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 15 of 15 Research Studies DisplayedBorah L, Zebib L, Sanders HM
State restrictions and geographic access to gender-affirming care for transgender youth.
This research letter described a study that estimated changes in geographic access and drive times to gender clinics after 20 states enacted legislation to restrict puberty-suppressing medications and hormones for those under the age of 18. Access to appropriate medical and social services for transgender youths was associated with mental health benefits and decreased levels of suicidality.
AHRQ-funded; HS028748.
Citation: Borah L, Zebib L, Sanders HM .
State restrictions and geographic access to gender-affirming care for transgender youth.
JAMA 2023 Jul 25; 330(4):375-78. doi: 10.1001/jama.2023.11299..
Keywords: Children/Adolescents, Vulnerable Populations, Access to Care, Policy
Mackie TI, Schaefer AJ, Palatucci JS
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
The purpose of this sequential multi-method study was to propose a classification for the procedural elements of informed consent policies based upon existing child welfare policies and then explored whether formal state policies across the United States authorized these elements. The researchers conducted interviews with 58 key informants primarily from state child welfare agencies to identify a classification of procedural elements for informed consent of psychotropic medications. A legislative review of the 50 states and D.C. was then conducted to characterize whether formal policies endorsed each procedural element. Key informants reported five procedural elements in policy, and 23 states endorsed relevant legislation. Only two states specified all five procedural elements, and the content of any procedural elements varied considerably across policies.
AHRQ-funded; HS02198501; HS026001
Citation: Mackie TI, Schaefer AJ, Palatucci JS .
The role of formal policy to promote informed consent of psychotropic medications for youth in child welfare custody: a national examination.
Adm Policy Ment Health 2022 Nov;49(6):986-1003. doi: 10.1007/s10488-022-01212-3..
Keywords: Children/Adolescents, Vulnerable Populations, Medication, Behavioral Health, Policy
Leifheit KM, Schwartz GL, Pollack CE
Building health equity through housing policies: critical reflections and future directions for research.
This article provides a series of recommendations to help build health equity through housing policies. The authors recommend more justice- and action-oriented research to help address current levels of housing insecurity that are the result of clear and inequitable policy choices, leading to the entrenchment of health inequities-particularly, across race and class.
AHRQ-funded; HS000046.
Citation: Leifheit KM, Schwartz GL, Pollack CE .
Building health equity through housing policies: critical reflections and future directions for research.
J Epidemiol Community Health 2022 Aug;76(8):759-63. doi: 10.1136/jech-2021-216439.
Keywords: Social Determinants of Health, Vulnerable Populations, Policy
Myong C, Hull P, Price M
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
This retrospective study examined the impact of funding for federally qualified health centers (FQHCs) on utilization and emergency department (ED) visits in Massachusetts. The authors theorized that greater funding for FQHCs could increase the local availability of clinic-based care and reduce more costly resource use, such as ED visits. Data from the Massachusetts All Payer Claims Database (APCD) 2010-2013 was used that included enrollees in 559 Massachusetts ZIP codes (2010 numbers 6,173,563). They calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year. They found that a standard deviation increase in prior year FQHC funding (31%) was associated with a 2.3% increase in enrollees with FQHC visits and a 1.3% decrease in enrollees at EDs. However, there were no significant changes in emergent ED visit rates.
AHRQ-funded; HS025378.
Citation: Myong C, Hull P, Price M .
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
PLoS One 2020 Dec 3;15(12):e0243279. doi: 10.1371/journal.pone.0243279..
Keywords: Community-Based Practice, Healthcare Utilization, Emergency Department, Healthcare Costs, Access to Care, Vulnerable Populations, Policy
Ornelas IJ, Yamanis TJ, Ruiz RA
The health of undocumented Latinx immigrants: what we know and future directions.
This review article summarizes the limited but growing literature on the health of undocumented Latinx immigrations and how exposure to trauma, immigration enforcement, changes to social networks, and discrimination negatively affect their mental and physical health. The authors discuss how policies and social ties can promote their health. They focus on areas of concern and recommend how future research should be conducted.
AHRQ-funded; HS013853.
Citation: Ornelas IJ, Yamanis TJ, Ruiz RA .
The health of undocumented Latinx immigrants: what we know and future directions.
Annu Rev Public Health 2020 Apr 2;41:289-308. doi: 10.1146/annurev-publhealth-040119-094211..
