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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 19 of 19 Research Studies DisplayedKakara M, Venkataramani AS
Earnings of US physicians with and without disabilities.
The researchers report that across industries, workers with disabilities earn less than workers without disabilities. As greater numbers of people with disabilities enter medicine, they face substantial challenges in medical education and higher risks of mistreatment at work. As physicians in older age groups grows, the incidence of disability increases. The purpose of this study was to explore possible disability earnings gaps in medicine. The study cohort included 92,469 physicians, 2.0% of whom reported having a disability. The study found that in the adjusted analyses of employed physicians, annual earned income was 20.8% lower and hourly earned income was 13.3% lower among physicians with disabilities. Physicians reporting disabilities worked an average of 110 hours fewer per year compared with those without disabilities. Estimated differences in annual income by disability status were similar after adjusting for hours worked and surgical specialty status and across age groups; estimates were much greater for disabilities affecting cognitive function, ambulation, independent living, and self-care than vision or hearing.
AHRQ-funded; HS026116.
Citation: Kakara M, Venkataramani AS .
Earnings of US physicians with and without disabilities.
JAMA Health Forum 2023 Dec; 4(12):e233954. doi: 10.1001/jamahealthforum.2023.3954..
Keywords: Provider: Physician, Disabilities
James TG, Sullivan MK, McKee MM
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
The objectives of this qualitative study were to describe emergency department (ED) care-seeking and patient-centered care perspectives among deaf and hard-of-hearing (DHH) patients and to explain quantitative findings related to ED outcomes among DHH and non-DHH patients. Researchers conducted semi-structured interviews with four DHH American Sign Language (ASL)-users and six DHH English speakers from north central Florida. Two themes emerged: DHH patients engage in complex decisionmaking processes to determine ED utilization and patient-centered ED care differs between DHH ASL-users and English speakers. The researchers concluded that their study underscores the importance of better understanding and intervention in DHH patient ED care seeking and delivery to improve patient outcomes.
AHRQ-funded; HS027537.
Citation: James TG, Sullivan MK, McKee MM .
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
Health Expect 2023 Dec; 26(6):2374-86. doi: 10.1111/hex.13842..
Keywords: Emergency Department, Patient-Centered Healthcare, Disabilities, Vulnerable Populations
Frehn JL, Li JN, Liu KR
Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.
This study assessed the results of implementing an intervention to increase screening of developmental delays in children at six federally qualified health center (FQHC) sites in Northern California from April 2014 to April 2017. The goals of the intervention were to increase (a) standardized developmental screening at recommended intervals and (b) follow-up care and support for early intervention services. The aim was to optimize each site's screening processes, supported by an automated electronic tablet-based system. Social workers were hired to conduct follow-up clinical assessments, provide psychosocial education and treatment, provide referrals, provide case management support, and collaborate with service partners. During the last year of the intervention, when tablet-based screening was adopted, the sites screened an estimated 6,550 children ages 0-18 at 23 intervals in three domains (developmental, autism, and psychosocial/behavioral), compared to a baseline where they screened children ages 0-3 at four intervals in one domain. Screening rates increased from 65.3% to 75.5% after automation was extended from the first to the second site and continued its’ increase to 91.8% after automation was expanded to the remaining sites. Ranges for follow-up visits were between 74% and 88%.
AHRQ-funded; HS000046.
Citation: Frehn JL, Li JN, Liu KR .
Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.
Fam Syst Health 2023 Dec; 41(4):454-66. doi: 10.1037/fsh0000803..
Keywords: Children/Adolescents, Disabilities, Screening, Implementation
Grove LR, Berkowitz SA, Cuddeback G
Permanent supportive housing receipt and health care use among adults with disabilities.
