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
51 to 75 of 195 Research Studies DisplayedSommers BD, Arntson E, Kenney GM
Lessons from early Medicaid expansions under health reform: interviews with Medicaid officials.
The impending 2014 Medicaid expansion features numerous policy challenges and unanswered questions. The researchers conducted in-depth interviews with high-ranking Medicaid officials in six early expanding states to glean important lessons from their experiences. They concluded that while the context of each state’s expansion is unique, key shared experiences were significant implementation challenges and opportunities for expanding access to needed services.
AHRQ-funded; HS021291.
Citation: Sommers BD, Arntson E, Kenney GM .
Lessons from early Medicaid expansions under health reform: interviews with Medicaid officials.
Medicare Medicaid Res Rev 2013 Nov 22;3(4). doi: 10.5600/mmrr.003.04.a02..
Keywords: Medicaid, Policy
Carroll AE, Buddenbaum JL
High and low-risk specialties experience with the U.S. medical malpractice system.
This study examining the experiences of high-liability risk and low-liability risk medical specialties with the malpractice system found that for the high liability risk specialties, 33 percent of claims result in indemnity payments compared to 28 percent for low-liability risk specialties. The average payment for high-liability risk specialties was $315, compared to $267, 146 for low-liability risk specialties.
AHRQ-funded; HS017572.
Citation: Carroll AE, Buddenbaum JL .
High and low-risk specialties experience with the U.S. medical malpractice system.
BMC Health Serv Res. 2013 Nov 6;13:465. doi: 10.1186/1472-6963-13-465..
Keywords: Medical Liability, Risk, Provider Performance
Cohen SB, Rohde F, Yu W
AHRQ Author: Cohen SB, Rohde F, Yu W
Building wave response rates in a longitudinal survey:Essential for nonsampling error reduction or last in–first out?
This study examined the implications of a reduction in targeted first-round response rates in the Medical Expenditure Panel Survey (MEPS), a national health care survey designed to produce estimates of health care utilization, expenditures, and insurance coverage. Study findings revealed nonuniform results when evaluating the capacity of alternative design strategies to achieve precision targets while simultaneously satisfying data collection budget constraints for a variety of medical care expenditure estimates.
AHRQ-authored.
Citation: Cohen SB, Rohde F, Yu W .
Building wave response rates in a longitudinal survey:Essential for nonsampling error reduction or last in–first out?
Field Methods 2013 Nov;25(4):361-87. doi: 10.1177/1525822x13507863..
Keywords: Medical Expenditure Panel Survey (MEPS), Research Methodologies
Percac-Lima S, Ashburner JM, Bond B
Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation.
The goal of this research was to evaluate whether a patient navigator (PN) program for refugee women decreases disparities in breast cancer screening. Results showed that linguistically and culturally tailored PN decreased disparities over time in breast cancer screening among female refugees from Somalia, the Middle East, and Bosnia.
AHRQ-funded; HS018161.
Citation: Percac-Lima S, Ashburner JM, Bond B .
Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation.
J Gen Intern Med 2013 Nov;28(11):1463-8. doi: 10.1007/s11606-013-2491-4.
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Keywords: Cancer: Breast Cancer, Cultural Competence, Disparities, Racial and Ethnic Minorities, Screening
Shah MN, Gillespie SM, Wood N
High-intensity telemedicine-enhanced acute care for older adults: an innovative healthcare delivery model.
This article describes an innovative healthcare model that uses high-intensity telemedicine services to provide rapid acute care for older adults without requiring them to leave their senior living community (SLC) residences. The project demonstrated that high-intensity telemedicine services for acute illnesses are feasible and acceptable and can provide definitive care without requiring ED or urgent care use.
AHRQ-funded; HS018047.
Citation: Shah MN, Gillespie SM, Wood N .
High-intensity telemedicine-enhanced acute care for older adults: an innovative healthcare delivery model.
J Am Geriatr Soc 2013 Nov;61(11):2000-7. doi: 10.1111/jgs.12523..
Keywords: Elderly, Telehealth, Health Information Technology (HIT), Healthcare Delivery, Long-Term Care
Sentell T, Unick GJ, Ahn HJ
Illness severity and psychiatric hospitalization rates among Asian Americans and Pacific Islanders.
