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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 25 of 128 Research Studies DisplayedFrimpong JA, Liu X, Liu L
AHRQ Author: Liu L
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
The purpose of this study was to explore the adoption of electronic health record (EHR) systems in substance use disorder (SUD) programs, with an emphasis on changes in adoption from 2014 to 2017, and identify organizational-level variables related with EHR adoption. The researchers utilized data from the 2014 and 2017 National Drug Abuse Treatment System Surveys, and analyzed 1,027 SUD programs. The study found the adoption of EHR increased significantly from 57.6% in 2014 to 69.2% in 2017. Nearly one-third of SUD programs had not yet adopted an EHR system by 2017. The researchers identified a significant increase in technology use and ownership by a parent company and a decrease in the percentage of uninsured patients in 2017 compared to 2014. Further analysis revealed significant differences by adoption status for three main barriers to adoption: 1. Costs of start-up, 2. Ongoing financial costs, and 3. Privacy or security concerns. Programs that used computerized scheduling and billing systems had a greater likelihood of adopting EHR. Ownership type, such as private nonprofit and public, or interest in taking part in a patient-centered medical home were related with a greater likelihood to adopt EHR. Overall, SUD programs were more likely to adopt an EHR system in 2017 compared to 2014.
AHRQ-authored.
Citation: Frimpong JA, Liu X, Liu L .
Adoption of electronic health record among substance use disorder treatment programs: nationwide cross-sectional survey study.
J Med Internet Res 2023 Dec 14; 25:e45238. doi: 10.2196/45238..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Substance Abuse, Behavioral Health
Rains A, Sibley AL, Levander XA
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
This study explored how people who use drugs in rural counties across the United States appraise sex work by themselves or other community members. The authors used qualitative interview data that came from the Rural Opioid Initiative (ROI), a project coordinated by research teams across 65 rural counties in 10 states. These interviews were individual and conducted from 2018 to 2020, with all participants reporting past 30-day opioid use and/or any injection drug use. Across sites, 355 interviews were conducted with a mean participant age of 36, 55% male, and 93% white. Negative attitudes were expressed towards sex work as a function of its criminal-legal repercussions or was framed as morally transgressive. Many appraisals were gendered, with the behavior described as being “easier” for women who were often described as "whores," with more neutral terms used to describe men. Some participants viewed sex work as an implicit “exchange” for drugs.
AHRQ-funded; HS026370.
Citation: Rains A, Sibley AL, Levander XA .
"I would do anything but that": attitudes towards sex work among rural people who use drugs.
Int J Drug Policy 2023 Dec; 122:104237. doi: 10.1016/j.drugpo.2023.104237..
Keywords: Rural Health, Vulnerable Populations, Substance Abuse, Behavioral Health
Zuvekas SH
AHRQ Author: Zuvekas SH
COVID-19, mental health, and mental health treatment among adults.
This AHRQ-authored paper seeks to examine the impact of the COVID-19 pandemic on mental health status and mental health treatment among adults residing in the U.S. civilian, non-institutionalized population. Data from the 2019-2020 MEPS was used. The author examined unadjusted and regression-adjusted differences between 2019 and 2020 in perceived mental health status (excellent, very good, good, fair, poor) and in the K6 general psychological distress, the PHQ-2 depression screener, and the VR-12 mental component summary score. Similarly, using the detailed MEPS data on health care encounters and prescription drug fills, he examined differences in mental health use treatment between 2019 and 2020. He focused specifically on changes in continuity of treatment among those already in treatment in January and February, before the pandemic fully struck, as well differences in the initiation of new episodes of treatment after the pandemic began. Results were that all four mental health scales included in the MEPS showed statistically significant declines in mental health between 2019 and 2020, particularly among younger adults. However, the percentage of US adults receiving mental health treatment did not change significantly. Continuity of treatment increased slightly in 2020, with 87.1% of adults in treatment January or February still receiving care in the second quarter, an increase of 2.5 percentage points. However, there were significant declines in the initiation of new treatment, especially in the second quarter of 2020.
AHRQ-authored.
Citation: Zuvekas SH .
COVID-19, mental health, and mental health treatment among adults.
J Ment Health Policy Econ 2023 Dec 1; 26(4):159-83..
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Behavioral Health
Goyal N, Gannon M, Sood E
Group well child care for mothers with opioid use disorder: framework for implementation.
