National Healthcare Quality and Disparities Report
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Topics
- Access to Care (2)
- Ambulatory Care and Surgery (1)
- Behavioral Health (5)
- Cancer (1)
- Cancer: Colorectal Cancer (1)
- Children/Adolescents (1)
- Community-Based Practice (2)
- Comparative Effectiveness (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- COVID-19 (1)
- Cultural Competence (3)
- Dementia (1)
- Depression (2)
- Diabetes (2)
- Diagnostic Safety and Quality (1)
- Disparities (6)
- Elderly (2)
- Evidence-Based Practice (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Delivery (1)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (3)
- Health Literacy (1)
- Hospitalization (1)
- Lifestyle Changes (1)
- Long-Term Care (1)
- Low-Income (2)
- Maternal Care (1)
- Medicaid (1)
- Medical Expenditure Panel Survey (MEPS) (2)
- Medicare (1)
- Neurological Disorders (1)
- Nursing Homes (1)
- Obesity (1)
- Obesity: Weight Management (1)
- Outcomes (1)
- Patient-Centered Healthcare (5)
- Patient-Centered Outcomes Research (1)
- Patient Experience (2)
- Pregnancy (2)
- Prevention (1)
- (-) Primary Care (21)
- Primary Care: Models of Care (3)
- Quality Improvement (2)
- Quality Measures (1)
- Quality of Care (1)
- (-) Racial and Ethnic Minorities (21)
- Screening (3)
- Shared Decision Making (1)
- Telehealth (2)
- Treatments (1)
- Urban Health (1)
- Vulnerable Populations (2)
- Women (1)
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 21 of 21 Research Studies DisplayedRubio K, Fraze TK, Bibi S
Racial-ethnic composition of primary care practices and Comprehensive Primary Care Plus initiative participation.
The purpose of this study was to explore whether primary care practices serving high rates of Black or Latino Medicare fee-for-service (FFS) beneficiaries were less likely to participate in CPC+ in 2021 compared to practices serving lower rates of these same populations. 11,718 primary care practices and 7,264,812 attributed Medicare FFS beneficiaries across 18 eligible regions participated in the study. The study found that 26.9% of the eligible practices were CPC+ participants. In statistically adjusted analyses, primary care practices with high shares of Black and Latino beneficiaries had a lower likelihood of participating in CPC+ compared to practices with lower shares of these beneficiary groups. Participation disparities for practices with relatively high shares of Black beneficiaries partially explained state differences in CPC+ participation rates but did not explain participation disparities for practices with relatively high shares of Latino beneficiaries.
AHRQ-funded; HS024075.
Citation: Rubio K, Fraze TK, Bibi S .
Racial-ethnic composition of primary care practices and Comprehensive Primary Care Plus initiative participation.
J Gen Intern Med 2023 Oct; 38(13):2945-52. Epub ahead of print. doi: 10.1007/s11606-023-08160-0..
Keywords: Racial and Ethnic Minorities, Primary Care, Medicare
Hua Y, Temkin-Greener H, Cai S
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
The purpose of this study was to explore primary care telemedicine use among Medicare beneficiaries with Alzheimer’s disease and related dementias (ADRD) who resided in Assisted Living Facilities (Als) during the early stage of the COVID-19 pandemic, with a focus on possible racial and socioeconomic differences. The study found that at the start of the pandemic in quarter 2 of 2020, Black residents were less likely to have telemedicine visits than their White counterparts. In the following two quarters, Black residents were more likely to receive primary care via telemedicine than White residents; a similar difference was observed between Hispanic and White residents, but with smaller effect sizes. Compared with nondual residents, dual residents were more likely to receive primary care via telemedicine in Q3. In addition, residents in AL communities with a higher proportion of dual residents, compared with those in low-dual ALs, were less likely to receive primary care via telemedicine throughout the study period. However, the difference in telemedicine use between higher vs lower dual ALs narrowed over time.
AHRQ-funded; HS026893.
Citation: Hua Y, Temkin-Greener H, Cai S .
Primary care telemedicine use among assisted living residents with dementia during COVID-19: race and dual enrollment status.
J Am Med Dir Assoc 2023 Aug; 24(8):1157-58.e3. doi: 10.1016/j.jamda.2023.05.005..
Keywords: COVID-19, Primary Care, Telehealth, Health Information Technology (HIT), Nursing Homes, Long-Term Care, Dementia, Neurological Disorders, Racial and Ethnic Minorities, Elderly
Han B, Chen PG, Yu H
Access to after-hours primary care: a key determinant of children's medical home status.
