National Healthcare Quality and Disparities Report
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- Access to Care (7)
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- Payment (5)
- (-) Policy (74)
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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 74 Research Studies DisplayedWilcox L, Sharko M, Hong M
The need for guidance and consistency in adolescent privacy policies: a survey of CMIOs.
Research examining whether and how adolescent patients should gain access to their electronic health records is gaining momentum. In this study, the investigators conducted a survey to explore diversity in adolescent privacy policies and identify common approaches in health information technology management for adolescent patients. Through descriptive analyses of survey data, they found a wide range of institutional policies regarding adolescent patient privacy, and large variations in health IT executives' baseline knowledge of access policies.
AHRQ-funded; HS021531.
Citation: Wilcox L, Sharko M, Hong M .
The need for guidance and consistency in adolescent privacy policies: a survey of CMIOs.
AMIA Annu Symp Proc 2018 Dec 5;2018:1084-92..
Keywords: Children/Adolescents, Policy, Electronic Health Records (EHRs), Health Information Technology (HIT)
Cohen JFW, Gorski Findling MT, Rosenfeld L
The impact of 1 year of healthier school food policies on students' diets during and outside of the school day.
In 2012, Massachusetts implemented both the updated national school meal standards and comprehensive competitive food/beverage standards that closely align with current national requirements for school snacks. This study examines the impact of these combined standards on school meal and snack food selections, as well as food choices outside of school. The investigators concluded that with the reduction in the number of unhealthy school snacks, significantly more students selected school meals. Students did not compensate for lack of unhealthy snacks in school by increased consumption of unhealthy snacks outside of school.
AHRQ-funded; HS000055.
Citation: Cohen JFW, Gorski Findling MT, Rosenfeld L .
The impact of 1 year of healthier school food policies on students' diets during and outside of the school day.
J Acad Nutr Diet 2018 Dec;118(12):2296-301. doi: 10.1016/j.jand.2018.07.009..
Keywords: Children/Adolescents, Education, Nutrition, Policy
Jacobs PD
AHRQ Author: Jacobs PD
Mandating health insurance coverage for high-income individuals.
In this study, the author describes the effect of the Affordable Care Act’s (ACA’s) individual mandate for health coverage by focusing on higher-income non-elderly adults and exploiting state differences in the rules governing premium setting and coverage issuance in the non-group market prior to 2014.
AHRQ-authored.
Citation: Jacobs PD .
Mandating health insurance coverage for high-income individuals.
National Tax Journal 2018 Dec;71(4):807-28. doi: 10.17310/ntj.2018.4.10..
Keywords: Health Insurance, Policy, Uninsured
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
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Huguet N, Springer R, Marino M
The impact of the Affordable Care Act (ACA) Medicaid expansion on visit rates for diabetes in safety net health centers.
The objectives of this study were to: (1) compare clinic-level uninsured, Medicaid-insured, and privately insured visit rates within and between expansion and nonexpansion states before and after the Affordable Care Act (ACA) Medicaid expansion among the 3 cohorts of patient populations; and (2) assess whether there was a change in clinic-level overall, primary care visits, preventive care visits, and diabetes screening rates in expansion versus nonexpansion states from pre-ACA to post-ACA Medicaid expansion.
AHRQ-funded; HS024270.
Citation: Huguet N, Springer R, Marino M .
The impact of the Affordable Care Act (ACA) Medicaid expansion on visit rates for diabetes in safety net health centers.
J Am Board Fam Med 2018 Nov-Dec;31(6):905-16. doi: 10.3122/jabfm.2018.06.180075..
Keywords: Diabetes, Healthcare Utilization, Policy, Medicaid
Angraal S, Khera R, Zhou S
Trends in 30-day readmission rates for Medicare and non-Medicare patients in the era of the Affordable Care Act.
In this study the investigators we assessed trends in all-cause readmission rates for 1 of the 3 HRRP conditions or conditions not targeted by the HRRP in age-insurance groups defined by age group (>/=65 years or <65 years) and payer (Medicare, Medicaid, or private insurance). The investigators concluded that there appeared to be a systematic improvement in readmission rates for patient groups beyond the population of fee-for-service, older, Medicare beneficiaries included in the HRRP.
AHRQ-funded; HS022882.
Citation: Angraal S, Khera R, Zhou S .
Trends in 30-day readmission rates for Medicare and non-Medicare patients in the era of the Affordable Care Act.
Am J Med 2018 Nov;131(11):1324-31.e14. doi: 10.1016/j.amjmed.2018.06.013..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Medicaid, Medicare
McManus KA, McManus K, Dillingham R
National survey of United States human immunodeficiency virus medical providers' knowledge and attitudes about the Affordable Care Act.