This study’s objective was to assess whether permanent supportive housing (PSH) participation is associated with health service use among a population of adults with disabilities, including people transitioning into PSH from community and institutional settings. Primary data sources used were 2014 to 2018 secondary data from a PSH program in North Carolina linked to Medicaid claims. The authors used propensity score weighting to estimate the average treatment effect on the treated of PSH participation. Using weighted analysis, they found that among individuals who were institutionalized prior to PSH, PSH participation was associated with greater hospitalizations and emergency department (ED) visits and fewer primary care visits during the follow-up period, compared with similar individuals who largely remained institutionalized. There was no significantly different health service use from similar comparison group members for individuals who entered PSH from community settings during the 12-month follow-up period.
AHRQ-funded; HS000032.
Citation: Grove LR, Berkowitz SA, Cuddeback G .
Permanent supportive housing receipt and health care use among adults with disabilities.
Med Care Res Rev 2023 Dec; 80(6):596-607. doi: 10.1177/10775587231183192..
Keywords: Disabilities, Vulnerable Populations, Access to Care
Fabius CD, Okoye SM, Wu MMJ
The role of place in person- and family-oriented long-term services and supports.
The authors developed a conceptual framework to identify environmental domains contributing to the use, care quality, and care experiences of long-term services and supports (LTSS). They found that LTSS-relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Measures of neighborhood social and economic deprivation were highly associated with adverse consequences due to unmet care needs. Measures of health care and social services delivery environment were inversely associated with participation restrictions in valued activities. The authors concluded that greater attention should be given to strengthening state- and community-based policies and practices that support aging in place.
AHRQ-funded; HS000029.
Citation: Fabius CD, Okoye SM, Wu MMJ .
The role of place in person- and family-oriented long-term services and supports.
Milbank Q 2023 Dec; 101(4):1076-138. doi: 10.1111/1468-0009.12664..
Keywords: Long-Term Care, Elderly, Disabilities
Zondlak AN, Oh EJ, Neiman PU
Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery.
Individuals with intellectual disabilities may be at higher risk of delayed presentation and worse outcomes for emergency general surgery (EGS) conditions. The purpose of this study was to explore the relationship between intellectual disability and both severity of disease and clinical outcomes in patients presenting with typical EGS conditions. The study found that of 1,317,572 adult EGS admissions, 0.38% of patients had an ICD-9/-10 code consistent with current intellectual disability. EGS patients with intellectual disabilities had 31% greater odds of more severe disease at presentation when compared with neurotypical patients. Intellectual disability was also related with a higher likelihood of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs.
AHRQ-funded; HS028672; HS027788.
Citation: Zondlak AN, Oh EJ, Neiman PU .
Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery.
Ann Surg 2023 Nov 1; 278(5):e1118-e22. doi: 10.1097/sla.0000000000005863..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disabilities, Surgery, Outcomes
Barnett S, Matthews K, DeWindt L
Deaf Weight Wise: a novel randomized clinical trial with Deaf sign language users.
The purpose of this research was to address the lack of scientifically supported weight management programs specifically designed for the Deaf population. The researchers developed the Deaf Weight Wise (DWW) trial and intervention which was informed by community-based participatory research. The primary focus of DWW is promoting a healthy lifestyle and weight management through dietary adjustments and physical activity. A total of 104 Deaf adults aged 40 to 70 years, with a BMI ranging from 25 to 45, were recruited from community settings in Rochester, New York. Participants were randomized into either immediate intervention (n = 48) or a 1-year delayed intervention group (n = 56). The latter group served as a no-intervention control until the trial's midpoint. Data were collected at five time points (every six months) from baseline to 24 months. All DWW intervention leaders and participants were Deaf individuals using American Sign Language (ASL). The study found that at the 6-month mark, the average weight change difference between the immediate-intervention group and the delayed-intervention group (no intervention yet) was -3.4 kg. A majority (61.6%) of those in the immediate intervention group lost ≥5% of their baseline weight, compared to 18.1% in the no-intervention-yet group. Indicators of participant engagement included an average attendance of 11/16 sessions (69%), and 92% completed the 24-month data collection. The researchers concluded that the DWW program, which is community-engaged, culturally tailored, and provides language accessibility, successfully supported weight loss among Deaf ASL users.