Researchers sought to identify individual survey items or domains that best predict medical home (MH) status for children and use them to develop brief markers of MH status. Using MEPS data, they found that accessibility, especially the ability to access health care after regular office hours, appeared to be the major predictor of having a MH among children. They recommended that the ongoing efforts to promote the MH model target improving accessibility of health care after regular hours for children overall and especially for Latino children.
AHRQ-funded; HS023336.
Citation: Han B, Chen PG, Yu H .
Access to after-hours primary care: a key determinant of children's medical home status.
BMC Health Serv Res 2021 Feb 27;21(1):185. doi: 10.1186/s12913-021-06192-y..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Primary Care: Models of Care, Primary Care, Patient-Centered Healthcare, Access to Care, Healthcare Delivery, Disparities, Racial and Ethnic Minorities
Rosas LG, Lv N, Xiao L
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
Identifying effective weight loss interventions for Latino adults at risk of diabetes is of critical public health importance. The purpose of this study was to determine whether a culturally adapted behavioral intervention for Latino adults was more effective than usual care for weight loss over 24 months. The investigators concluded that among Latino adults with high diabetes risk, a culturally adapted behavioral lifestyle intervention was effective for weight loss over 12 months but not 24 months.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Xiao L .
Effect of a culturally adapted behavioral intervention for Latino adults on weight loss over 2 years: a randomized clinical trial.
JAMA Netw Open 2020 Dec;3(12):e2027744. doi: 10.1001/jamanetworkopen.2020.27744..
Keywords: Racial and Ethnic Minorities, Obesity: Weight Management, Obesity, Cultural Competence, Diabetes, Primary Care, Outcomes, Patient-Centered Outcomes Research, Comparative Effectiveness, Evidence-Based Practice
Jonassaint CR, Belnap BH, Huang Y
Racial differences in the effectiveness of Internet-delivered mental health care.
The purpose of this study was to examine race differences in the impact of computerized cognitive behavioral therapy (cCBT) use on mental health outcomes among White and African American primary care patients. Participants were patients aged 18-75 who were referred by their primary care physicians and who met the eligibility criteria. Findings showed that, compared to usual care, cCBT had no effect on quality of life, depression, or anxiety for Whites. However, for African American patients, cCBT was associated with a significant 6-month decrease in depression and anxiety scores; thus, cCBT may be an efficient and scalable first step to eliminating disparities in mental health care.
AHRQ-funded; HS022989.
Citation: Jonassaint CR, Belnap BH, Huang Y .
Racial differences in the effectiveness of Internet-delivered mental health care.
J Gen Intern Med 2020 Feb;35(2):490-97. doi: 10.1007/s11606-019-05542-1..
Keywords: Behavioral Health, Telehealth, Racial and Ethnic Minorities, Disparities, Primary Care, Treatments
Li J, Pesko MF, Unruh MA
Effect of the Medicaid primary care rate increase on prenatal care utilization among Medicaid-insured women.
The purpose of this study was to evaluate the effect of the 2013-2014 ACA Medicaid Primary Care Rate Increase on Medicaid-insured women's prenatal care utilization, overall and by race and ethnicity. The investigators concluded that the Medicaid "fee bump" improved prenatal care utilization for non-Hispanic Black and White women. They suggest that policymakers may consider reinstating higher Medicaid reimbursements to improve access to care for disadvantaged populations.
AHRQ-funded; HS024357.
Citation: Li J, Pesko MF, Unruh MA .
Effect of the Medicaid primary care rate increase on prenatal care utilization among Medicaid-insured women.
Matern Child Health J 2019 Nov;23(11):1564-72. doi: 10.1007/s10995-019-02804-6..
Keywords: Medicaid, Primary Care, Maternal Care, Pregnancy, Women, Healthcare Utilization, Racial and Ethnic Minorities, Disparities
Howard SD, Lee KL, Nathan AG
Healthcare experiences of transgender people of color.
Researchers investigated how transgender people of color (TPOC) healthcare experiences are shaped by both race/ethnicity and gender identity. Using interviews and focus groups with participants in the Chicago area, they found that all participants described healthcare experiences where providers responded negatively to their race/ethnicity and/or gender identity. A majority of participants sought out healthcare locations designated as lesbian, gay, bisexual, and transgender-friendly in an effort to avoid discrimination, but feared experiencing racism there. When describing positive healthcare experiences, participants were most likely to highlight providers' respect for their gender identity. The researchers concluded that TPOC have different experiences compared with white transgender or cisgender racial/ethnic minorities and recommended that providers improve understanding of intersectional experiences of TPOC to improve quality of care.
