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
76 to 100 of 171 Research Studies DisplayedKeenan PS, Jacobs PD, Miller GE
AHRQ Author: Kennan PS, Jacobs PD, Miller GE
Despite coverage gains, one-third of people in small-firm low-income families were uninsured in 2014-15.
Using data from the Medical Expenditure Panel Survey, the investigators examined health insurance coverage for workers at small firms and the self-employed and found that the overall uninsurance rate for these workers and their families declined by 5 percentage points over the past decade, but one-third of those with lower incomes remained uninsured in 2014-15.
AHRQ-authored.
Citation: Keenan PS, Jacobs PD, Miller GE .
Despite coverage gains, one-third of people in small-firm low-income families were uninsured in 2014-15.
Health Aff 2018 Oct;37(10):1673-77. doi: 10.1377/hlthaff.2018.0479..
Keywords: Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS), Uninsured
Schnall R, Cho H, Mangone A
Mobile health technology for improving symptom management in low income persons living with HIV.
This study aimed to examine the impact of an mHealth application (app), comprised of evidence-based self-care strategies, on the symptom experience of persons living with HIV (PLWH). In this 12-week trial, an mHealth app, mobile Video Information Provider (mVIP), was associated with improved symptom burden and increased medication adherence in PLWH.
AHRQ-funded; HS023963.
Citation: Schnall R, Cho H, Mangone A .
Mobile health technology for improving symptom management in low income persons living with HIV.
AIDS Behav 2018 Oct;22(10):3373-83. doi: 10.1007/s10461-017-2014-0..
Keywords: Chronic Conditions, Health Information Technology (HIT), Human Immunodeficiency Virus (HIV), Low-Income, Vulnerable Populations
Sen AP, Chen LM, Wong Samson L
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
The purpose of this study was to examine performance by accountable care organizations (ACOs) in the top quintile of their proportion of beneficiaries who were dually enrolled in Medicare and Medicaid (high-dual), and the top quintile of disabled beneficiaries (high-disabled). Measures used were quality scores, savings per beneficiary, whether or not the ACO shared savings and the amount of shared savings. The researchers found that high-dual and high-disabled ACOs had similar or higher spending than other ACOs at baseline, but achieved greater savings and were equally or more likely to earn shared savings; alternative payment models can have positive financial outcomes for providers serving vulnerable populations.
AHRQ-funded; HS024698.
Citation: Sen AP, Chen LM, Wong Samson L .
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
Med Care 2018 Sep;56(9):805-11. doi: 10.1097/mlr.0000000000000968..
Keywords: Disabilities, Medicare, Healthcare Costs, Provider Performance, Payment, Low-Income, Vulnerable Populations
Wong MS, Roberts ET, Arnold CM
HUD housing assistance and levels of physical activity among low-income adults.
The objective of this study was to assess whether participation in HUD housing assistance programs was associated with increased physical activity among low-income adults. The investigators found that receiving HUD housing assistance was associated with being physically active among nonsenior low-income adults.
AHRQ-funded; HS000029.
Citation: Wong MS, Roberts ET, Arnold CM .
HUD housing assistance and levels of physical activity among low-income adults.
Prev Chronic Dis 2018 Jul 19;15:E94. doi: 10.5888/pcd15.170517..
Keywords: Lifestyle Changes, Low-Income, Vulnerable Populations
Gorski Findling MT, Wolfson JA, Rimm EB
Differences in the neighborhood retail food environment and obesity among US children and adolescents by SNAP participation.
The authors sought to understand the association between children's neighborhood food access and overweight/obesity in a national sample of US households, and whether this association differs by Supplemental Nutrition Assistance Program (SNAP) participation or household purchases. Using data from the National Household Food Acquisition and Purchase Survey, 2012-2013, they found that the odds of childhood overweight/obesity were higher with greater access to combination grocery/other stores overall and for children in SNAP. Eligible non-SNAP children had higher odds of overweight/obesity with greater access to convenience stores. The average child lived in a household with 6.3% of total spending at food outlets on sugary beverages. They concluded that greater neighborhood access to combination grocery/other stores is associated with higher obesity prevalence for children overall and those in SNAP.
