National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (37)
- Adverse Drug Events (ADE) (1)
- Adverse Events (1)
- Alcohol Use (2)
- Ambulatory Care and Surgery (4)
- Asthma (3)
- Autism (1)
- Behavioral Health (28)
- Blood Pressure (3)
- Cancer (10)
- Cancer: Breast Cancer (2)
- Cancer: Colorectal Cancer (4)
- Cancer: Lung Cancer (1)
- Cardiovascular Conditions (2)
- Care Coordination (4)
- Caregiving (3)
- Care Management (2)
- Case Study (4)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (52)
- Chronic Conditions (16)
- Clinician-Patient Communication (2)
- Colonoscopy (1)
- Communication (2)
- Community-Based Practice (12)
- Community Partnerships (2)
- Comparative Effectiveness (3)
- COVID-19 (9)
- Critical Care (1)
- Cultural Competence (5)
- Dental and Oral Health (2)
- Depression (6)
- Diabetes (5)
- Diagnostic Safety and Quality (4)
- Disabilities (18)
- Disparities (20)
- Domestic Violence (5)
- Education (1)
- Education: Patient and Caregiver (2)
- Elderly (13)
- Electronic Health Records (EHRs) (12)
- Electronic Prescribing (E-Prescribing) (1)
- Emergency Department (11)
- Emergency Medical Services (EMS) (2)
- Evidence-Based Practice (7)
- Family Health and History (4)
- Healthcare Cost and Utilization Project (HCUP) (5)
- Healthcare Costs (7)
- Healthcare Delivery (13)
- Healthcare Utilization (10)
- Health Information Exchange (HIE) (2)
- Health Information Technology (HIT) (16)
- Health Insurance (9)
- Health Literacy (4)
- Health Promotion (4)
- Health Services Research (HSR) (3)
- Health Status (5)
- Hepatitis (3)
- Home Healthcare (2)
- Hospital Discharge (3)
- Hospitalization (3)
- Hospital Readmissions (4)
- Hospitals (3)
- Human Immunodeficiency Virus (HIV) (14)
- Imaging (3)
- Implementation (2)
- Infectious Diseases (3)
- Inpatient Care (1)
- Labor and Delivery (1)
- Lifestyle Changes (3)
- Long-Term Care (1)
- Low-Income (31)
- Maternal Care (2)
- Medicaid (16)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (8)
- Medication (19)
- Medication: Safety (1)
- Mortality (2)
- Newborns/Infants (3)
- Nursing (1)
- Nursing Homes (3)
- Nutrition (11)
- Obesity (5)
- Obesity: Weight Management (1)
- Opioids (4)
- Organizational Change (1)
- Outcomes (4)
- Patient-Centered Healthcare (15)
- Patient-Centered Outcomes Research (6)
- Patient Adherence/Compliance (6)
- Patient and Family Engagement (4)
- Patient Experience (10)
- Patient Safety (4)
- Patient Self-Management (5)
- Payment (5)
- Policy (15)
- Practice Improvement (1)
- Practice Patterns (3)
- Pregnancy (3)
- Prevention (12)
- Primary Care (15)
- Primary Care: Models of Care (2)
- Provider (1)
- Provider: Clinician (1)
- Provider: Health Personnel (1)
- Provider: Nurse (2)
- Provider: Physician (1)
- Provider Performance (3)
- Public Health (10)
- Public Reporting (1)
- Quality Improvement (2)
- Quality Indicators (QIs) (1)
- Quality Measures (2)
- Quality of Care (9)
- Quality of Life (2)
- Racial and Ethnic Minorities (30)
- Research Methodologies (1)
- Respiratory Conditions (5)
- Risk (5)
- Rural/Inner-City Residents (3)
- Rural Health (7)
- Screening (17)
- Sex Factors (1)
- Sexual Health (4)
- Shared Decision Making (8)
- Sickle Cell Disease (1)
- Sleep Problems (1)
- Social Determinants of Health (32)
- Social Stigma (6)
- Stress (2)
- Substance Abuse (13)
- Surgery (2)
- Teams (1)
- Telehealth (9)
- Tobacco Use (4)
- Training (1)
- Transitions of Care (1)
- Trauma (1)
- Treatments (1)
- U.S. Preventive Services Task Force (USPSTF) (1)
- Uninsured (9)
- Urban Health (14)
- Vaccination (5)
- (-) Vulnerable Populations (231)
- Web-Based (1)
- Women (12)
- Workflow (1)
- Workforce (1)
- Young Adults (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 231 Research Studies DisplayedSequeira GM, Asante PG, Bocek K
Evaluating an electronic consultation platform to support pediatric primary care providers in caring for transgender and nonbinary adolescents.