AHRQ-funded; HS023050.
Citation: Howard SD, Lee KL, Nathan AG .
Healthcare experiences of transgender people of color.
J Gen Intern Med 2019 Oct;34(10):2068-74. doi: 10.1007/s11606-019-05179-0..
Keywords: Patient Experience, Vulnerable Populations, Cultural Competence, Racial and Ethnic Minorities, Primary Care, Ambulatory Care and Surgery
Bravo RI, Kietzman KG, Toy P
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
This paper describes the Healthy Aging Partnerships in Prevention Initiative (HAPPI) which aims to increase colorectal cancer screening and other preventive services among underserved Latinos and African-Americans in South Los Angeles who are 50 years and older. It uses an evidence-based model (SPARC) to leverage existing resources and has multi-sectoral partnerships among different agencies, community health centers (CHCs), and a university. The authors engaged five CHCs in quality improvement activities and eight non-governmental organizations in networking and programming to increase awareness of these preventive services.
AHRQ-funded; HS010858.
Citation: Bravo RI, Kietzman KG, Toy P .
Linking primary care and community organizations to increase colorectal cancer screening rates: the HAPPI project.
Salud Publica Mex 2019 Jul-Aug;61(4):427-35. doi: 10.21149/9450..
Keywords: Cancer: Colorectal Cancer, Cancer, Screening, Prevention, Primary Care: Models of Care, Primary Care, Elderly, Racial and Ethnic Minorities, Vulnerable Populations, Patient-Centered Healthcare
Tieu L, Hobbs A, Sarkar U
Adapting patient experience data collection processes for lower literacy patient populations using tablets at the point of care.
This study compared the acceptability of low-literacy tablet-based and traditional paper-based patient experience surveys in English and Spanish. The Consumer Assessment of Healthcare Providers & Systems Clinician & Group Survey (CG-CAHPS) was adapted for a pilot survey using low-literacy questions in Spanish and English. The majority of interview participants preferred the tablet version over the traditional paper-based survey. This was especially true for the younger and Latino respondents.
AHRQ-funded; HS022408.
Citation: Tieu L, Hobbs A, Sarkar U .
Adapting patient experience data collection processes for lower literacy patient populations using tablets at the point of care.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S140-s48. doi: 10.1097/mlr.0000000000001030..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Information Technology (HIT), Health Literacy, Patient Experience, Primary Care, Quality of Care, Quality Improvement, Racial and Ethnic Minorities, Urban Health
Sorkin DH, Rizzo S, Biegler K
AHRQ Author: Ngo-Metzger Q
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
This article describes a multicomponent health information technology screening tool designed to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder (PTSD) in the primary care setting, with an eye toward meeting the mental health needs of traumatized refugees in the US Cambodian community. In a randomized controlled trial, 18 primary care providers were randomized to receive access to the mental health screening intervention, or to a minimal intervention control group. Cambodian American patients empaneled to participating providers were assigned to the providers' randomized group. From the results, the authors conclude that this approach offers the potential for training providers to diagnose and treat traumatized patients seeking mental health care in primary care.
AHRQ-authored.
Citation: Sorkin DH, Rizzo S, Biegler K .
Novel health information technology to aid provider recognition and treatment of major depressive disorder and posttraumatic stress disorder in primary care.
Med Care 2019 Jun;57 Suppl 6 Suppl 2:S190-s96. doi: 10.1097/mlr.0000000000001036..
Keywords: Depression, Diagnostic Safety and Quality, Health Information Technology (HIT), Behavioral Health, Primary Care, Primary Care: Models of Care, Racial and Ethnic Minorities, Screening
Jones AL, Cochran SD, Leibowitz A
Racial, ethnic, and nativity differences in mental health visits to primary care and specialty mental health providers: analysis of the Medical Expenditures Panel Survey, 2010-2015.
The researchers sought to guide post-ACA efforts to address mental health service disparities, by using a nationally representative sample to characterize baseline race-, ethnicity-, and nativity-associated differences in mental health services in the context of primary care. They found that all racial/ethnic groups were less likely than non-Latino Whites to have any primary care (PC) visit. Their conclusion was that racial-, ethnic-, and nativity-associated disparities persist in PC provided mental health services.
AHRQ-funded; HS021721.
Citation: Jones AL, Cochran SD, Leibowitz A .
Racial, ethnic, and nativity differences in mental health visits to primary care and specialty mental health providers: analysis of the Medical Expenditures Panel Survey, 2010-2015.
