National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Blood Clots (2)
- Chronic Conditions (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Disparities (1)
- Electronic Health Records (EHRs) (1)
- Emergency Department (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (4)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (1)
- Health Insurance (1)
- Health Services Research (HSR) (2)
- Hospital Readmissions (2)
- Hospitals (5)
- Imaging (1)
- Infectious Diseases (1)
- Long-Term Care (1)
- Medicaid (1)
- Medicare (9)
- Nursing Homes (1)
- Patient-Centered Outcomes Research (1)
- Patient Experience (3)
- Patient Safety (3)
- (-) Payment (23)
- Policy (6)
- Practice Patterns (1)
- Prevention (2)
- Primary Care (2)
- Provider Performance (14)
- Public Reporting (1)
- (-) Quality Improvement (23)
- Quality Indicators (QIs) (2)
- Quality Measures (1)
- Quality of Care (17)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (2)
- Risk (1)
- Shared Decision Making (1)
- Surgery (2)
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 23 of 23 Research Studies DisplayedWaltman A, Konetzka RT, Chia S
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
This single-site retrospective observational study evaluated the impact of an evidence-based transitions of care program on episode costs and readmission rates, comparing patients hospitalized for COPD exacerbations who received versus those who did not receive the intervention. Between October 2015 and September 2018, 132 received and 161 did not receive the program. Below target mean episode costs were found for six out of eleven quarters for the intervention group, as opposed to only one out of twelve quarters for the control group. Overall, there were non-significant mean savings of $2551 in episode costs relative to target costs for the intervention group, though results varied by index admission diagnosis-related group (DRG). There were additional costs of $4184 per episode for the least-complicated cohort (DRG 192), but savings of $1897 and $1753 for the most complicated index admissions (DRGs 191 and 190, respectively). A significant mean decrease of 0.24 readmissions per episode for intervention was observed in 90-day readmission rates relative to control. Skilled nursing facility readmissions and hospital discharges were factors of higher costs (mean increases of $9098 and $17,095 per episode respectively).
AHRQ-funded; HS027804.
Citation: Waltman A, Konetzka RT, Chia S .
Effectiveness of a bundled payments for care improvement program for chronic obstructive pulmonary disease.
J Gen Intern Med 2023 Sep; 38(12):2662-70. doi: 10.1007/s11606-023-08249-6..
Keywords: Respiratory Conditions, Chronic Conditions, Payment, Quality Improvement, Quality of Care
Liao JM, Wang E, Isidro U
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
This research evaluated whether the association between participation in bundled payments for medical conditions and episode outcomes differed for clinically high-risk versus other patients in regard to length of stay (LOS) at skilled nursing facilities (SNFs). Participants included 471,421 Medicare patients hospitalized at bundled payment and propensity-matched non-participating hospitals. Primary outcomes were SNF LOS and 90-day unplanned readmissions. SNF length of stay was differentially lower among frail patients, patients with advanced age (>85 years), and those with prior institutional post-acute care provider utilization compared to non-frail, younger, and patients without prior utilization, respectively. Bundled payment participation was also associated with differentially greater SNF LOS among disabled patients. It was not associated with differential changes in readmissions in any high-risk group but was associated with changes in quality, utilization, and spending measures for some groups.
AHRQ-funded; HS027595.
Citation: Liao JM, Wang E, Isidro U .
The association between bundled payment participation and changes in medical episode outcomes among high-risk patients.
Healthcare 2022 Dec 12; 10(12). doi: 10.3390/healthcare10122510..
Keywords: Payment, Quality Improvement, Quality of Care, Risk, Policy
Collins CR, Abel MK, Shui A
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
This study aimed to assess where the largest opportunities for care improvement lay with the bundled payment reimbursement model and how best to identify patients at high risk of suffering costly complications, including hospital readmission. The authors used a cohort of patients from 2014 and 2016 who met inclusion criteria for the Major Bowel Bundled Payment Program and performed a cost analysis to identify opportunities for improved care efficiency. Using the results, they identified readmissions as a target for improvement and then assessed whether the American College of Surgeons' National Surgical Quality Improvement Program surgical risk calculator (ACS NSQIP SRC) could accurately identify patients within the bundled payment population who were at high risk of readmission using a logistic regression model. Patients who were readmitted within 90-days post-surgery were 2.53 times more likely to be high-cost (>$60,000) then non-readmitted patients. However, the ACS NSQIP SRC did not accurately predict patients at high risk of readmission within the first 30 days post-surgery.