An electronic consultation (e-consult) platform was introduced to conduct a study to aid pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. A study assessed its impact on PCP confidence and referral patterns. Results showed increased confidence and a 19% decrease in specialty referrals among PCPs. The platform received positive usability feedback, suggesting its potential to enhance care access and reduce specialty referrals for TNB adolescents.
AHRQ-funded; HS026393.
Citation: Sequeira GM, Asante PG, Bocek K .
Evaluating an electronic consultation platform to support pediatric primary care providers in caring for transgender and nonbinary adolescents.
Telemed J E Health 2024 Feb; 30(2):595-600. doi: 10.1089/tmj.2023.0266.
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Primary Care, Vulnerable Populations
Engelberg RS, Scheidell JD, Islam N
Associations between incarceration history and risk of hypertension and hyperglycemia: consideration of differences among Black, Hispanic, Asian and White Subgroups.
This study’s objective was to assess racial/ethnic group differences in the association between incarceration and hypertension and hyperglycemia. The authors performed a secondary data analysis using the National Longitudinal Survey of Adolescent to Adult Health (Add Health). They used Poisson regression to estimate the associations between lifetime history of incarceration reported during early adulthood with hypertension and hyperglycemia outcomes measured in mid-adulthood, including incident diagnosis. They evaluated whether associations varied by self-reported race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, and Asian) with an analytic sample of 4,015 Add Health respondents. Outcome measures included hypertension, systolic blood pressure >130 mmHG, and hyperglycemia. There was no evidence of an association between incarceration and measured health outcomes among non-Hispanic Black and non-Hispanic White participants. Among Hispanic participants, incarceration was associated with hyperglycemia (Adjusted Risk Ratio (ARR): 2.1), but not with hypertension risk. Incarceration was associated with elevated systolic blood pressure (ARR: 3.1) and hypertension (ARR: 1.7) among Asian participants, but not with hyperglycemia risk. Incarceration was associated with incident hypertension (ARR 2.5) among Asian subgroups.
AHRQ-funded; HS026120.
Citation: Engelberg RS, Scheidell JD, Islam N .
Associations between incarceration history and risk of hypertension and hyperglycemia: consideration of differences among Black, Hispanic, Asian and White Subgroups.
J Gen Intern Med 2024 Jan; 39(1):5-12. doi: 10.1007/s11606-023-08327-9..
Keywords: Vulnerable Populations, Racial and Ethnic Minorities, Blood Pressure, Cardiovascular Conditions, Risk
Zamalin D, Hamlin Shults, J J
Predictors of making a referral to child protective services prior to expert consultation.
This study investigated factors affecting child protective services (CPS) referrals before consultation by a Child Abuse Pediatrician (CAP) for suspected cases of physical abuse in children under 5 years old. Analysis revealed that despite the CAP expressing low concern for abuse in 38% of cases, 61% received preconsultation referrals. Socioeconomic biases, particularly evident in referral rates based on insurance status, were found to influence referral decisions.
AHRQ-funded; HS028847.
Citation: Zamalin D, Hamlin Shults, J J .
Predictors of making a referral to child protective services prior to expert consultation.
Acad Pediatr 2024 Jan-Feb; 24(1):78-86. doi: 10.1016/j.acap.2023.05.002..
Keywords: Children/Adolescents, Domestic Violence, Vulnerable Populations
Wurcel AG, Guardado R, Grussing ED
Racial differences in testing for infectious diseases: an analysis of jail intake data.