Healthcare 2018 Mar 22;6(2). doi: 10.3390/healthcare6020029.
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Keywords: Disparities, Medical Expenditure Panel Survey (MEPS), Behavioral Health, Primary Care, Racial and Ethnic Minorities
Hines AL, Roter D, Ghods Dinoso BK
Informed and patient-centered decision-making in the primary care visits of African Americans with depression.
This study examined the prevalence and extent of informed decision-making (IDM) and patient-centered decision-making (PCDM) in primary care visits of African Americans with depression. It concluded that the associations between IDM and PCDM with interpersonal ratings were moderated by overall patient-centeredness of the visit, which may be indicative of broader cross-cultural communication issues. Strengthening partnerships between depressed African Americans and their clinicians may improve patient-engaged decision-making.
AHRQ-funded; HS013645.
Citation: Hines AL, Roter D, Ghods Dinoso BK .
Informed and patient-centered decision-making in the primary care visits of African Americans with depression.
Patient Educ Couns 2018 Feb;101(2):233-40. doi: 10.1016/j.pec.2017.07.027.
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Keywords: Shared Decision Making, Depression, Patient-Centered Healthcare, Primary Care, Racial and Ethnic Minorities
Smith JJ, Johnston JM, Hiratsuka VY
Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
The researchers investigated changes in trend for type 2 diabetes mellitus (DM-II) quality indicators after patient-centered medical home (PCMH) implementation at Southcentral Foundation, a tribal health organization in Alaska. They found that rates of new DM-II diagnoses were stable prior to but increased after implementation. DM-II rates of HbA1c screening increased, though not significantly before and remained stable after implementation.
AHRQ-funded; HS019154.
Citation: Smith JJ, Johnston JM, Hiratsuka VY .
Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.
Prim Care Diabetes 2015 Apr;9(2):120-6. doi: 10.1016/j.pcd.2014.06.005..
Keywords: Diabetes, Patient-Centered Healthcare, Primary Care, Quality Measures, Racial and Ethnic Minorities
Rosas LG, Lv N, Xiao L
Evaluation of a culturally-adapted lifestyle intervention to treat elevated cardiometabolic risk of Latino adults in primary care (Vida Sana): a randomized controlled trial.
The authors discussed the 5-year Vida Sana study, which tests a culturally adapted and technology-enhanced group-based Diabetes Prevention Program intervention in a randomized controlled trial with overweight/obese Latino adults who have metabolic syndrome and/or pre-diabetes. The main goal was to determine the effectiveness of the intervention. The authors hypothesized that the intervention will lead to a greater mean reduction in weight at 24 months vs. usual care.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Xiao L .
Evaluation of a culturally-adapted lifestyle intervention to treat elevated cardiometabolic risk of Latino adults in primary care (Vida Sana): a randomized controlled trial.
Contemp Clin Trials 2016 May;48:30-40. doi: 10.1016/j.cct.2016.03.003.
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Keywords: Cultural Competence, Lifestyle Changes, Racial and Ethnic Minorities, Primary Care, Racial and Ethnic Minorities
Hernandez SE, Taylor L, Grembowski D
A first look at PCMH implementation for minority veterans: room for improvement.
The researchers sought to determine if the degree of Patient Aligned Care Teams (a patient-centered medical home model), implementation at Veterans Health Administration hospital-based and community-based primary care facilities varied with the percentage of minority veteran patients at each facility. They found that overall implementation of the care teams varied with respect to the racial/ethnic composition of a facility, with medium and high minority facilities having lower implementation scores.
AHRQ-funded; HS013853; HS023376.
Citation: Hernandez SE, Taylor L, Grembowski D .
A first look at PCMH implementation for minority veterans: room for improvement.
Med Care 2016 Mar;54(3):253-61. doi: 10.1097/mlr.0000000000000512.
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Keywords: Patient-Centered Healthcare, Racial and Ethnic Minorities, Community-Based Practice, Primary Care
Patel SR, Gorritz M, Olfson M
Training community-based primary care physicians in the screening and management of mental health disorders among Latino primary care patients.
The researchers evaluated a quality improvement intervention to improve the screening and management (e.g., referral to psychiatric care) of common mental disorders in small independent Latino primary care practices. They concluded that improving the quality of mental health care in low-resourced primary care settings may require academic detailing and consultation/liaison psychiatric intervention supplemented with staff outreach to achieve meaningful improvement in the processes of care.
AHRQ-funded; HS021112.
