National Healthcare Quality and Disparities Report
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Topics
- Access to Care (4)
- Cancer (1)
- Cardiovascular Conditions (2)
- Children/Adolescents (2)
- Chronic Conditions (1)
- Disparities (1)
- Healthcare Cost and Utilization Project (HCUP) (2)
- Healthcare Costs (2)
- Healthcare Delivery (1)
- Healthcare Utilization (3)
- Health Insurance (3)
- Hospital Readmissions (1)
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- Long-Term Care (1)
- (-) Medicaid (12)
- Medicare (3)
- Orthopedics (3)
- Outcomes (2)
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- Provider Performance (1)
- Quality Improvement (1)
- Quality of Care (1)
- (-) Surgery (12)
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 12 of 12 Research Studies DisplayedRoberts ET, Xue L, Lovelace J
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
This study’s objective was to evaluate changes in care associated with integrating Medicare and Medicaid coverage in a fully integrated dual-eligible special needs plan (FIDE-SNP) in Pennsylvania. This cohort study used a difference-in-differences analysis compared changes in care between 2 cohorts of dual-eligible individuals: (1) an integration cohort composed of Medicare Dual Eligible Special Needs Plan enrollees who joined a companion Medicaid plan following a 2018 state reform mandating Medicaid managed care (leading to integration), and (2) a comparison cohort with nonintegrated coverage before and after the start of Medicaid managed care. Analyses were conducted of outcomes in 4 domains: use of home- and community-based services (HCBS), care management and coordination, hospital stays and postacute care, and long-term nursing home stays. The study included 7967 individuals in the integration cohort and 3832 individuals in the comparison cohort. HCBS use increased differentially in the integration vs comparison cohorts by 0.61 days/person-month. However, integration was not associated with changes in care management and coordination, including medication use for chronic conditions (-0.02 fills/person-month) or follow-up outpatient care after a hospital stay (-0.01 visits/hospital stay). There was no significant difference in hospital stays between the cohorts.
AHRQ-funded; HS026727.
Citation: Roberts ET, Xue L, Lovelace J .
Changes in care associated with integrating Medicare and Medicaid for dual-eligible individuals.
JAMA Health Forum 2023 Dec; 4(12):e234583. doi: 10.1001/jamahealthforum.2023.4583..
Keywords: Medicare, Medicaid, Health Insurance, Surgery, Outcomes
Crook S, Dragan K, Woo JL
Long-term health care utilization after cardiac surgery in children covered under Medicaid.
The purpose of this study was to examine the long-term burden of health care expenditures and utilization after pediatric cardiac surgery to improve care and reduce outcome inequities. The study compared children under the age of 18 undergoing cardiac surgery from 2006-2019 to a similar cohort of children without cardiac surgical disease. The research concluded that children after cardiac surgery have substantial long-term health care needs than noncardiac surgical comparators.
AHRQ-funded; HS000055.
Citation: Crook S, Dragan K, Woo JL .
Long-term health care utilization after cardiac surgery in children covered under Medicaid.
J Am Coll Cardiol 2023 Apr 25; 81(16):1605-17. doi: 10.1016/j.jacc.2023.02.021..
Keywords: Children/Adolescents, Healthcare Utilization, Long-Term Care, Cardiovascular Conditions, Medicaid, Surgery
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
Taylor K, Diaz A, Nuliyalu U
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
The purpose of this study was to assess whether treatment at high-quality hospitals mitigates dual-eligibility-associated disparities in outcomes and spending for cancer surgery. Medicare beneficiaries 65 years or older who underwent colectomy, rectal resection, lung resection, or pancreatectomy were evaluated. The findings indicate that, even among the highest-quality hospitals, dual-eligibility patients had poorer outcomes and higher spending. Dually eligible patients were more likely to be discharged to a facility and thus incurred higher post-acute care costs. Although treatment at high-quality hospitals is associated with reduced differences in outcomes, dual-eligibility patients remain at high risk for adverse post-operative outcomes as well as increased readmissions and post-acute care use.
AHRQ-funded; HS024763.
Citation: Taylor K, Diaz A, Nuliyalu U .
Association of dual Medicare and Medicaid eligibility with outcomes and spending for cancer surgery in high-quality hospitals.
JAMA Surg 2022 Apr;157(4):e217586. doi: 10.1001/jamasurg.2021.7586..
Keywords: Cancer, Surgery, Medicare, Medicaid, Outcomes, Hospitals
Greenberg JK, Brown DS, Olsen MA
Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care.
This study's goal was to evaluate the impact of Medicaid expansion under the Affordable Care Act on the volume and payer mix of elective spine surgery in the United States. The authors evaluated elective spinal surgeries performed in the U.S. from 2011 to 2016 and included 10 states with expanded Medicaid access and 4 states that did not. They identified 218,648 surgical procedures performed in 10 Medicaid expansion states and 118,693 procedures performed in 4 nonexpansion states. Medicaid expansion was associated with a 17% increase in mean hospital spine surgical volume and a 23% increase in Medicaid volume. Privately insured surgical volumes did not change significantly. This increase indicated improved access to care.
AHRQ-funded; HS027075.
Citation: Greenberg JK, Brown DS, Olsen MA .
Association of Medicaid expansion under the Affordable Care Act with access to elective spine surgical care.
J Neurosurg Spine 2022 Feb;36(2):336–44. doi: 10.3171/2021.3.Spine2122..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Access to Care, Surgery
Dy CJ, Salter A, Barker A
Increased utilization of total joint arthroplasty after Medicaid expansion.