AHRQ-funded; HS000055.
Citation: Gorski Findling MT, Wolfson JA, Rimm EB .
Differences in the neighborhood retail food environment and obesity among US children and adolescents by SNAP participation.
Obesity 2018 Jun;26(6):1063-71. doi: 10.1002/oby.22184.
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Keywords: Children/Adolescents, Low-Income, Nutrition, Obesity, Social Determinants of Health
Goodman SM, Mandi LA, Mehta B
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
The authors assessed the interaction between education and poverty on 2-year Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function. They found that having no college was associated with worse pain and function at baseline and 2 years and that living in a poor neighborhood was associated with worse 2-year pain and function. There was a strong interaction between individual education and community poverty with WOMAC scores at 2 years. Patients without college living in poor communities had pain scores that were ~10 points worse than those with some college; in wealthy communities, college was associated with a 1-point difference in pain. Function was similar. The authors recommended further study on how education protects those in impoverished communities.
AHRQ-funded; HS016075.
Citation: Goodman SM, Mandi LA, Mehta B .
Does education level mitigate the effect of poverty on total knee arthroplasty outcomes?
Arthritis Care Res 2018 Jun;70(6):884-91. doi: 10.1002/acr.23442..
Keywords: Arthritis, Education, Low-Income, Orthopedics, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Cheng TL, Mistry KB, Wang G
AHRQ Author: Mistry KB
Folate nutrition status in mothers of the Boston birth cohort, sample of a US urban low-income population.
Researchers examined maternal folic acid supplementation and plasma folate concentrations in the Boston Birth Cohort, a predominantly urban, low-income, minority population. Their findings indicated that fewer than 5 percent of mothers in the Boston Birth Cohort started folic acid supplements before pregnancy, and approximately one third of mothers had either too low or too high plasma folate levels.
AHRQ-authored.
Citation: Cheng TL, Mistry KB, Wang G .
Folate nutrition status in mothers of the Boston birth cohort, sample of a US urban low-income population.
Am J Public Health 2018 Jun;108(6):799-807. doi: 10.2105/ajph.2018.304355.
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Keywords: Nutrition, Maternal Care, Low-Income, Urban Health, Rural/Inner-City Residents
Fiechtner L, Perkins M, Biggs V
Rationale and design of the Clinic and Community Approaches to Healthy Weight Randomized Trial.
Recent studies have demonstrated the effectiveness of family-centered, pediatric weight management programs in reducing childhood obesity. Yet, programs to optimize the care of low-income children with obesity are needed. The investigators sought to examine the comparative effectiveness of two, potentially scalable pediatric weight management programs delivered to low-income children in a clinical or community setting.
AHRQ-funded; HS024332; HS022986.
Citation: Fiechtner L, Perkins M, Biggs V .
Rationale and design of the Clinic and Community Approaches to Healthy Weight Randomized Trial.
Contemp Clin Trials 2018 Apr;67:16-22. doi: 10.1016/j.cct.2018.01.002..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Low-Income, Vulnerable Populations, Nutrition, Patient-Centered Healthcare, Family Health and History, Evidence-Based Practice, Comparative Effectiveness
Han B, Cohen DA, Derose KP
Violent crime and park use in low-income urban neighborhoods.
This study aimed to assess the association between crime rates and use of local parks in low-income urban neighborhoods. The study concluded that gun-related violent crimes have relatively long-term negative associations with population health by reducing utilization of outdoor park space.
AHRQ-funded; HS000046.
Citation: Han B, Cohen DA, Derose KP .
Violent crime and park use in low-income urban neighborhoods.
Am J Prev Med 2018 Mar;54(3):352-58. doi: 10.1016/j.amepre.2017.10.025..
Keywords: Low-Income, Urban Health
Cardet JC, Louisias M, King TS
Income is an independent risk factor for worse asthma outcomes.