This analysis examines HIV and hepatitis C virus (HCV) testing in Middlesex House of Corrections (MHOC) in Massachusetts. Only 38% of incarcerated individuals who requested testing received it. Black non-Hispanic and Hispanic individuals were more likely to request and complete testing compared to white individuals. These disparities may reflect broader issues of access to care. The study highlights the need for improved testing completion rates and interdisciplinary collaboration in jails.
AHRQ-funded; HS026008.
Citation: Wurcel AG, Guardado R, Grussing ED .
Racial differences in testing for infectious diseases: an analysis of jail intake data.
PLoS One 2023 Dec 20; 18(12):e0288254. doi: 10.1371/journal.pone.0288254.
Keywords: Hepatitis, Human Immunodeficiency Virus (HIV), Racial and Ethnic Minorities, Vulnerable Populations
Rains A, Sibley AL, Levander XA
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
This study explored how people who use drugs in rural counties across the United States appraise sex work by themselves or other community members. The authors used qualitative interview data that came from the Rural Opioid Initiative (ROI), a project coordinated by research teams across 65 rural counties in 10 states. These interviews were individual and conducted from 2018 to 2020, with all participants reporting past 30-day opioid use and/or any injection drug use. Across sites, 355 interviews were conducted with a mean participant age of 36, 55% male, and 93% white. Negative attitudes were expressed towards sex work as a function of its criminal-legal repercussions or was framed as morally transgressive. Many appraisals were gendered, with the behavior described as being “easier” for women who were often described as "whores," with more neutral terms used to describe men. Some participants viewed sex work as an implicit “exchange” for drugs.
AHRQ-funded; HS026370.
Citation: Rains A, Sibley AL, Levander XA .
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
Int J Drug Policy 2023 Dec; 122:104237. doi: 10.1016/j.drugpo.2023.104237..
Keywords: Rural Health, Vulnerable Populations, Substance Abuse, Behavioral Health
Squires A, Gerchow L, Ma C
A multi-language qualitative study of limited English proficiency patient experiences in the United States.
The objective of this study was to understand the experience of limited English proficiency patients with health care services in an urban setting. Individuals who spoke either Spanish, Russian, Cantonese, Mandarin, or Korean shared their experiences through semi-structured interviews. A major theme that emerged throughout all interviews was a sense that the language barrier with clinicians posed a threat to safety when receiving healthcare. Participants also identified factors they felt would improve their sense of security specific to clinician interactions. The authors concluded that these findings highlight ongoing challenges that spoken language barriers pose at multiple points of care in the US health care system.
AHRQ-funded; HS023593.
Citation: Squires A, Gerchow L, Ma C .
A multi-language qualitative study of limited English proficiency patient experiences in the United States.
PEC Innov 2023 Dec; 2:100177. doi: 10.1016/j.pecinn.2023.100177..
Keywords: Patient Experience, Disparities, Vulnerable Populations
Mistry KB, Chesley FD, Chin MH
AHRQ Author: Msitry KB, Chesley FD, Valdez RB
Advancing health equity-Agency for Healthcare Research and Quality research and action agenda.
This article described the agenda-building process developed by a multistakeholder Health Equity Summit held by AHRQ; AHRQ invited summaries of the state of evidence in order to provide input for an equity research agenda in five action domains which could drive more equitable care. This commentary also described the Research and Action Health Equity Framework used by Summit participants to explore the action domains and highlighted key cross-cutting themes that emerged from the five domain papers.
AHRQ-authored.
Citation: Mistry KB, Chesley FD, Chin MH .
Advancing health equity-Agency for Healthcare Research and Quality research and action agenda.
Health Serv Res 2023 Dec; 58(suppl 3):275-80. doi: 10.1111/1475-6773.14230..
Keywords: Vulnerable Populations
Engelberg R, Hood Q, Shah K
Challenges unique to transgender persons in US correctional settings: a scoping review.
