National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
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- Care Coordination (1)
- Dementia (1)
- Diagnostic Safety and Quality (1)
- Healthcare-Associated Infections (HAIs) (1)
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- (-) Hospitals (8)
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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 8 of 8 Research Studies DisplayedLiao JM, Huang Q, Wang E
Performance of physician groups and hospitals participating in bundled payments among Medicare beneficiaries.
This cohort study compared how physician group practices (PGPs) performed in bundled payments compared with hospitals. The authors used 2011 to 2018 Medicare claims data to compare the association of participants in the Bundled Payments for Care Improvement (BCPI) initiative with episode outcomes. Primary outcome was 90-day total episode spending. The total sampled comprised data from 1,288,781 Medicare beneficiaries, of whom mean age was 76.2 years, 59.7% women, and 85.5% White, with 592,071 individuals receiving care from 6405 physicians in in BPCI-participating PGPs and 24,758 propensity-matched physicians in non-BPCI-participating PGPs. For PGPs, BPCI participation was associated with greater reductions in episode spending for surgical (difference, -$1648 to -$1088) but not for medical episodes (difference, -$410 to $206). Hospital participation in BPCI was associated with greater reductions in episode spending for both surgical ($1345 to -$675) and medical -$1139 to -$386) episodes.
AHRQ-funded; HS027595.
Citation: Liao JM, Huang Q, Wang E .
Performance of physician groups and hospitals participating in bundled payments among Medicare beneficiaries.
JAMA Health Forum 2022 Dec 2; 3(12):e224889. doi: 10.1001/jamahealthforum.2022.4889..
Keywords: Provider Performance, Payment, Hospitals, Medicare, Quality of Care
Likosky DS, Yang G, Zhang M
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
The purpose of this study was to examine differences in durable ventricular assist device implantation infection rates and associated costs across hospitals. The researchers utilized clinical data for 8,688 patients who received primary durable ventricular assist devices from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) and merged that data with post-implantation 90-day Medicare claims. The primary outcome included infections within 90 days of implantation and Medicare payments. The study found that 27.8% of patients developed 3982 identified infections. The median adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 and differed according to hospital. Total Medicare payments from implantation to 90 days were 9.0% more in high versus low infection tercile hospitals. The researchers concluded that health-care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures.
AHRQ-funded; HS026003.
Citation: Likosky DS, Yang G, Zhang M .
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
J Thorac Cardiovasc Surg 2022 Nov;164(5):1561-68. doi: 10.1016/j.jtcvs.2021.04.074..
Keywords: Healthcare-Associated Infections (HAIs), Medical Devices, Medicare, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Payment, Healthcare Costs
Friedman HR, Holmes GM
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
This study looked at trends in admission to urban hospitals by rural Medicare FFS beneficiaries from 2010 to 2018. The authors combined data from the 2010 to 2018 Hospital Service Area File (HSAF) and the 2010-2017 American Hospital Association (AHA) survey. They found that controlling for distance to the nearest hospitals, an increase of 1 year was associated with a 2.0% increase in the number of admissions to urban hospitals from each rural ZIP code. New system affiliation of the nearest rural hospital was associated with an increase of 1.7%.
AHRQ-funded; HS000032.
Citation: Friedman HR, Holmes GM .
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
Health Serv Res 2022 Oct;57(5):1029-34. doi: 10.1111/1475-6773.14017..
Keywords: Medicare, Rural Health, Hospitals, Access to Care
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
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
Everson J, Adler-Milstein JR, Hollingsworth JM
Dispersion in the hospital network of shared patients is associated with less efficient care.
The purpose of this study was to examine the level of distribution of patient-sharing networks across U.S. hospitals and its relationship with 3 measures of care delivered by hospitals that were likely to relate to coordination. The researchers utilized data from 2016 Medicare Fee-for-Service claims to measure the volume of patients that hospitals treated in common, and then calculated a measure of dispersion for each hospital. The relationship between network dispersion, Medicare spending per beneficiary, readmission rates, and emergency department (ED) throughput rates were then estimated. The study reported that hospitals with more dispersed networks had greater spending rates but not higher admission rates or slower ED processes. Among hospitals with less resources, more dispersion was associated with higher readmission rates and slower ED processes. The researchers concluded that dispersed interhospital networks create difficulties in coordinating patients who are treated at multiple hospitals, and that the structure of patient-sharing networks may be an overlooked factor that influences the delivery of care in health care organizations.
AHRQ-funded; HS026395, HS024525, HS024728, HS024454.
Citation: Everson J, Adler-Milstein JR, Hollingsworth JM .
Dispersion in the hospital network of shared patients is associated with less efficient care.
Health Care Manage Rev 2022 Apr-Jun;47(2):88-99. doi: 10.1097/hmr.0000000000000295..
Keywords: Medicare, Hospitals, Care Coordination, Healthcare Delivery
Herrin J, Yu H, Venkatesh AK
Identifying high-value care for Medicare beneficiaries: a cross-sectional study of acute care hospitals in the USA.
Investigators sought to define hospital value and identify the characteristics of hospitals which provide high-value care. Participants were Medicare beneficiaries with claims included in CMS Overall Star Ratings or in publicly available Medicare spending per beneficiary data. The researchers found that there are high quality hospitals that are not high value, and a number of factors are strongly associated with being low or high value. They suggested that their findings can inform efforts of policymakers and hospitals to increase the value of care.
AHRQ-funded; HS022882; HS026980.
Citation: Herrin J, Yu H, Venkatesh AK .
Identifying high-value care for Medicare beneficiaries: a cross-sectional study of acute care hospitals in the USA.
BMJ Open 2022 Mar 31;12(3):e053629. doi: 10.1136/bmjopen-2021-053629..
Keywords: Medicare, Quality of Care, Hospitals
Hua CL, Thomas KS, Bunker JN
Dementia diagnosis in the hospital and outcomes among patients with advanced dementia documented in the Minimum Data Set.
This retrospective cohort study examined the association between a dementia diagnosis listed on a hospital claim and patient outcomes among individuals with a Minimum Data Set (MDS) assessment. The cohort was comprised of hospitalized patients aged 66 years and older with advanced dementia noted on an MDS assessment completed within 120 days prior to their first hospitalization in 2017. Among 120,989 patients with advanced dementia and a nursing home stay, 90.6% had a dementia diagnosis on their hospital claims. Documentation of a dementia diagnosis was associated with lower use of intensive care unit or coronary care unit, use of invasive mechanical ventilation, and 30-day mortality. These patients also had a shorter hospital length of stay.
AHRQ-funded; HS000011.
Citation: Hua CL, Thomas KS, Bunker JN .
Dementia diagnosis in the hospital and outcomes among patients with advanced dementia documented in the Minimum Data Set.
J Am Geriatr Soc 2022 Mar;70(3):846-53. doi: 10.1111/jgs.17564..
Keywords: Dementia, Diagnostic Safety and Quality, Medicare, Hospitals, Neurological Disorders