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
26 to 50 of 96 Research Studies DisplayedHernandez I, Zhang Y
Comparing clinical and economic outcomes of biologic and conventional medications in postmenopausal women with osteoporosis.
This study compared clinical and economic outcomes between teriparatide (monthly costs $1120) and bisphosphonates (monthly costs $14) among postmenopausal women with osteoporosis. It found that teriparatide users had higher risk of fracture and higher costs, compared with similar bisphosphonates users. The hazard ratios of fracture for teriparatide relative to bisphosphonates ranged from 1.37 to 2.12, depending on methods.
AHRQ-funded; HS018657.
Citation: Hernandez I, Zhang Y .
Comparing clinical and economic outcomes of biologic and conventional medications in postmenopausal women with osteoporosis.
J Eval Clin Pract 2015 Oct;21(5):840-7. doi: 10.1111/jep.12389.
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Keywords: Medication, Women, Osteoporosis, Healthcare Costs
Rahman M, Keohane L, Trivedi AN
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
The investigators examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. They found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care, short-term nursing home care, and home health care. These results were magnified among people who were enrolled in both Medicare and Medicaid.
AHRQ-funded; HS000011.
Citation: Rahman M, Keohane L, Trivedi AN .
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
Health Aff 2015 Oct;34(10):1675-81. doi: 10.1377/hlthaff.2015.0272.
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Keywords: Healthcare Costs, Home Healthcare, Long-Term Care, Medicare, Nursing Homes
DeLia D
Monte Carlo analysis of payer and provider risks in shared savings arrangements.
This article provides a thorough empirical analysis of random variation in shared savings arrangements. Among all the accountable care organizations (ACOs) examined, the observed savings rate can be several percentage points higher or lower than the assumed true savings rate, leading to large probabilities of Type I and Type II error in determining the existence of savings.
AHRQ-funded; HS023493.
Citation: DeLia D .
Monte Carlo analysis of payer and provider risks in shared savings arrangements.
Med Care Res Rev 2015 Oct;73(5):511-31. doi: 10.1177/1077558715618320.
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Keywords: Healthcare Costs, Policy
Zhang Y, Talisa V, Baik SH
Part D plan switching among Medicare beneficiaries with schizophrenia.
The authors examined Medicare plan switching and factors affecting switching among beneficiaries with schizophrenia. They found several factors that affected the likelihood of switching, including age, geographic region, and proportion of prescriptions filled by beneficiaries who were covered or whose prescriptions required utilization review in the original plan. They concluded that plan switching among Medicare beneficiaries with schizophrenia was relatively infrequent but may be driven by the need for better drug coverage and less restrictive utilization policies.
AHRQ-funded; HS018657.
Citation: Zhang Y, Talisa V, Baik SH .
Part D plan switching among Medicare beneficiaries with schizophrenia.
Psychiatr Serv 2015 Oct;66(10):1105-8. doi: 10.1176/appi.ps.201400476.
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Keywords: Healthcare Costs, Medicare, Behavioral Health
Carey K
Price increases were much lower in ambulatory surgery centers than hospital outpatient departments in 2007-12.
This study examined the revenue side of ASC growth by using a large national claims database that contains information on actual prices paid. It found that for six common outpatient surgical procedures, prices paid to ASCs on the whole grew in line with general medical care prices, while overall prices paid to hospital outpatient departments for the same procedures climbed sharply.
AHRQ-funded; HS023780.
Citation: Carey K .
Price increases were much lower in ambulatory surgery centers than hospital outpatient departments in 2007-12.
Health Aff 2015 Oct;34(10):1738-44. doi: 10.1377/hlthaff.2015.0252..
Keywords: Ambulatory Care and Surgery, Healthcare Costs, Surgery
Ramamonjiarivelo Z, Weech-Maldonado R, Hearld L
Public hospitals in financial distress: Is privatization a strategic choice?