The authors conducted a literature review on challenges unique to transgender individuals within US correctional settings. Themes that emerged revealed challenges in key domains of violence, health, healthcare access, housing, and a pervasive culture of transphobia. Legal analyses supported policy changes such as case-by-case housing classification systems, gender-affirming care, and safeguarding gender expression.
AHRQ-funded; HS026120.
Citation: Engelberg R, Hood Q, Shah K .
Challenges unique to transgender persons in US correctional settings: a scoping review.
J Urban Health 2023 Dec; 100(6):1170-89. doi: 10.1007/s11524-023-00794-z..
Keywords: Vulnerable Populations
James TG, Sullivan MK, McKee MM
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
The objectives of this qualitative study were to describe emergency department (ED) care-seeking and patient-centered care perspectives among deaf and hard-of-hearing (DHH) patients and to explain quantitative findings related to ED outcomes among DHH and non-DHH patients. Researchers conducted semi-structured interviews with four DHH American Sign Language (ASL)-users and six DHH English speakers from north central Florida. Two themes emerged: DHH patients engage in complex decisionmaking processes to determine ED utilization and patient-centered ED care differs between DHH ASL-users and English speakers. The researchers concluded that their study underscores the importance of better understanding and intervention in DHH patient ED care seeking and delivery to improve patient outcomes.
AHRQ-funded; HS027537.
Citation: James TG, Sullivan MK, McKee MM .
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
Health Expect 2023 Dec; 26(6):2374-86. doi: 10.1111/hex.13842..
Keywords: Emergency Department, Patient-Centered Healthcare, Disabilities, Vulnerable Populations
Grove LR, Berkowitz SA, Cuddeback G
Permanent supportive housing receipt and health care use among adults with disabilities.
This study’s objective was to assess whether permanent supportive housing (PSH) participation is associated with health service use among a population of adults with disabilities, including people transitioning into PSH from community and institutional settings. Primary data sources used were 2014 to 2018 secondary data from a PSH program in North Carolina linked to Medicaid claims. The authors used propensity score weighting to estimate the average treatment effect on the treated of PSH participation. Using weighted analysis, they found that among individuals who were institutionalized prior to PSH, PSH participation was associated with greater hospitalizations and emergency department (ED) visits and fewer primary care visits during the follow-up period, compared with similar individuals who largely remained institutionalized. There was no significantly different health service use from similar comparison group members for individuals who entered PSH from community settings during the 12-month follow-up period.
AHRQ-funded; HS000032.
Citation: Grove LR, Berkowitz SA, Cuddeback G .
Permanent supportive housing receipt and health care use among adults with disabilities.
Med Care Res Rev 2023 Dec; 80(6):596-607. doi: 10.1177/10775587231183192..
Keywords: Disabilities, Vulnerable Populations, Access to Care
Frank M, Loh R, Everhart R
No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system.
This retrospective cohort study of persons released from correctional facilities examined healthcare utilization by merging records from Denver Health (DH), an urban safety-net healthcare system, and the Colorado Department of Corrections (CDOC), for people released from January 1 to June 30, 2021. The study population was either 1) released to the Denver metro area (Denver and its five neighboring counties); or (2 assigned to the DH Regional Accountable Entity; or (3 assigned to the DH medical home based on Colorado Department of Healthcare Policy and Financing attribution methods. From January to June 2021 3242 people were released from CDOC and 2848 were included in the data exchange. 905 individuals of the total 2848 were released to the Denver metro area or attributed to DH. In the study population over three-fourths (78.1%) had a chronic medical or psychological condition. Within the first 6 months of release, 31.1% utilized any health service, 24.5% utilized at least one outpatient service, and 17.1% utilized outpatient services two or more times. Within the first 30 days of release 10.1% utilized outpatient services.
AHRQ-funded; HS027389.
Citation: Frank M, Loh R, Everhart R .
No health without access: using a retrospective cohort to model a care continuum for people released from prison at an urban, safety net health system.
Health Justice 2023 Nov 18; 11(1):49. doi: 10.1186/s40352-023-00248-3..