Keywords: Racial and Ethnic Minorities, Vulnerable Populations, Social Determinants of Health, Policy
Keohane LM, Trivedi A, Mor V
States with medically needy pathways: differences in long-term and temporary Medicaid entry for low-income Medicare beneficiaries.
Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs. However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with an increase in the probability of switching to partial Medicaid and an increase in the probability of exiting Medicaid within 12 months. Alternative strategies for protecting low-income Medicare beneficiaries' access to care could provide more stable coverage.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi A, Mor V .
States with medically needy pathways: differences in long-term and temporary Medicaid entry for low-income Medicare beneficiaries.
Med Care Res Rev 2019 Dec;76(6):711-35. doi: 10.1177/1077558717737152..
Keywords: Vulnerable Populations, Low-Income, Medicaid, Medicare, Policy
Kemmick Pintor J, Call KT
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Investigators sought to measure differences in insurance by mother's documentation status among a nationally representative sample of US-born children in immigrant families and to examine the role of state-level immigrant access to prenatal coverage. They found that, in states with nonrestrictive prenatal coverage for immigrants, there were no differences in children's insurance by mother's documentation status, while large inequities were observed within states with restrictive policies.
AHRQ-funded; HS021973.
Citation: Kemmick Pintor J, Call KT .
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Glob Pediatr Health 2019 Sep 26;6:2333794x19873535. doi: 10.1177/2333794x19873535..
Keywords: Policy, Health Insurance, Children/Adolescents, Access to Care, Vulnerable Populations, Disparities
Chatterjee P, Qi M, Coe NB
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
The authors sought to determine whether patterns of skilled nursing facility (SNF) discharge are associated with the change in Medicare payment responsibility on day 20. They found that Medicare beneficiaries were more often discharged from SNFs on benefit day 20 than on benefit days 19 or 21. Those discharged on day 20 were more likely to be racial/ethnic minorities and to live in areas of lower socioeconomic status compared with those discharged before or after day 20. Their findings suggested an association between disproportionately high SNF discharge rates of vulnerable patients and existing Medicare payment policies. The authors recommended that payment policies be designed with consideration of the potential for such unintended consequences, and that any potential consequences be mitigated by balancing existing payment structures with incentives to provide optimal patient care.
AHRQ-funded; HS024266.
Citation: Chatterjee P, Qi M, Coe NB .
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
JAMA Intern Med 2019 Sep;179(9):1296-98. doi: 10.1001/jamainternmed.2019.1209.
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Keywords: Vulnerable Populations, Nursing Homes, Medicare, Payment, Policy, Social Determinants of Health
Gordon SH, Sommers BD, Wilson I
The impact of Medicaid expansion on continuous enrollment: a two-state analysis.
Researchers assessed the impact of Medicaid expansion under the Affordable Care Act on continuity of Medicaid coverage among those enrolled prior to expansion. Comparing Colorado to Utah, they found that, following Medicaid expansion, enrollees in Colorado gained an additional 2 months of coverage over two years of follow-up and were 16 percentage points less likely to experience a coverage disruption in a given year relative to enrollees in Utah. They concluded that increasing Medicaid eligibility levels appeared to be an effective strategy with important implications for other states that are considering Medicaid expansion.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson I .
The impact of Medicaid expansion on continuous enrollment: a two-state analysis.
J Gen Intern Med 2019 Sep;34(9):1919-24. doi: 10.1007/s11606-019-05101-8..
Keywords: Medicaid, Health Insurance, Policy, Access to Care, Vulnerable Populations
Roberts ET, Hayley Welsh J, Donohue JM
Association of state policies with Medicaid disenrollment among low-income Medicare beneficiaries.
This study examined the role that state policies play in Medicaid disenrollment among low-income Medicare beneficiaries. Medicaid disenrollment among fee-for-service Medicare beneficiaries was examined for the period 2012-2016. During that period, 18.2% of beneficiaries disenrolled for reasons other than death. Disenrollment was 24% lower in states that automatically enrolled recipients of the Supplemental Security Income program in full Medicaid, 33% lower in states with more generous provider payment policies, and 37% lower in states with less restrictive asset limits for partial Medicaid.
AHRQ-funded; HS026727.
Citation: Roberts ET, Hayley Welsh J, Donohue JM .
Association of state policies with Medicaid disenrollment among low-income Medicare beneficiaries.
Health Aff 2019 Jul;38(7):1153-62. doi: 10.1377/hlthaff.2018.05165..