The purpose of this study was to utilize an implementation science framework to examine barriers and facilitators to group well child care (WCC) interventions for parents with opioid use disorder and their children. The researchers conducted a qualitative study using structured phone interviews as a component of the planning phase of a trial of group WCC. Eligible parents were English speaking and had a child less than two years old. Thirty-one parents and 13 pediatric clinicians participated in the interviews. 68% of parents reported that they would be likely or very likely to bring their child to the OUD treatment center for WCC. The researchers found 6 themes emerged describing perceived implementation barriers, including intervention difficulty, complexity, and potential negative outcomes including loss of privacy. Six themes emerged as implementation facilitators: 1. focus on parental OUD and recovery, 2. peer support, 3. accessibility and coordination of care, 4. clinician skill and expertise in parental OUD, 5. increased time for patient care, and 6. continuity of care.
AHRQ-funded; HS027399.
Citation: Goyal N, Gannon M, Sood E .
Group well child care for mothers with opioid use disorder: framework for implementation.
Matern Child Health J 2023 Dec; 27(suppl 1):75-86. doi: 10.1007/s10995-023-03762-w..
Keywords: Children/Adolescents, Women, Substance Abuse, Opioids, Behavioral Health
Liebschutz JM, Subramaniam GA, Stone R
Subthreshold Opioid Use Disorder Prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.
This article described the Subthreshold Opioid Use Disorder Prevention (STOP) Trial, a cluster randomized controlled trial designed to study the efficacy of the STOP intervention to reduce risky opioid use and to prevent progression to moderate/severe opioid use disorder (OUD) in adult primary care patients with subthreshold OUD. The STOP intervention consisted of a nurse care manager providing patient-participant education and primary care provider support, brief advice delivered to patient participants about health risks of opioid misuse, and up to six sessions of telephone health coaching to motivate and support behavioral change. The authors concluded that the STOP Trial offers a potential blueprint for feasible and effective improvement of outcomes for adult subthreshold OUD patients.
AHRQ-funded; HS026120.
Citation: Liebschutz JM, Subramaniam GA, Stone R .
Subthreshold Opioid Use Disorder Prevention (STOP) trial: a cluster randomized clinical trial: study design and methods.
Addict Sci Clin Pract 2023 Nov 18; 18(1):70. doi: 10.1186/s13722-023-00424-8..
Keywords: Opioids, Substance Abuse, Behavioral Health, Prevention
Hails KA, Wellen BC, Simoni M
Parents' preferences for primary care-based behavioral services and the COVID-19 pandemic: a mixed method study.
This mixed method study examined how family factors impacted parents' attitudes toward integrated behavioral health (IBH) in pediatric primary care during the COVID-19 pandemic. The authors hypothesized that COVID-19 impact would predict family functioning challenges, and that pre-existing familial contextual factors would predict parents' interest in IBH modalities. A survey was completed by parents of children ages 1.5-5 years (N = 301) from five primary care clinics with measures assessing familial contextual factors (income, race and ethnicity, and parents' childhood adversity), COVID-19 impact on family relationships and wellbeing, family functioning (child behavior, parenting self-efficacy, and parent psychological functioning), and parents' preferences for behavioral support in primary care. A subsample of 23 parents completed qualitative interviews to provide deeper insights into quantitative relationships. The higher the COVID-19 impact, the more it was significantly associated with worse parent mental health and child behavior problems, as well as lower interest in IBH virtual support options. Lower SES and racial and/or ethnic minority parents both indicated greater interest in IBH modalities compared to higher SES and White parents, respectively. Qualitative interviews conducted found that pandemic stressors led to increases in parents’ desire for behavioral support from pediatricians, with parents sharing perspectives on the nature of support they desired, including proactive communication from providers and variety and flexibility in the behavioral supports offered.
AHRQ-funded; HS022981.
Citation: Hails KA, Wellen BC, Simoni M .
Parents' preferences for primary care-based behavioral services and the COVID-19 pandemic: a mixed method study.
J Pediatr Psychol 2023 Nov 16; 48(11):879-92. doi: 10.1093/jpepsy/jsad034..
Keywords: Children/Adolescents, COVID-19, Behavioral Health, Primary Care
Efird CR, Barrington c, Metzl JM
"We grew up in the church": a critical discourse analysis of Black and White rural residents' perceptions of mental health.