The objective of the study was to explore HIV medical providers' knowledge and attitudes about the Affordable Care Act (ACA). The investigators concluded that: medical providers in Medicaid expansion states were more optimistic about the ACA's likelihood to improve their patients' HIV outcomes; there are gaps in HIV medical providers' understanding of the ACA; and education could enhance systems-based practice.
AHRQ-funded; HS024196.
Citation: McManus KA, McManus K, Dillingham R .
National survey of United States human immunodeficiency virus medical providers' knowledge and attitudes about the Affordable Care Act.
Clin Infect Dis 2018 Oct 15;67(9):1403-10. doi: 10.1093/cid/ciy296..
Keywords: Policy, Human Immunodeficiency Virus (HIV), Medicaid, Provider
Wu VY, Fingar KR, Jiang HJ
AHRQ Author: Jiang HJ
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
The purpose of the study was to examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). The investigators concluded that postexpansion, non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing non-SNHs over SNHs or a crowd-out of private insurance.
AHRQ-authored; AHRQ-funded; 290201300002.
Citation: Wu VY, Fingar KR, Jiang HJ .
Early impact of the Affordable Care Act coverage expansion on safety-net hospital inpatient payer mix and market shares.
Health Serv Res 2018 Oct;53(5):3617-39. doi: 10.1111/1475-6773.12812..
Keywords: Policy, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicaid
Barnett ML, Clark KL, Sommers BD
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
This study examined patient satisfaction among Medicaid enrollees nationally from 2014-2015. Significant disparities were found among racial/ethnic groups. Managed care enrollees had higher satisfaction ratings than those with fee-for-service. If the patient had a personal doctor that increased satisfaction for an average 4.6 percent.
AHRQ-funded; HS021291.
Citation: Barnett ML, Clark KL, Sommers BD .
State policies and enrollees' experiences in Medicaid: evidence from a new national survey.
Health Aff 2018 Oct;37(10):1647-55. doi: 10.1377/hlthaff.2018.0505..
Keywords: Access to Care, Disparities, Medicaid, Patient Experience, Policy, Racial and Ethnic Minorities
Law AC, Stevens JP, Hohmann S
Patient outcomes after the introduction of statewide ICU nurse staffing regulations.
The objective of this study was to assess whether Massachusetts legislation directed at ICU nurse staffing was associated with improvements in patient outcomes. The investigators found that state regulation of patient-to-nurse staffing with the aid of patient complexity scores in intensive care was not associated with either increased nurse staffing or changes in patient outcomes.
AHRQ-funded; HS024288.
Citation: Law AC, Stevens JP, Hohmann S .
Patient outcomes after the introduction of statewide ICU nurse staffing regulations.
Crit Care Med 2018 Sep 4;46(10):1563-69. doi: 10.1097/ccm.0000000000003286..
Keywords: Intensive Care Unit (ICU), Policy, Nursing, Outcomes, Patient Safety
Pelech D
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
This paper explored the relationship between insurer competition and health plan benefit generosity by examining the impact of a regulatory change that caused the cancellation of 40% of the private plans in Medicare. The investigator found that insurers in markets affected by cancellation reduced the benefit generosity of the plans remaining in the market.
AHRQ-funded; HS023477; HS000055.
Citation: Pelech D .
Paying more for less? Insurer competition and health plan generosity in the Medicare Advantage program.
J Health Econ 2018 Sep;61:77-92. doi: 10.1016/j.jhealeco.2018.07.002..
Keywords: Healthcare Costs, Health Insurance, Medicare, Policy
Davis CS, Green TC, Hernandez-Delgado H
Status of US state laws mandating timely reporting of nonfatal overdose.
Timely, actionable, nonfatal overdose data are urgently needed to improve public health response to the overdose crisis. The purpose of this paper was to provide background and catalyze discussion regarding this important issue. The authors briefly report the results of a systematic analysis of state laws mandating reporting of nonfatal overdose, and provide suggestions for improving the collection and use of nonfatal overdose data to improve the public health response to this ongoing epidemic.
AHRQ-funded; HS024021.
Citation: Davis CS, Green TC, Hernandez-Delgado H .
Status of US state laws mandating timely reporting of nonfatal overdose.
Am J Public Health 2018 Sep;108(9):1159-61. doi: 10.2105/ajph.2018.304589..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Opioids, Policy, Public Health, Substance Abuse
Skinner D, Franz B, Howard J
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
The purpose of this study was to understand the perspectives of primary care innovators treating patient populations not traditionally considered to be within the purview of primary care. The authors indicated that their study findings suggested that the politics surrounding entrenched professional identities contributed to barriers faced by conference participants in their efforts to provide innovative care for these nontraditional populations. Specifically, obstacles surfaced in relation to sharing patients across disciplinary boundaries, which resulted in issues of possessiveness, a questioning of provider qualifications, and a lack of interprofessional trust.
