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
1 to 17 of 17 Research Studies DisplayedBeidler LB, Razon N, Lang H
"More than just giving them a piece of paper": interviews with primary care on social needs referrals to community-based organizations.
The purpose of this qualitative study was to describe primary care practice’s referrals to community-based organizations. The researchers utilized semi-structured interviews with 50 healthcare administrators in charge of social care efforts within their organization. Fifty diverse United States healthcare organizations and agencies were included. The study found that social needs referrals were an essential element of administrator’s social care activities. Administrators described the optimal referral program as one which places limited burden on care teams, provides patients with customized referrals, and facilitates closed-loop referrals. The researchers identified three key challenges organizations encounter when trying to implement the optimal referrals program: 1) developing and maintaining resources lists; 2) aligning referrals with patient needs; and 3) measuring the efficacy of referrals. Administrators The study concluded that primary care practice referrals to community-based organizations were used to improve patients' social conditions, but administrators report challenges providing customized and current information to their patients.
AHRQ-funded; HS024075.
Citation: Beidler LB, Razon N, Lang H .
"More than just giving them a piece of paper": interviews with primary care on social needs referrals to community-based organizations.
J Gen Intern Med 2022 Dec;37(16):4160-67. doi: 10.1007/s11606-022-07531-3..
Keywords: Primary Care, Social Determinants of Health, Community-Based Practice, Healthcare Delivery
White A, Fulda KG, Blythe R
Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety.
The purpose of this narrative review was to further define the nature of collaboration between pharmacists and primary care providers in improving medication safety in community settings, and to describe related barriers and strategies. The researchers searched PubMed studies published between January 2000 and December 2020 using search terms including: "collaboration," "community pharmacy," "patient safety," "medication safety," and "primary care physician." The identified articles were placed into 3 categories: 1) defining collaboration, 2) types of collaboration, and 3) barriers and solutions to collaboration. The authors concluded that medication review and other strategies are a common form of collaboration between pharmacists and primary care providers, and that barriers to that collaboration can include erroneous beliefs regarding roles, variation in access to clinical information, and differences in community pharmacy practice.
AHRQ-funded; HS027277.
Citation: White A, Fulda KG, Blythe R .
Defining and enhancing collaboration between community pharmacists and primary care providers to improve medication safety.
Expert Opin Drug Saf 2022 Nov;21(11):1357-64. doi: 10.1080/14740338.2022.2147923..
Keywords: Provider: Pharmacist, Primary Care, Medication, Patient Safety, Community-Based Practice
Hashemi A, Vasquez K, Guishard D
Implementing dash-aligned congregate meals and self-measured blood pressure in two senior centers: An open label study.
This study tested whether implementing two evidence-based interventions--DASH-aligned meals provided through an existing congregate meal program, and support for home Self-Measured Blood Pressure (SMBP) monitoring--lowers blood pressure among participants at two senior centers serving low-income, racially diverse communities. Participants were clients aged ≥60, eating ≥4 meals/week at two NYC senior centers. They received DASH-aligned congregate meals, and training in nutrition, BP management education, and personal SMBP device. Primary outcomes was a) change in systolic BP measured by independent health professionals, and b) change in percent with "controlled BP" (Eighth Joint National Committee (JNC-8) Guidelines), at Month 1 compared to Baseline. The authors enrolled 94 participants, with COVID closures interrupting implementation mid-study. Mean systolic BP at Month-1 changed by -4.41 mmHg compared to Baseline. Participants with controlled BP increased at Month 1 and changes in mean BP at Month 1 was significantly correlated with BMI, age, and baseline BP. Mean systolic mean SMBP changed by -6.9 mmHg at Months 5/6.
AHRQ-funded; HS021667.
Citation: Hashemi A, Vasquez K, Guishard D .
Implementing dash-aligned congregate meals and self-measured blood pressure in two senior centers: An open label study.
Nutr Metab Cardiovasc Dis 2022 Aug;32(8):1998-2009. doi: 10.1016/j.numecd.2022.05.018..
Keywords: Elderly, Blood Pressure, Community-Based Practice, Patient Self-Management, Nutrition, Lifestyle Changes, Vulnerable Populations
Luo Q, Moghtaderi A, Markus A
Financial impacts of the Medicaid expansion on community health centers.