The authors investigated whether low income, low education, and high perceived stress were independent risk factors for treatment failure and asthma exacerbations in the context of a randomized controlled trial. They found that participants with lower income were more likely to experience adverse asthma outcomes independent of education, perceived stress, race, and medication adherence.
AHRQ-funded; HS022986.
Citation: Cardet JC, Louisias M, King TS .
Income is an independent risk factor for worse asthma outcomes.
J Allergy Clin Immunol 2018 Feb;141(2):754-60.e3. doi: 10.1016/j.jaci.2017.04.036..
Keywords: Asthma, Chronic Conditions, Low-Income, Outcomes, Patient-Centered Outcomes Research, Risk, Social Determinants of Health
Davis MM, Freeman M, Shannon J
A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States - how, what and when?
Researchers conducted this systematic review to determine how implementation strategies and contextual factors influenced the uptake of interventions to increase fecal testing for colorectal cancer in rural and low-income populations. They found that provision of kits through the mail, use of pre-addressed stamped envelopes, client reminders and in-clinic distribution appeared most frequently in the highly effective/effective clinic-based study arms. Few studies described contextual factors or implementation strategies.
AHRQ-funded; HS022981.
Citation: Davis MM, Freeman M, Shannon J .
A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States - how, what and when?
BMC Cancer 2018 Jan 6;18(1):40. doi: 10.1186/s12885-017-3813-4.
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Keywords: Cancer: Colorectal Cancer, Health Promotion, Low-Income, Rural Health, Screening
Akwo EA, Kabagambe EK, Harrell FE, Jr.
Neighborhood deprivation predicts heart failure risk in a low-income population of blacks and whites in the southeastern United States.
The researchers investigated whether neighborhood deprivation predicts risk of incident heart failure (HF) beyond individual socioeconomic status in a low-income population. They concluded that, in a low-income population from the Southern Community Cohort Study, scant neighborhood resources compounded the risk of HF above and beyond individual socioeconomic status and traditional cardiovascular risk factors.
AHRQ-funded; HS022990.
Citation: Akwo EA, Kabagambe EK, Harrell FE, Jr. .
Neighborhood deprivation predicts heart failure risk in a low-income population of blacks and whites in the southeastern United States.
Circ Cardiovasc Qual Outcomes 2018 Jan;11(1):e004052. doi: 10.1161/circoutcomes.117.004052.
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Keywords: Heart Disease and Health, Low-Income, Racial and Ethnic Minorities, Risk, Social Determinants of Health
Goff SL, Mazor KM, Guhn-Knight H
Factors that matter to low-income and racial/ethnic minority mothers when choosing a pediatric practice: a mixed methods analysis.
The authors sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice. They found that pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics.
AHRQ-funded; HS021864.
Citation: Goff SL, Mazor KM, Guhn-Knight H .
Factors that matter to low-income and racial/ethnic minority mothers when choosing a pediatric practice: a mixed methods analysis.
J Racial Ethn Health Disparities 2017 Dec;4(6):1051-60. doi: 10.1007/s40615-016-0309-x.
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Keywords: Access to Care, Quality of Care, Low-Income, Children/Adolescents, Racial and Ethnic Minorities
Selden TM, Lipton BJ, Decker SL
AHRQ Author: Selden TM, Lipton BJ, Decker SL
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
The researchers found that as of 2015, adults with incomes of 100-138 percent of the federal poverty level had experienced large declines in uninsurance rates in both expansion and nonexpansion states. Adults in expansion and nonexpansion states also experienced similar increases in having a usual source of care and primary care visits, and similar reductions in delayed receipt of medical care due to cost.
AHRQ-authored.
Citation: Selden TM, Lipton BJ, Decker SL .
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
Health Aff 2017 Dec;36(12):2069-77. doi: 10.1377/hlthaff.2017.0830.
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Keywords: Access to Care, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Tung EL, Cagney KA, Peek ME
Spatial context and health inequity: reconfiguring race, place, and poverty.