AHRQ-funded; HS015700
Citation: Barnett S, Matthews K, DeWindt L .
Deaf Weight Wise: a novel randomized clinical trial with Deaf sign language users.
Obesity 2023 Apr;31(4):965-76. doi: 10.1002/oby.23702.
Keywords: Obesity: Weight Management, Disabilities, Obesity
Lindly OJ, Martin AJ, Lally K
A profile of care coordination, missed school days, and unmet needs among Oregon children with special health care needs with behavioral and mental health conditions.
In order to inform Oregon's Title V needs assessment activities, researchers sought to characterize the state's subpopulation of children with special health care needs (CSHCN) with behavioral and mental health conditions (B/MHC) and to determine associations of care coordination with missed school days and unmet needs for this subpopulation. They found that among Oregon CSHCN with B/MHC, 48.9% missed 4 or more school days, 25% had one or more unmet health services need, and 14.8% had one or more unmet family support services need. They concluded that their approach to identify Oregon CSHCN with B/MHC may be adopted by other states endeavoring to improve health for this vulnerable subpopulation.
AHRQ-funded; HS000063.
Citation: Lindly OJ, Martin AJ, Lally K .
A profile of care coordination, missed school days, and unmet needs among Oregon children with special health care needs with behavioral and mental health conditions.
Community Ment Health J 2020 Nov;56(8):1571-80. doi: 10.1007/s10597-020-00609-4..
Keywords: Children/Adolescents, Disabilities, Behavioral Health, Care Coordination, Healthcare Delivery
Stransky ML, Oshita JY, Morris MA
Prevalence of behavioral health problems among adults with and without communication disabilities.
Adults with communication disabilities (CDs) experience poor health and health care outcomes. Few studies have examined behavioral health outcomes among this population. In this retrospective cohort study, the investigators compared the behavioral health of adults with CDs to their peers without such disabilities. The investigators examined the 2012 National Health Interview Survey Voice, Speech, and Language Supplement.
AHRQ-funded; HS022242.
Citation: Stransky ML, Oshita JY, Morris MA .
Prevalence of behavioral health problems among adults with and without communication disabilities.
J Am Board Fam Med 2020 Nov-Dec;33(6):932-41. doi: 10.3122/jabfm.2020.06.200216..
Keywords: Behavioral Health, Disabilities, Communication
Biel F, Darney B, Caughey A
Medical indications for primary cesarean delivery in women with and without disabilities.
The purpose of this study was to examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries. Findings showed that women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.
AHRQ-funded; HS022981.
Citation: Biel F, Darney B, Caughey A .
Medical indications for primary cesarean delivery in women with and without disabilities.
J Matern Fetal Neonatal Med 2020 Oct;33(20):3391-98. doi: 10.1080/14767058.2019.1572740..
Keywords: Labor and Delivery, Pregnancy, Disabilities, Women, Maternal Care
Lindly O, Crossman M, Eaves M
Health literacy and health outcomes among children with developmental disabilities: a systematic review.
This systematic literature review focused on the impact of health literacy on health outcomes of children with developmental disabilities (DDs). A review of the literature of most of the major scientific databases was conducted. Out of 2,768 unique records identified, 53 full text articles were reviewed and four articles were included. The associations of family health literacy with health outcomes among children with DDs were mixed. Future research was recommended.
AHRQ-funded; HS000063.
Citation: Lindly O, Crossman M, Eaves M .
Health literacy and health outcomes among children with developmental disabilities: a systematic review.
Am J Intellect Dev Disabil 2020 Sep 1;125(5):389-407. doi: 10.1352/1944-7558-125.5.389..
Keywords: Children/Adolescents, Health Literacy, Disabilities, Evidence-Based Practice, Patient-Centered Outcomes Research, Outcomes
Arana-Chicas E, Kioumarsi A, Carroll-Scott A
Barriers and facilitators to mammography among women with intellectual disabilities: a qualitative approach.