This study of mental illness severity and psychiatric hospitalization among Asian Americans and Pacific Islanders (AA/PIs) in Hawaii found that AA/PI subgroups (Chinese, Japanese, Filipino, and Native Hawaiians) had lower psychiatric hospitalization rates than whites, but rates varied across AA/PI subgroups.
AHRQ-funded; HS019990
Citation: Sentell T, Unick GJ, Ahn HJ .
Illness severity and psychiatric hospitalization rates among Asian Americans and Pacific Islanders.
Psychiatr Serv. 2013 Nov;64(11):1095-102. doi: 10.1176/appi.ps.201200408..
Keywords: Behavioral Health, Hospitalization, Racial and Ethnic Minorities, Disparities
Neugebauer R, Fireman B, Roy JA
Impact of specific glucose-control strategies on microvascular and macrovascular outcomes in 58,000 adults with type 2 diabetes.
This study used comparative effectiveness research methods to compare the effect of four distinct glucose-control strategies on subsequent myocardial infarction and nephropathy in type 2 diabetes. It found that in a large group of adults with type 2 diabetes, more aggressive glucose-control strategies have mixed short-term effects on microvascular complications and do not reduce the myocardial infarction rate over 4 years of follow-up.
AHRQ-funded; 29020050033I.
Citation: Neugebauer R, Fireman B, Roy JA .
Impact of specific glucose-control strategies on microvascular and macrovascular outcomes in 58,000 adults with type 2 diabetes.
Diabetes Care 2013 Nov;36(11):3510-6. doi: 10.2337/dc12-2675..
Keywords: Comparative Effectiveness, Diabetes, Outcomes, Patient-Centered Outcomes Research, Treatments
Zeidan AM, Gore SD, McNally DL
AHRQ Author: Davidoff AJ
Lenalidomide performance in the real world: patterns of use and effectiveness in a Medicare population with myelodysplastic syndromes.
The authors examined the use of lenalidomide in the Medicare population. They found that reductions in transfusion rates were overall consistent with data from clinical trials, and response rates were higher when ≥ 3 lenalidomide cycles were received.
AHRQ-authored.
Citation: Zeidan AM, Gore SD, McNally DL .
Lenalidomide performance in the real world: patterns of use and effectiveness in a Medicare population with myelodysplastic syndromes.
Cancer 2013 Nov 1;119(21):3870-8. doi: 10.1002/cncr.28298.
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Keywords: Comparative Effectiveness, Elderly, Medicare, Medication
Everett C, Thorpe C, Palta M
Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.
The investigators compared outcomes for two groups of adult Medicare patients with diabetes whose conditions were at various levels of complexity: those whose care teams included PAs or NPs in various roles, and those who received care from physicians only. They found that outcomes were generally equivalent in thirteen comparisons but mixed in seven others, so that no role was best for all outcomes. They concluded that patient characteristics, as well as patients' and organizations' goals, should be considered when determining when and how to deploy PAs and NPs on primary care teams.
AHRQ-funded; HS017646; HS018368; HS000083.
Citation: Everett C, Thorpe C, Palta M .
Physician assistants and nurse practitioners perform effective roles on teams caring for Medicare patients with diabetes.
Health Aff 2013 Nov;32(11):1942-8. doi: 10.1377/hlthaff.2013.0506.
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Keywords: Diabetes, Provider: Health Personnel, Patient-Centered Healthcare, Primary Care, Teams
Abdus S, Selden TM
AHRQ Author: Abdus S, Selden TM
Preventive services for adults: how have differences across subgroups changed over the past decade?
This study uses MEPS data to track changes over time in the distribution of preventive services use across groups defined by poverty status, race/ethnicity, insurance coverage, Census region, and urbanicity. The analysis found that differences across subgroups tended to persist over time, with some of the largest gaps between adults with and without coverage. Regional differences persisted or widened over the study period.
AHRQ-authored.
Citation: Abdus S, Selden TM .
Preventive services for adults: how have differences across subgroups changed over the past decade?
Med Care 2013 Nov;51(11):999-1007. doi: 10.1097/MLR.0b013e3182a97bc0.
