Kamal AH, Hanson LC
Clinician perspectives guiding approach to comprehensiveness of palliative care assessment.
This paper discusses the results of a two-part web-based survey of palliative care clinicians from five academic groups in the United States. The objective was to describe clinicians’ assessment practices and factors influencing their approach to quality palliative care in contrast to the National Consensus Project guidelines for palliative care. Nineteen out of 25 invited clinicians completed the survey, including physicians, nurse practitioners, and physician assistants. The majority (62%) reported that their usual practice was to tailor the focus of the consultation, mainly due to time limitations and workload, followed by beliefs that comprehensive assessment was unnecessary, and absence of the full interdisciplinary team. Most participants cited reason for consult as factors influencing a tailored approach. Physical symptoms were the most commonly assessed factor (81%), with spiritual and cultural factors least commonly (24% and 19%, respectively) listed. Although most clinicians reported usually tailoring their consultations, mean importance scores for almost all assessment elements were high (mean of 7.1 on a 0-9 importance scale).
AHRQ-funded; HS022763.
Citation: Gray NA, Kamal AH, Hanson LC .
Clinician perspectives guiding approach to comprehensiveness of palliative care assessment.
J Palliat Med 2022 Feb;25(2):307-11. doi: 10.1089/jpm.2021.0391..
Keywords: Palliative Care, Provider: Nurse
Dionne-Odom JN, Wells RD, Guastaferro K
An early palliative care telehealth coaching intervention to enhance advanced cancer family caregivers' decision support skills: the CASCADE pilot factorial trial.
The purpose of this study was to evaluate the feasibility, acceptability, and efficacy of the modules of a telehealth palliative care decision support training program (CASCADE training- CAre Supporters Coached to be Adept DEcision Partners) for caregivers of cancer patients. The researchers conducted a pilot trial between October 2019 and October 2020 in which 46 dyads of newly diagnosed cancer patients and their caregivers were randomized and assigned to one of eight experimental conditions. Each experimental condition included a combination of one of three CASCADE modules. Measures of decision support and caregiver and patient distress, training feasibility, and training acceptability were collected. The study found that the individual CASCADE modules were reported to have a possible benefit for decision support and caregiver distress, and that the average caregiver rating for recommending the program was 9.9 on a scale of 1(Not at all likely) to 10 (Extremely likely). The study concluded that the pilot trial was a success and justify and warrant a full-scale trial.
AHRQ-funded; HS013852.
Citation: Dionne-Odom JN, Wells RD, Guastaferro K .
An early palliative care telehealth coaching intervention to enhance advanced cancer family caregivers' decision support skills: the CASCADE pilot factorial trial.
J Pain Symptom Manage 2022 Jan;63(1):11-22. doi: 10.1016/j.jpainsymman.2021.07.023..
Keywords: Palliative Care, Cancer, Telehealth, Health Information Technology (HIT), Caregiving
Chyr LC, DeGroot L, Waldfogel JM
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
The purpose of this study was to assess the implementation of models for integrating palliative care into ambulatory care for adults with noncancer serious chronic illness. Between January 2000 to May 2020, the researchers reviewed 3 electronic databases and included qualitative, mixed methods studies, and randomized and nonrandomized controlled trial studies. Quantitative analysis included 14 studies of 2,934 US adult patients. The study found that when compared to usual care the models assessed were not more effective for improving patient health-related quality of life (HRQOL) or for patient depressive symptom scores. Qualitative analysis included 5 studies of 146 patients. There was variance in patient preferences for appropriate timing of palliative care; barriers to implementation included costs, additional visits, and travel. The researchers concluded that models were not more effective than usual care for improving HRQOL or depressive symptom scores and may have little to no effect on decreasing overall symptom burden but were more effective for increasing AD documentation.
AHRQ-funded; 2902015000061
Citation: Chyr LC, DeGroot L, Waldfogel JM .
Implementation and effectiveness of integrating palliative care into ambulatory care of noncancer serious chronic illness: mixed methods review and meta-analysis.
Ann Fam Med 2022 Jan-Feb;20(1):77-83. doi: 10.1370/afm.2754..
Keywords: Chronic Conditions, Palliative Care, Implementation, Patient-Centered Healthcare, Quality of Life
Marcus KL, Kao PC, Ma C
Symptoms and suffering at end of life for children with complex chronic conditions.
The objective of this study was to evaluate symptoms and suffering at end of life for children with noncancer, noncardiac complex chronic conditions (CCCs), as well as parental distress related to their child’s suffering. Nearly one-third of bereaved parents of children with CCCs who completed the survey reported high suffering in their child's final days of life. Parental preparedness was associated with lower perceived suffering. The authors concluded that future research should target symptoms contributing to parent and child distress and assess whether enhancing parent preparedness reduces perceived child suffering.
