National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (2)
- Behavioral Health (1)
- Cardiovascular Conditions (1)
- Children/Adolescents (3)
- Chronic Conditions (1)
- Emergency Department (2)
- Healthcare Cost and Utilization Project (HCUP) (3)
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- (-) Healthcare Utilization (14)
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- Newborns/Infants (2)
- Nursing (1)
- Nursing Homes (1)
- Opioids (1)
- Outcomes (1)
- Policy (2)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (3)
- Racial and Ethnic Minorities (1)
- Rural Health (1)
- Sexual Health (1)
- Surgery (2)
- Telehealth (1)
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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 DisplayedHoffmann JA, Carter CP, Olsen CS
Pediatric firearm injury emergency department visits from 2017 to 2022: a multicenter study.
This retrospective study aimed to assess how pediatric firearm injury emergency department (ED) visits during the pandemic differed from expected prepandemic trends. The authors looked at firearm injury ED visits by children <18 years old at 9 US hospitals participating in the Pediatric Emergency Care Applied Research Network Registry before (January 2017 to February 2020) and during (March 2020 to November 2022) the pandemic. They calculated rate ratios (RRs) of observed to expected visits per 30 days, overall, and by sociodemographic characteristics. They identified 1904 firearm injury ED visits (52.3% 15-17 years old, 80.0% male, 63.5% non-Hispanic Black), with 694 prepandemic visits and 1210 visits during the pandemic. Death in the ED/hospital increased from 3.1% prepandemic to 6.1% during the pandemic. Firearm injury visits per 30 days increased from 18.0 prepandemic to 36.1 during the pandemic (RR 2.09). Increases beyond expected rates were seen for 10- to 14-year-olds (RR 2.61), females (RR 2.46), males (RR 2.00), Hispanic children (RR 2.30), and Black non-Hispanic children (RR 1.88).
AHRQ-funded; R01HS020270.
Citation: Hoffmann JA, Carter CP, Olsen CS .
Pediatric firearm injury emergency department visits from 2017 to 2022: a multicenter study.
Pediatrics 2023 Dec; 152(6). doi: 10.1542/peds.2023-063129..
Keywords: Children/Adolescents, Emergency Department, Healthcare Utilization, Injuries and Wounds
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
Yu J, Huckfeldt PJ, Mink PJ
Evaluating the association between expanded coverage of direct-to-consumer telemedicine and downstream utilization and quality of care for urinary tract infections and sinusitis.
The purpose of this study was to compare rates of testing, follow-up health care use, and quality for urinary tract infections (UTIs) and sinusitis between direct-to-consumer (DTC) telemedicine and in-person visits. Primary outcomes included number of laboratory tests, antibiotics filled, office and outpatient visits, emergency department (ED) visits, and standardized spending, based on standardized health service prices. The UTI and sinusitis samples included 215,134 and 624,630 episodes of care, respectively. Following the introduction of coverage for DTC telemedicine, 15.7% of UTI episodes and 8.9% of sinusitis episodes were initiated with DTC telemedicine. When compared to episodes without coverage for DTC telemedicine, UTI episodes with coverage had 0.25 fewer lab tests, lower standardized spending for the first UTI visit, and no change in office and outpatient visits, ED visits, antibiotics filled, or standardized medical spending. Sinusitis episodes with coverage for DTC telemedicine had fewer antibiotics filled and a minor increase in ED visits but no difference in lab tests, office and outpatient visits, or standardized medical spending.
AHRQ-funded; HS026088.
Citation: Yu J, Huckfeldt PJ, Mink PJ .
Evaluating the association between expanded coverage of direct-to-consumer telemedicine and downstream utilization and quality of care for urinary tract infections and sinusitis.
Health Serv Res 2023 Oct; 58(5):976-87. doi: 10.1111/1475-6773.14129..
Keywords: Telehealth, Health Information Technology (HIT), Healthcare Utilization, Quality of Care
Mellor JM, McInerney M, Garrow RC
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
This study examined indirect spillover effects of Affordable Care Act (ACA) Medicaid expansions to working-age adults on health care coverage, spending, and utilization by older low-income Medicare beneficiaries. The authors used data from the 2010-2018 Health and Retirement Study survey linked to annual Medicare beneficiary summary files. They estimated individual-level difference-in-differences models of total spending for inpatient, institutional outpatient, physician/professional provider services; inpatient stays, outpatient visits, physician visits; and Medicaid and Part A and B Medicare coverage. They also compared changes in outcomes before and after Medicaid expansion in expansion versus nonexpansion states. The sample included low-income respondents aged 69 and older with linked Medicare data, enrolled in full-year traditional Medicare, and living in the community. ACA Medicaid expansion was associated with a 9.8 percentage point increase in Medicaid coverage, a 4.4 percentage point increase in having any institutional outpatient spending, and a positive but statistically insignificant 2.4 percentage point change in Part B enrollment.
AHRQ-funded; HS025422.
Citation: Mellor JM, McInerney M, Garrow RC .
