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 25 of 52 Research Studies DisplayedAmu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
King CA, Beetham T, Smith N
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
This study examined adolescent residential addiction treatment facilities in the United States, and their accessibility and cost. The authors used the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data to identify 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. They called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose to inquire about policies and costs. A little over half (54.5%) had a bed immediately available. The mean wait time for a bed was 28.4 days among sites with a waitlist. Of the facilities that provided cost information, the mean cost of treatment per day was $878, with daily costs among for-profit facilities triple of nonprofit facilities. Half of facilities required up-front payments by noninsured patients, with a mean up-front cost of $28,731. They were unable to identify any facilities for adolescents in ten states or Washington, D.C.
AHRQ-funded; HS017589.
Citation: King CA, Beetham T, Smith N .
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
Health Aff 2024 Jan; 43(1):64-71. doi: 10.1377/hlthaff.2023.00777..
Keywords: Children/Adolescents, Substance Abuse, Healthcare Costs, Access to Care
Adams DR
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
The goal of this study was to assess the availability of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. A comprehensive sample of Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) received a 5-minute survey approximately one year after the beginning of the COVID-19 pandemic. The response indicated that 10% of health centers had closed and 20% reported that they were not offering outpatient mental health services. Reported wait times were longer at CMHCs than FQHCs. The author concluded that these findings suggested that online directories such as the SAMHSA Treatment Locator are often inaccurate or out-of-date.
AHRQ-funded; HS000084.
Citation: Adams DR .
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
Community Ment Health J 2024 Jan; 60(1):88-97. doi: 10.1007/s10597-023-01127-9..
Keywords: Children/Adolescents, Behavioral Health, Access to Care, COVID-19, Public Health
Eliason EL, Agostino J, Vivier P
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
This cross-sectional study examined the impact that the COVID-19 pandemic had on infant health care, and broke it down by race and ethnicity, income, and insurance type. This study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. The authors found that among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. They found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments was also significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries.
AHRQ-funded; HS000011.
Citation: Eliason EL, Agostino J, Vivier P .
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
Acad Pediatr 2024 Jan-Feb; 24(1):105-10. doi: 10.1016/j.acap.2023.07.005..
Keywords: Newborns/Infants, Racial and Ethnic Minorities, COVID-19, Access to Care, Uninsured, Health Insurance, Healthcare Delivery
Cron DC, Braun HJ, Ascher NL
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
The objective of this study was to determine association of sex with access to liver transplantation among candidates with the highest possible model for end-stage liver disease score (MELD 40). Using national transplant registry data, researchers compared liver offer acceptance and waitlist outcomes by sex for waitlisted liver transplant candidates who reached MELD 40. Results showed that even among candidates with high disease severity and equally high MELD scores, women have reduced access to liver transplantation and worse outcomes compared with men. The researchers concluded that policies addressing this disparity should consider factors beyond MELD score adjustments.
AHRQ-funded; HS028476.
Citation: Cron DC, Braun HJ, Ascher NL .
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
Ann Surg 2024 Jan; 279(1):112-18. doi: 10.1097/sla.0000000000005933..
Keywords: Disparities, Access to Care, Sex Factors, Transplantation
Mitchell JM, Kranz AM, Steiner ED
Barriers and strategies used to continue school-based health services during the COVID-19 pandemic.
This study examined perceived barriers and strategies adopted to continue the delivery of school-based health services when schools reopened in Fall of 2021 during the COVID-19 pandemic and to assess whether these barriers and strategies varied by locality. The authors developed and subsequently conducted an online survey of school nurses who worked at the 1178 public elementary schools in Virginia in May 2021 to describe the impact of the COVID-19 pandemic on the delivery of school-based health services. They compared perceived barriers, strategies adopted and the effectiveness of strategies to continue the delivery of school-based health services by geographic locality (city vs. rural; suburban vs. rural and city vs. suburban). More than half of urban schools expected nine of ten potential barriers to affect the delivery of school-based health services during Fall 2021. More than half of responding schools located in urban, suburban, and rural areas indicated that external barriers outside of their control, including insufficient funding and families not able to bring students to school, were likely to be barriers to delivering care. There was no variation in strategies identified as “very effective” by locality.
