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- Access to Care (2)
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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 14 of 14 Research Studies DisplayedDecker S, Dworsky M, Gibson TB
AHRQ Author: Decker S
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
The authors leveraged ACA coverage expansions, including Medicaid expansion and Marketplaces, to study the impact of health insurance on opioid-related emergency department (ED) visits. They used ZIP-code–level ED utilization data from HCUP’s State Inpatient Databases (SID) and State Emergency Department Databases (SEDD) for 29 states. They found evidence of a dose-response relationship between pre-ACA uninsured and changes in ED visit rates in both expansion and non-expansion states: areas with higher uninsured rates prior to ACA saw larger reductions in opioid-related ED visits after the ACA took effect. The authors concluded that these findings suggest that increased insurance coverage may to help mitigate the opioid crisis.
AHRQ-authored.
Citation: Decker S, Dworsky M, Gibson TB .
The Impact of the Affordable Care Act Insurance Expansions on Opioid-Related Emergency Department Visits.
American Journal of Health Economics 2023 Sum; 9(3):405–34..
Keywords: Healthcare Cost and Utilization Project (HCUP), Opioids, Policy, Health Insurance, Emergency Department, Access to Care, Medicaid, Healthcare Utilization
Encinosa W, Lane K, Cornelio N
AHRQ Author: Encinosa W
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
This article discusses the 2022 No Surprises Act whose goal was to prevent patients from receiving unexpected emergency department (ED) out-of-network physician bills and restrict out-of-network co-payments to in-network co-payment levels. Similar state bans were examined to determine whether the large reduction in out-of-pocket payments under bans will have an unintended consequence of an increase in ED visits and spending. The authors examined 16 million nonelderly, fully funded, privately insured health maintenance organization (HMO) enrollees between 2007 and 2018 from 15 states with balance billing bans for HMO ED visits and 16 states without bans as the control group. They found that the bans reduced spending per visit by 14% but spurred a demand response with an increase of 3 percentage points in ED visits which wiped away the cost savings. The authors predict that the federal ban will result in $5.1 billion in savings but 3.5 million more ED visits at $4.2 billion in extra spending per year, largely negating expected savings.
AHRQ-authored; AHRQ-funded; HS027698.
Citation: Encinosa W, Lane K, Cornelio N .
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
Am J Manag Care 2022 Sep;28(9):e333-e38. doi: 10.37765/ajmc.2022.89226..
Keywords: Healthcare Costs, Emergency Department, Policy, Healthcare Utilization
Zachrison KS, Boggs KM, Cash RE
Are state telemedicine parity laws associated with greater use of telemedicine in the emergency department?
Telemedicine is a valuable tool to improve access to specialty care in emergency departments (EDs), and states have passed telemedicine parity laws requiring insurers to reimburse for telemedicine visits. The objective of this study was to determine if there was an association between such laws and the use of telemedicine in an ED. The investigators concluded that telemedicine parity laws were not associated with use of telemedicine in the ED.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Boggs KM, Cash RE .
Are state telemedicine parity laws associated with greater use of telemedicine in the emergency department?
J Am Coll Emerg Physicians Open 2021 Feb;2(1):e212359. doi: 10.1002/emp2.12359..
Keywords: Telehealth, Emergency Department, Health Information Technology (HIT), Policy, Payment
Myong C, Hull P, Price M
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
This retrospective study examined the impact of funding for federally qualified health centers (FQHCs) on utilization and emergency department (ED) visits in Massachusetts. The authors theorized that greater funding for FQHCs could increase the local availability of clinic-based care and reduce more costly resource use, such as ED visits. Data from the Massachusetts All Payer Claims Database (APCD) 2010-2013 was used that included enrollees in 559 Massachusetts ZIP codes (2010 numbers 6,173,563). They calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year. They found that a standard deviation increase in prior year FQHC funding (31%) was associated with a 2.3% increase in enrollees with FQHC visits and a 1.3% decrease in enrollees at EDs. However, there were no significant changes in emergent ED visit rates.