The impact of Medicaid expansion on spending and utilization by older low-income Medicare beneficiaries.
Health Serv Res 2023 Oct; 58(5):1024-34. doi: 10.1111/1475-6773.14155..
Keywords: Medicaid, Medicare, Low-Income, Healthcare Utilization, Healthcare Costs, Health Insurance
Decker 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
Smith DC, Phillippi JC, Tilden EL
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
The objective of this study was to describe the application and utility of the World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) to compare hospital-level cesarean births rates for use in quality improvement and benchmarking. The authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from births from 2002-08 at 12 sites across the US. Results showed a variation in use of cesarean birth, labor induction, and trial of labor after cesarean (TOLAC) across the 12 sites. The authors concluded that TGCS provides a method for between-hospital comparisons and adoption of TGCS in the US would provide an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.
AHRQ-funded; HS024733.
Citation: Smith DC, Phillippi JC, Tilden EL .
Comparing cesarean birth utilization between US hospitals: a demonstration of the robson ten-group classification system for use in quality improvement and benchmarking.
J Perinat Neonatal Nurs 2023 Jul-Sep; 37(3):214-22. doi: 10.1097/jpn.0000000000000670..
Keywords: Hospitals, Healthcare Utilization, Maternal Care, Women, Quality Improvement, Quality Measures, Quality of Care
Lake ET, Staiger D, Smith JG
The association of missed nursing care with very low birthweight infant outcomes.
This study examined the association of missed nursing care and health outcomes of very low birthweight (VLBW) infants in neonatal intensive care units (NICUs). The authors used 2016 hospital administrative discharge abstracts for VLBW newborns (n = 7,595) and NICU registered nurse survey responses (n = 6,963) from the National Database of Nursing Quality Indicators. Mortality, morbidity, and length of stay (LOS) was examined in 190 sample hospitals from 19 states in all regions. There was a significant association between higher odds of bloodstream infection and longer LOS, but not mortality or severe intraventricular hemorrhage and missed nursing care.
AHRQ-funded; HS024918.
Citation: Lake ET, Staiger D, Smith JG .
The association of missed nursing care with very low birthweight infant outcomes.
Med Care Res Rev 2023 Jun; 80(3):293-302. doi: 10.1177/10775587221150950..
Keywords: Healthcare Cost and Utilization Project (HCUP), Quality Indicators (QIs), Nursing, Newborns/Infants, Outcomes, Healthcare Utilization, Quality of Care
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
Meille G, Post B
AHRQ Author: Meille G
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
This AHRQ-authored paper describes the effect of the Affordable Care Act Medicaid expansion on hospital utilization, employment, and capital. The authors conducted a difference-in-differences analysis that compared changes to hospital demand and supply in Medicaid expansion and nonexpansion states. They used 2010-2016 data from the American Hospital Association and the Healthcare Cost Report Information System to quantify changes to hospital utilization and characterize how hospitals adjusted labor and capital inputs. Medicaid expansion was associated with increases in emergency department visits and other outpatient hospital visits. They found strong evidence that hospitals met increases in demand by hiring nursing staff and weaker evidence that they increased hiring of technicians and investments in equipment. They found no evidence that hospitals adjusted hiring of physicians, support staff, or investments in other capital inputs.
AHRQ-authored.
Citation: Meille G, Post B .
The effects of the Medicaid expansion on hospital utilization, employment, and capital.
Med Care Res Rev 2023 Apr;80(2):165-74. doi: 10.1177/10775587221133165.
Keywords: Medicaid, Hospitals, Healthcare Utilization, Health Insurance, Policy, Access to Care, Uninsured
Wu AJ, Du N, Chen TY
Sociodemographic differences of hospitalization and associations of resource utilization for failure to thrive.
The objective of this study was to examine sociodemographic differences between elective and nonelective admissions for failure to thrive. Researchers investigated associations between admission type and hospital resource utilization, including length of stay and feeding tube placement. The study included data on children less than 2 years old with failure to thrive in the Kids' Inpatient Database. The findings showed differences by race and ethnicity, income, and insurance type, among other factors. Nonelective admissions had higher proportions of infants who were Black, Hispanic, and of lower-income, and were associated with longer lengths of stay. The researchers concluded that future research is needed to elucidate drivers of these differences, particularly those related to racial and ethnic disparities and structural racism.
AHRQ-funded; HS000063.
Citation: Wu AJ, Du N, Chen TY .
Sociodemographic differences of hospitalization and associations of resource utilization for failure to thrive.
J Pediatr Gastroenterol Nutr 2023 Mar;76(3):385-89. doi: 10.1097/mpg.0000000000003694.
Keywords: Newborns/Infants, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Healthcare Utilization, Children/Adolescents, Racial and Ethnic Minorities, Low-Income
Kalata S, Howard R, Diaz A
Association of skilled nursing facility ownership by health care networks with utilization and spending.