This study’s objective was to determine the impact of Medicaid expansion on community health centers. The authors combined data from the Uniform Data System, IRS nonprofit tax returns, and county-level characteristics from the Census Bureau. Their final dataset included 5841 center-year observations. They found a $2.08 million relative increase in Medicaid revenues, offset by a $0.44 million decrease in total grants among community health centers in expansion states compared with centers in non-expansion states. They found a large but not statistically significant $0.98 million relative increase in total expenditures among expansion state centers. Uncompensated care for health centers in expansion states decreased by $1.19 million relative to their counterparts in non-expansion states.
AHRQ-funded; HS026816.
Citation: Luo Q, Moghtaderi A, Markus A .
Financial impacts of the Medicaid expansion on community health centers.
Health Serv Res 2022 Jun;57(3):634-43. doi: 10.1111/1475-6773.13897..
Keywords: Medicaid, Community-Based Practice, Healthcare Costs
McDowell A, Myong C, Tevis D
Sexual orientation and gender identity data reporting among U.S. health centers.
This study examined sexual orientation and gender identity data reporting among community health centers. The study used the 2016-2019 Uniform Data System for 1,381 community health centers to look at trends in reporting. From 2016 to 2016, the percentage of community health centers with sexual orientation and gender identity data for ≥75% of patients increased from 14.9% to 53.0%. In 2019, community health centers were more likely to have this data for ≥75% of patients if they were in nonmetro counties versus metro, were in the South or West (versus Northeast), and had more patients aged between 18 and 39 years, between 40 and 64 years (versus <18 years), or veterans. This was less likely among smaller community health centers serving 10-20,000 patients or >20,000 patients, and centers with more patients of American Indian/Alaskan Native or unknown race (versus White).
AHRQ-funded; HS025378.
Citation: McDowell A, Myong C, Tevis D .
Sexual orientation and gender identity data reporting among U.S. health centers.
Am J Prev Med 2022 Jun;62(6):e325-e32. doi: 10.1016/j.amepre.2021.12.017..
Keywords: Vulnerable Populations, Community-Based Practice
King C, Goldstein E, Crits-Christoph P
The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.
The purpose of this study was to: examine the comorbidities of mental health issues and a medical condition in a community mental health setting with a primarily Medicare and Medicaid population; describe the range of comorbid medical conditions in this setting; and explore the association between medical conditions on the alliance, attrition from services and outcome. The researchers accessed patient charts and conducted structured clinical interviews to collect medical diagnoses from 353 participants who had previously had a baseline evaluation as a participant in a study of therapies for major depressive disorder. The researchers reported that a high percentage of patients in the study experienced a comorbid medical condition. There were no significant correlations between the number of medical conditions and treatment outcome or early attrition from treatment. Further analyses revealed that the presence of a nervous system disorder was correlated with poorer treatment outcomes. The researchers concluded that patients undergoing treatment for major depressive disorder may benefit from simultaneously attending to the impact of medical conditions on physical functioning.
AHRQ-funded; HS018440.
Citation: King C, Goldstein E, Crits-Christoph P .
The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.
Psychotherapy 2022 Jun;59(2):199-208. doi: 10.1037/pst0000380..
Keywords: Depression, Behavioral Health, Community-Based Practice
Hatch B, Tillotson C, Hoopes M
Patient-level factors associated with receipt of preventive care in the safety net.
Researchers used electronic health record data from a national network of community health centers in the U.S. to measure patient-level status with preventive ratios for twelve preventive services and an aggregate preventive index. The results indicated that smoking, homelessness, and lack of health insurance were associated with lower preventive ratios for cancer and cardiovascular screenings; more ambulatory visits, better continuity of care, and enrollment in the patient portal were associated with higher preventive ratios for most services but the receipt of preventive services overall was low. The researchers concluded that these associations should inform future efforts to improve delivery of preventive healthcare.
AHRQ-funded; HS025155.
Citation: Hatch B, Tillotson C, Hoopes M .
Patient-level factors associated with receipt of preventive care in the safety net.
Prev Med 2022 May; 158:107024. doi: 10.1016/j.ypmed.2022.107024..