Keywords: Access to Care, Vulnerable Populations, Urban Health, Rural/Inner-City Residents
Hua Y, Wang L, Nguyen V
A deep learning approach for transgender and gender diverse patient identification in electronic health records.
The research described in this article used transgender and gender diverse (TGD) populations as a case study to build an accurate patient gender identity predictive, deep learning model; the goal was to address challenges in identifying relevant patient-level information from electronic health record (EHR) data. Participants were adult patients in a large healthcare system in Boston, MA. The deep learning model significantly outperformed rule-based algorithms. The researchers concluded that future work should evaluate additional diverse data sources for more generalizable algorithms.
AHRQ-funded; HS028916.
Citation: Hua Y, Wang L, Nguyen V .
A deep learning approach for transgender and gender diverse patient identification in electronic health records.
J Biomed Inform 2023 Nov; 147:104507. doi: 10.1016/j.jbi.2023.104507..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations
Vasan A, Kyle MA, Venkataramani AS
Inequities in time spent coordinating care for children and youth with special health care needs.
The purpose of this cross-sectional study was to examine sociodemographic inequities in time spent coordinating care for children and youth with special health care needs (CYSHCN) and examine the relationship between time spent coordinating care and forgone medical care. The study utilized 2018-2020 data from the National Survey of Children's Health, which included 102,740 children across all 50 states. The researchers characterized the time spent coordinating care for children with less complex special health care needs (SHCN) (managed through medications) and more complex SHCN (resulting in functional limitations or requiring specialized therapies). Race-, ethnicity-, income-, and insurance-based differences in time spent coordinating care among CYSHCN were examined, and multivariable logistic regression was utilized to explore the relationship between time spent coordinating care and forgone medical care. The study found that over 40% of caregivers of children with more complex SHCN reported spending time coordinating their children's care each week. CYSHCN whose caregivers spent 5 hours per week or more on care coordination were disproportionately Hispanic, low-income, and publicly insured or uninsured. Increased time spent coordinating care was related with an increasing probability of forgone medical care.
AHRQ-funded; HS028555.
Citation: Vasan A, Kyle MA, Venkataramani AS .
Inequities in time spent coordinating care for children and youth with special health care needs.
Acad Pediatr 2023 Nov-Dec; 23(8):1526-34. doi: 10.1016/j.acap.2023.03.002..
Keywords: Children/Adolescents, Care Coordination, Vulnerable Populations, Disparities
Heintzman J, Springer R, Marino M
Latino adolescent-mother language concordance, neighborhood deprivation, and vaccinations in community health centers.
Researchers examined the association between adolescent-mother language concordance and neighborhood social deprivation with adolescent vaccination completion in order to understand social/family factors related to Latino adolescent vaccination. They used a multistate, EHR-based dataset of community health center patients to compare three Latino groups; their sample included over 56,000 adolescent-mother dyads. Their findings indicated that English-preferring adolescents with Spanish-preferring mothers had the highest completion rates. The researchers concluded that future studies could attempt to understand what advantage this language dyad may have in adolescent vaccination completion.
AHRQ-funded; HS025962.
Citation: Heintzman J, Springer R, Marino M .
Latino adolescent-mother language concordance, neighborhood deprivation, and vaccinations in community health centers.
Matern Child Health J 2023 Nov; 27(11):2026-37. doi: 10.1007/s10995-023-03742-0..
Keywords: Racial and Ethnic Minorities, Community-Based Practice, Vaccination, Children/Adolescents, Vulnerable Populations, Social Determinants of Health
Plummer N, Guardado R, Ngassa Y
Racial differences in self-report of mental illness and mental illness treatment in the community: an analysis of jail intake data.
This cross-sectional study evaluated the frequency of racial/ethnic differences in the self-report of mental illness and psychiatric medication use at jail entry. The authors used data from the "Offender Management System," the administrative database used by the jail containing data on people who are incarcerated, and COREMR, the electronic medical record (EMR) used in the Middlesex Jail & House of Correction, located in Billerica, MA. They evaluated two primary outcomes: (1) self-reported mental illness history and (2) self-reported use of psychiatric medication, with the primary indicator of interest as race/ethnicity. At intake over half (57%) in the sample self-reported a history of mental illness, with 20% reporting the use of psychiatric medications. Among people who self-reported a history of mental illness, non-White inmates all had decreased odds of reporting psychiatric medication. Only 20% reported receiving medications in the community prior to incarceration.