This study’s purpose was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. The authors conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. They found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. White rural residents tended to have condemning discourses that illustrated their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. On the other hand, Black residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors for White residents differ from Black residents with White residents primarily concerned about perceived social changes and Black residents referencing experiences of interpersonal and structure racism. Both Black and White residents found social support from involvement in their respective religious organizations as help for coping, but only Black residents signified that a personal relationship with a higher ower was an essential positive coping mechanism.
AHRQ-funded; HS000032.
Citation: Efird CR, Barrington c, Metzl JM .
"We grew up in the church": a critical discourse analysis of Black and White rural residents' perceptions of mental health.
Soc Sci Med 2023 Nov; 336:116245. doi: 10.1016/j.socscimed.2023.116245..
Keywords: Racial and Ethnic Minorities, Rural Health, Rural/Inner-City Residents, Behavioral Health
Meiselbach MK, Huskamp HA, Eddelbuettel JCP
Choice of high-deductible health plans among enrollees with a substance use disorder.
Researchers examined factors associated with the decision of individuals with substance use disorders (SUDs) to enroll in high-deductible health plans (HDHPs). They used de-identified administrative commercial claims and enrollment data from OptumLabs to identify individuals at employers that offered at least one HDHP and one non-HDHP plan. Their findings showed that a health reimbursement arrangement was associated with a higher probability of new and re-enrollment in an HDHP. Older enrollees with SUD were less likely to enroll in a new HDHP, while enrollees who were non-White, lower income, and in lower educational attainment census blocks were more likely to newly enroll. The researchers concluded that, given the emerging evidence that HDHPs may discourage SUD treatment, higher HDHP enrollment could exacerbate health disparities.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Huskamp HA, Eddelbuettel JCP .
Choice of high-deductible health plans among enrollees with a substance use disorder.
J Subst Use Addict Treat 2023 Nov; 154:209152. doi: 10.1016/j.josat.2023.209152.
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Keywords: Health Insurance, Substance Abuse, Behavioral Health
Kang-Yi CD, Kuriyan A, Kinkler G
Generating actionable evidence for school-based mental health service delivery: public-academic partnership based evaluations.
This paper reported the key findings of evaluations of Philadelphia's school mental health programs reimbursable through Medicaid billing since 2008. The evaluations included acute mental health service use of children who received school-based care and Medicaid expenditure, children's behaviors to measure school mental health providers' performance, and effects of school mental health programs on children's behavioral health functioning, school outcomes, and other service usage. The paper discussed how programs have been refined based on evaluation results, and shared lessons learned for successful public-academic partnership-based evaluations.
AHRQ-funded; HS026862.
Citation: Kang-Yi CD, Kuriyan A, Kinkler G .
Generating actionable evidence for school-based mental health service delivery: public-academic partnership based evaluations.
Community Ment Health J 2023 Nov; 59(8):1588-600. doi: 10.1007/s10597-023-01147-5..
Keywords: Children/Adolescents, Behavioral Health, Healthcare Delivery, Community-Based Practice
Bridges NC, Taber R, Foulds AL
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
This study’s purpose was to gain a better understanding of the barriers and facilitators operating at multiple levels to access or provide medications for opioid use disorder (MOUD) in rural Pennsylvania. The authors interviewed patients and providers who were involved in the Rural Access to Medication Assisted Treatment in Pennsylvania (RAMP) Project, which facilitated adoption of MOUD in rural primary care clinics. The study conducted 35 semi-structured interviews with MOUD patients and MOUD providers participating in RAMP. The interviews were coded by the study team. Themes from the qualitative interviews were organized in five nested levels: individual, interpersonal, health care setting, community, and public policy. Patients and providers agreed on many barriers (such as lack of providers, lack of transportation, insufficient rapport and trust in patient-provider relationship, and cost, etc.); however, their interpretation of the barrier, or indicated solution, diverged in meaningful ways. Patients described their experiences in broad terms pointing to the social determinants of health while providers focused on their professional roles, responsibilities, and operations within the primary care setting.
AHRQ-funded; HS025072.
Citation: Bridges NC, Taber R, Foulds AL .
Medications for opioid use disorder in rural primary care practices: patient and provider experiences.
J Subst Use Addict Treat 2023 Nov; 154:209133. doi: 10.1016/j.josat.2023.209133..