AHRQ-funded; HS025378.
Citation: Myong C, Hull P, Price M .
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
PLoS One 2020 Dec 3;15(12):e0243279. doi: 10.1371/journal.pone.0243279..
Keywords: Community-Based Practice, Healthcare Utilization, Emergency Department, Healthcare Costs, Access to Care, Vulnerable Populations, Policy
Terp S, Seabury SA, Axeen S
The association between hospital characteristics and Emergency Medical Treatment and Labor Act citation events.
The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law enacted in 1986 prohibiting patient dumping (refusing or transferring patients with emergency medical conditions without appropriate stabilization), and discrimination based upon ability to pay. In this study, the investigators evaluated hospital-level features associated with citation for EMTALA violation. They concluded that for-profit ownership was associated with increased odds of EMTALA citations after adjusting for other characteristics.
AHRQ-funded; HS025281.
Citation: Terp S, Seabury SA, Axeen S .
The association between hospital characteristics and Emergency Medical Treatment and Labor Act citation events.
Med Care 2020 Sep;58(9):793-99. doi: 10.1097/mlr.0000000000001360..
Keywords: Emergency Department, Hospitals, Policy, Transitions of Care
Lines LM, Li NC, Mick EO
Emergency department and primary care use in Massachusetts 5 years after health reform.
The goal of this study was to identify characteristics of insured Massachusetts residents associated with primary care sensitive (PCS) emergency department (ED) use, and compare such use for public versus private insurees. The researchers used data on people under age 65 taken from the Massachusetts All-Payer Claims Data for 2011-2012. Their conclusions indicate that public insurance was associated with less access to primary care and more PCS ED use; statewide labor shortages and low reimbursement rates from public insurance may have provided inadequate access to care that might otherwise have helped reduce PCS ED use.
AHRQ-funded; HS022194.
Citation: Lines LM, Li NC, Mick EO .
Emergency department and primary care use in Massachusetts 5 years after health reform.
Med Care 2019 Feb;57(2):101-08. doi: 10.1097/mlr.0000000000001025..
Keywords: Emergency Department, Health Insurance, Policy, Primary Care
Coupet E, Karp D, Wiebe DJ
Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.
In this study, the investigators determined the total annual charges for the acute care of injuries from interpersonal violence and the shift in financial responsibility for these charges after the Medicaid expansion from the Affordable Care Act in 2014. After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7 billion in annual charges for the acute care of violent injury in the U.S. The investigators suggest that these findings highlight the benefit to state Medicaid programs of preventing interpersonal violence.
AHRQ-funded; HS000028.
Citation: Coupet E, Karp D, Wiebe DJ .
Shift in U.S. payer responsibility for the acute care of violent injuries after the Affordable Care Act: Implications for prevention.
Am J Emerg Med 2018 Dec;36(12):2192-96. doi: 10.1016/j.ajem.2018.03.070..
Keywords: Domestic Violence, Emergency Department, Healthcare Costs, Policy, Healthcare Cost and Utilization Project (HCUP), Medicaid
Mullen MT, Pajerowski W, Messe SR
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
The purpose of this study was to evaluate the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and to use geographic modeling in order to evaluate expected changes for a comprehensive stroke center policy. Suspected stroke emergency medical services encounters in Philadelphia, PA, were identified, and transport times before and after the initiation of a PSC destination policy in October 2011 were compared. Geographic modeling was used to estimate the impact of bypassing the closest hospital for the closest PSC or comprehensive stroke centers, which was common before the official policy and increased steadily over time. The researchers conclude that the time taken to route patients to PSCs or comprehensive stroke centers is low.
AHRQ-funded; HS018362.
Citation: Mullen MT, Pajerowski W, Messe SR .
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
Stroke 2018 Apr;49(4):1021-23. doi: 10.1161/strokeaha.118.020691.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitals, Policy, Stroke
Melnick ER, Probst MA, Schoenfeld E
Development and testing of shared decision making interventions for use in emergency care: a research agenda.
