National Healthcare Quality and Disparities Report
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- Access to Care (1)
- Cancer (1)
- Case Study (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (1)
- Disparities (1)
- Healthcare-Associated Infections (HAIs) (1)
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- Nursing Homes (2)
- Organizational Change (2)
- Patient-Centered Healthcare (1)
- Patient Experience (1)
- Patient Safety (4)
- Payment (6)
- (-) Policy (21)
- Primary Care (1)
- Primary Care: Models of Care (1)
- Provider Performance (5)
- Public Reporting (4)
- Quality Improvement (8)
- Quality Indicators (QIs) (2)
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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 21 of 21 Research Studies DisplayedWatnick S, Blake PG, Mehrotra R
System-level strategies to improve home dialysis: policy levers and quality initiatives.
This article discusses trends in home dialysis use, reviews the evolving understanding of what constitutes high quality care for the home dialysis population (as well as how this can be measured), and discusses policy and advocacy efforts that continue to shape the care of US patients, and compares with experiences in other countries. The authors conclude by discussing future directions for quality and advocacy efforts.
AHRQ-funded; HS028684.
Citation: Watnick S, Blake PG, Mehrotra R .
System-level strategies to improve home dialysis: policy levers and quality initiatives.
Clin J Am Soc Nephrol 2023 Dec; 18(12):1616-25. doi: 10.2215/cjn.0000000000000299..
Keywords: Home Healthcare, Kidney Disease and Health, Policy, Quality Improvement, Quality of Care
Liao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
AHRQ-funded; HS027595.
Citation: Liao JM, Wang E, Isidro U .
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy
Tedesco D, Moghavem N, Weng Y
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
This study’s aim was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. The study analyzed 13 patient safety indicators (PSIs) that were developed by AHRQ. PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013 were analyzed. Twelve of the thirteen PSIs had decreasing or stable trends in the last 5 years of the study. Central-line bloodstream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013) whereas postoperative respiratory failure had the smallest annual percent change (-3.5 between 2005 and 2013). Significant decreases in trends preceded federal payment reform initiatives in all but postoperative hip fracture. These findings suggest that intense public discourses targeting patient safety may drive national policy reforms.
AHRQ-funded; HS018558.
Citation: Tedesco D, Moghavem N, Weng Y .
Improvement in patient safety may precede policy changes: trends in patient safety indicators in the United States, 2000-2013.
J Patient Saf 2021 Jun 1;17(4):e327-e34. doi: 10.1097/pts.0000000000000615..
Keywords: Patient Safety, Quality Improvement, Quality Indicators (QIs), Quality Measures, Quality of Care, Policy
Vsevolozhskaya OA, Manz KC, Zephyr PM
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. In this article, the authors posit that some of this disconnect may be driven by frequent scoring updates.
AHRQ-funded; HS025148.
Citation: Vsevolozhskaya OA, Manz KC, Zephyr PM .
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
BMC Health Serv Res 2021 Feb 10;21(1):131. doi: 10.1186/s12913-021-06108-w..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Policy, Quality Improvement, Quality of Care, Patient Safety
Fashaw SA, Thomas KS, McCreedy E
Thirty-year trends in nursing home composition and quality since the passage of the Omnibus Reconciliation Act.
In 1987, the Omnibus Reconciliation Act (OBRA) called for a dramatic overhaul of the nursing home (NH) quality assurance system. This study examined trends in facility, resident, and quality characteristics since passage of that legislation. The investigators indicated that the 30th anniversary of OBRA provided a unique opportunity to reflect, consider lessons learned, and think about the future of this and other sectors of long-term care
AHRQ-funded; HS000011.
Citation: Fashaw SA, Thomas KS, McCreedy E .
Thirty-year trends in nursing home composition and quality since the passage of the Omnibus Reconciliation Act.
J Am Med Dir Assoc 2020 Feb;21(2):233-39. doi: 10.1016/j.jamda.2019.07.004..
Keywords: Nursing Homes, Quality of Care, Long-Term Care, Policy
Schlesinger MJ, Rybowski L, Shaller D
Americans' growing exposure to clinician quality information: insights and implications.