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Keywords: Healthcare Utilization, Health Insurance, Medical Expenditure Panel Survey (MEPS), Prevention, Social Determinants of Health
Begum R, Smith Ryan M, Winther CH
Small practices' experience with EHR, quality measurement, and incentives.
The researchers surveyed clinicians participating in Health eHearts, a cluster-randomized trial of the effect of a financial incentive and quality improvement (QI) assistance program on measures of cardiovascular care compared with the effect of providing quality reports and QI assistance. No differences were detected between groups regarding agreement with selected clinical measures or their relevance to the patient population.
AHRQ-funded; HS019164; HS018275.
Citation: Begum R, Smith Ryan M, Winther CH .
Small practices' experience with EHR, quality measurement, and incentives.
Am J Manag Care 2013 Nov;19(10 Spec No):eSP12-8..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Quality Improvement, Primary Care, Practice Patterns
Navarro-Millán I, Sattui SE, Curtis JR
Systematic review of tumor necrosis factor inhibitor discontinuation studies in rheumatoid arthritis.
The objective of this article is to conduct a systematic review of the available literature on discontinuation of anti-tumor necrosis factor (anti-TNF) agents in rheumatoid arthritis (RA) patients and the associated features of study designs, including eligibility criteria, outcome definitions, and outcomes of discontinuation. The authors concluded that discontinuation of anti-TNF therapy is achievable for many RA patients who start in clinical remission or low disease activity.
AHRQ-funded; HS018517
Citation: Navarro-Millán I, Sattui SE, Curtis JR .
Systematic review of tumor necrosis factor inhibitor discontinuation studies in rheumatoid arthritis.
Clin Ther. 2013 Nov;35(11):1850-61.e1. doi: 10.1016/j.clinthera.2013.09.015..
Keywords: Comparative Effectiveness, Outcomes, Arthritis, Medication, Chronic Conditions
Hanlon JT, Schmader KE
The medication appropriateness index at 20: where it started, where it has been, and where it may be going.
The objective of this narrative review is to describe finding regarding the reliability of the Medication Appropriateness Index (MAI), a comparison of the MAI with other quality measures of potentially inappropriate prescribing, the predictive value of the MAI with important health outcomes, and the responsiveness of the MAI to change within the framework of randomized controlled trials.
AHRQ-funded; HS018721
Citation: Hanlon JT, Schmader KE .
The medication appropriateness index at 20: where it started, where it has been, and where it may be going.
Drugs Aging. 2013 Nov;30(11):893-900. doi: 10.1007/s40266-013-0118-4..
Keywords: Quality of Care, Medication, Outcomes, Quality Measures, Medication: Safety
Encinosa WE, Bae J
AHRQ Author: Encinosa WE
Will meaningful use electronic medical records reduce hospital costs?
The authors examined what impact the 5 core medication meaningful use (MU) criteria have on hospital-acquired adverse drug events (ADEs) and their costs in 2010, as a baseline for the start of MU implementation in 2011. They developed a quality indicator to track in-hospital ADEs and concluded that the adoption of core medication MU elements will cut ADE rates, with cost savings that recoup 22% of information technology costs.
AHRQ-authored.
Citation: Encinosa WE, Bae J .
Will meaningful use electronic medical records reduce hospital costs?
Am J Manag Care 2013 Nov;19(10 Spec No):eSP19-25.
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Keywords: Adverse Drug Events (ADE), Electronic Health Records (EHRs), Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Medication
Harris AD, Pineles L, Belton B
Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial.
Antibiotic-resistant bacteria are associated with increased patient morbidity and mortality. It is unknown whether wearing gloves and gowns for all patient contact in the intensive care unit (ICU) decreases acquisition of antibiotic-resistant bacteria. The purpose of this study was to assess whether wearing gloves and gowns for all patient contact in the ICU decreases acquisition of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) compared with usual care.
AHRQ-funded; HS018111; 290200600015.
Citation: Harris AD, Pineles L, Belton B .
Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial.