AHRQ-funded; HS024532.
Citation: Collins CR, Abel MK, Shui A .
Preparing for participation in the centers for Medicare and Medicaid Services' bundle care payment initiative-advanced for major bowel surgery.
Perioper Med 2022 Dec 9;11(1):54. doi: 10.1186/s13741-022-00286-9..
Keywords: Provider Performance, Payment, Hospital Readmissions, Quality Improvement, Quality of Care, Surgery, Medicare, Medicaid
Waters TM, Burns N, Kaplan CM
Combined impact of medicare's hospital pay for performance programs on quality and safety outcomes is mixed.
The authors examined the combined impact of Medicare's pay for performance (P4P) programs on clinical areas and populations targeted by the programs, as well as those outside their focus. Using HCUP data, and consistent with previous studies for individual programs, they detected minimal, if any, effect of Medicare's hospital P4P programs on quality and safety. They recommended a redesigning of the P4P programs before continuing to expand them.
AHRQ-funded; HS025148.
Citation: Waters TM, Burns N, Kaplan CM .
Combined impact of medicare's hospital pay for performance programs on quality and safety outcomes is mixed.
BMC Health Serv Res 2022 Jul 28;22(1):958. doi: 10.1186/s12913-022-08348-w..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicare, Payment, Provider Performance, Hospitals, Quality Indicators (QIs), Quality Measures, Quality Improvement, Quality of Care, Patient Safety
Roberts ET, Song Z, Ding L
Changes in patient experiences and assessment of gaming among large clinician practices in precursors of the merit-based incentive payment system.
Medicare's Merit-Based Incentive Payment System (MIPS), a public reporting and pay-for-performance program, adjusts clinician payments based on publicly reported measures that are chosen primarily by clinicians or their practices. Within precursor programs of the MIPS, this study examined 1) practices' selection of Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience measures for quality scoring under pay-for-performance and 2) the association between mandated public reporting on CAHPS measures and performance on those measures.
AHRQ-funded; HS026727.
Citation: Roberts ET, Song Z, Ding L .
Changes in patient experiences and assessment of gaming among large clinician practices in precursors of the merit-based incentive payment system.
JAMA Health Forum 2021 Oct;2(10). doi: 10.1001/jamahealthforum.2021.3105..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Medicare, Provider Performance, Payment, Quality Improvement, Quality of Care
Markovitz AA, Ayanian JZ, Warrier A
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Using national data for 2008-18, investigators found that double bonuses were not associated with either improvements in plan quality or increased Medicare Advantage enrollment. Additionally, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. These findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. This study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Warrier A .
Medicare Advantage plan double bonuses drive racial disparity in payments, yield no quality or enrollment improvements.
Health Aff 2021 Sep;40(9):1411-19. doi: 10.1377/hlthaff.2021.00349..
Keywords: Medicare, Health Insurance, Payment, Quality Improvement, Quality of Care, Disparities, Racial and Ethnic Minorities
Rosenthal M, Shortell S, Shah ND
Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data.
The purpose of this study was to characterize the strategies that physician practices use to improve clinician performance and determine their association with accountable care organizations (ACOs) and other payment reforms. The investigators concluded that ACO-affiliated practices are using more performance improvement strategies than other practices, but base only a small fraction of compensation on quality or cost.
AHRQ-funded; HS024075.
Citation: Rosenthal M, Shortell S, Shah ND .
Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data.
Health Serv Res 2019 Dec;54(6):1214-22. doi: 10.1111/1475-6773.13238..
Keywords: Provider Performance, Payment, Quality Improvement, Quality of Care
Sheetz KH, Dimick JB, Englesbe MJ
Hospital-acquired condition reduction program is not associated with additional patient safety improvement.
In 2013 the Centers for Medicare and Medicaid Services announced that it would begin levying penalties against hospitals with the highest rates of hospital-acquired conditions through the Hospital-Acquired Condition Reduction Program. This study evaluates whether the program has been successful in improving patient safety or not. The investigators concluded that the program did not improve patient safety in Michigan beyond existing trends.
AHRQ-funded; HS000053; HS026244.
Citation: Sheetz KH, Dimick JB, Englesbe MJ .