The authors of this article examined the impact of changes in the growth of consumer information seeking and the availability of patient narratives about care on consumer awareness of quality information and sociodemographic differences. Public exposure to quality information of any type doubled between 2010 and 2015, ad exposure to patient narratives and experience surveys tripled. Minority consumers were better informed than whites consistently over this period, although there were differences across subgroups regarding the types of information encountered. An education-related gradient in quality awareness also emerged. The authors conclude that public policy should respond to these emerging trends in information exposure by establishing standards for rigorous elicitation of narratives and assisting consumer learning via a combination of narratives and quantified clinician quality metrics.
AHRQ-funded; HS016978; HS016980; HS021858.
Citation: Schlesinger MJ, Rybowski L, Shaller D .
Americans' growing exposure to clinician quality information: insights and implications.
Health Aff 2019 Mar;38(3):374-82. doi: 10.1377/hlthaff.2018.05006..
Keywords: Policy, Provider Performance, Public Reporting, Quality of Care, Quality Measures
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Alderwick H, Shortell SM, Briggs ADM
Can accountable care organisations really improve the English NHS? Lessons from the United States.
The authors summarize evidence on accountable care organizations in the US - including what they look like, their effect on the quality and cost of healthcare, and how they are redesigning care. Recognizing major differences in context, they offer lessons from the US experience for National Health Service policy makers as they consider the future of similar ventures in England.
AHRQ-funded; HS022241; HS024075.
Citation: Alderwick H, Shortell SM, Briggs ADM .
Can accountable care organisations really improve the English NHS? Lessons from the United States.
BMJ 2018 Mar 2;360:k921. doi: 10.1136/bmj.k921.
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Keywords: Healthcare Costs, Quality of Care, Health Services Research (HSR), Policy
Ahluwalia SC, Damberg CL, Silverman M
What defines a high-performing health care delivery system: a systematic review.
A systematic review was conducted to determine if there is a commonly used, agreed-on definition of what constitutes a "high-performing" health care delivery system. No consistent definition of a high-performing health care system or organization was identified. High performance was variably defined across different dimensions, including quality (93 percent of articles), cost (67 percent), access (35 percent), equity (26 percent), patient experience (21 percent), and patient safety (18 percent).
AHRQ-funded; HS024067.
Citation: Ahluwalia SC, Damberg CL, Silverman M .
What defines a high-performing health care delivery system: a systematic review.
Jt Comm J Qual Patient Saf 2017 Sep;43(9):450-59. doi: 10.1016/j.jcjq.2017.03.010.
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Keywords: Healthcare Delivery, Quality of Care, Policy, Quality Measures
Cole MB, Galarraga O, Wilson IB
At federally funded health centers, Medicaid expansion was associated with improved quality of care.
In 2014 many uninsured, low-income nonelderly adults gained access to health insurance in states that expanded Medicaid eligibility under the Affordable Care Act. The researchers used a difference-in-differences approach to compare changes among 1,057 such centers in expansion versus nonexpansion States. Medicaid expansion was associated with improved quality for asthma treatment, Pap testing, body mass index assessment, and hypertension control.
AHRQ-funded; HS024652.
Citation: Cole MB, Galarraga O, Wilson IB .
At federally funded health centers, Medicaid expansion was associated with improved quality of care.
Health Aff 2017 Jan;36(1):40-48. doi: 10.1377/hlthaff.2016.0804.
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Keywords: Quality of Care, Policy, Uninsured, Low-Income, Access to Care
Christensen AL, Petersen DM, Burton RA
What factors influence states' capacity to report children's health care quality measures? A multiple-case study.
The objective of this study was to describe factors that influence the ability of state Medicaid agencies to report the Centers for Medicare & Medicaid Services' (CMS) core set of children's health care quality measures . Reporting capacity was influenced by a state's Medicaid data availability, ability to link to other state data systems, past experience with quality measurement, staff time and technical expertise, and demand for the measures.
AHRQ-funded; 290200900019I; 29032004T.
Citation: Christensen AL, Petersen DM, Burton RA .
What factors influence states' capacity to report children's health care quality measures? A multiple-case study.
Matern Child Health J 2017 Jan;21(1):187-98. doi: 10.1007/s10995-016-2108-8.
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Keywords: Quality Measures, Quality of Care, Children's Health Insurance Program (CHIP), Children/Adolescents, Medicaid, Health Insurance, Policy, Case Study
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
AHRQ-authored.
Citation: Kronick R, Casalino LP, Bindman AB .
Apple pickers or federal judges: strong versus weak incentives in physician payment.
Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
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Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
AHRQ-funded
Citation: Berenson RA, Rice T .