AHRQ-funded; HS025430.
Citation: Mitchell JM, Kranz AM, Steiner ED .
Barriers and strategies used to continue school-based health services during the COVID-19 pandemic.
Matern Child Health J 2024 Jan; 28(1):155-64. doi: 10.1007/s10995-023-03824-z.
Keywords: COVID-19, Children/Adolescents, Access to Care
Jarman MP, Castillo RC
Rural risk: geographic disparities in trauma mortality.
The authors sought to quantify differences in injury mortality comparing rural and nonrural residents with traumatic injuries. They concluded that rural residents are significantly more likely than nonrural residents to die after traumatic injury, a disparity that varies by trauma center designation, injury severity, and US Census region.
AHRQ-funded; HS000029.
Citation: Jarman MP, Castillo RC .
Rural risk: geographic disparities in trauma mortality.
Surgery 2016 Dec;160(6):1551-59. doi: 10.1016/j.surg.2016.06.020.
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Keywords: Access to Care, Disparities, Emergency Medical Services (EMS), Healthcare Cost and Utilization Project (HCUP), Rural Health
Toomey SL, Elliott MN, Schwebel DC
Relationship between adolescent report of patient-centered care and of quality of primary care.
This study investigated whether adolescent self-report of patient-centered care (PCC) varied by patient characteristics and whether receipt of PCC is associated with measures of adolescent primary care quality. It found that adolescent-reported PCC positively correlates with measures of high-quality adolescent primary care. The study provides support for using adolescent-report of PCC as a measure of adolescent primary care quality.
AHRQ-funded; HS020513.
Citation: Toomey SL, Elliott MN, Schwebel DC .
Relationship between adolescent report of patient-centered care and of quality of primary care.
Acad Pediatr 2016 Nov - Dec;16(8):770-76. doi: 10.1016/j.acap.2016.01.006.
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Keywords: Children/Adolescents, Primary Care, Clinician-Patient Communication, Quality of Care, Access to Care
Kirby JB, Vistnes JP
AHRQ Author: Kirby JB, Vistnes JP
Access to care improved for people who gained Medicaid or marketplace coverage in 2014.
Newly available longitudinal survey data show that people who lacked health insurance in 2013 and gained coverage through Medicaid or the Marketplaces in 2014 were far more likely to obtain a usual source of care and receive preventive care services than their counterparts who remained uninsured in 2014.
AHRQ-authored.
Citation: Kirby JB, Vistnes JP .
Access to care improved for people who gained Medicaid or marketplace coverage in 2014.
Health Aff 2016 Oct 1;35(10):1830-34. doi: 10.1377/hlthaff.2016.0716.
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Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Medicaid, Health Insurance
Sommers BD, Blendon RJ, Orav EJ
Changes in utilization and health among low-income adults after Medicaid expansion or expanded private insurance.
The researchers assessed changes in access to care, utilization, and self-reported health among low-income adults in 3 states taking alternative approaches to the ACA. They concluded that in the second year of expansion, Kentucky's Medicaid program and Arkansas's private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health.
AHRQ-funded; HS021291.
Citation: Sommers BD, Blendon RJ, Orav EJ .
Changes in utilization and health among low-income adults after Medicaid expansion or expanded private insurance.
JAMA Intern Med 2016 Oct;176(10):1501-09. doi: 10.1001/jamainternmed.2016.4419.
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Keywords: Healthcare Utilization, Low-Income, Health Insurance, Medicaid, Access to Care
Beckman AL, Bilinski A, Boyko R
New hepatitis C drugs are very costly and unavailable to many state prisoners.