Hospital-acquired condition reduction program is not associated with additional patient safety improvement.
Health Aff 2019 Nov;38(11):1858-65. doi: 10.1377/hlthaff.2018.05504..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Patient Safety, Provider Performance, Quality Improvement, Quality of Care, Infectious Diseases, Payment
Martin BI, Lurie JD, Farrokhi FR
Early effects of Medicare's Bundled Payment For Care Improvement program for lumbar fusion.
The purpose of this study was to describe the early effects of Bundled Payment for Care Improvement (BPCI) program participation for lumbar fusion on 90-day reimbursement, procedure volume, reoperation, and readmission. The investigators included 89,605 beneficiaries undergoing lumbar fusion, finding that the mean age was 73.4 years, with 59% women, 92% White, and 22% with a Charlson Comorbidity Index of 2 or more. Participant hospitals had greater procedure volume, bed size, and total discharges. Relative to nonparticipants, risk-bearing hospitals had a slightly increased fusion procedure volume from 2012 to 2013, did not reduce 90-day episode of care costs, increased 90-day readmission rate, and increased repeat surgery rates.
AHRQ-funded; HS024714; HS024075; HS021695.
Citation: Martin BI, Lurie JD, Farrokhi FR .
Early effects of Medicare's Bundled Payment For Care Improvement program for lumbar fusion.
Spine 2018 May 15;43(10):705-11. doi: 10.1097/brs.0000000000002404.
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Keywords: Payment, Medicare, Quality Improvement, Patient-Centered Outcomes Research, Surgery
Cohen DJ, Dorr DA, Knierim K
Primary care practices' abilities and challenges in using electronic health record data for quality improvement.
Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. This study concluded that the current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.
AHRQ-funded; HS023940.
Citation: Cohen DJ, Dorr DA, Knierim K .
Primary care practices' abilities and challenges in using electronic health record data for quality improvement.
Health Aff 2018 Apr;37(4):635-43. doi: 10.1377/hlthaff.2017.1254.
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Keywords: Electronic Health Records (EHRs), Primary Care, Quality Improvement, Quality of Care, Health Information Technology (HIT), Payment
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
AHRQ-funded; HS021860.
Citation: Paddock SM, Damberg CL, Yanagihara D .
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
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Keywords: Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Bhatt SP, Wells JM, Iyer AS
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
This study evaluated whether a comprehensive chronic obstructive pulmonary disease (COPD) multidisciplinary intervention focusing on inpatient, transitional, and outpatient care as part of an institution's Bundled Payments for Care Improvement (BPCI) participation would reduce 30-day all-cause readmission rates for COPD exacerbations and reduce overall costs. It concluded that a Medicare BPCI intervention did not reduce 30-day all-cause readmission rates or overall costs after hospitalization for acute exacerbation of COPD.
AHRQ-funded; HS013852.
Citation: Bhatt SP, Wells JM, Iyer AS .
Results of a Medicare bundled payments for care improvement initiative for chronic obstructive pulmonary disease readmissions.
Ann Am Thorac Soc 2017 May;14(5):643-48. doi: 10.1513/AnnalsATS.201610-775BC.
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Keywords: Respiratory Conditions, Payment, Hospital Readmissions, Medicare, Quality Improvement
Lau BD, Haut ER, Hobson DB
ICD-9 code-based venous thromboembolism performance targets fail to measure up.
Suboptimal prevention practices have prompted payers to consider hospital-associated Venous thromboembolism (VTE) as a potentially preventable condition for which financial incentives or penalties exist to drive practice improvement. The authors reviewed a subset of hospital-associated VTE that were identified by ICD-9 codes used by a state-run pay-for-performance quality improvement program and discuss their findings.
AHRQ-funded; HS017952.
Citation: Lau BD, Haut ER, Hobson DB .
ICD-9 code-based venous thromboembolism performance targets fail to measure up.
Am J Med Qual 2016 Sep;31(5):448-53. doi: 10.1177/1062860615583547.
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Keywords: Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Prevention, Hospitals, Quality Improvement, Blood Clots, Payment, Provider Performance
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
AHRQ-authored.
Citation: Kronick R, Casalino LP, Bindman AB .
Apple pickers or federal judges: strong versus weak incentives in physician payment.
Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
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Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
AHRQ-funded
Citation: Berenson RA, Rice T .
Beyond measurement and reward: methods of motivating quality improvement and accountability.
Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
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Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Payment
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
AHRQ-funded; HS018546.
Citation: Layton TJ, Ryan AM .
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Health Services Research (HSR), Quality Improvement, Quality of Care
Berdahl C, Schuur JD, Fisher NL
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
In May 2015, Academic Emergency Medicine convened a consensus conference titled "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." As part of the conference, a panel of health care policy leaders and emergency physicians discussed the effect of the Affordable Casre Act and other quality programs on ED diagnostic imaging. This article discusses the content of the panel's presentations.
AHRQ-funded; HS023498.
Citation: Berdahl C, Schuur JD, Fisher NL .
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
Acad Emerg Med 2015 Dec;22(12):1393-9. doi: 10.1111/acem.12829.
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Keywords: Emergency Department, Healthcare Costs, Payment, Policy, Imaging, Policy, Quality Improvement
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
AHRQ-funded.
Citation: Schlesinger M, Grob R, Shaller D .
Using patient-reported information to improve clinical practice.
Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
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Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Payment, Public Reporting
Chen LM, Meara E, Birkmeyer JD
Medicare's Bundled Payments for Care Improvement initiative: expanding enrollment suggests potential for large impact.
The researchers examined the cross-sectional association between Bundled Payments for Care Improvement (BPCI) participation and providers' structural and cost characteristics. Overall participation in BPCI increased from about 400 in October 2013 to more than 2000 in June 2014. The authors concluded that growing participation in BPCI suggests strong interest in bundled payments.
AHRQ-funded; HS020671.
Citation: Chen LM, Meara E, Birkmeyer JD .
Medicare's Bundled Payments for Care Improvement initiative: expanding enrollment suggests potential for large impact.
Am J Manag Care 2015 Nov;21(11):814-20.
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Keywords: Healthcare Costs, Payment, Medicare, Quality Improvement
Abrahamson K, Miech E, Davila HW
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
The researchers explored ways in which data were collected, thought about and used by nursing home employees as a result of participation in a pay-for-performance (P4P) program. Their findings indicated that participants in the Minnesota Performance-based Incentive Payment Program’s quality improvement (QI) projects perceived a change in the rate and manner in which they gathered, used, and considered data in their QI decisions.
AHRQ-funded; HS018464
Citation: Abrahamson K, Miech E, Davila HW .
Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.
BMJ Qual Saf. 2015 May;24(5):311-7. doi: 10.1136/bmjqs-2014-003362..
Keywords: Nursing Homes, Long-Term Care, Payment, Provider Performance, Shared Decision Making, Policy, Quality Improvement, Quality of Care
Michtalik HJ, Carolan HT, Haut ER
Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.
The researchers sequentially examined an individualized physician dashboard and pay-for-performance program to improve venous thromboembolism (VTE) prophylaxis rates among hospitalists. They found that direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program.
AHRQ-funded; HS017952; HS022331.
Citation: Michtalik HJ, Carolan HT, Haut ER .
Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.
J Hosp Med 2015 Mar;10(3):172-8. doi: 10.1002/jhm.2303..
Keywords: Provider Performance, Payment, Blood Clots, Prevention, Quality Improvement, Quality of Care, Hospitals, Patient Safety
Ryan AM, Burgess JF, Pesko MF
The early effects of Medicare's mandatory hospital pay-for-performance program.
This study evaluated the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period. It found that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program’s initial implementation period.
AHRQ-funded; HS018546
Citation: Ryan AM, Burgess JF, Pesko MF .
The early effects of Medicare's mandatory hospital pay-for-performance program.
Health Serv Res. 2015 Feb;50(1):81-97. doi: 10.1111/1475-6773.12206..
Keywords: Medicare, Provider Performance, Payment, Hospitals, Quality Improvement, Quality of Care, Patient Experience
DeVoe JE, Stenger R
Aligning provider incentives to improve primary healthcare delivery in the United States.
This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create 'prisoner's dilemmas' that have stalled past reform efforts, then illustrates an escape from the dilemma. It concludes that a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved.
AHRQ-funded; HS014645; HS016181.
Citation: DeVoe JE, Stenger R .
Aligning provider incentives to improve primary healthcare delivery in the United States.
OA Fam Med 2013 Jun 1;1(1):7.
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Keywords: Healthcare Delivery, Payment, Primary Care, Quality Improvement