Keywords: Rural Health, Rural/Inner-City Residents, Opioids, Medication, Substance Abuse, Behavioral Health, Primary Care
Plummer N, Guardado R, Ngassa Y
Racial differences in self-report of mental illness and mental illness treatment in the community: an analysis of jail intake data.
This cross-sectional study evaluated the frequency of racial/ethnic differences in the self-report of mental illness and psychiatric medication use at jail entry. The authors used data from the "Offender Management System," the administrative database used by the jail containing data on people who are incarcerated, and COREMR, the electronic medical record (EMR) used in the Middlesex Jail & House of Correction, located in Billerica, MA. They evaluated two primary outcomes: (1) self-reported mental illness history and (2) self-reported use of psychiatric medication, with the primary indicator of interest as race/ethnicity. At intake over half (57%) in the sample self-reported a history of mental illness, with 20% reporting the use of psychiatric medications. Among people who self-reported a history of mental illness, non-White inmates all had decreased odds of reporting psychiatric medication. Only 20% reported receiving medications in the community prior to incarceration.
AHRQ-funded; HS026008.
Citation: Plummer N, Guardado R, Ngassa Y .
Racial differences in self-report of mental illness and mental illness treatment in the community: an analysis of jail intake data.
Adm Policy Ment Health 2023 Nov; 50(6):966-75. doi: 10.1007/s10488-023-01297-4..
Keywords: Racial and Ethnic Minorities, Behavioral Health, Vulnerable Populations
Dopp AR, Hunter SB, Godley MD
Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study.
This study’s goal was to compare organization-focused and state-focused financing strategies on their provider-level reach of a youth substance use treatment model. The authors evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing the two US federal grant mechanisms on organization-level A-CRA reach outcomes. Implementation of these A-CRA grants took place from 2006 to 2021. They used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, they calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding and also tested differences in certification rate by grant type. They also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. Overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants. They did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities).
AHRQ-funded; HS000046.
Citation: Dopp AR, Hunter SB, Godley MD .
Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study.
Implement Sci 2023 Oct 12; 18(1):50. doi: 10.1186/s13012-023-01305-z..
Keywords: Children/Adolescents, Substance Abuse, Behavioral Health
Kornfield R, Lattie EG, Nicholas J
"Our job is to be so temporary": designing digital tools that meet the needs of care managers and their patients with mental health concerns.
The purpose of this study was to improve understanding of how to integrate digital tools in routine healthcare, especially for patients with both physical and mental health needs. The researchers conducted interviews and design workshops with 1. a group of care managers who support patients with complex health needs, and 2. their patients whose health needs include mental health concerns. The researchers examined both groups' views of potential applications of digital tools within care management. The study found that care managers felt underprepared to addressing mental health issues on an ongoing basis and had concerns about the burden and confusion of providing support through new digital channels. Patients envisioned benefiting from ongoing mental health support from care managers, including support in using digital tools. The needs of patients and care managers may be so different that meeting both through the same tools represents a substantial challenge, and could require altering these professionals' roles in mental health support.
AHRQ-funded; HS028003.
Citation: Kornfield R, Lattie EG, Nicholas J .
"Our job is to be so temporary": designing digital tools that meet the needs of care managers and their patients with mental health concerns.
Proc ACM Hum Comput Interact 2023 Oct; 7(CSCW2):302. doi: 10.1145/3610093..
Keywords: Behavioral Health, Health Information Technology (HIT), Care Coordination
Pederson CA, Dir AL, Schwartz K
Associations between outpatient treatment and the use of intensive psychiatric healthcare services.
This study examined concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (median = 13.4) and had a psychiatric Medicaid claim (N = 33,590). Outcome was use of psychiatric services coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistical regression analyses by the authors indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. The authors found that for remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care.
AHRQ-funded; HS022681; HS023318
Citation: Pederson CA, Dir AL, Schwartz K .
Associations between outpatient treatment and the use of intensive psychiatric healthcare services.
Clin Child Psychol Psychiatry 2023 Oct; 28(4):1380-92. doi: 10.1177/13591045231154106..
Keywords: Behavioral Health, Healthcare Utilization
Acolin J, Cadigan JM, Fleming CB
Trajectory of depressive symptoms in the context of romantic relationship breakup: characterizing the “natural course” of response and recovery in young adults.