Keywords: Prevention, Community-Based Practice, Access to Care
Kranz AM, Steiner ED, Mitchell JM
School-based health services in Virginia and the COVID-19 pandemic.
The purpose of this study was to examine how the COVID-19 pandemic may have impacted the provision of school health services and related student needs. In May 2021, all 1178 Virginia public elementary schools received a web-based survey regarding the impact of the pandemic on school-based health services, with 65% of schools responding (N=767). Schools reported providing fewer school-based health services during the pandemic than before, with dental screenings declining the most (51% before vs 15% after). The study also reported that mental health as a top concern for students increased from 15% before the pandemic to 27% during the pandemic. The study concluded that schools reported providing fewer health services to students during pandemic in the 2020-2021 school year and increased concern about students' mental health.
AHRQ-funded; HS025430.
Citation: Kranz AM, Steiner ED, Mitchell JM .
School-based health services in Virginia and the COVID-19 pandemic.
J Sch Health 2022 May;92(5):436-44. doi: 10.1111/josh.13147..
Keywords: COVID-19, Children/Adolescents, Public Health, Healthcare Delivery, Community-Based Practice
Shadowen H, O'Loughlin K, Cheung K
Exploring the relationship between community program location and community needs.
Investigators identified and geolocated community programs in Richmond, Virginia, that aid with 9 domains of needs. They identified 280 community programs that provide aid for the 9 domains, with programs most often providing financial assistance and housing support. They found no relationship between the number of community programs and the level of need, with 2 exceptions: A positive association between financial programs and financial need, and a negative association between housing programs and housing need. They concluded that community programs were generally not co-located with need.
AHRQ-funded; HS026223.
Citation: Shadowen H, O'Loughlin K, Cheung K .
Exploring the relationship between community program location and community needs.
J Am Board Fam Med 2022 Jan-Feb;35(1):55-72. doi: 10.3122/jabfm.2022.01.210310..
Keywords: Social Determinants of Health, Community-Based Practice
Van der Wees PJ, Friedberg MW, Guzman EA
Comparing the implementation of team approaches for improving diabetes care in community health centers.
The researchers sought to clarify implementation processes and experiences of integrating office-based medical assistant (MA) panel management and community health worker (CHW) community-based management into routine care for diabetic patients. They found that CHW and MA responsibilities converged over time to focus on health coaching of diabetic patients, with the MA health coaches experiencing difficulty in allocating dedicated time due to other responsibilities. Time constraints also limited the personal introduction of patients to health coaches by clinicians. Participants highlighted the importance of a supportive team climate and proactive leadership as important enablers for MAs and CHWs to implement their health coaching responsibilities. This study suggests that a flexible approach to implementing health coaching is more important than fidelity to rigid models that do not allow for variable allocation of responsibilities across team members.
AHRQ-funded; HS020120.
Citation: Van der Wees PJ, Friedberg MW, Guzman EA .
Comparing the implementation of team approaches for improving diabetes care in community health centers.
BMC Health Serv Res 2014 Dec 3;14:608. doi: 10.1186/s12913-014-0608-z.
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Keywords: Community-Based Practice, Diabetes, Patient-Centered Healthcare, Quality Improvement, Teams
Davidson AJ, McCormick EV, Dickinson LM
Population-level obesity surveillance: monitoring childhood body mass index z-score in a safety-net system.
The objective of this study was to determine the utility of repeated patient-level body mass index (BMI) measurements among higher-risk patients seen at safety-net clinics as a community-level monitoring tool for overweight and obesity population trends. The researchers found that childhood obesity prevalence was high, with substantial progression to overweight and obesity from first to last visit and concluded that clinically derived BMI z-score per person-year measures can effectively show population trends not observed using standard weight status categories.
AHRQ-funded; HS021138.
Citation: Davidson AJ, McCormick EV, Dickinson LM .
Population-level obesity surveillance: monitoring childhood body mass index z-score in a safety-net system.
Acad Pediatr 2014 Nov-Dec;14(6):632-8. doi: 10.1016/j.acap.2014.06.007.
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Keywords: Children/Adolescents, Community-Based Practice, Obesity
Laiteerapong N, Kirby J, Gao Y
AHRQ Author: Kirby J, Ngo-Metzger Q
Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care.
