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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.
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1 to 7 of 7 Research Studies DisplayedJiang S, Mathias PC, Hendrix N
Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis.
This paper describes a cost-effectiveness model that was constructed to assess the clinical and economic value of a clinical decision support (CDS) alert program that provides pharmacogenomic (PGx) testing results compared to no alert program in acute coronary syndrome (ACS) and atrial fibrillation (AF) from a health system perspective. The authors projected that 20% of 500,000 health-system members between the ages of 55 and 65 received PGx testing for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) annually. Clinical events, costs, and quality-adjusted life years (QALYs) were calculated for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) testing outcomes annually. Clinical events, costs, and quality-adjusted life years (QALYs) over 20 years were calculated with an annual discount rate of 3%. A total of 3169 alerts would be fired. The CDS alert program was predicted to help avoid 16 major clinical events and 6 deaths for ACS; and 2 clinical events and 0.9 deaths for AF. The incremental cost-effectiveness ratio was measured as $39,477/QALY, which would make the alert program cost-effective.
AHRQ-funded; HS026544.
Citation: Jiang S, Mathias PC, Hendrix N .
Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis.
Pharmacogenomics J 2022 May;22(3):188-97. doi: 10.1038/s41397-022-00275-7..
Keywords: Clinical Decision Support (CDS), Healthcare Costs, Health Systems, Health Information Technology (HIT)
Chhabra KR, Sheetz KH, Regenbogen SE
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Researchers sought to measure the extent of variation in episode spending around total hip replacement for fee-for-service Medicare patients within and across hospital systems identified in the American Hospital Association Annual Survey. They found that average episode payments varied nearly as much within hospital systems as they did between the lowest- and highest-cost quintiles of systems, with variation driven by post-acute care utilization.
AHRQ-funded; HS000053.
Citation: Chhabra KR, Sheetz KH, Regenbogen SE .
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Ann Surg 2021 Dec 1;274(6):e1078-e84. doi: 10.1097/sla.0000000000003741..
Keywords: Surgery, Health Systems, Medicare, Healthcare Costs, Hospitals
Diaz A, Chhabra KR, Dimick JB
Variations in surgical spending within hospital systems for complex cancer surgery.
Researchers sought to measure variations in episode spending within and across hospital systems among Medicare beneficiaries undergoing complex cancer surgery. They found wide variations in surgical episode spending both within and across hospital systems. They recommended that system leaders seek better understanding of variations in practices among their hospitals to standardize care and reduce variations in outcomes, use, and costs.
AHRQ-funded; HS024763.
Citation: Diaz A, Chhabra KR, Dimick JB .
Variations in surgical spending within hospital systems for complex cancer surgery.
Cancer 2021 Feb 15;127(4):586-97. doi: 10.1002/cncr.33299..
Keywords: Surgery, Cancer, Healthcare Costs, Health Systems, Hospitals
Machta RM, Reschovsky J, Jones DJ
AHRQ Author: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ .
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Health Systems, Hospitals, Orthopedics, Healthcare Costs, Payment, Quality of Care
Funk RJ, Owen-Smith J, Kaufman SA
Association of informal clinical integration of physicians with cardiac surgery payments.
This study examined how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. It found that when beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0 percent) and postacute care services (5.8 percent).
AHRQ-funded; HS024728.
Citation: Funk RJ, Owen-Smith J, Kaufman SA .
Association of informal clinical integration of physicians with cardiac surgery payments.
JAMA Surg 2018 May;153(5):446-53. doi: 10.1001/jamasurg.2017.5150.
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Keywords: Healthcare Costs, Payment, Health Systems, Surgery
Henke RM, Karaca Z, Moore B
AHRQ Author: Karaca Z, Wong HS
Impact of health system affiliation on hospital resource use intensity and quality of care.
This study assessed the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality. It found that hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge.
AHRQ-authored.
Citation: Henke RM, Karaca Z, Moore B .
Impact of health system affiliation on hospital resource use intensity and quality of care.
Health Serv Res 2018 Feb;53(1):63-86. doi: 10.1111/1475-6773.12631..
Keywords: Healthcare Costs, Quality of Care, Health Systems, Healthcare Cost and Utilization Project (HCUP), Hospitals
Peiris D, Phipps-Taylor MC, Stachowski CA
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
The researchers examined differences between commercial accountable care organizations (ACOs) and noncommercial ACOs. They found that among all ACOs, there was low uptake of quality and efficiency activities; commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods; and about two-thirds of the ACOs had established processes for distributing any savings accrued. They concluded that ACO delivery systems remain at a nascent stage.
AHRQ-funded; HS024075.
Citation: Peiris D, Phipps-Taylor MC, Stachowski CA .
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
Health Aff 2016 Oct;35(10):1849-56. doi: 10.1377/hlthaff.2016.0387.
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Keywords: Healthcare Costs, Payment, Health Systems, Medicaid, Medicare