The purpose of this study was to investigate whether financial distress is associated with privatization among public hospitals. It found that public hospitals in financial distress had greater odds of being privatized than public hospitals not in financial distress. The study population consisted of all U.S. nonfederal acute care public hospitals in 1997 tracked through 2009.
AHRQ-funded; HS019465.
Citation: Ramamonjiarivelo Z, Weech-Maldonado R, Hearld L .
Public hospitals in financial distress: Is privatization a strategic choice?
Health Care Manage Rev 2015 Oct-Dec;40(4):337-47. doi: 10.1097/hmr.0000000000000032.
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Keywords: Hospitals, Healthcare Costs
Gray SH, Trudell EK, Emans SJ
Total direct medical expenses and characteristics of privately insured adolescents who incur high costs.
This study assessed health care expenditures for high-cost adolescents and described the patient characteristics associated with high medical costs. It concluded that total direct medical expenses for privately insured high-cost adolescents are associated with medical complexity, mental health conditions, and obesity. Cost reduction strategies in similar populations should be tailored to these cost drivers.
AHRQ-funded; HS023092.
Citation: Gray SH, Trudell EK, Emans SJ .
Total direct medical expenses and characteristics of privately insured adolescents who incur high costs.
JAMA Pediatr 2015 Oct;169(10):e152682. doi: 10.1001/jamapediatrics.2015.2682..
Keywords: Access to Care, Children/Adolescents, Healthcare Costs, Health Insurance
Smith MW, Friedman B, Karaca Z
AHRQ Author: Friedman B, Karaca Z, Wong HS
Predicting inpatient hospital payments in the United States: a retrospective analysis.
The researchers evaluated whether payment-to-charge ratios (PCRs) can be predicted for hospitals in States that do not provide detailed financial data. They found that inpatient payments can be estimated with modest accuracy for community hospital stays funded by Medicare, Medicaid, and private insurance.
AHRQ-authored.
Citation: Smith MW, Friedman B, Karaca Z .
Predicting inpatient hospital payments in the United States: a retrospective analysis.
BMC Health Serv Res 2015 Sep 10;15(1):372. doi: 10.1186/s12913-015-1040-8..
Keywords: Healthcare Cost and Utilization Project (HCUP), Inpatient Care, Healthcare Costs, Hospitalization
Lee BY, Bartsch SM, Mvundura M
An economic model assessing the value of microneedle patch delivery of the seasonal influenza vaccine.
The researchers utilized a susceptible-exposed-infectious-recovered transmission model linked to an economic influenza outcomes model to assess the economic value of introducing the microneedle patch (MNP) into the U.S. influenza vaccine market from the third-party payer and societal perspectives. They concluded that if healthcare providers administered the MNP, its introduction would be less costly and more effective in the majority of scenarios assessed.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Mvundura M .
An economic model assessing the value of microneedle patch delivery of the seasonal influenza vaccine.
Vaccine 2015 Sep 08;33(37):4727-36. doi: 10.1016/j.vaccine.2015.02.076.
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Keywords: Healthcare Delivery, Healthcare Costs, Influenza, Vaccination
Tilden EL, Lee VR, Allen AJ
Cost-effectiveness analysis of latent versus active labor hospital admission for medically low-risk, term women.
The purpose of this study was to assess the outcomes and costs of hospital admission during the latent versus active phase of labor. It found that delaying admission until active labor would result in 672,000 fewer epidurals, 67,232 fewer cesarean deliveries, and 9.6 fewer maternal deaths in our theoretic cohort as compared to admission during latent labor.
AHRQ-funded; HS017582.
Citation: Tilden EL, Lee VR, Allen AJ .
Cost-effectiveness analysis of latent versus active labor hospital admission for medically low-risk, term women.
Birth 2015 Sep;42(3):219-26. doi: 10.1111/birt.12179..
Keywords: Labor and Delivery, Comparative Effectiveness, Healthcare Costs, Patient-Centered Outcomes Research, Hospitalization
Magill MK, Ehrenberger D, Scammon DL
The cost of sustaining a patient-centered medical home: experience from 2 states.