This study examined prior analyses that greater utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) was to be expected after Medicaid expansion in 2014. Using 2012-2015 data from the HCUP Database, 9 expansion states (Arkansas, Arizona, Colorado, Iowa, Massachusetts, Maryland, Nevada, New York, and Vermont) were compared to 2 states that did not expand Medicaid (Florida and Missouri). After adjusting for community characteristics, THA and TKA increased 15% in 2014 and 23% in 2015 within expansion states compared to 2013. In non-expansion states, compared to 2013, there were significant decreases of 18% in 2014 and 11% in 2015.
AHRQ-funded; HS019455.
Citation: Dy CJ, Salter A, Barker A .
Increased utilization of total joint arthroplasty after Medicaid expansion.
J Bone Joint Surg Am 2021 Mar 17;103(6):524-31. doi: 10.2106/jbjs.20.00303..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Orthopedics, Surgery, Healthcare Utilization, Access to Care
Encinosa WE
AHRQ Author: Encinosa WE
Is it time for ACOs to start tackling the high costs of surgery?
This article discusses an article appearing in the same issue revisiting the impact of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) on surgery expenditures. The author suggests that, in order to engage even more surgeons, it is likely that MSSP ACOs will have to work with surgeons in the various Medicare bundled payment programs for surgery. He concludes that the next stage is to examine how these different programs can work together to produce even more savings in surgical care.
AHRQ-authored.
Citation: Encinosa WE .
Is it time for ACOs to start tackling the high costs of surgery?
Am J Accountable Care 2020 Sep 15;8(3):26-27..
Keywords: Surgery, Healthcare Costs, Medicaid, Health Insurance, Payment
Dy CJ, Tipping AD, Nickel KB
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
This study examined rates of Medicaid-funded surgical procedures for orthopedic patients. The authors hypothesized that orthopedists and hospitals are often unwilling to perform surgery on underinsured patients. The payer mix was examined for select inpatient orthopedic surgical procedures within a single region, including elective cases (total knee or hip arthroplasty; spinal decompression or fusion) and trauma cases (hip hemiarthroplasty; femoral or tibial or fibular fracture repair) among 22 hospitals from 2011 to 2016 for patients aged 18 to 64 years. For all cases (n = 19,204) the mean percentage of Medicaid-funded surgical procedures was 7.6%. Elective surgery cases were 5.5% and trauma cases 14.7% which supports their beliefs about delivery rates of orthopedic care on the basis of socioeconomic markers.
AHRQ-funded; HS019455.
Citation: Dy CJ, Tipping AD, Nickel KB .
Variation in the delivery of inpatient orthopaedic care to Medicaid beneficiaries within a single metropolitan region.
J Bone Joint Surg Am 2019 Aug 21;101(16):1451-59. doi: 10.2106/jbjs.18.01198.
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Keywords: Orthopedics, Healthcare Delivery, Medicaid, Surgery, Access to Care, Disparities, Health Insurance
Dy CJ, Brown DS, Maryam H
Two-state comparison of total joint arthroplasty utilization following Medicaid expansion.
The aim of this study was to determine whether Medicaid expansion was associated with increased utilization rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Illinois (which expanded Medicaid) relative to Missouri (which did not expand Medicaid). The investigators concluded that their study demonstrated that Medicaid expansion in Illinois was associated with increased utilization of THA and TKA. They suggested that further study is needed to understand the impact of Medicaid expansion in other states and for other procedures.
AHRQ-funded; HS019455.
Citation: Dy CJ, Brown DS, Maryam H .
Two-state comparison of total joint arthroplasty utilization following Medicaid expansion.
J Arthroplasty 2019 Apr;34(4):619-25.e1. doi: 10.1016/j.arth.2018.12.019..
Keywords: Healthcare Utilization, Medicaid, Orthopedics, Surgery
Silber JH, Rosenbaum PR, Wang W
Practice style variation in Medicaid and non-Medicaid children with complex chronic conditions undergoing surgery.
With differential payment between Medicaid and Non-Medicaid services, researchers asked whether style-of-practice differs between similar Medicaid and Non-Medicaid children with complex chronic conditions (CCCs) undergoing surgery. They found that treatment style differences between Medicaid and Non-Medicaid children were small, suggesting little disparity with in-hospital surgical care for patients with CCCs operated on within Children's Hospitals.
AHRQ-funded; HS020508.
Citation: Silber JH, Rosenbaum PR, Wang W .
Practice style variation in Medicaid and non-Medicaid children with complex chronic conditions undergoing surgery.
Ann Surg 2018 Feb;267(2):392-400. doi: 10.1097/sla.0000000000002061.
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Keywords: Children/Adolescents, Chronic Conditions, Healthcare Costs, Medicaid, Surgery
Charles EJ, Johnston LE, Herbert MA
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. It concluded that Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving health care financing, Medicaid expansion may positively affect patient care and outcomes.
AHRQ-funded; HS022535.
Citation: Charles EJ, Johnston LE, Herbert MA .
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
Ann Thorac Surg 2017 Oct;104(4):1251-58. doi: 10.1016/j.athoracsur.2017.03.079.
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Keywords: Patient-Centered Outcomes Research, Medicaid, Surgery, Cardiovascular Conditions, Policy
Aliu O, Auger KA, Sun GH
The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care.
Using the natural experiment of Medicaid expansion in New York (NY) State in October 2001, the study investigators examined whether Medicaid expansion increased access to common musculoskeletal procedures for Medicaid beneficiaries. They concluded that Medicaid expansion in NY State significantly improved access to common musculoskeletal procedures for Medicaid beneficiaries.
AHRQ-funded; HS020672.
Citation: Aliu O, Auger KA, Sun GH .
The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care.
Med Care 2014 Sep;52(9):790-5. doi: 10.1097/mlr.0000000000000175..
Keywords: Access to Care, Policy, Medicaid, Surgery