AHRQ-funded; HS022986.
Citation: Marcus KL, Kao PC, Ma C .
Symptoms and suffering at end of life for children with complex chronic conditions.
J Pain Symptom Manage 2022 Jan; 63(1):88-97. doi: 10.1016/j.jpainsymman.2021.07.010..
Keywords: Children/Adolescents, Chronic Conditions, Palliative Care, Pain
Hwang D, Teno JM, Clark M
Family perceptions of quality of hospice care in the nursing home.
The investigators examined bereaved family members' perceptions of nursing home-hospice collaborations in terms of what family members believe went well or could have been improved. The focus group participants identified three major aspects of collaboration as important to care delivery: knowing who (nursing home or hospice) is responsible for which aspects of patient care, concern about information coordination between the nursing home and hospice, and the need for hospice to advocate for high-quality care rather than their having to directly do so on behalf of their family members. These concerns have been incorporated into the revised Family Evaluation of Hospice Care, a post-death survey used to evaluate quality of hospice care.
AHRQ-funded; HS019675.
Citation: Hwang D, Teno JM, Clark M .
Family perceptions of quality of hospice care in the nursing home.
J Pain Symptom Manage 2014 Dec;48(6):1100-7. doi: 10.1016/j.jpainsymman.2014.04.003.
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Keywords: Care Coordination, Nursing Homes, Palliative Care, Quality of Care
Rocke DJ, Beumer HW, Taylor DH, Jr.
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
The investigators sought to determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. They found that, compared with patients and caregivers, otolaryngology-head and neck surgery (OHNS) physician allocations differed significantly in all 15 benefit categories except home care. They concluded that understanding the effect of baseline attitudes is important for effective end-of-life discussions.
AHRQ-funded; HS018360.
Citation: Rocke DJ, Beumer HW, Taylor DH, Jr. .
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
JAMA Otolaryngol Head Neck Surg 2014 Jun;140(6):497-503. doi: 10.1001/jamaoto.2014.494.
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Keywords: Cancer, Caregiving, Medicare, Palliative Care, Provider: Physician, Quality of Life
Huo J, Lairson DR, Du XL
Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
The authors analyzed the association of hospice use with survival and health care costs among patients diagnosed with metastatic melanoma. They found that the median survival time was 6.1 months for patients with no hospice care, 6.5 months for patients enrolled in hospice for 1 to 3 days, and 10.2 months for patients enrolled for 4 or more days. Patients with 4 or more days of hospice care incurred lower end-of-life costs than the comparison groups.
AHRQ-funded; HS018956.
Citation: Huo J, Lairson DR, Du XL .
Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
Am J Manag Care 2014 May;20(5):366-73.
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Keywords: Cancer, Cancer: Skin Cancer, Healthcare Costs, Palliative Care, Patient-Centered Outcomes Research
Kavalieratos D, Kamal AH, Abernethy AP
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
This study characterized the unresolved symptom and treatment needs which patients with heart failure and those with cancer present to palliative care. It found that patients with HF presented with fewer unresolved symptoms; however, they were more likely to report dyspnea and more commonly experienced dyspnea-related treatment gaps.
AHRQ-funded; HS000032; HS017587
Citation: Kavalieratos D, Kamal AH, Abernethy AP .
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
J Palliat Med. 2014 Apr;17(4):475-81. doi: 10.1089/jpm.2013.0526..
Keywords: Palliative Care, Cancer, Heart Disease and Health, Chronic Conditions
Martinez KA, Aslakson RA, Wilson RF
A systematic review of health care interventions for pain in patients with advanced cancer.
The authors sought to synthesize the evidence on the effectiveness of pain-focused interventions in patients with advanced cancer. In nineteen studies, they found moderate strength of evidence that pain management in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.
AHRQ-funded; 290200710061.
Citation: Martinez KA, Aslakson RA, Wilson RF .
A systematic review of health care interventions for pain in patients with advanced cancer.
Am J Hosp Palliat Care 2014 Feb;31(1):79-86. doi: 10.1177/1049909113476129.
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Keywords: Cancer, Comparative Effectiveness, Pain, Palliative Care, Quality Improvement
Kamal AH
Getting to proven: evaluating quality across all of palliative care.
In this letter, Kamal calls for the development of quality measures for palliative care, paying attention to procedures, multidisciplinary team members who perform multidomain assessments, the new settings of care where quality measurement should be tailored, and the care models that transition across generalist and specialist palliative care.
AHRQ-funded; HS022763.
Citation: Kamal AH .
Getting to proven: evaluating quality across all of palliative care.
J Pain Symptom Manage 2014 Jan;47(1):e1-2. doi: 10.1016/j.jpainsymman.2013.09.007.
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Keywords: Quality of Care, Health Services Research (HSR), Palliative Care, Quality Measures, Quality Measures