The authors build on the Chicago School of Sociology's contributions in urban research and one of its contemporary elaborations, often described as the "neighborhood effects approach," to propose a three-axis model of health inequity. This model, in alignment with Chicago School theory, postulates a dynamic and adaptive relationship between spatial context and health inequity. Compositional axes of race and poverty form the foundation of the model.
AHRQ-funded; HS023007.
Citation: Tung EL, Cagney KA, Peek ME .
Spatial context and health inequity: reconfiguring race, place, and poverty.
J Urban Health 2017 Dec;94(6):757-63. doi: 10.1007/s11524-017-0210-x.
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Keywords: Disparities, Low-Income, Racial and Ethnic Minorities, Social Determinants of Health, Urban Health
Magnusson DM, Minkovitz CS, Kuhlthau KA
AHRQ Author: Mistry KB
Beliefs regarding development and early intervention among low-income African American and Hispanic mothers.
This study sought to understand the role of health beliefs in shaping maternal decisions regarding help-seeking for children with developmental delay (DD) and explore differences between African American and Hispanic mothers. Five major themes emerged describing the role of maternal health beliefs in shaping key stages of the help-seeking pathway for children with DD. Differences between African American and Hispanic mothers are also described.
AHRQ-authored.
Citation: Magnusson DM, Minkovitz CS, Kuhlthau KA .
Beliefs regarding development and early intervention among low-income African American and Hispanic mothers.
Pediatrics 2017 Nov;140(5):pii: e20172059. doi: 10.1542/peds.2017-2059.
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Keywords: Children/Adolescents, Shared Decision Making, Disabilities, Low-Income, Racial and Ethnic Minorities
Lines LM, Rosen AB, Ash AS
Enhancing administrative data to predict emergency department utilization: the role of neighborhood sociodemographics.
Much of emergency department (ED) use is avoidable, and high-quality primary care can reduce it, but performance measures related to ED use may be inadequately risk-adjusted. To explore associations between ED use and neighborhood poverty, a secondary analysis of Massachusetts managed care network data, 2009-2011, was conducted.
AHRQ-funded; HS022194.
Citation: Lines LM, Rosen AB, Ash AS .
Enhancing administrative data to predict emergency department utilization: the role of neighborhood sociodemographics.
J Health Care Poor Underserved 2017;28(4):1487-508. doi: 10.1353/hpu.2017.0129..
Keywords: Emergency Department, Low-Income, Social Determinants of Health, Healthcare Utilization
Xavier Moore J, Donnelly JP, Griffin R
Community characteristics and regional variations in sepsis.
This study aimed to determine the influence of community characteristics upon regional variations in sepsis incidence and case fatality. The study concluded that regional variations in sepsis incidence may be partly explained by community poverty. Other community characteristics do not explain regional variations in sepsis incidence or case fatality.
AHRQ-funded; HS013852.
Citation: Xavier Moore J, Donnelly JP, Griffin R .
Community characteristics and regional variations in sepsis.
Int J Epidemiol 2017 Oct 1;46(5):1607-17. doi: 10.1093/ije/dyx099..
Keywords: Disparities, Low-Income, Mortality, Sepsis, Social Determinants of Health
Kangovi S, Mitra N, Grande D
Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial.
The researchers sought to determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions. They concluded that a standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems.
AHRQ-funded; HS021706.
Citation: Kangovi S, Mitra N, Grande D .
Community health worker support for disadvantaged patients with multiple chronic diseases: a randomized clinical trial.
Am J Public Health 2017 Oct;107(10):1660-67. doi: 10.2105/ajph.2017.303985.
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Keywords: Chronic Conditions, Community-Based Practice, Low-Income, Patient-Centered Outcomes Research
Louisias M, Phipatanakul W
Managing asthma in low-income, underrepresented minority, and other disadvantaged pediatric populations: closing the gap.
The authors review current understanding of the epidemiology and etiology of disparities in asthma. They also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors.
AHRQ-funded; HS022986.
Citation: Louisias M, Phipatanakul W .
Managing asthma in low-income, underrepresented minority, and other disadvantaged pediatric populations: closing the gap.