This study found that in the forty-one states whose departments of corrections reported data, 106,266 inmates (10 percent of their prisoners) were known to have hepatitis C on or about January 1, 2015. Only 949 of those inmates were being treated. Prices for a twelve-week course of direct-acting antivirals such as sofosbuvir and the combination drug ledipasvir/sofosbuvir varied widely as of September 30, 2015 ($43,418-$84,000 and $44,421-$94,500, respectively).
AHRQ-funded; HS000055.
Citation: Beckman AL, Bilinski A, Boyko R .
New hepatitis C drugs are very costly and unavailable to many state prisoners.
Health Aff 2016 Oct;35(10):1893-901. doi: 10.1377/hlthaff.2016.0296.
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Keywords: Access to Care, Healthcare Costs, Hepatitis, Medication, Vulnerable Populations
Ray KN, Mehrotra A
Trends in access to primary care for children in the United States, 2002-2013.
Using MEPS data, the authors described how access to primary care has changed over the last decade for children. They found no change in the proportion of children with a usual source of care (USC). Other measures improved, but out-of-pocket costs increased among privately insured children. Results suggested that after-hours accommodation within the USC is worsening, despite the promotion of patient-centered medical home initiatives. All measures of acceptability improved, consistent with a growing focus on family-centeredness of care.
AHRQ-funded; HS022989.
Citation: Ray KN, Mehrotra A .
Trends in access to primary care for children in the United States, 2002-2013.
JAMA Pediatr 2016 Oct;170(10):1023-25. doi: 10.1001/jamapediatrics.2016.0985.
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Keywords: Access to Care, Children/Adolescents, Health Services Research (HSR), Medical Expenditure Panel Survey (MEPS), Primary Care
Horner-Johnson W, Dobbertin K
Dental insurance and dental care among working-age adults: differences by type and complexity of disability.
The purpose of this study was to examine differences in dental insurance, receipt of dental checkups, and delayed and unmet needs for dental care by type and complexity of disability. It found that all disability types except hearing had significantly higher adjusted odds of being without dental insurance, as did people with complex activity limitations. Further, disparities in care were apparent even when controlling for presence of dental insurance.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Dobbertin K .
Dental insurance and dental care among working-age adults: differences by type and complexity of disability.
J Public Health Dent 2016 Sep;76(4):330-39. doi: 10.1111/jphd.12160.
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Keywords: Access to Care, Dental and Oral Health, Disabilities, Health Insurance, Medical Expenditure Panel Survey (MEPS)
Shao H, Brown L, Diana ML
Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.
The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation. The estimated incremental cost for clinics that underwent transformation was $37.61 per visit per 6 months, and overall it cost $24.86 per visit per 6 months in grant funds to support a clinic's transformation.
AHRQ-funded; HS022624.
Citation: Shao H, Brown L, Diana ML .
Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.
Medicine 2016 Sep;95(39):e4990. doi: 10.1097/md.0000000000004990.
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Keywords: Patient-Centered Healthcare, Healthcare Costs, Access to Care, Organizational Change
Ray KN, Kahn JM, Miller E
Use of adult-trained medical subspecialists by children seeking medical subspecialty care.
The objectives of this study are to quantify the use of adult-trained medical subspecialists by children and to determine the association between geographic access to pediatric subspecialty care and the use of adult-trained subspecialists. Among medical subspecialty fields with pediatric and adult-trained subspecialists, the authors found that adult-trained subspecialists provided 10% of care to children overall and 18% of care to children living more than 90 minutes from pediatric referral centers.
AHRQ-funded; HS022989.
Citation: Ray KN, Kahn JM, Miller E .
Use of adult-trained medical subspecialists by children seeking medical subspecialty care.
J Pediatr 2016 Sep;176:173-81.e1. doi: 10.1016/j.jpeds.2016.05.073.
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Keywords: Access to Care, Children/Adolescents, Provider: Health Personnel, Children/Adolescents
Wittmeier KD, Restall G, Mulder K
Central intake to improve access to physiotherapy for children with complex needs: a mixed methods case report.