This article provides background on decision aids and the conclusions of the 2016 Academic Emergency Medicine consensus conference SDM in practice work group regarding "Shared Decision Making in the Emergency Department: Development of a Policy-Relevant, Patient-Centered Research Agenda."
AHRQ-funded; HS021271; HS024311.
Citation: Melnick ER, Probst MA, Schoenfeld E .
Development and testing of shared decision making interventions for use in emergency care: a research agenda.
Acad Emerg Med 2016 Dec;23(12):1346-53. doi: 10.1111/acem.13045.
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Keywords: Shared Decision Making, Emergency Department, Emergency Medical Services (EMS), Patient-Centered Healthcare, Policy
Grudzen CR, Anderson JR, Carpenter CR
The 2016 Academic Emergency Medicine Consensus Conference, Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda May 10, 2016, New Orleans, LA.
The authors described the current state of shared decision making in the emergency department context and provided an overview of the conference. They explained that the results of the conference published in the same journal issue provided an essential summary of the future research priorities for shared decision making to increase quality of care and patient-centered outcomes.
AHRQ-funded; HS024172.
Citation: Grudzen CR, Anderson JR, Carpenter CR .
The 2016 Academic Emergency Medicine Consensus Conference, Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda May 10, 2016, New Orleans, LA.
Acad Emerg Med 2016 Dec;23(12):1313-19. doi: 10.1111/acem.13047.
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Keywords: Shared Decision Making, Emergency Department, Emergency Medical Services (EMS), Patient-Centered Healthcare, Policy
Kim HS, Monte AA
Colorado cannabis legalization and its effect on emergency care.
The authors noted that increased marijuana use after legalization has been accompanied by increases in emergency department visits and hospitalizations due to marijuana intoxication. They recommended that providers in states with impending legalization measures should become familiar with the symptoms and management of acute marijuana intoxication, as well as understand the effects on chronic diseases frequently observed in the emergency department. Further, they suggested that residency program directors should make an effort to integrate this topic into their residency curricula.
AHRQ-funded; HS000078.
Citation: Kim HS, Monte AA .
Colorado cannabis legalization and its effect on emergency care.
Ann Emerg Med 2016 Jul;68(1):71-5. doi: 10.1016/j.annemergmed.2016.01.004.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitalization, Policy, Substance Abuse
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
Lee J, Ding R, Zeger SL
Impact of subsidized health insurance coverage on emergency department utilization by low-income adults in Massachusetts.
The authors aimed to estimate the change in emergency department (ED) utilization per individual among a cohort who qualified for subsidized health insurance following the Massachusetts health care reform. They concluded that expanding subsidized health insurance did not uniformly change ED utilization for all newly insured low-income adults in Massachusetts.
AHRQ-funded; HS017957.
Citation: Lee J, Ding R, Zeger SL .
Impact of subsidized health insurance coverage on emergency department utilization by low-income adults in Massachusetts.
Med Care 2015 Jan;53(1):38-44. doi: 10.1097/mlr.0000000000000279.
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Keywords: Emergency Department, Healthcare Utilization, Health Insurance, Policy, Low-Income
Hernandez-Boussard T, Burns CS, Wang NE
The Affordable Care Act reduces emergency department use by young adults: evidence from three States.
The authors tested the impact of the Affordable Care Act (ACA) on how young adults used ED services. They found that the largest relative decreases were found in women and blacks. This relative decrease in ED use implies a total reduction of more than 60,000 visits from young adults across three states in 2011.
AHRQ-funded; HS018558.
Citation: Hernandez-Boussard T, Burns CS, Wang NE .
The Affordable Care Act reduces emergency department use by young adults: evidence from three States.
Health Aff 2014 Sep;33(9):1648-54. doi: 10.1377/hlthaff.2014.0103.
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Keywords: Emergency Department, Health Insurance, Policy, Healthcare Cost and Utilization Project (HCUP), Young Adults