The purpose of this qualitative study was to examine barriers and facilitators to mammography among women with intellectual disabilities. During 2015-2016 the researchers administered in-depth interviews with 30 women with intellectual disabilities and their caregivers in Philadelphia. The study found additional evidence supporting prior research on barriers to mammography among women with intellectual disabilities as well as novel barriers (e.g., lack of awareness of breast ultrasound, sedation failing to work, and lack of mammogram education) and novel facilitators (e.g., extended family support and positive attitudes.) The researchers concluded that the study results support the need to address barriers and focus on facilitators to improve the mammography experience in women with intellectual disabilities.
AHRQ-funded; HS023966.
Citation: Arana-Chicas E, Kioumarsi A, Carroll-Scott A .
Barriers and facilitators to mammography among women with intellectual disabilities: a qualitative approach.
Disabil Soc 2020;35(8):1290-314. doi: 10.1080/09687599.2019.1680348..
Keywords: Women, Disabilities, Vulnerable Populations, Screening, Prevention, Cancer: Breast Cancer, Cancer, Imaging
Capo-Lugo CE, Askew RL, Muldoon K
Longer time before acute rehabilitation therapy worsens disability after intracerebral hemorrhage.
This study examines the association of time to initiation of acute rehabilitation therapy to increases in disability after intracerebral hemorrhage (ICH), and identifies predictors of time to initiation of rehabilitation therapy. Retrospective data analysis was conducted using ICH patients from a large comprehensive stroke center in a metropolitan area. Disability was assessed using a modified Rankin Scale (mRS) with poor outcome defined as mRS 4-6. There was a median time of 3 days from hospital admission and the first consult by any rehabilitation therapy specialist. Each additional day between admission and initiation of acute rehabilitation therapy was associated with odds of poor outcome at 30 days and at 90 days. Predictors of later initiation of acute rehabilitation therapy included heavy drinking (>5 drinks per day), premorbid mRS<4, presence of pulmonary embolism and longer length of stay in the intensive care unit.
AHRQ-funded; HS024366; HS023437; HS000078.
Citation: Capo-Lugo CE, Askew RL, Muldoon K .
Longer time before acute rehabilitation therapy worsens disability after intracerebral hemorrhage.
Arch Phys Med Rehabil 2020 May;101(5):870-76. doi: 10.1016/j.apmr.2019.11.006..
Keywords: Rehabilitation, Disabilities, Stroke, Cardiovascular Conditions, Outcomes, Patient-Centered Outcomes Research
Dissanayake MV, Darney BG, Caughey AB
Miscarriage occurrence and prevention efforts by disability status and type in the United States.
This study compares miscarriage rates among women by disability and type in the United States. Data from the 2011-2015 National Survey of Family Growth was used to examine outcomes in women with at least one completed pregnancy within the past 5 years. Analyses was conducted for women in six disability categories (any, hearing, vision, cognitive, physical, independent living) who had experienced miscarriage within the past 5 years. Overall, 21.83% women without disabilities and 31.63% of women with disabilities experienced a miscarriage. Women with any, cognitive, physical, and independent living had higher adjusted odds of experiencing miscarriage. A higher proportion of women with any, vision, physical, or independent living received recommendations for bedrest (65%) than women without (34%).
AHRQ-funded; HS022981; HS025155.
Citation: Dissanayake MV, Darney BG, Caughey AB .
Miscarriage occurrence and prevention efforts by disability status and type in the United States.
J Womens Health 2020 Mar;29(3):345-52. doi: 10.1089/jwh.2019.7880..
Keywords: Pregnancy, Women, Maternal Care, Disabilities
Horner-Johnson W, Dissanayake M, Wu JP
Pregnancy intendedness by maternal disability status and type in the United States.
Using data from the National Survey of Family Growth, researchers studied pregnancy-intendedness among U.S. women with disabilities. They found that a higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities, and that women with independent living disability had the highest proportion. They recommend further research to understand differences in unintended pregnancy by type and extent of disability, as well as the inclusion of people with disabilities in sex education and the incorporation of their routine care in discussions of reproductive planning.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Dissanayake M, Wu JP .