AHRQ-funded; HS021287.
Citation: Skinner D, Franz B, Howard J .
The politics of primary care expansion: lessons from cancer survivorship and substance abuse.
J Healthc Manag 2018 Sep-Oct;63(5):323-36. doi: 10.1097/jhm-d-16-00030..
Keywords: Primary Care, Primary Care: Models of Care, Patient-Centered Healthcare, Cancer, Substance Abuse, Policy, Healthcare Delivery, Organizational Change, Quality of Care
Hudson JL, Moriya AS
AHRQ Author: Hudson JL, Moriya AS
Association between marketplace policy and public coverage among Medicaid or Children's Health Insurance Program-eligible children and parents.
This paper examines the association between marketplace policy and public coverage among Medicaid or Children’s Health Insurance Program (CHIP)-eligible children and parents. The study’s results suggest that streamlining Medicaid/CHIP enrollment may have played a substantial role in increased take-up of public coverage.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
Association between marketplace policy and public coverage among Medicaid or Children's Health Insurance Program-eligible children and parents.
JAMA Pediatr 2018 Sep;172(9):881-82. doi: 10.1001/jamapediatrics.2018.1497..
Keywords: Children's Health Insurance Program (CHIP), Health Insurance, Medicaid, Policy
Trish E, Herring B
Does limiting allowable rating variation in the small group health insurance market affect employer self-insurance?
This study evaluated the impact of limiting allowable rating variation on employer self-insurance across industries with varied health risk. The investigators found that lower-risk employers subject to laws limiting allowable premium rating variation had a predicted probability of self-insurance that was about 18 percentage points higher than otherwise-similar higher-risk employers, suggesting that selection concerns are warranted.
AHRQ-funded; HS000046.
Citation: Trish E, Herring B .
Does limiting allowable rating variation in the small group health insurance market affect employer self-insurance?
J Risk Insur 2018 Sep;85(3):607-33. doi: 10.1111/jori.12184.
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Keywords: Healthcare Costs, Health Insurance, Policy
Rhee C, Wang R, Jentzsch MS
Impact of the 2012 Medicaid health care-acquired conditions policy on catheter-associated urinary tract infection and vascular catheter-associated infection billing rates.
This study examines the impact of the 2012 Medicaid health care-acquired conditions policy on catheter-associated urinary tract infection and vascular catheter-associated infection billing rates. The investigators found no impact of the policy on rates of the two conditions among Medicaid or non-Medicaid patients.
AHRQ-funded; HS025008; HS018414; HS000063.
Citation: Rhee C, Wang R, Jentzsch MS .
Impact of the 2012 Medicaid health care-acquired conditions policy on catheter-associated urinary tract infection and vascular catheter-associated infection billing rates.
Open Forum Infect Dis 2018 Sep;5(9):ofy204. doi: 10.1093/ofid/ofy204..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Medicaid, Payment, Policy
Marino M, Angier H, Valenzuela S
Medicaid coverage accuracy in electronic health records.
The objective of the study was to evaluate the validity of electronic health record (EHR) data for monitoring longitudinal Medicaid coverage and assess variation by patient demographics, visit types, and clinic characteristics. The researchers conducted a retrospective, observational study comparing Medicaid status agreement between Oregon community health center EHR data linked at the patient-level to Medicaid enrollment data (gold standard).
AHRQ-funded; HS024270.
Citation: Marino M, Angier H, Valenzuela S .
Medicaid coverage accuracy in electronic health records.
Prev Med Rep 2018 Sep;11:297-304. doi: 10.1016/j.pmedr.2018.07.009..
Keywords: Electronic Health Records (EHRs), Health Insurance, Health Services Research (HSR), Medicaid, Policy
Johnston K, Alley L, Novak K
Pharmacists' attitudes, knowledge, utilization, and outcomes involving prescription drug monitoring programs: a brief scoping review.
Researchers sought to identify and synthesize findings from current literature on community pharmacists' attitudes toward, knowledge of, and registration and utilization behaviors regarding prescription drug monitoring programs (PDMPs). While considered studies varied greatly in methodological approach, generally, pharmacists' attitudes and knowledge of PDMPs positively influenced likelihood to register and use state's program. The researchers recommended pharmacist-targeted PDMPs and opioid safety training in order to increase knowledge of and insight into behavioral change.
AHRQ-funded; HS024227.
Citation: Johnston K, Alley L, Novak K .
Pharmacists' attitudes, knowledge, utilization, and outcomes involving prescription drug monitoring programs: a brief scoping review.
J Am Pharm Assoc 2018 Sep - Oct;58(5):568-76. doi: 10.1016/j.japh.2018.06.003..