The objective of this cross-sectional study was to determine the association of vertical integration of skilled nursing facilities (SNFs) within hospital networks with SNF utilization, readmissions, and spending. Claims data from Medicare beneficiaries aged 66 to 99 who had undergone elective hip replacement in nonfederal acute care hospitals during the study period was analyzed. Results showed that vertical SNF integration was associated with a higher rate of SNF utilization and a lower 30-day readmission rate; in spite of higher utilization, 30-day episode payments were slightly lower. Adjusted readmission rates were especially low for patients who were not sent to an SNF but were significantly higher for patients with a length of stay of less than 5 days. The authors concluded these findings support the value of integrating SNFs into hospital networks, but there is room for improvement in postoperative care early in the SNF patients’ stay.
AHRQ-funded; HS028606.
Citation: Kalata S, Howard R, Diaz A .
Association of skilled nursing facility ownership by health care networks with utilization and spending.
JAMA Netw Open 2023 Feb; 6(2):e230140. doi: 10.1001/jamanetworkopen.2023.0140..
Keywords: Nursing Homes, Healthcare Utilization, Healthcare Costs, Medicare
Ehlers AP, Howard R, Lai YL
Postacute care utilization and episode of care payments following common elective operations.
The purpose of the cross-sectional study was to analyze post-acute care (PAC) usage and its associated costs for patients undergoing common elective procedures. The researchers examined adult patients in a statewide administrative claims database who underwent elective cholecystectomy, ventral or incisional hernia repair (VIHR), and groin hernia repair between 2012 and 2019. The study found that among the 34,717 patients who underwent elective cholecystectomy, PAC was utilized by 0.7%, resulting in significantly higher payments ($19,047 vs $7,830, P < 0.001). For the 29,826 patients who underwent VIHR, 1.7% utilized PAC, leading to significantly higher payments ($19,766 vs $9,439, P < 0.001). Of the 37,006 patients who underwent groin hernia repair, 0.3% utilized PAC services, incurring significantly higher payments ($14,886 vs $8,062, P < 0.001). The study identified both modifiable and non-modifiable risk factors associated with PAC utilization. Morbid obesity was linked to PAC usage following VIHR. Male gender was associated with reduced odds of PAC utilization for VIHR and groin hernia repair. The researchers concluded that the study identified both modifiable (e.g., obesity) and nonmodifiable (e.g., female gender) patient factors associated with PAC utilization. To optimize patients and minimize PAC usage, it is essential to understand patient risk factors and implement systems and processes that address these factors.
AHRQ-funded; HS025778.
Citation: Ehlers AP, Howard R, Lai YL .
Postacute care utilization and episode of care payments following common elective operations.
Ann Surg 2023 Feb; 277(2):e266-e72. doi: 10.1097/sla.0000000000004814.
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Keywords: Surgery, Healthcare Utilization
Levander XA, Foot CA, Magnusson SL
Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: a cross-sectional survey.
This study’s goal was to compare contraceptive use prevalence among women who use drugs (WWUD) in rural communities with women who do not use drugs from similar rural areas. The authors used survey data from the Rural Opioids Initiative (ROI), a cross-sectional survey using respondent-driven sampling (RDS) involving eight rural U.S. regions (January 2018-March 2020) and the National Survey on Family Growth (NSFG), a nationally representative U.S. household reproductive health survey (2017-2019). Women aged 18-49 with prior 30-day non-prescribed opioid and/or non-opioid injection drug use were included. Of 855 women in the ROI, 36.8% and 38.6% reported contraceptive use, compared to 66% of rural women in the NSFG sample. Among the ROI women, 27% had received prior 30-day SUD treatment via outpatient counseling or inpatient program and these women had increased odds of contraceptive use. There was a positive association between contraception use and recent medications for opioid use disorder and prior 6-month primary care utilization that did not meet the threshold for statistical significance.
AHRQ-funded; HS02637; HS027088.
Citation: Levander XA, Foot CA, Magnusson SL .
Contraception and healthcare utilization by reproductive-age women who use drugs in rural communities: a cross-sectional survey.
J Gen Intern Med 2023 Jan; 38(1):98-106. doi: 10.1007/s11606-022-07558-6..
Keywords: Sexual Health, Women, Healthcare Utilization, Rural Health
Chang E, Ali R, Seibert J
Interventions to improve outcomes for high-need, high-cost patients: a systematic review and meta-analysis.
The authors of this article reviewed evidence on the effectiveness of complex interventions designed to change the healthcare of high-need, high-cost patients. They found limited evidence of intervention effectiveness in relation to cost and use, but note that additional evidence is needed to strengthen their confidence in these findings. Few studies reported clinical/functional or social risk factor outcomes or sufficient details for determining why individual interventions work. They conclude that future evaluations could provide additional insights in assessing the impact of complex interventions.
AHRQ-funded; 290201500011I.
Citation: Chang E, Ali R, Seibert J .
Interventions to improve outcomes for high-need, high-cost patients: a systematic review and meta-analysis.
J Gen Intern Med 2023 Jan; 38(1):185-94. doi: 10.1007/s11606-022-07809-6..
Keywords: Healthcare Costs, Healthcare Delivery, Chronic Conditions, Healthcare Utilization