JAMA 2013 Oct 16;310(15):1571-80. doi: 10.1001/jama.2013.277815..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Methicillin-Resistant Staphylococcus aureus (MRSA), Infectious Diseases, Intensive Care Unit (ICU), Hospitals, Prevention, Critical Care
Nicholas LH, Dimick JB
Bariatric surgery in minority patients before and after implementation of a centers of excellence program.
This study compared rates of bariatric surgery for minority Medicare vs. non-Medicare patients before and after the 2006 implementation of a national coverage decision (NCD) restricting Medicare patients to centers of excellence for bariatric surgery. It found that the proportion of nonwhite Medicare patients receiving this procedure dropped from 27.5 percent before the NCD to 25.9 percent afterwards.
AHRQ-funded; HS017765
Citation: Nicholas LH, Dimick JB .
Bariatric surgery in minority patients before and after implementation of a centers of excellence program.
JAMA. 2013 Oct 2;310(13):1399-400. doi: 10.1001/jama.2013.277915..
Keywords: Racial and Ethnic Minorities, Medicare, Healthcare Utilization, Obesity
Raebel MA, Newcomer SR, Reifler LM
Chronic use of opioid medications before and after bariatric surgery.
This study of 11,179 obese patients receiving bariatric surgery found that among the 933 who were using opioids chronically before bariatric surgery, 77 percent continued chronic opioid use in the year following surgery (excluding the first 30 days after surgery). The amount of chronic opioid use was greater postoperatively than preoperatively.
AHRQ-funded; HS019912
Citation: Raebel MA, Newcomer SR, Reifler LM .
Chronic use of opioid medications before and after bariatric surgery.
JAMA. 2013 Oct 2;310(13):1369-76. doi: 10.1001/jama.2013.278344..
Keywords: Medication, Obesity, Opioids, Pain, Substance Abuse, Surgery
Zhang M, Shubina M, Morrison F
Following the money: copy-paste of lifestyle counseling documentation and provider billing.
To find out whether copied documentation of lifestyle counseling was used to justify higher evaluation and management (E&M) charges, researchers investigated 12,527 patient encounters in which lifestyle counseling was documented. When time spent on counseling was recorded, copied lifestyle counseling was associated with a decrease of 70.5% in the odds of higher E&M charges.
AHRQ-funded; HS017030
Citation: Zhang M, Shubina M, Morrison F .
Following the money: copy-paste of lifestyle counseling documentation and provider billing.
BMC Health Serv Res. 2013 Oct 2;13:377. doi: 10.1186/1472-6963-13-377..
Keywords: Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Health Insurance, Lifestyle Changes, Payment
Kirby JB, Kaneda T
AHRQ Author: Kirby JB
'Double jeopardy' measure suggests blacks and Hispanics face more severe disparities than previously indicated.
The authors proposed a new way of conceptualizing and quantifying the racial and ethnic disadvantages of uninsurance over the course of a lifetime. Their measures indicated that, compared to whites, Hispanics and blacks are more likely not only to be uninsured at any point throughout most of their lives, but also to spend more years uninsured and spend more of these uninsured years at high risk of needing medical care. They concluded that these life expectancy measures have the potential to reframe the discussion of disparities and monitor progress toward their elimination.
AHRQ-authored.
Citation: Kirby JB, Kaneda T .
'Double jeopardy' measure suggests blacks and Hispanics face more severe disparities than previously indicated.
Health Aff 2013 Oct;32(10):1766-72. doi: 10.1377/hlthaff.2013.0434.
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Keywords: Disparities, Health Insurance, Health Status, Racial and Ethnic Minorities, Uninsured
Chen J, Liu L, Zhang D
A flexible model for the mean and variance functions, with application to medical cost data.
The authors considered an extension to generalized linear models by assuming nonlinear associations of covariates in the mean function and allowing the variance to be an unknown but smooth function of the mean. They discussed their application of the model to the annual medical costs of heart failure patients in the clinical data repository at the University of Virginia Hospital System.
AHRQ-funded; HS020263.
Citation: Chen J, Liu L, Zhang D .
A flexible model for the mean and variance functions, with application to medical cost data.
Stat Med 2013 Oct 30;32(24):4306-18. doi: 10.1002/sim.5838.