Beyond measurement and reward: methods of motivating quality improvement and accountability.
Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
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Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Payment
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
AHRQ-funded.
Citation: Schlesinger M, Grob R, Shaller D .
Using patient-reported information to improve clinical practice.
Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
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Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Payment, Public Reporting
Schulz J, DeCamp M, Berkowitz SA
Medicare Shared Savings Program: public reporting and shared savings distributions.
The objectives of this paper are to determine if Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) are meeting public reporting requirements related to shared savings plans, to quantitate the composition of shared savings distribution plans, and to investigate whether early ACO success is associated with specific plan or ACO characteristics. The authors found that just over one-half of MSSP ACOs report detailed shared savings distribution plans online, and these plans vary widely. They concluded that there appears to be no single shared savings distribution plan determinate of ACO success.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz SA .
Medicare Shared Savings Program: public reporting and shared savings distributions.
Am J Manag Care 2015 Aug;21(8):546-53.
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Keywords: Quality of Care, Payment, Policy, Medicare, Public Reporting
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Shared Decision Making, Policy, Quality Improvement, Quality of Care
Mukamel DB, Haeder SF, Weimer DL
Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.
The authors reviewed the extant literature on regulation and report cards. They found evidence of both functional and dysfunctional effects and identified the areas in which additional research would most likely be valuable.
AHRQ-funded; HS021844.
Citation: Mukamel DB, Haeder SF, Weimer DL .
Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.
Annu Rev Public Health 2014;35:477-97. doi: 10.1146/annurev-publhealth-082313-115826.
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Keywords: Quality of Care, Policy, Policy, Public Reporting
Kronick R, McKinney M
AHRQ Author: Kronick R
Ready to provide evidence for ‘making adjustments’ in Obamacare.
In this interview with Modern Healthcare, Richard Kronick, director of the Agency for Healthcare Research and Quality (AHRQ), states that his main objective for AHRQ is to produce evidence to improve the quality, safety, accessibility, and affordability of health care. He discusses several AHRQ programs and places them in the context of changes in the healthcare system triggered by Affordable Care Act.
AHRQ-authored
Citation: Kronick R, McKinney M .
Ready to provide evidence for ‘making adjustments’ in Obamacare.
Mod Healthc. 2014 Jan 6;44(1):28-9..
Keywords: Healthcare Costs, Quality of Care, Policy, Patient Safety
Kachalia A, Little A, Isavoran M
Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by physicians.
The Oregon Health Authority analyzed the potential for safe harbors to improve patient safety and the performance of the medical liability system, as well as legal challenges and stakeholder concerns that might arise with legislation enacting safe harbors. They found that such legislation would have changed the liability outcome in favor of the physician defendant in only 1 percent of 266 claims from the period 2002–09 that were reviewed.
AHRQ-funded; HS019535.
Citation: Kachalia A, Little A, Isavoran M .
Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by physicians.
Health Aff 2014 Jan;33(1):59-66. doi: 10.1377/hlthaff.2013.0834..
Keywords: Patient Safety, Medical Liability, Medical Errors, Quality of Care, Policy
Conway PH, Mostashari F, Clancy CM
AHRQ Author: Clancy CM
The future of quality measurement for improvement and accountability.
The authors describe the characteristics of the quality measurement enterprise of the future, outline a potential roadmap for the transition, and identify a set of opportunities for public- and private-sector collaboration.
AHRQ-authored.
Citation: Conway PH, Mostashari F, Clancy CM .
The future of quality measurement for improvement and accountability.
JAMA 2013 Jun 5;309(21):2215-6. doi: 10.1001/jama.2013.4929.
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Keywords: Healthcare Delivery, Policy, Organizational Change, Quality Indicators (QIs), Quality Measures, Quality of Care
Clancy CM, Moy E
AHRQ Author: Clancy CM, Moy E
Commentary: measuring what matters most.
The authors discuss a Milbank Quarterly best practices article by Frank and Haw and how it relates to AHRQ's National Healthcare Disparities Report, concluding that helping policymakers glean the information they most need from an overload of data noise will improve the chances that critical disparities can be recognized, targeted, and eliminated.
AHRQ-authored.
Citation: Clancy CM, Moy E .
Commentary: measuring what matters most.
Milbank Q 2013 Mar;91(1):201-4. doi: 10.1111/milq.12008.
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Keywords: Disparities, Quality of Care, Health Status, Policy, Social Determinants of Health