National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Behavioral Health (2)
- Children/Adolescents (3)
- Chronic Conditions (1)
- COVID-19 (2)
- Depression (1)
- Diabetes (2)
- Disabilities (1)
- Elderly (1)
- Electronic Health Records (EHRs) (1)
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- Medical Expenditure Panel Survey (MEPS) (2)
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- (-) Obesity (13)
- Obesity: Weight Management (6)
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- Pain (1)
- Patient Safety (1)
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- Quality of Care (1)
- Racial and Ethnic Minorities (2)
- Social Stigma (1)
- Stress (1)
- Substance Abuse (1)
- Surgery (5)
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 13 of 13 Research Studies DisplayedBorgatti AC, Crockett KB, Jacob AE
Correlates of psychological distress among adults with obesity during the COVID-19 pandemic.
The objective of this study was to evaluate changes in stress and loneliness among participants with obesity who were engaged in weight loss self-management in the US during COVID-19, and to identify risk factors that may increase psychosocial distress during this period. Participants completed an online survey about social, economic and health behavior changes during COVID-19 and their relationship to changes in perceived stress and loneliness. Results indicated that stress and loneliness increased two months into the COVID-19 pandemic-related shutdown. Factors associated with increased stress and/or loneliness included higher body mass index, social distancing, alcohol intake, and working from home. The authors concluded that ongoing attention to psychosocial well-being among individuals with obesity remains imperative both during the ongoing pandemic and afterwards.
AHRQ-funded; HS013852.
Citation: Borgatti AC, Crockett KB, Jacob AE .
Correlates of psychological distress among adults with obesity during the COVID-19 pandemic.
Psychol Health 2022 Dec; 37(12):1547-64. doi: 10.1080/08870446.2022.2038790..
Keywords: COVID-19, Obesity, Stress, Social Stigma, Behavioral Health
Persaud A, Castro I, Simione M
Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention.
The objective of this study was to examine the perspectives of local, state, and national clinic and community stakeholders as an aid to developing successful pediatric weight management interventions (PWMI) in primary care and community settings, and to identify barriers and facilitators to implementation. Stakeholders in health centers and predominantly lower income, Hispanic community YMCAs were interviewed. Twenty-six of the stakeholders perceived formal curriculum with illustrative examples, patient- and family-centered programs, group visits, and high-quality multidisciplinary personnel to be components needed for a PWMI. These responses led to the creation of a group visit curriculum, implementation trainings, and cross-site collaborative technical assistance. The authors conclude that their findings highlight the importance of engaging multi-sector stakeholders during pre-implementation to ensure that valued components are included.
AHRQ-funded; HS022986; HS024332.
Citation: Persaud A, Castro I, Simione M .
Multi-sector stakeholder's perceptions of determinants of successful implementation of a pediatric weight management intervention.
Front Public Health 2022 Aug 25;10:954063. doi: 10.3389/fpubh.2022.954063..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity
Chao GF, Chhabra KR, Yang J
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
The purpose of this study was to compare safety and healthcare use after sleeve gastrectomy versus Roux-en-Y gastric bypass in a national Medicare cohort. The researchers analyzed Medicare claims from 2012-2017 for 30,105 bariatric surgery patients receiving benefits due to age or disability and compared all outcomes between sleeve and bypass for each benefit group at 30 days, 1 year, and 3 years. The study found that among the disabled patients (n = 21,595), sleeve gastrectomy was associated with lower 3-year ED utilization, complications, reinterventions, rehospitalizations, and mortality. Cumulative expenditures were $46,277 after sleeve gastrectomy and $48,211 after gastric bypass. Among the elderly (n = 8510), sleeve was associated with lower 3-year ED utilization, complications, reinterventions, and rehospitalizations. Expenditures were $38,632 after sleeve gastrectomy and $39,270 after gastric bypass. Procedure treatment effect significantly differed by benefit group for paraesophageal hernia repair, revision, and mortality. The study concluded that healthcare utilization benefits of sleeve over bypass are maintained across Medicare elderly populations and Medicare disabled subpopulations.
AHRQ-funded; HS025778.
Citation: Chao GF, Chhabra KR, Yang J .
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
Ann Surg 2022 Jul 1;276(1):133-39. doi: 10.1097/sla.0000000000004526..
Keywords: Obesity: Weight Management, Obesity, Surgery, Medicare, Elderly, Disabilities
Huo T, Li Q, Cardel MI
AHRQ Author: Mistry K
Enhancing quality measurement with clinical information: a use case of body mass index change among children taking second generation antipsychotics.