This study’s objective was to characterize the trajectory of depressive symptoms before, during, and after relationship breakup in young adults and to examine subjective appraisal and sense of control. The authors used the PHQ-2 survey to screen for depressive symptoms. In their sample of participants reporting a single breakup during the 2-year study period (N = 156), breakup was associated with a temporary increase in depressive symptoms that returned to pre-breakup levels within 3 months. They observed increased symptoms among negatively appraised, but not positive or neutral, events. The lower the sense of control, the more depressive symptoms were demonstrated at all time points.
AHRQ-funded; HS013853.
Citation: Acolin J, Cadigan JM, Fleming CB .
Trajectory of depressive symptoms in the context of romantic relationship breakup: characterizing the “natural course” of response and recovery in young adults.
Emerging Adulthood 2023 Oct; 11(5):1211-22. doi: 10.1177/21676968231184922..
Keywords: Depression, Young Adults, Behavioral Health
Narindrarangkura P, Alafaireet PE, Khan U
Association rule mining of real-world data: uncovering links between race, glycemic control, lipid profiles, and suicide attempts in individuals with diabetes.
The objective of this study was to use the association rule mining (ARM) technique to identify a high-risk group of suicide attempts among patients with diabetes. Cerner Real-World Data™ was mined using this technique. The study results indicated that patients with diabetes who were never married and had average blood glucose levels below 150 mg/dl were more likely to attempt suicide, while patients aged 60 and older who had diabetes for less than five years were less likely to attempt suicide. The authors concluded that ARM showed the potential for knowledge discovery in large multi-center electronic health records data, and the results could be used by providers during outpatient clinic visits.
Citation: Narindrarangkura P, Alafaireet PE, Khan U .
Association rule mining of real-world data: uncovering links between race, glycemic control, lipid profiles, and suicide attempts in individuals with diabetes.
Inform Med Unlocked 2023; 42. doi: 10.1016/j.imu.2023.101345..
Keywords: Diabetes, Behavioral Health, Risk
Holland JE, Rettew DC, Varni SE
Associations between mental and physical illness comorbidity and hospital utilization.
The purpose of this study was to describe the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and evaluate the relationship of comorbidity on hospital use. The sample analyzed was 50% female, 63% Medicaid, and 43% had 1 or more chronic illness. The study found that mental illness was common (31%) and highly comorbid with multiple physical illnesses. In AYA with pulmonary illness, those with comorbid mental illness had 1.74-times higher odds of ED use and 2.9-times higher odds of hospitalization than those without mental illness. Comorbid endocrine and mental illness had 1.84-times higher odds of ED use and 2.1-times higher odds of hospitalization, comorbid neurologic and mental illness had 1.36-times higher odds of ED use and 2.4-times higher odds of hospitalization and comorbid musculoskeletal and mental illness had 1.38-times higher odds of ED use and 2.1-times higher odds of hospitalization.
AHRQ-funded; HS024575.
Citation: Holland JE, Rettew DC, Varni SE .
Associations between mental and physical illness comorbidity and hospital utilization.
Hosp Pediatr 2023 Sep; 13(9):841-48. doi: 10.1542/hpeds.2022-006984..
Keywords: Behavioral Health, Chronic Conditions, Hospitalization
Franklin MK, Karpyn A, Christofferson J
Barriers and facilitators to discussing parent mental health within child health care: perspectives of parents raising a child with congenital heart disease.
This study’s objective was to identify barriers and facilitators to the discussion of parental mental health within child health care for children with congenital heart disease (CHD). Participants were parents of young children with CHD who received care across 40 hospitals in the US. They responded to questions about discussing their mental health with their child's health care providers and described multiple barriers including perceived expectation to "stay strong," and fear of negative judgment or repercussions. Facilitators included care team ability to provide support and personal connections with health care providers. The authors concluded that is important that health care providers normalize the impact of child illness on the family and create an environment in which parents feel comfortable discussing mental health challenges.
AHRQ-funded; HS026393.
Citation: Franklin MK, Karpyn A, Christofferson J .
Barriers and facilitators to discussing parent mental health within child health care: perspectives of parents raising a child with congenital heart disease.
J Child Health Care 2023 Sep; 27(3):360-73. doi: 10.1177/13674935211058010..
Keywords: Children/Adolescents, Behavioral Health, Heart Disease and Health, Cardiovascular Conditions
Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A
High-deductible health plans and nonfatal opioid overdose.