This study’s objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. It found that costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices.
AHRQ-funded; HS022620.
Citation: Magill MK, Ehrenberger D, Scammon DL .
The cost of sustaining a patient-centered medical home: experience from 2 states.
Ann Fam Med 2015 Sep;13(5):429-35. doi: 10.1370/afm.1851..
Keywords: Patient-Centered Healthcare, Healthcare Costs, Quality of Care, Primary Care
Yang NH, Dharmar M, Yoo BK
Economic evaluation of pediatric telemedicine consultations to rural emergency departments.
The researchers conducted an economic evaluation to estimate the cost, effectiveness, and return on investment (ROI) of telemedicine consultations provided to health care providers of acutely ill and injured children in rural EDs compared with telephone consultations from a health care payer prospective. They found that treating 10 acutely ill and injured children at each rural ED with telemedicine resulted in an annual cost-savings of $46,620 per ED. They concluded that telemedicine consultations to health care providers of acutely ill and injured children presenting to rural EDs are cost-saving or cost-effective compared with telephone consultations.
AHRQ-funded; HS013179.
Citation: Yang NH, Dharmar M, Yoo BK .
Economic evaluation of pediatric telemedicine consultations to rural emergency departments.
Med Decis Making 2015 Aug;35(6):773-83. doi: 10.1177/0272989x15584916.
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Keywords: Healthcare Costs, Emergency Department, Children/Adolescents, Rural Health, Telehealth
Kawai AT, Calderwood MS, Jin R
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
The 2008 Centers for Medicare & Medicaid Services (CMS) hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable. This study examined whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI). The CMS policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates.
AHRQ-funded; HS018414.
Citation: Kawai AT, Calderwood MS, Jin R .
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
Infect Control Hosp Epidemiol 2015 Aug;36(8):871-7. doi: 10.1017/ice.2015.86.
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Keywords: Healthcare-Associated Infections (HAIs), Policy, Medicare, Payment, Hospitals, Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare Costs
Nuckols TK, Asch SM, Patel V
Implementing Computerized Provider Order Entry In Acute Care Hospitals in the United States could generate substantial savings to society.
This study was conducted to evaluate from the societal perspective the cost-utility of implementing computerized physician order entry (CPOE) in acute care hospitals in the United States. It found that relative to paper ordering and using typical estimates of implementation costs, CPOE had, on average, a 99 percent probability of yielding savings to society and improving health.
AHRQ-funded; HS017954.
Citation: Nuckols TK, Asch SM, Patel V .
Implementing Computerized Provider Order Entry In Acute Care Hospitals in the United States could generate substantial savings to society.
Jt Comm J Qual Patient Saf 2015 Aug;41(8):341-50..
Keywords: Health Information Technology (HIT), Hospitals, Clinical Decision Support (CDS), Healthcare Costs
Ray KN, Chari AV, Engberg J
Opportunity costs of ambulatory medical care in the United States.
The authors aimed to quantify the opportunity costs for adults seeking medical care for themselves or others. Using the 2003-2010 American Time Use Survey, they found that total opportunity costs per year for all physician visits in the United States were $52 billion in 2010. They concluded that, for every dollar spent in visit reimbursement, an additional 15 cents were spent in opportunity costs.
AHRQ-funded; HS022989.
Citation: Ray KN, Chari AV, Engberg J .
Opportunity costs of ambulatory medical care in the United States.
Am J Manag Care 2015 Aug;21(8):567-74.
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Keywords: Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Ambulatory Care and Surgery
Jacobs PD, Buntin MB
AHRQ Author: Jacobs PD
Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?
This study evaluated the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D. It found that Medicare Advantage enrollees are relatively insensitive to premiums, but more responsive to reductions in medical cost sharing in their benefit packages.
AHRQ-authored.
Citation: Jacobs PD, Buntin MB .
Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?
Am J Manag Care 2015 Jul;21(7):498-504..
Keywords: Medicare, Health Insurance, Healthcare Costs
Kleweno CP, O'Toole RV, Ballreich J
Does fracture care make money for the hospital? An analysis of hospital revenues and costs for treatment of common fractures.
The authors sought to determine the relative profitability for a hospital of treatment of common fractures within a state-regulated reimbursement system. They found that the factors most influencing cost included length of stay, supplies, and operating room use, and that the most profitable diagnosis was pelvic fracture.
AHRQ-funded; HS000029.
Citation: Kleweno CP, O'Toole RV, Ballreich J .
Does fracture care make money for the hospital? An analysis of hospital revenues and costs for treatment of common fractures.
J Orthop Trauma 2015 Jul;29(7):e219-24. doi: 10.1097/bot.0000000000000263.
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Keywords: Injuries and Wounds, Healthcare Costs, Hospitals, Orthopedics
Silverberg JI
Health care utilization, patient costs, and access to care in US adults with eczema: a population-based study.
This study examined the out-of-pocket costs, health care access and utilization in adult eczema in the United States. It found that adults with eczema had $371 to $489 higher out-of-pocket costs per person-year compared with those without eczema, with higher odds of increased out-of-pocket costs.
AHRQ-funded; HS023011.
Citation: Silverberg JI .
Health care utilization, patient costs, and access to care in US adults with eczema: a population-based study.
JAMA Dermatol 2015 Jul;151(7):743-52. doi: 10.1001/jamadermatol.2014.5432.
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Keywords: Access to Care, Healthcare Costs, Healthcare Utilization, Skin Conditions
Trish EE, Herring BJ
How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?
The authors examined the relationship between employer-sponsored fully-insured health insurance premiums and the level of concentration in local insurer and hospital markets using the nationally-representative 2006-2011 KFF/HRET Employer Health Benefits Survey. They found that premiums are higher for plans sold in markets with higher levels of concentration relevant to insurer transactions with employers, lower for plans in markets with higher levels of insurer concentration relevant to insurer bargaining with hospitals, and higher for plans in markets with higher levels of hospital market concentration.
AHRQ-funded; HS000046.
Citation: Trish EE, Herring BJ .
How do health insurer market concentration and bargaining power with hospitals affect health insurance premiums?
J Health Econ 2015 Jul;42:104-14. doi: 10.1016/j.jhealeco.2015.03.009.
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Keywords: Health Insurance, Healthcare Costs, Payment, Health Insurance, Hospitals
Malecki K, Wisk LE, Walsh M
Oral health equity and unmet dental care needs in a population-based sample: findings from the Survey of the Health of Wisconsin.
The authors explored individual-, psychosocial-, and community-level predictors of oral health status in the Survey of the Health of Wisconsin Oral Health Screening project. Their results suggested that costs were a primary predictor of access to care and poor oral health status, underscoring the role that primary care, in conjunction with dental health care providers, could play in promoting oral health care, particularly in reducing barriers and promoting preventive health behaviors.
AHRQ-funded; HS000063.
Citation: Malecki K, Wisk LE, Walsh M .
Oral health equity and unmet dental care needs in a population-based sample: findings from the Survey of the Health of Wisconsin.
Am J Public Health 2015 Jul;105 Suppl 3:S466-74. doi: 10.2105/ajph.2014.302338.
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Keywords: Access to Care, Dental and Oral Health, Disparities, Healthcare Costs, Health Services Research (HSR)
Roth JA, Sullivan SD, Goulart BH
Projected clinical, resource use, and fiscal impacts of implementing low-dose computed tomography lung cancer screening in Medicare.
The Centers for Medicare and Medicaid Services (CMS) recently issued a national coverage determination that provides reimbursement for low-dose computed tomography (CT) lung cancer screening for enrollees age 55 to 77 years. This study’s simulation model projected that over 5 years, that low-dose CT screening will result in 10.7 million more low-dose CT scans, 52,000 more lung cancers detected, and increased overall expenditure of $6.8 billion.