The investigators compared utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. They found that HC patients had fewer office visits and hospitalizations, were more likely to receive breast cancer screening, had fewer outpatient and emergency room visits, and were more likely to receive dietary advice compared to non-HC patients.
AHRQ-authored.
Citation: Laiteerapong N, Kirby J, Gao Y .
Health care utilization and receipt of preventive care for patients seen at federally funded health centers compared to other sites of primary care.
Health Serv Res 2014 Oct;49(5):1498-518. doi: 10.1111/1475-6773.12178.
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Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Utilization, Prevention, Community-Based Practice, Healthcare Delivery
Snyder ME, Frail CK, Jaynes H
Predictors of medication-related problems among Medicaid patients participating in a pharmacist-provided telephonic medication therapy management program.
The objective of this study was to identify predictors of medication-related problems (MRPs) among Medicaid patients participating in a telephonic medication therapy management (MTM) program. The analysis of study results supports the relative importance of number of medications as a predictor of MRPs in the Medicaid population and identifies other predictors.
AHRQ-funded; HS022119.
Citation: Snyder ME, Frail CK, Jaynes H .
Predictors of medication-related problems among Medicaid patients participating in a pharmacist-provided telephonic medication therapy management program.
Pharmacotherapy 2014 Oct;34(10):1022-32. doi: 10.1002/phar.1462..
Keywords: Adverse Drug Events (ADE), Care Management, Community-Based Practice, Medicaid, Medication, Provider: Pharmacist
Heintzman J, Marino M, Hoopes M
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
This study used EHR data to compare the preventive service utilization of uninsured patients receiving care at Oregon community health centers (CHCs) in 2008 through 2011 with that of continuously insured patients at the same CHCs in the same period. The results showed that CHCs provided many preventive services to uninsured patients, but that uninsured patients were less likely than continuously insured patients to receive 5 of 11 preventive services. The authors concluded that lack of insurance is a barrier to preventive service utilization, even in patients who can access care at a CHC.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Hoopes M .
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
Prev Med 2014 Oct;67:306-10. doi: 10.1016/j.ypmed.2014.08.006.
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Keywords: Community-Based Practice, Electronic Health Records (EHRs), Healthcare Utilization, Prevention, Uninsured
Sharma R, Lebrun-Harris LA, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q
Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.
The authors determined the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). They found that, compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings.
AHRQ-authored.
Citation: Sharma R, Lebrun-Harris LA, Ngo-Metzger Q .
Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.
Medicare Medicaid Res Rev 2014 Sep 8;4(3). doi: 10.5600/mmrr.004.03.a05.
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Keywords: Access to Care, Community-Based Practice, Quality of Care, Low-Income, Medicare
Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q
Substance use, risk of dependence, counseling and treatment among adult health center patients.
The authors examined the prevalence of substance use and risk of dependence among health center patients, and identified factors associated with desire for counseling/treatment and discussions about substance use with a clinician. They found that 84% of patients who desired substance use counseling or treatment reported receiving it, and those patients most likely to desire substance use counseling or treatment were male, unmarried, insured, current smokers, and indicated mental health problems.
AHRQ-authored.
Citation: Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q .
Substance use, risk of dependence, counseling and treatment among adult health center patients.
J Health Care Poor Underserved 2014 Aug;25(3):1217-30. doi: 10.1353/hpu.2014.0130.
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Keywords: Behavioral Health, Community-Based Practice, Substance Abuse, Vulnerable Populations
Halbert CH, Briggs V, Bowman M
Acceptance of a community-based navigator program for cancer control among urban African Americans.
The researchers evaluated acceptance of a community-based navigator program for cancer control and identified factors having significant independent associations with navigation acceptance in an urban sample of African Americans. They found that age and perceived risk of developing cancer had a significant independent association with navigation acceptance. Participants who believed that they were at high risk for developing cancer had a lower likelihood of completing navigation.
AHRQ-funded; HS019339.
Citation: Halbert CH, Briggs V, Bowman M .
Acceptance of a community-based navigator program for cancer control among urban African Americans.
Health Educ Res 2014 Feb;29(1):97-108. doi: 10.1093/her/cyt098..
Keywords: Cancer, Care Coordination, Care Management, Community-Based Practice, Racial and Ethnic Minorities, Urban Health