This study examined whether an employer offering a high-deductible health plan (HDHP) had an impact on nonfatal opioid overdose among commercially insured individuals with opioid use disorder (OUD) in the United States. The authors used deidentified insurance claims data from 2007 to 2017 with 97,788 person-years. They estimated the change in the probability of a nonfatal opioid overdose among enrollees with OUD whose employers began offering an HDHP insurance option during the study period compared with the change among those whose employer never offered an HDHP. Across both groups, 2% of the sample experienced a nonfatal opioid overdose during the study period. They found no association of HDHP with an observed increase in the probability of nonfatal opioid overdose among commercially insured person-years with OUD.
AHRQ-funded; HS000029.
Citation: Eddelbuettel JCP, Barry CL, Kennedy-Hendricks A .
High-deductible health plans and nonfatal opioid overdose.
Med Care 2023 Sep; 61(9):601-04. doi: 10.1097/mlr.0000000000001886..
Keywords: Healthcare Costs, Health Insurance, Opioids, Substance Abuse, Behavioral Health
Lewis A, Howland RE, Horwitz LI
Medicaid value-based payments and health care use for patients with mental illness.
This retrospective cohort study’s objective was to investigate if New York State's Medicaid value-based payment reform was associated with improved utilization patterns for patients with mental illness (major depression disorder, bipolar disorder, and/or schizophrenia). The cohort included Medicaid 306,290 individuals with depression (67.4% female; mean age, 38.6 years), 85,105 patients with bipolar disorder (59.6% female; mean age, 38.0 years), and 71,299 patients with schizophrenia (45.1% female mean age, 40.3 years). After adjustment, the analysis estimated a statistically significant, positive association between value-based payments and behavioral health visits for patients with depression (0.91 visits) and bipolar disorder (1.01 visits). There were no statistically significant changes to primary care visits for patients with depression and bipolar disorder, but value-based payments were associated with reductions in primary care visits for patients with schizophrenia (-1.31 visits). In every diagnostic population, value-based payment was associated with significant reductions in mental health emergency department visits (population with depression: -0.01 visits; population with bipolar disorder: -0.02 visits; population with schizophrenia: -0.04 visits).
AHRQ-funded; HS026980; HS026120.
Citation: Lewis A, Howland RE, Horwitz LI .
Medicaid value-based payments and health care use for patients with mental illness.
JAMA Health Forum 2023 Sep; 4(9):e233197. doi: 10.1001/jamahealthforum.2023.3197..
Keywords: Medicaid, Behavioral Health, Payment, Depression
Somohano VC, Smith CL, Saha S
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
This article examined the role that trust in a prescribing provider has on shared decision-making and opioid misuse in opioid-specific pain management. A secondary analysis of data from a prospective cohort study was conducted of US Veterans (N = 1273) prescribed long-term opioid therapy (LTOT) for chronic non-cancer pain. Patient-provider shared decision-making had a total significant effect on opioid misuse, in the absence of the mediator, such that higher levels of shared decision-making were associated with lower levels of reported opioid misuse. When trust in provider was added to the mediation model, the indirect effect of shared decision-making on opioid misuse through trust in provider remained significant.
AHRQ-funded; HS026370.
Citation: Somohano VC, Smith CL, Saha S .
Patient-provider shared decision-making, trust, and opioid misuse among US veterans prescribed long-term opioid therapy for chronic pain.
J Gen Intern Med 2023 Sep; 38(12):2755-60. doi: 10.1007/s11606-023-08212-5..
Keywords: Shared Decision Making, Opioids, Medication, Substance Abuse, Behavioral Health, Pain, Chronic Conditions
Button D, Levander XA, Cook RR
Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: a cross-sectional survey.
This study evaluated how technology access (cell phone use and access to the Internet) affected substance use disorder (SUD) treatment prior to COVID-19 for people who use drugs in rural areas. The authors used data from the Rural Opioid Initiative (January 2018-March 2020), which was a cross-sectional study of people with prior 30-day injection drug or nonprescribed opioid use from rural areas of 10 states. They found that out of 3,026 participants, 71% used heroin and 76% used methamphetamine with 35% having no cell phone and 10% having no prior 30-day Internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use and a higher likelihood of SUD counseling in the prior 30 days. Lack of cell phone was associated with decreased days of MOUD and a lower likelihood of prior 30-day SUD counseling.