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Keywords: Healthcare Delivery, Healthcare Costs, Health Services Research (HSR)
Albrecht JS, McGregor JC, Fromme EK
A nationwide analysis of antibiotic use in hospice care in the final week of life.
This study uses data form the 2007 National Home and Hospice Care Survey to estimate antibiotic utilization in hospice care patients and identify potential infectious indications and facility and patient characteristics associated with antibiotic use in this population. It found that 27 percent of hospice patients received an antibiotic during the last seven days of life, most without a documented infectious diagnosis.
AHRQ-funded; HS021068
Citation: Albrecht JS, McGregor JC, Fromme EK .
A nationwide analysis of antibiotic use in hospice care in the final week of life.
J Pain Symptom Manage. 2013 Oct;46(4):483-90. doi: 10.1016/j.jpainsymman.2012.09.010..
Keywords: Antibiotics, Antimicrobial Stewardship, Home Healthcare, Medication, Palliative Care, Practice Patterns
Falck S, Adimadhyam S, Meltzer DO
A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation.
The authors measured the accuracy and completeness of electronic problem list additions using indication-based prescribing of antihypertensives. They found that clinical decision support using indication-based prescribing of antihypertensives produced accurate problem placement roughly two-thirds of the time with fewer than 5% inaccurate problems placed; performance of alerts was sensitive to the number of potential indications of the medication and attendings vs. other clinicians prescribing.
AHRQ-funded; HS016967.
Citation: Falck S, Adimadhyam S, Meltzer DO .
A trial of indication based prescribing of antihypertensive medications during computerized order entry to improve problem list documentation.
Int J Med Inform 2013 Oct;82(10):996-1003. doi: 10.1016/j.ijmedinf.2013.07.003.
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Keywords: Blood Pressure, Medication, Clinical Decision Support (CDS), Electronic Prescribing (E-Prescribing), Health Information Technology (HIT)
Lieberthal RD
Analyzing the health care cost curve: a case study.
The author uses data from a self-insured employer plan to perform an analysis into the properties of the health care cost curve. He finds that costs rise continuously, not on an annual or monthly basis as typically charted by actuarial models. He concludes that population health management programs and health policy should be based on continuous analysis and adaption.
AHRQ-funded; HS018835
Citation: Lieberthal RD .
Analyzing the health care cost curve: a case study.
Popul Health Manag. 2013 Oct;16(5):341-8. doi: 10.1089/pop.2012.0102..
Keywords: Healthcare Costs, Health Insurance, Health Insurance
Bobo WV, Cooper WO, Stein CM
Antipsychotics and the risk of type 2 diabetes mellitus in children and youth.
This study found that in a group of 25, 834 Medicaid-enrolled children and youth who had recently initiated use of either an antipsychotic or a control psychotropic drug, antipsychotic users had a risk of a newly diagnosed type 2 diabetes 3 times greater than the propensity-score matched controls. This group was confined to those who had not been diagnosed with conditions for which antipsychotics were the only recognized pharmacotherapy.
AHRQ-funded; HS0116974
Citation: Bobo WV, Cooper WO, Stein CM .
Antipsychotics and the risk of type 2 diabetes mellitus in children and youth.
JAMA Psychiatry. 2013 Oct;70(10):1067-75. doi: 10.1001/jamapsychiatry.2013.2053..
Keywords: Children/Adolescents, Behavioral Health, Diabetes, Medication, Medicaid
Johnson TJ, Weaver MD, Borrero S
Association of race and ethnicity with management of abdominal pain in the emergency department.
This study, examining racial/ethnic differences in analgesic administration and prolonged length of stay (LOS) in the emergency department (ED) found that among children 21 years of age and younger presenting to EDs with abdominal pain, those who were non-Hispanic black patients were less likely than non-Hispanic white patients to receive any analgesics for pain. They were also more likely to have a prolonged LOS.
AHRQ-funded; HS017587
Citation: Johnson TJ, Weaver MD, Borrero S .
Association of race and ethnicity with management of abdominal pain in the emergency department.
Pediatrics. 2013 Oct;132(4):e851-8. doi: 10.1542/peds.2012-3127..
Keywords: Children/Adolescents, Emergency Medical Services (EMS), Racial and Ethnic Minorities, Disparities, Chronic Conditions