Keywords: Medicare, Medicaid, Low-Income, Policy, Vulnerable Populations
Wisk LE, Levy S, Weitzman ER
Parental views on state cannabis laws and marijuana use for their medically vulnerable children.
Given a rapidly changing policy landscape, the investigators sought to characterize the effects of state marijuana laws on parents' views of marijuana use by their teenage children. The investigators found that among parents of medically vulnerable children, perceiving state marijuana policies as more permissive was strongly associated with lower perceived riskiness of marijuana use for their children.
AHRQ-funded; HS022986.
Citation: Wisk LE, Levy S, Weitzman ER .
Parental views on state cannabis laws and marijuana use for their medically vulnerable children.
Drug Alcohol Depend 2019 Jun 1;199:59-67. doi: 10.1016/j.drugalcdep.2018.12.027..
Keywords: Children/Adolescents, Policy, Vulnerable Populations, Chronic Conditions, Substance Abuse
Anderson VR, Ouyang F, Tu W
Medicaid coverage and continuity for juvenile justice-involved youth.
This retrospective cohort study examined Medicaid coverage and continuity for youth with varying levels of justice system involvement and the impact of a policy change allowing Medicaid suspension, rather than termination. The study highlighted the importance of maximizing opportunities to keep youth enrolled, as gaps in coverage likely affect juveniles' access to physical, mental, and behavioral health care.
AHRQ-funded; HS022681.
Citation: Anderson VR, Ouyang F, Tu W .
Medicaid coverage and continuity for juvenile justice-involved youth.
J Correct Health Care 2019 Jan;25(1):45-54. doi: 10.1177/1078345818820043..
Keywords: Access to Care, Children/Adolescents, Medicaid, Policy, Vulnerable Populations
Cohen MS, Schpero WL
Household immigration status had differential impact on Medicaid enrollment in expansion and nonexpansion states.
This study identified households that likely included undocumented immigrants and then examined whether gains in health care coverage due to the expansion of Medicaid eligibility under the Affordable Care Act (ACA) were dampened for eligible people living in households with mixed immigration status. It found that coverage gains were significantly lower for people in mixed-status households relative to those in non-mixed-status households in nonexpansion states.
AHRQ-funded; HS017589.
Citation: Cohen MS, Schpero WL .
Household immigration status had differential impact on Medicaid enrollment in expansion and nonexpansion states.
Health Aff 2018 Mar;37(3):394-402. doi: 10.1377/hlthaff.2017.0978.
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Keywords: Health Insurance, Policy, Medicaid, Racial and Ethnic Minorities, Vulnerable Populations
Colla CH, Lewis VA, Kao LS
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
The purpose of this cohort study was to examine the effect of Medicare accountable care organization (ACO) contracts on both spending and high-cost institutional utilization for all Medicare beneficiaries and for clinically vulnerable beneficiaries. The main outcomes and measures for this study were total spending per beneficiary-quarter, spending categories, utilization of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. The study found that total spending decreased by $34 per beneficiary-quarter after implementation of ACO contracts across the overall Medicare population and decreased $114 in clinically vulnerable patients. In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively. Hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively. Variations in total spending related with ACOs did not differ by clinical condition of beneficiaries.
AHRQ-funded; HS024075.
Citation: Colla CH, Lewis VA, Kao LS .
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
JAMA Intern Med 2016 Aug;176(8):1167-75. doi: 10.1001/jamainternmed.2016.2827.
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Keywords: Medicare, Policy, Healthcare Costs, Payment, Vulnerable Populations
Whittle HJ, Palar K, Hufstedler LL
Food insecurity, chronic illness, and gentrification in the San Francisco Bay Area: an example of structural violence in United States public policy.
This study sought to explore the experiences and structural determinants of food insecurity among a group of low-income PLHIV in the San Francisco Bay Area. It found that the lived experience of food insecurity among participants included periods of insufficient quantity of food and resultant hunger, as well as long-term struggles with quality of food that led to concerns about the poor health effects of a cheap diet.
AHRQ-funded; HS000046.
Citation: Whittle HJ, Palar K, Hufstedler LL .
Food insecurity, chronic illness, and gentrification in the San Francisco Bay Area: an example of structural violence in United States public policy.
Soc Sci Med 2015 Oct;143:154-61. doi: 10.1016/j.socscimed.2015.08.027..
Keywords: Chronic Conditions, Policy, Social Determinants of Health, Nutrition, Vulnerable Populations