Keywords: Medication, Provider: Pharmacist, Policy
Friedman SA, Azocar F, Xu H
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
The purpose of the stud was to assess whether implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) was associated with: 1. Reduced differences in financial requirements (i.e., copayments and coinsurance) for substance use disorder (SUD) versus specialty mental health (MH) care and 2. Reductions in the level of cost-sharing for SUD-specific services.
AHRQ-funded; HS024866.
Citation: Friedman SA, Azocar F, Xu H .
The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: did parity differentially affect substance use disorder and mental health benefits offered by behavioral healthcare carve-out and carve-in plans?
Drug Alcohol Depend 2018 Sep 1;190:151-58. doi: 10.1016/j.drugalcdep.2018.06.008..
Keywords: Behavioral Health, Health Insurance, Policy, Substance Abuse
Moniz MH, Kirch MA, Solway E
Association of access to family planning services with Medicaid expansion among female enrollees in Michigan.
The purpose of this study was to evaluate the association of Medicaid expansion coverage with access to birth control and family planning services among women of reproductive age enrolled in the Michigan expansion plan. The investigators found that one in 3 women of reproductive age reported better ability to access birth control and family planning services through Healthy Michigan Plan compared with before enrollment.
AHRQ-funded; HS025465.
Citation: Moniz MH, Kirch MA, Solway E .
Association of access to family planning services with Medicaid expansion among female enrollees in Michigan.
JAMA Network Open 2018 Aug 31;1(4). doi: 10.1001/jamanetworkopen.2018.1627..
Keywords: Medicaid, Women, Sexual Health, Access to Care, Policy
Baker MA, Butler MG, Seymour S
The impact of FDA regulatory activities on incident dispensing of LABA-containing medication: 2005-2011.
In this study, the authors described the impact of the regulatory activities on incident long-acting beta2-agonist (LABA)-containing medication dispensing. They concluded that the 2005 and 2010 FDA regulatory activities likely had an impact on communicating the safety concerns of LABA products but cautioned that the impact cannot be viewed independent of scientific publications, guidelines for asthma treatment, and other regulatory activities.
AHRQ-funded; HS019669; HS022093.
Citation: Baker MA, Butler MG, Seymour S .
The impact of FDA regulatory activities on incident dispensing of LABA-containing medication: 2005-2011.
J Asthma 2018 Aug;55(8):907-14. doi: 10.1080/02770903.2017.1378355..
Keywords: Medication, Policy
Sharko M, Wilcox L, Hong MK
Variability in adolescent portal privacy features: how the unique privacy needs of the adolescent patient create a complex decision-making process.
Medical privacy policies, which are clear-cut for adults and young children, become ambiguous during adolescence. Yet medical organizations must establish unambiguous rules about patient and parental access to electronic patient portals. In this paper, the investigators conducted a national interview study to characterize the diversity in adolescent portal policies across a range of institutions and determine the factors influencing decisions about these policies.
AHRQ-funded; HS021531.
Citation: Sharko M, Wilcox L, Hong MK .
Variability in adolescent portal privacy features: how the unique privacy needs of the adolescent patient create a complex decision-making process.
J Am Med Inform Assoc 2018 Aug;25(8):1008-17. doi: 10.1093/jamia/ocy042..
Keywords: Children/Adolescents, Electronic Health Records (EHRs), Health Information Technology (HIT), Policy
Decker SL, Moriya AS, Soni A
AHRQ Author: AHRQ authors - Decker and Moriya
Coverage for self-employed and others without employer offers increased after 2014.
This study examined how the Affordable Care Act might have differentially affected insurance coverage for self-employed workers, wage earners with and without offers of employer-sponsored insurance, and people not employed.
AHRQ-authored.
Citation: Decker SL, Moriya AS, Soni A .
Coverage for self-employed and others without employer offers increased after 2014.
Health Aff 2018 Aug;37(8):1238-42. doi: 10.1377/hlthaff.2017.1663..
Keywords: Health Insurance, Policy, Uninsured
Hollingsworth JM, Oerline MK, Ellimoottil C
Effects of the Medicare Modernization Act on spending for outpatient surgery.
The objective of the study was to examine the effects of Medicare's revised ambulatory surgery center (ASC) payment schedule on overall payments for outpatient surgery. The study concluded that despite lessening demand, reduced ASC facility payments did not curb spending for outpatient surgery. In fact, overall payments actually increased following the policy change, driven by higher average episode payments.
AHRQ-funded; HS024525; HS024728.
Citation: Hollingsworth JM, Oerline MK, Ellimoottil C .
Effects of the Medicare Modernization Act on spending for outpatient surgery.
Health Serv Res 2018 Aug;53 Suppl 1:2858-69. doi: 10.1111/1475-6773.12807..
Keywords: Payment, Policy, Ambulatory Care and Surgery, Surgery