The authors sought to examine the extent to which body mass index (BMI) was available in electronic health records for Florida Medicaid recipients aged 5 to 18 years taking Second-Generation Antipsychotics (SGAP). They concluded that meeting the 2030 CMS goal of digital monitoring of quality of care will require continuing expansion of clinical encounter data capture to provide the data needed for digital quality monitoring. Using linked electronic health records and claims data allows identifying children at higher risk for SGAP-induced weight gain.
AHRQ-authored; AHRQ-funded; HS025298.
Citation: Huo T, Li Q, Cardel MI .
Enhancing quality measurement with clinical information: a use case of body mass index change among children taking second generation antipsychotics.
Acad Pediatr 2022 Apr;22(3S):S140-S49. doi: 10.1016/j.acap.2021.11.012..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Obesity, Obesity: Weight Management, Quality Measures, Quality of Care
Crockett KB, Borgatti A, Tan F
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
This study examined the role that weight discrimination and race is associated with pre-treatment depressive symptoms. A cohort of Black and White adults were enrolled in a 16-week obesity intervention treatment (N = 271; mean BMI = 35.7 kg/m2); 59% Black; 92% women). They reported prior experiences of weight discrimination and completed the Center for Epidemiological Studies Depression (CES-D) Scale at baseline. Their weekly attendance at group sessions was recorded, and weight was measured at baseline and post-treatment. Participants with a history of weight discrimination scored 2.4 points higher on the CES-D and lost 2% less weight relative to those without weight discrimination. Race modified the association between weight discrimination and treatment session attendance, such that Black participants attended fewer sessions if they had prior experience of weight discrimination. However, this association was not true among White individuals.
AHRQ-funded; HS013852.
Citation: Crockett KB, Borgatti A, Tan F .
Weight discrimination experienced prior to enrolling in a behavioral obesity intervention is associated with treatment response among Black and White adults in the Southeastern U.S.
Int J Behav Med 2022 Apr;29(2):152-59. doi: 10.1007/s12529-021-10009-x..
Keywords: Obesity, Obesity: Weight Management, Behavioral Health, Racial and Ethnic Minorities, Depression
Chhabra KR, Telem DA, Chao GF
Comparative safety of sleeve gastrectomy and gastric bypass: an instrumental variables approach.
This study compared the safety of sleeve gastrectomy versus gastric bypass surgery. Sleeve gastrectomy has become the most common bariatric surgery, rising from 52.6% in 2012 to 75% in 2016 among the cohort of 38,153 patients identified using commercially insured patients in the IBM MarketScan claims database. At 2 years from surgery, patients undergoing sleeve gastrectomy had fewer re-interventions (sleeve 9.9%, bypass 15.6%) and complications (sleeve 6.6%, bypass 9.6%), and lower overall healthcare spending ($47,891 vs $55,213), than patients undergoing gastric bypass. However, at the 2-year mark, revisions were slightly more common in sleeve gastrectomy than in gastric bypass (sleeve 0.6%, bypass 0.4%).
AHRQ-funded; HS025778.
Citation: Chhabra KR, Telem DA, Chao GF .
Comparative safety of sleeve gastrectomy and gastric bypass: an instrumental variables approach.
Ann Surg 2022 Mar;275(3):539-45. doi: 10.1097/sla.0000000000004297..
Keywords: Obesity: Weight Management, Obesity, Surgery, Patient Safety
Howard R, Chao GF, Yang J
Medication use for obesity-related comorbidities after sleeve gastrectomy or gastric bypass.
The purpose of this comparative effectiveness research study was to evaluate prior laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass patients and compare the incidence of medication discontinuation and restart of diabetes, hypertension, and hyperlipidemia medications. The researchers reviewed the records of adult Medicare beneficiaries who underwent sleeve gastrectomy or gastric bypass between January 1, 2012, to December 31, 2018, and had a claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months before surgery with a corresponding diagnosis. The study found that when compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher 5-year cumulative incidence of medication discontinuation among 30,588 patients with diabetes medication use and diagnosis at the time of surgery, 5,081 patients with antihypertensive medication use and diagnosis at the time of surgery and 35,055 patients with lipid-lowering medication use and diagnosis at the time of surgery. Among the patients who discontinued medication, gastric bypass was also associated with a slightly lower incidence of medication restart up to 5 years after discontinuation. The researchers concluded that gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart among patients who discontinued medication than sleeve gastrectomy.