AHRQ-funded; HS026008.
Citation: Plummer N, Guardado R, Ngassa Y .
Racial differences in self-report of mental illness and mental illness treatment in the community: an analysis of jail intake data.
Adm Policy Ment Health 2023 Nov; 50(6):966-75. doi: 10.1007/s10488-023-01297-4..
Keywords: Racial and Ethnic Minorities, Behavioral Health, Vulnerable Populations
Beck AF, Wymer L, Pinzer E
Reduced prevalence of childhood asthma after housing renovations in an underresourced community.
This study’s goal as to determine whether housing renovations affect the prevalence of asthma in an underresourced community. Between 2010 and 2012, the Fay Apartments (~800 units) in Cincinnati, Ohio, were renovated to "green building" standards and renamed the Villages at Roll Hill. Asthma prevalence among 7-year-olds was determined by accessing Ohio Medicaid data for the years 2013 to 2021. Average prevalence of asthma among 7-year-olds averaged 12.7% in the first 6 years after the renovations (2013-2018). But in postrenovation years 7-9 (2019-221), average prevalence of asthma had dropped to 5.9%.
AHRQ-funded; HS027996.
Citation: Beck AF, Wymer L, Pinzer E .
Reduced prevalence of childhood asthma after housing renovations in an underresourced community.
J Allergy Clin Immunol Glob 2023 Nov; 2(4):1-4. doi: 10.1016/j.jacig.2023.100143..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Vulnerable Populations, Social Determinants of Health
Routh D, Simmons R, Sanders J
Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review.
The purpose of this study was to conduct a systematic review of policy and practice recommendations to improve contraceptive care to reproductive-aged, incarcerated individuals in the US. The researchers used the Joanna Briggs Institute methodology, framed within the National Implementation Research Network's (NIRN) Exploration stage. Sources included MedLine, ProQuest, PSYCInfo, PubMed, SCOPUS, Social Science Citation Index, and Web of Science, as well as the reference sections of included materials. A total of 45 materials met the inclusion criteria. The researchers identified seven themes: 1. policy changes needed for care implementation; 2. the need for contraceptive care in carceral systems; 3. Barriers from justice agencies regarding the provision of contraceptive care; 4. policy barriers to access to contraceptives; 5. funding strategies to improve care; 6. patient preferences for contraceptive care delivery; and 7. healthcare provider knowledge about contraceptive care. The seven themes highlighted the need for contraceptive care provision to incarcerated individuals, as well as gaps, barriers, and facilitators of current contraceptive care provision for this population.
AHRQ-funded; HS027220.
Citation: Routh D, Simmons R, Sanders J .
Building an implementation framework to address unmet contraceptive care needs in a carceral setting: a systematic review.
Health Justice 2023 Oct 20; 11(1):43. doi: 10.1186/s40352-023-00243-8..
Keywords: Sexual Health, Vulnerable Populations
Ryus CR, Janke AT, Kunnath N
Association of hospital discharge against medical advice and coded housing instability in the US.
This study examined the relationship between discharge type and housing instability, then identified primary reasons for hospitalization among self-discharged patients with housing instability. This cross-sectional, retrospective study analyzed the National Inpatient Sample between January 2017 and December 2019, available from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project. Among 85,402,831 hospitalizations analyzed, 1.6% resulted in self-discharge. Compared to admissions with planned discharges, self-discharges were more likely to have coded housing instability. Among hospitalizations resulting in self-discharge, admissions with coded housing instability were more likely to result in self-discharge than those without coded housing instability. Relationships between housing instability and self-discharges were found among major medical conditions: septicemia, acute myocardial infarction, and respiratory failure. Alcohol-related disorders and opioid-related disorders were among the highest self-discharge volumes, but relationships were minimal.
AHRQ-funded; HS028963.