AHRQ-funded; HS026370.
Citation: Button D, Levander XA, Cook RR .
Substance use disorder treatment and technology access among people who use drugs in rural areas of the United States: a cross-sectional survey.
J Rural Health 2023 Sep; 39(4):772-79. doi: 10.1111/jrh.12737..
Keywords: Substance Abuse, Behavioral Health, Rural Health, Telehealth, Health Information Technology (HIT), Opioids, Rural/Inner-City Residents
Overhage L, Hailu R, Busch AB
Trends in acute care use for mental health conditions among youth during the COVID-19 pandemic.
This study’s objective was to examine youth acute mental health care use (emergency department [ED], boarding, and subsequent inpatient care) during the second year of the COVID-19 pandemic. This cross-sectional analysis used data from national, deidentified commercial health insurance claims of youth mental health ED and hospital care that took place between March 2019 and February 2022. Among 4.1 million commercial insurance enrollees aged 5 to 17 years, 17,614 in the baseline year (March 2019-February 2020) and 16,815 youth in pandemic year 2 (March 2021-February 2022) had at least 1 mental health ED visit. Comparing baseline to pandemic year 2, there was a 6.7% increase in youth with any mental health ED visits. Among adolescent females, there was a larger increase (22.1%). The fraction of ED visits that resulted in a psychiatric admission increased by 8.4%. Mean length of inpatient psychiatric stay increased 3.8%. The fraction of episodes with prolonged boarding increased 76.4%.
AHRQ-funded; HS026503.
Citation: Overhage L, Hailu R, Busch AB .
Trends in acute care use for mental health conditions among youth during the COVID-19 pandemic.
JAMA Psychiatry 2023 Sep; 80(9):924-32. doi: 10.1001/jamapsychiatry.2023.2195..
Keywords: COVID-19, Behavioral Health, Children/Adolescents
Held P, Splaine CC, Smith DL
Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection.
The purpose of this study was to examine negative post-trauma cognitions (NPCs) change trajectories in individuals who were determined to be non-optimally responsive to intensive PTSD treatment. The researchers utilized a 3-week Cognitive Processing Therapy-based intensive PTSD treatment (ITP) sample of 243 participants. Analyses were replicated in a separate 2-week ITP sample of 215 participants. The study found that in both non-optimal responder samples, two trajectories emerged; a no NPC change group which represented those with an overall lack of NPC change throughout treatment and an NPC change group which represented those with an overall reduction of NPCs occurring primarily later in treatment. Changes in PTSD symptom severity during treatment was the only consistent predictor of NPC change trajectory group membership among treatment non-optimal responders across ITPs.
AHRQ-funded; HS028511.
Citation: Held P, Splaine CC, Smith DL .
Examining trauma cognition change trajectories among initial PTSD treatment non-optimal responders: a potential avenue to guide subsequent treatment selection.
Eur J Psychotraumatol 2023; 14(2):2237361. doi: 10.1080/20008066.2023.2237361..
Keywords: Trauma, Behavioral Health, Stress
Bongiovanni T, Pletcher MJ, Lau C
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) has become a foundational strategy to decrease the use of opioids, but data is lacking to describe recommending utilization when admitting patients using electronic health record systems. The purpose of this study was to assess an electronic health record system to increase ordering of NSAIDs for hospitalized adults. The researchers conducted a cluster randomized controlled trial of clinicians admitting adult patients to a health system over a period of 9-months. Clinicians in the intervention arm were required to actively order or decline NSAIDs; the control arm was provided the same order but without a required response. A total of 20,085 hospitalizations were included. The study found that among the hospitalizations, 52% were admitted by a clinician randomized to the intervention arm. NSAIDs were ordered in 22% of the interventions and 22% of the control admissions. There were no statistically significant differences in NSAID administration, pain scores, or opioid prescribing. There were no differences in clinical harms, with average pain scores of 3.36 in the control group and 3.39 in the intervention group, on a scale of 0-5.
AHRQ-funded; HS026383.
Citation: Bongiovanni T, Pletcher MJ, Lau C .
A behavioral intervention to promote use of multimodal pain medication for hospitalized patients: a randomized controlled trial.
J Hosp Med 2023 Aug; 18(8):685-92. doi: 10.1002/jhm.13153..
Keywords: Pain, Opioids, Medication, Behavioral Health, Practice Patterns