AHRQ-funded; HS025778; HS025365.
Citation: Howard R, Chao GF, Yang J .
Medication use for obesity-related comorbidities after sleeve gastrectomy or gastric bypass.
JAMA Surg 2022 Mar;157(3):248-56. doi: 10.1001/jamasurg.2021.6898..
Keywords: Obesity, Obesity: Weight Management, Surgery, Medication
Kumar V, Encinosa W
AHRQ Author: Encinosa W
Revisiting the obesity paradox in health care expenditures among adults with diabetes.
This AHRQ-authored study explored and examined an obesity paradox identified by recent studies which suggests that in people without diabetes mortality risk increases with weight and in people with diabetes mortality risk decreases with weight. The researchers assessed changes in the association between body mass index (BMI) and health care expenditures in populations with diabetes and without diabetes while controlling for confounding risk factors. The researchers found that there is no obesity paradox; it is the result of statistical biases, and the study concluded that obesity in people with diabetes does not save costs.
AHRQ-authored.
Citation: Kumar V, Encinosa W .
Revisiting the obesity paradox in health care expenditures among adults with diabetes.
Clin Diabetes 2022 Spring;40(2):185-95. doi: 10.2337/cd20-0122..
Keywords: Medical Expenditure Panel Survey (MEPS), Obesity, Diabetes, Healthcare Costs
Wu AJ, Aris IM, Hivert MF
Association of changes in obesity prevalence with the COVID-19 pandemic in youth in Massachusetts.
Using the Massachusetts Department of Public Health’s disease surveillance system (MDPHnet), the authors examined obesity prevalence in 3 periods from 2018 to 2020 in a fixed cohort of children and adolescents. They found that, although childhood obesity prevalence was rising prior to COVID-19, the prevalence increased by a greater difference in Massachusetts youth during the COVID-19 pandemic. They observed greater increases in obesity prevalence in Black and Hispanic youth, particularly in boys aged 6 to 11 years.
AHRQ-funded; HS000063.
Citation: Wu AJ, Aris IM, Hivert MF .
Association of changes in obesity prevalence with the COVID-19 pandemic in youth in Massachusetts.
JAMA Pediatr 2022 Feb;176(2):198-201. doi: 10.1001/jamapediatrics.2021.5095..
Keywords: Children/Adolescents, COVID-19, Obesity
Chhabra KR, Ghaferi AA, Yang J
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
This study’s objective was to evaluate sources of 90-day episode spending variation in Medicare patients undergoing bariatric surgery and whether spending variation was related to quality of care. A retrospective analysis of fee-for-service Medicare claims data from 761 acute care hospitals providing inpatient bariatric surgery was conducted between January 1, 2011 and September 30, 2016. Of 64,537 bariatric patients, 46% went sleeve gastrectomy, 22% revisited the emergency department (ED) within 90 days, and 12.5% were readmitted. Average 90-day payments were $14,124, ranging from $12,220 to $16,887. The largest components of spending variation were readmissions (44% of variation), post-acute care (19%), and index professional fees (15%). The lowest spending hospitals had the lowest complication, ED visit, post-acute utilization, and readmission rates.
AHRQ-funded; HS024403; HS023597.
Citation: Chhabra KR, Ghaferi AA, Yang J .
Relationship between health care spending and clinical outcomes in bariatric surgery: implications for Medicare bundled payments.
Ann Surg 2022 Feb;275(2):356-62. doi: 10.1097/sla.0000000000003979..
Keywords: Healthcare Costs, Surgery, Obesity, Outcomes
Kumar V, Encinosa W
AHRQ Author: Kumar V, Encinosa W
Explaining the obesity paradox in healthcare utilization among people with type 2 diabetes.
The authors sought to examine changes in the relationship between BMI and number of visits in diabetic vs nondiabetic populations, controlling for confounding risk factors. Using MEPS data, they found that the obesity paradox does not exist at the utilization level and is due to the presence of statistical biases such as confounding and reverse causation.
AHRQ-authored.
Citation: Kumar V, Encinosa W .
Explaining the obesity paradox in healthcare utilization among people with type 2 diabetes.
Diabetol Int 2022 Jan;13(1):232-43. doi: 10.1007/s13340-021-00530-5..
Keywords: Medical Expenditure Panel Survey (MEPS), Obesity, Diabetes, Chronic Conditions, Healthcare Utilization
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