Citation: Patel SR, Gorritz M, Olfson M .
Training community-based primary care physicians in the screening and management of mental health disorders among Latino primary care patients.
Gen Hosp Psychiatry 2016 Jan-Feb;38:71-8. doi: 10.1016/j.genhosppsych.2015.09.006.
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Keywords: Community-Based Practice, Primary Care, Behavioral Health, Racial and Ethnic Minorities, Quality Improvement
Wielen LM, Gilchrist EC, Nowels MA
Not near enough: racial and ethnic disparities in access to nearby behavioral health care and primary care.
The authors addressed disparities associated with integrated behavioral health and primary care services. They found that primary care providers practicing in neighborhoods with higher percentages of African Americans and Hispanics were less likely to have geographically proximate behavioral health professionals; this also applied to rural areas. They concluded that additional behavioral health professionals are needed in racial/ethnic minority neighborhoods and rural areas to provide access to behavioral health services, and to progress toward more integrated primary care.
AHRQ-funded; HS022444.
Citation: Wielen LM, Gilchrist EC, Nowels MA .
Not near enough: racial and ethnic disparities in access to nearby behavioral health care and primary care.
J Health Care Poor Underserved 2015 Aug;26(3):1032-47. doi: 10.1353/hpu.2015.0083.
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Keywords: Behavioral Health, Disparities, Primary Care, Racial and Ethnic Minorities
Leis JA, Solomon BS, Wasserman KE
Preventing postpartum depression in a pediatric primary care clinic: a pilot study.
The goal of this study was to integrate an evidence-based preventive intervention for perinatal depression—the Mothers and Babies (MB) Course—into a pediatric primary care clinic serving low-income, minority families, and to explore intervention acceptability and preliminary outcomes. Findings from this pilot study provide preliminary evidence for the acceptability and feasibility of implementing an evidence-based preventive intervention for postpartum depression.
AHRQ-funded; HS017596.
Citation: Leis JA, Solomon BS, Wasserman KE .
Preventing postpartum depression in a pediatric primary care clinic: a pilot study.
Clin Pediatr 2015 May;54(5):487-90. doi: 10.1177/0009922814536775..
Keywords: Pregnancy, Primary Care, Evidence-Based Practice, Low-Income, Racial and Ethnic Minorities
Chang E, Chan KS, Han HR
Effect of acculturation on variations in having a usual source of care among Asian Americans and non-Hispanic whites in California.
This study examined variations in having a usual source of care among non-Hispanic White and Asian American adults in California. It found that, after adding in acculturation factors, there was no statistically significant racial disparity between the two groups. However, higher education was not associated with better access among Asian Americans.
AHRQ-funded; HS021684
Citation: Chang E, Chan KS, Han HR .
Effect of acculturation on variations in having a usual source of care among Asian Americans and non-Hispanic whites in California.
Am J Public Health 2015 Feb;105(2):398-407. doi: 10.2105/AJPH.2014.301950..
Keywords: Primary Care, Disparities, Racial and Ethnic Minorities
Basu J
AHRQ Author: Basu J
Has access to care changed in minority communities? A study of preventable hospitalizations over time in selected States.
Basu assessed the changes in access to care in minority communities by examining the association between preventable hospitalization rates and racial/ethnic composition of the community during 1995-2005. Using HCUP data, the results indicated increases in barriers faced by minority adults in accessing primary care over time, with no similar evidence for the elderly subgroup.
AHRQ-authored.
Citation: Basu J .
Has access to care changed in minority communities? A study of preventable hospitalizations over time in selected States.
J Ambul Care Manage 2014 Oct-Dec;37(4):314-30. doi: 10.1097/jac.0000000000000024.
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Keywords: Access to Care, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Primary Care, Racial and Ethnic Minorities
Gupta S, Brenner AT, Ratanawongsa N
Patient trust in physician influences colorectal cancer screening in low-income patients.
The study objective was to characterize the relationship between patient trust and colorectal cancer (CRC) screening behavior among racially and ethnically diverse, low-income patients who had all received a physician recommendation for screening. After controlling for traditional factors, trust in the primary care provider remained the only significant driver of CRC screening completion.
AHRQ-funded; HS013853; HS000032; HS022561
Citation: Gupta S, Brenner AT, Ratanawongsa N .
Patient trust in physician influences colorectal cancer screening in low-income patients.
Am J Prev Med. 2014 Oct;47(4):417-23. doi: 10.1016/j.amepre.2014.04.020..
Keywords: Screening, Racial and Ethnic Minorities, Low-Income, Primary Care