Pregnancy intendedness by maternal disability status and type in the United States.
Perspect Sex Reprod Health 2020 Mar;52(1):31-38. doi: 10.1363/psrh.12130..
Keywords: Pregnancy, Women, Disabilities
Bennett WE, Jr., Hendrix KS, Thompson-Fleming RT
Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
The researchers used a novel computerized decision support system to gather data from multiple general pediatrics offices.They found an association between the introduction of cow's milk before 1 year of age and the rate of delayed developmental milestones after 1 year of age, adding strength to the recommendations from the AAP and IOM to delay cow's milk introduction until after 1 year of age.
AHRQ-funded; HS017939; HS018453; HS020640.
Citation: Bennett WE, Jr., Hendrix KS, Thompson-Fleming RT .
Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age.
Eur J Pediatr 2014 Jul;173(7):887-92. doi: 10.1007/s00431-014-2265-y.
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Keywords: Clinical Decision Support (CDS), Disabilities, Health Information Technology (HIT), Newborns/Infants, Nutrition
Davidoff AJ, Gardner LD, Zuckerman IH
AHRQ Author: Davidoff AJ
Validation of disability status, a claims-based measure of functional status for cancer treatment and outcomes studies.
The researchers implemented and validated a disability status (DS) measure in 4 cohorts of cancer patients. They found that the DS measure is a significant independent predictor of cancer-directed treatment, but unobserved factors continue to play a role in determining treatments.
AHRQ-authored.
Citation: Davidoff AJ, Gardner LD, Zuckerman IH .
Validation of disability status, a claims-based measure of functional status for cancer treatment and outcomes studies.
Med Care 2014 Jun;52(6):500-10. doi: 10.1097/mlr.0000000000000122.
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Keywords: Cancer, Cancer: Breast Cancer, Disabilities, Health Status, Cancer: Lung Cancer
Rowland M, Peterson-Besse J, Dobbertin K
Health outcome disparities among subgroups of people with disabilities: a scoping review.
The authors described recent research activity that has examined health outcome disparities within populations of people with disabilities. They found that the health outcomes most frequently examined were diabetes and heart disease, and the most frequently examined disparity factors were the type of disabling condition and gender. Identifying that there are significant gaps in available research, they concluded that building a body of research that identifies disparities and potentially vulnerable subgroups may improve understanding of the causes of disparities and contribute to efforts to improve quality of life and health outcomes for individuals with disabilities.
AHRQ-funded.
Citation: Rowland M, Peterson-Besse J, Dobbertin K .
Health outcome disparities among subgroups of people with disabilities: a scoping review.
Disabil Health J 2014 Apr;7(2):136-50. doi: 10.1016/j.dhjo.2013.09.003.
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Keywords: Disabilities, Disparities, Health Status, Patient-Centered Outcomes Research
Bettger JP, Zhao X, Bushnell C
The association between socioeconomic status and disability after stroke: findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry.
The authors examined the association of three indicators of SES--educational attainment, working status, and perceived adequacy of household income--with disability 3-months following an acute ischemic stroke. They found that 58% of the Adherence eValuation After Ischemic stroke--Longitudinal study patients had a high school or less education, 61% were not working, and 27% perceived their household income as inadequate prior to their stroke. Thirty five percent of patients were disabled at 3-months. They concluded that, in this cohort of stroke survivors, socioeconomic status was associated with disability following acute ischemic stroke.
AHRQ-funded; HS019479; HS016964.
Citation: Bettger JP, Zhao X, Bushnell C .
The association between socioeconomic status and disability after stroke: findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry.
BMC Public Health 2014 Mar 26;14:281. doi: 10.1186/1471-2458-14-281.
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Keywords: Disabilities, Patient-Centered Outcomes Research, Social Determinants of Health, Stroke