The researchers evaluated the process and impact of implementing a central intake system, using pediatric physiotherapy as a case example. They found that central intake implementation achieved the intended outcomes of streamlining processes and improving transparency and access to pediatric physiotherapy for families of children with complex needs. They recommended future research to build on this single discipline case study approach.
AHRQ-funded; HS016657.
Citation: Wittmeier KD, Restall G, Mulder K .
Central intake to improve access to physiotherapy for children with complex needs: a mixed methods case report.
BMC Health Serv Res 2016 Aug 31;16:455. doi: 10.1186/s12913-016-1700-3.
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Keywords: Access to Care, Children/Adolescents, Care Coordination, Patient Experience, Children/Adolescents
Zhang W, Lyman S, Boutin-Foster C
Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty.
The researchers sought to study racial disparities in the utilization of total knee arthroplasty (TKA), the use of high-volume hospitals, and TKA outcomes, including mortality and complications, using all-payer databases. They found that minorities had lower rates of TKA utilization but higher rates of adverse health outcomes associated with the procedure, even after adjusting for patient-related and health-care system-related characteristics.
AHRQ-funded; HS021734.
Citation: Zhang W, Lyman S, Boutin-Foster C .
Racial and ethnic disparities in utilization rate, hospital volume, and perioperative outcomes after total knee arthroplasty.
J Bone Joint Surg Am 2016 Aug 3;98(15):1243-52. doi: 10.2106/jbjs.15.01009.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Healthcare Utilization, Surgery, Access to Care
Sampson UK, Kaplan RM, Cooper RS
AHRQ Author: Kaplan RM
Reducing health inequities in the U.S.: recommendations from the NHLBI's health inequities think tank meeting.
The National, Heart, Lung, and Blood Institute convened a Think Tank meeting to obtain insight and recommendations regarding the objectives and design of the next generation of research aimed at reducing health inequities in the United States. Details of the panel's remarks and recommendations are provided in this report.
AHRQ-authored.
Citation: Sampson UK, Kaplan RM, Cooper RS .
Reducing health inequities in the U.S.: recommendations from the NHLBI's health inequities think tank meeting.
J Am Coll Cardiol 2016 Aug 2;68(5):517-24. doi: 10.1016/j.jacc.2016.04.059.
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Keywords: Access to Care, Disparities, Guidelines, Policy
Caldwell JT, Ford CL, Wallace SP
Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States.
The researchers examined whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. They cocluded that rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.
AHRQ-funded; HS022811.
Citation: Caldwell JT, Ford CL, Wallace SP .
Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States.
Am J Public Health 2016 Aug;106(8):1463-9. doi: 10.2105/ajph.2016.303212.
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Keywords: Rural Health, Urban Health, Racial and Ethnic Minorities, Access to Care, Social Determinants of Health
Rivera-Hernandez M, Rahman M, Mor V
The Impact of social health insurance on diabetes and hypertension process indicators among older adults in Mexico.
The researchers examined the impact of Seguro Popular (Mexican social health insurance for the poor) on diabetes and hypertension care, They concluded that social health insurance for the poor improved some but not all health care process indicators among diabetic and hypertensive older people in Mexico.
AHRQ-funded; HS000011.
Citation: Rivera-Hernandez M, Rahman M, Mor V .
The Impact of social health insurance on diabetes and hypertension process indicators among older adults in Mexico.
Health Serv Res 2016 Aug;51(4):1323-46. doi: 10.1111/1475-6773.12404.
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Keywords: Health Insurance, Diabetes, Blood Pressure, Elderly, Access to Care
Haidari LA, Brown ST, Constenla D
The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique.
The researchers assessed how well tetanus toxoid (TT) immunization locations meet population demand in Mozambique. They found that TT immunization locations are not geographically accessible by a significant proportion of pregnant women, resulting in substantial healthcare and productivity costs that could potentially be averted by adding or reconfiguring TT immunization locations.