Curr Allergy Asthma Rep 2017 Sep 15;17(10):68. doi: 10.1007/s11882-017-0734-x.
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Keywords: Asthma, Children/Adolescents, Low-Income, Racial and Ethnic Minorities, Vulnerable Populations
Hudson JL, Moriya AS
AHRQ Author: Hudson JL, Moriya AS
Medicaid expansion for adults had measurable 'welcome mat' effects on their children.
This study used data from the 2013-15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children's coverage post Affordable Care Act (ACA). It estimated that 710,000 low-income children gained coverage through these effects. The study was also the first to show a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
Medicaid expansion for adults had measurable 'welcome mat' effects on their children.
Health Aff 2017 Sep;36(9):1643-51. doi: 10.1377/hlthaff.2017.0347.
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Keywords: Children/Adolescents, Health Insurance, Policy, Low-Income
Beckman AL, Herrin J, Nasir K
Trends in cardiovascular health of US adults by income, 2005-2014.
This research letter discusses the trends in cardiovascular health of US adults by income from 2005-2014. The investigators assessed national trends in cardiovascular risk factors by income level among adults aged 25 years and older using data from the National Health and Nutrition Examination Surveys, a nationally representative, multistage probability sample of the US population, across 5 periods: 2005 to 2006, 2007 to 2008, 2009 to 2010, 2011 to 2012, and 2013 to 2014.
AHRQ-funded; HS023000.
Citation: Beckman AL, Herrin J, Nasir K .
Trends in cardiovascular health of US adults by income, 2005-2014.
JAMA Cardiol 2017 Jul;2(7):814-16. doi: 10.1001/jamacardio.2017.1654..
Keywords: Cardiovascular Conditions, Risk, Disparities, Health Status, Blood Pressure, Obesity, Diabetes, Low-Income, Tobacco Use
Heintzman J, Bailey SR, DeVoe J
In low-income Latino patients, post-affordable care act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon.
This study compared the insurance status of low-income patients served in 23 community health centers (CHCs) in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion in 2014. It found that among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos.
AHRQ-funded; HS021522; HS024270.
Citation: Heintzman J, Bailey SR, DeVoe J .
In low-income Latino patients, post-affordable care act insurance disparities may be reduced even more than broader national estimates: evidence from Oregon.
J Racial Ethn Health Disparities 2017 Jun;4(3):329-36. doi: 10.1007/s40615-016-0232-1.
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Keywords: Disparities, Health Insurance, Policy, Low-Income, Racial and Ethnic Minorities
Sommers BD, Maylone B, Blendon RJ
Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.
Using survey data collected from low-income adults through the end of 2016 in three states: Kentucky, which expanded Medicaid; Arkansas, which expanded private insurance to low-income adults using the federal Marketplace; and Texas, which did not expand coverage, researchers found that by the end of 2016 the uninsurance rate in the two expansion states had dropped by more than 20 percentage points relative to the nonexpansion state.
AHRQ-funded; HS021291.
Citation: Sommers BD, Maylone B, Blendon RJ .
Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults.
Health Aff 2017 Jun;36(6):1119-28. doi: 10.1377/hlthaff.2017.0293.
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Keywords: Policy, Low-Income, Access to Care, Health Insurance, Uninsured
Decker SL, Lipton BJ, Sommers BD
AHRQ Author: Decker SL, Lipton BJ
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
The researchers used detailed federal survey data through 2015 to analyze recent changes in coverage for low-income adults after the expansion associated with the Affordable Care Act's (ACA's) Medicaid expansion in 2014. They found that the uninsurance rate fell in both expansion and nonexpansion states but that it fell significantly more in expansion states.
AHRQ-authored; AHRQ-funded; HS021291.
Citation: Decker SL, Lipton BJ, Sommers BD .
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
Health Aff 2017 May;36(5):819-25. doi: 10.1377/hlthaff.2016.1462.
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Keywords: Medicaid, Low-Income, Health Insurance, Uninsured, Policy