Citation: Ryus CR, Janke AT, Kunnath N .
Association of hospital discharge against medical advice and coded housing instability in the US.
J Gen Intern Med 2023 Oct; 38(13):3082-85. doi: 10.1007/s11606-023-08240-1..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Social Determinants of Health, Vulnerable Populations, Hospital Readmissions
Smith K, Padmanabhan P, Chen A
The impacts of the 340B Program on health care quality for low-income patients.
This study’s objective was to assess the effects of hospital 340B eligibility on quality of inpatient care provided to Medicaid and uninsured patients and for all patients. HCUP State Inpatient Data, Hospital Cost Reporting Information System Data, Office of Pharmacy Affairs Information System Data, and the American Hospital Association Annual Survey were all used to extract inpatient data from general acute care hospitals from 2008 to 2014 in 15 states. Data was linked on hospital 340B eligibility and participation. The authors did not find discontinuities in inpatient care quality across the Program eligibility threshold for Medicaid and uninsured patients; specifically, on all-cause mortality, 30-day readmission rates, or other measures. Among insured and non-Medicaid patients, they found discontinuities for acute myocardial infarction and postoperative sepsis mortality.
AHRQ-funded; HS026980.
Citation: Smith K, Padmanabhan P, Chen A .
The impacts of the 340B Program on health care quality for low-income patients.
Health Serv Res 2023 Oct; 58(5):1089-97. doi: 10.1111/1475-6773.14204..
Keywords: Low-Income, Hospitals, Vulnerable Populations, Medicaid, Uninsured, Inpatient Care, Quality of Care
Anderson AJ, Noyes K, Hewner S
Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge.
This report discussed the challenges for implementing cross-sector collaboration (CSC). A recuperative care collaborative in Buffalo, NY, provided care transition support at an acute care hospital discharge via a medical respite program for people who had experienced homelessness. Using the Expert Recommendations for Implementing Change (ERIC) framework and feedback from the cross-sector collaborative team, implementation strategies were derived from three validated ERIC implementation strategy clusters: development of stakeholder relationships, use of evaluative and iterative strategies, and changes to infrastructure. The authors concluded that future research would address external organizational influences and emphasize CSC as central to interventions.
AHRQ-funded; HS028000.
Citation: Anderson AJ, Noyes K, Hewner S .
Expanding the evidence for cross-sector collaboration in implementation science: creating a collaborative, cross-sector, interagency, multidisciplinary team to serve patients experiencing homelessness and medical complexity at hospital discharge.
Front Health Serv 2023 Sep 8; 3:1124054. doi: 10.3389/frhs.2023.1124054..
Keywords: Hospital Discharge, Chronic Conditions, Vulnerable Populations, Care Coordination, Transitions of Care
Hughes PM, Carda-Auten J, DiRosa EA
"You can get a couple of ramen noodle packs for a Buspar(Ⓡ)": a qualitative examination of medication access, policy, and procedures in southern jails.
Over10 million people are being incarcerated every year in the US, and jails are required to provide health care to them, a substantial percentage of whom require medications. However, not much is known about the medication prescription, acquisition, and administration process for incarcerated persons in jails. The purpose of this study was to characterize access to medication and related medication policies and procedures in jails. The researchers administered semi-structured interviews with administrators and health workers from 34 jails (of 125 contacted) across 5 states in the southeastern US. The qualitative interview guide encompassed all facets of healthcare in jails from entry to release, but the current study focused only on medications. The study found that 4 processes characterized medication utilization from intake to release: 1) jail entry and health screening, 2) pharmacy and medication protocols, 3) protocols specific to medication dispensing and administration, and 4) medications upon release. Many jails had processes for utilizing medications brought to the jail from home, although some jails did not agree to use those medications. Researchers discovered that contracted healthcare providers were the primary medication decision-makers in jails, and most medications were obtained from contract pharmacies. The study also found almost all jails banned narcotics, but other medication restrictions varied by jail. Most jails charged a copay for medications. Study participants shared a variety of privacy practices related to the distribution of medication, as well as approaches to the prevention of diversion of medications away from intended recipients and into the prison population. Transition planning for pre-release medication management processes ranged from no planning to sending additional prescriptions to the patient's pharmacy.