AHRQ-funded; HS023317.
Citation: Haidari LA, Brown ST, Constenla D .
The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique.
Vaccine 2016 Jul 29;34(35):4161-65. doi: 10.1016/j.vaccine.2016.06.065.
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Keywords: Access to Care, Healthcare Costs, Health Services Research (HSR), Pregnancy, Vaccination
Mueller LE, Haidari LA, Wateska AR
The impact of implementing a demand forecasting system into a low-income country's supply chain.
The authors evaluated the potential impact and value of applications of data from demand forecasting systems implemented in a lower-income country's vaccine supply chain with different levels of population change to urban areas. They used their HERMES software to study Niger's entire vaccine supply chain and found that demand forecasting systems have the potential to greatly improve vaccine demand fulfilment, and decrease logistics cost/dose, when implemented with storage and transportation increases.
AHRQ-funded; HS023317.
Citation: Mueller LE, Haidari LA, Wateska AR .
The impact of implementing a demand forecasting system into a low-income country's supply chain.
Vaccine 2016 Jul 12;34(32):3663-9. doi: 10.1016/j.vaccine.2016.05.027.
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Keywords: Access to Care, Health Services Research (HSR), Low-Income, Medication, Vaccination
Hung D, Chung S, Martinez M
Effect of organizational culture on patient access, care continuity, and experience of primary care.
The authors examined relationships between organizational culture and patient-centered outcomes in primary care. They found that, compared with a "Group-oriented" culture, a "Rational" culture type was associated with longer appointment wait times, and both "Hierarchical" and "Developmental" culture types were associated with less care continuity, but better patient experiences with care.
AHRQ-funded; HS019815; HS019167.
Citation: Hung D, Chung S, Martinez M .
Effect of organizational culture on patient access, care continuity, and experience of primary care.
J Ambul Care Manage 2016 Jul-Sep;39(3):242-52. doi: 10.1097/jac.0000000000000116.
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Keywords: Access to Care, Organizational Change, Patient-Centered Healthcare, Patient Experience, Primary Care
Creedon TB, Cook BL
Access to mental health care increased but not for substance use, while disparities remain.
The researchers assessed whether early implementation of Affordable Care Act (ACA) Medicaid expansion and state health insurance exchanges increased access to mental health and substance use treatment among those in need and whether these changes differed by racial/ethnic group. They found that mental health treatment rates increased significantly but found no evidence of a reduction in the wide racial/ethnic disparities in mental health treatment that preceded ACA expansion from 2005 to 2013.
AHRQ-funded; HS021486.
Citation: Creedon TB, Cook BL .
Access to mental health care increased but not for substance use, while disparities remain.
Health Aff 2016 Jun;35(6):1017-21. doi: 10.1377/hlthaff.2016.0098.
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Keywords: Access to Care, Disparities, Health Insurance, Policy, Medicaid, Behavioral Health, Substance Abuse
Davis MM, Spurlock M, Dulacki K
Disparities in alcohol, drug use, and mental health condition prevalence and access to care in rural, isolated, and reservation areas: Findings from the South Dakota Health Survey.
The authors studied alcohol, drug use, and mental health (ADM) condition prevalence and access to care across diverse geographies in a predominantly rural state. They concluded that geographic disparities in ADM conditions are related to differences in access as opposed to prevalence, particularly for individuals in isolated and reservation areas.
AHRQ-funded; HS022981.
Citation: Davis MM, Spurlock M, Dulacki K .
Disparities in alcohol, drug use, and mental health condition prevalence and access to care in rural, isolated, and reservation areas: Findings from the South Dakota Health Survey.
J Rural Health 2016 Jun;32(3):287-302. doi: 10.1111/jrh.12157.
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Keywords: Disparities, Behavioral Health, Rural Health, Access to Care, Substance Abuse