AHRQ-funded; HS022982.
Citation: Roth JA, Sullivan SD, Goulart BH .
Projected clinical, resource use, and fiscal impacts of implementing low-dose computed tomography lung cancer screening in Medicare.
J Oncol Pract 2015 Jul;11(4):267-72. doi: 10.1200/jop.2014.002600.
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Keywords: Cancer: Lung Cancer, Screening, Medicare, Healthcare Costs, Healthcare Utilization
Bennette CS, Gallego CJ, Burke W
The cost-effectiveness of returning incidental findings from next-generation genomic sequencing.
The researchers developed a decision-analytic policy model to project the quality-adjusted life-years and lifetime costs associated with returning ACMG-recommended incidental findings in three hypothetical cohorts of 10,000 patients. They found that returning incidental findings are likely cost-effective for certain patient populations. Screening of generally healthy individuals is likely not cost-effective based on current data.
AHRQ-funded; HS023340.
Citation: Bennette CS, Gallego CJ, Burke W .
The cost-effectiveness of returning incidental findings from next-generation genomic sequencing.
Genet Med 2015 Jul;17(7):587-95. doi: 10.1038/gim.2014.156..
Keywords: Healthcare Costs, Genetics, Shared Decision Making
Herring B, Trish E
The distributional effects of the Affordable Care Act's Cadillac tax by worker income.
The authors discuss a provision of the ACA that will introduce a 40 percent excise tax on health benefits exceeding a $10,200 threshold for single coverage and a $27,500 threshold for family coverage, annually. They argue that the low-income workers receive a relatively smaller subsidy to offset a portion of the Cadillac tax while the high-income workers receive a relatively larger subsidy to offset a portion of the Cadillac tax. All this adds up to a regressive effect.
AHRQ-funded; HS000046.
Citation: Herring B, Trish E .
The distributional effects of the Affordable Care Act's Cadillac tax by worker income.
AMA J Ethics 2015 Jul;17(7):672-9. doi: 10.1001/journalofethics.2015.17.7.sect1-1507..
Keywords: Healthcare Costs, Health Insurance, Policy
Shih YC, Smieliauskas F, Geynisman DM
Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011.
This study sought to define and identify drivers of trends in cost and use of targeted therapeutics among privately insured nonelderly patients with cancer receiving chemotherapy between 2001 and 2011. It found a large increase in the use of targeted intravenous anticancer medications and a gradual increase in targeted oral anticancer medications; targeted therapies accounted for 63 percent of all chemotherapy expenditures in 2011.
AHRQ-funded; HS018535; HS020263.
Citation: Shih YC, Smieliauskas F, Geynisman DM .
Trends in the cost and use of targeted cancer therapies for the privately insured nonelderly: 2001 to 2011.
J Clin Oncol 2015 Jul 1;33(19):2190-6. doi: 10.1200/jco.2014.58.2320..
Keywords: Healthcare Costs, Cancer, Health Insurance, Medication
Haidari LA, Wahl B, Brown ST
One size does not fit all: the impact of primary vaccine container size on vaccine distribution and delivery.
The researchers examined the questions of how the design of the primary container may affect the distribution of the vaccine, its resulting cost, and whether the vial is ultimately opened. Using a simulation model, they determined that when choosing a primary vaccine container, the choice depends on characteristics of the vaccine, the vaccine supply chain, immunization session size, and goals of decision makers. In fact, the optimal vial size may vary among locations within a country.
AHRQ-funded; HS023317.
Citation: Haidari LA, Wahl B, Brown ST .
One size does not fit all: the impact of primary vaccine container size on vaccine distribution and delivery.
Vaccine 2015 Jun 22;33(28):3242-7. doi: 10.1016/j.vaccine.2015.04.018..
Keywords: Healthcare Costs, Vaccination