AHRQ-funded; HS000032.
Citation: Hughes PM, Carda-Auten J, DiRosa EA .
"You can get a couple of ramen noodle packs for a Buspar(Ⓡ)": a qualitative examination of medication access, policy, and procedures in southern jails.
Res Social Adm Pharm 2023 Sep; 19(9):1298-306. doi: 10.1016/j.sapharm.2023.05.013..
Keywords: Medication, Vulnerable Populations, Access to Care
Heerman WJ, Sneed NM, Sommer EC
Ultra-processed food consumption and BMI-Z among children at risk for obesity from low-income households.
The purpose of this study was to assess the relationship between baseline ultra-processed food consumption in early childhood and child BMI Z-score over 36 months. Among 595 children, median baseline age was 4.3 years, 65.4% had normal weight, 33.8% were overweight, and 0.8% were obese. When compared with low ultra-processed consumption (300 kcals/day), High ultra-processed intake (1300 kcals/day) was related with a 1.2 higher BMI-Z at 36 months for 3-year-olds and a 0.6 higher BMI-Z for 4-year-olds. The difference was not statistically significant for 5-year-olds or overall.
AHRQ-funded; HS026122.
Citation: Heerman WJ, Sneed NM, Sommer EC .
Ultra-processed food consumption and BMI-Z among children at risk for obesity from low-income households.
Pediatr Obes 2023 Aug; 18(8):e13037. doi: 10.1111/ijpo.13037..
Keywords: Children/Adolescents, Obesity, Low-Income, Nutrition, Vulnerable Populations
Borah 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
Diaz C, Ortiz V, Sanchez L
Harmful by design-a qualitative study of the health impacts of immigration detention.
This study examined how the US immigration detention system impacts health from the perspective of people who were recently detained by Immigrations and Customs Enforcement (ICE). This qualitative study used anonymous, semi-structured phone interviews in English and Spanish with adults who had been detained at least 30 days in the New York City metropolitan area within the previous 2 years. They interviewed 16 participants of whom 13 identified as male; five as lesbian, gay, bisexual, or queer; and four as Black; coming from nine different countries. Participants had spent a median of 20 years in the US, and had spent a median of 11 months in immigration detention. Four themes emerged from the author’s analysis: (1) poor conditions and inhumane treatment, (2) a pervasive sense of injustice, (3) structural barriers limiting access to care, and (4) negative health impacts of immigration detention.
AHRQ-funded; HS026396.
Citation: Diaz C, Ortiz V, Sanchez L .
Harmful by design-a qualitative study of the health impacts of immigration detention.
J Gen Intern Med 2023 Jul; 38(9):2030-37. doi: 10.1007/s11606-022-07914-6..
Keywords: Vulnerable Populations, Health Status
Sun CJ, Doran KM, Sevelius JM
A qualitative examination of tobacco use and smoking cessation among gender minority adults.
Researchers conducted qualitative, semi-structured in-depth interviews to identify and examine factors that influence tobacco use and cessation for gender minority adults. Participants were recruited from the Portland, OR metropolitan area. The researchers then used a conceptual framework based on the Model of Gender Affirmation and Gender Minority Stress Model. Four main themes were generated: general and gender minority-specific stressors; social behavior influenced and sustained by community and interpersonal relationships; health concerns; and conducive life circumstances. Participants expressed a strong desire for gender minority-specific tobacco cessation programs. The researchers concluded that interventions are urgently needed for this population and should be tailored to address the unique factors that impact tobacco use and cessation among gender minority people to increase the possibility of success.
AHRQ-funded; HS022981.
Citation: Sun CJ, Doran KM, Sevelius JM .
A qualitative examination of tobacco use and smoking cessation among gender minority adults.
Ann Behav Med 2023 Jun 30; 57(7):530-40. doi: 10.1093/abm/kaac072..
Keywords: Tobacco Use, Vulnerable Populations