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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 5 of 5 Research Studies DisplayedKleinman LC, Howell EA
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
The researchers report that in the context of quality improvement research, risk adjustment (RA) methods can obscure disparities in health care. In this study the researchers address the impact of considering equity when conducting risk adjustments in pediatric health, and describe the danger of veiled justice, a type of overadjustment that takes place when risk adjustments obscure real disparities because more than one covariate, such as race and socioeconomic status, are on related causal paths. Underadjustment can occur when these same structural characteristics are not addressed when calculating models of payment. The purpose of this study was to describe the literature and present a conceptual framework that identifies these two problems for validity related to the interactions between risk adjustment and health equity in pediatric health care. The researchers conclude that the science of quality improvement must address issues of health equity as an essential construct, with the development of a specific conceptual model. Statistical analysis should be interpreted using the conceptual model, and the dynamics of child development and life course should also be addressed, as well as additional contextual and process factors such as the role of caregivers and public insurance, the epidemiology of the disease, family financial status, and others. The goal of RA is to make valid conclusions such that observed differences can be attributed to the relevant causes. When higher risk is attributed to social determinants and not disease differences, RA can obscure disparities (veiled injustice) and differences at the population level and experienced by individuals are falsely hidden. Not addressing these same structural characteristics when calculating models of payment can lead to patterns of underadjustment. The authors advise that these 2 sides of a similar coin reveal the critical importance of both the underlying model and the capacity to reliably evaluate disparities and quality.
AHRQ-funded; HS020518; 233201550088A.
Citation: Kleinman LC, Howell EA .
Equity and the hazard of veiled injustice: a methodological reflection on risk adjustment.
Pediatrics 2022 Mar;149(Suppl 3). doi: 10.1542/peds.2020-045948G.
Keywords: Children/Adolescents, Disparities, Racial and Ethnic Minorities, Risk
Javalkar K, Robson VK, Gaffney L
Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome.
Researchers characterized the socioeconomic and racial and/or ethnic disparities impacting the diagnosis and outcomes of multisystem inflammatory syndrome in children (MIS-C). They found that lower socioeconomic status or higher social vulnerability index, Hispanic ethnicity, and Black race independently increased risk for MIS-C. They recommended additional studies to target interventions to improve health equity for children.
AHRQ-funded; HS000063.
Citation: Javalkar K, Robson VK, Gaffney L .
Socioeconomic and racial and/or ethnic disparities in multisystem inflammatory syndrome.
Pediatrics 2021 May;147(5). doi: 10.1542/peds.2020-039933..
Keywords: Children/Adolescents, Social Determinants of Health, Disparities, Racial and Ethnic Minorities, Risk
Farmer C, Yehia BR, Fleishman JA
AHRQ Author: Fleishman JA
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network.
The researchers evaluated the clinical and demographic characteristics of non-perinatally HIV (nPHIV)-infected youth associated with retention in care 1 year after initiating care and in the 2 years thereafter. They concluded that patients who were Hispanic, were men who have sex with men, or were seen at pediatric clinics were more likely to be retained in care.
AHRQ-authored.
Citation: Farmer C, Yehia BR, Fleishman JA .
Factors associated with retention among non-perinatally HIV-infected youth in the HIV research network.
J Pediatric Infect Dis Soc 2016 Mar;5(1):39-46. doi: 10.1093/jpids/piu102.
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Keywords: Healthcare Delivery, Children/Adolescents, Human Immunodeficiency Virus (HIV), Risk, Racial and Ethnic Minorities
Rivera-Soto WT, Rodriguez-Figueroa L
Is waist-to-height ratio a better obesity risk-factor indicator for Puerto Rican children than is BMI or waist circumference?
This study aimed to explore the association of a single blood pressure reading with 3 different obesity indicators (WC, BMI, and WHtR). Its findings suggest the possibility of higher prevalence of high blood pressure in obese Puerto Rican children. The waist-to height ratio could be the best indicator to measure obesity and potential hypertension in Puerto Rican children.
AHRQ-funded; HS014060.
Citation: Rivera-Soto WT, Rodriguez-Figueroa L .
Is waist-to-height ratio a better obesity risk-factor indicator for Puerto Rican children than is BMI or waist circumference?
P R Health Sci J 2016 Mar;35(1):20-5.
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Keywords: Racial and Ethnic Minorities, Obesity, Children/Adolescents, Risk, Blood Pressure
Zamora-Kapoor A, Nelson L, Buchwald D
Maternal correlates of body mass index in American Indian/Alaska Native and white adolescents: differences between mother/son and mother/daughter pairs.
This study sough to determine the influence of maternal correlates on adolescent body mass index (BMI), and the extent to which the size and significance of these correlates vary by adolescent sex and race. Its findings suggest that maternal factors are critical in the transmission of obesogenic behaviors from one generation to the next, and their effects vary between mother/son and mother/daughter pairs, and are similar for AI/ANs and Whites.
AHRQ-funded; HS021686.
Citation: Zamora-Kapoor A, Nelson L, Buchwald D .
Maternal correlates of body mass index in American Indian/Alaska Native and white adolescents: differences between mother/son and mother/daughter pairs.
Eat Behav 2016 Jan;20:43-7. doi: 10.1016/j.eatbeh.2015.11.002..
Keywords: Children/Adolescents, Obesity, Racial and Ethnic Minorities, Risk, Social Determinants of Health