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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 20 of 20 Research Studies DisplayedGlynn A, Hernandez I, Roberts ET
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
This study’s objective was to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. Data from the Health and Retirement Study linked to Medicare administrative data from 2008 to 2016 was used. The authors first estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), they conducted propensity score-weighted regression analyses to compare out-of-pocket costs, prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. Among Medicare beneficiaries with diabetes, 68.1% of those considered near-poor (incomes >100% to ≤150% of FPL) received the LIS, compared to 90.3% of those with incomes ≤100% of FPL. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518], filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs, and were 8.9 percentage points more likely to report skipping drugs due to cost. all compared to LIS enrollees.
AHRQ-funded; HS026727.
Citation: Glynn A, Hernandez I, Roberts ET .
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
Health Serv Res 2022 Oct;57(5):1136-44. doi: 10.1111/1475-6773.13990..
Keywords: Medication, Diabetes, Chronic Conditions, Low-Income, Medicare, Healthcare Costs
Kumar V, Encinosa W
AHRQ Author: Encinosa W
Revisiting the obesity paradox in health care expenditures among adults with diabetes.
This AHRQ-authored study explored and examined an obesity paradox identified by recent studies which suggests that in people without diabetes mortality risk increases with weight and in people with diabetes mortality risk decreases with weight. The researchers assessed changes in the association between body mass index (BMI) and health care expenditures in populations with diabetes and without diabetes while controlling for confounding risk factors. The researchers found that there is no obesity paradox; it is the result of statistical biases, and the study concluded that obesity in people with diabetes does not save costs.
AHRQ-authored.
Citation: Kumar V, Encinosa W .
Revisiting the obesity paradox in health care expenditures among adults with diabetes.
Clin Diabetes 2022 Spring;40(2):185-95. doi: 10.2337/cd20-0122..
Keywords: Medical Expenditure Panel Survey (MEPS), Obesity, Diabetes, Healthcare Costs
Flory JH, Mushlin AI
Effect of cost and formulation on persistence and adherence to initial metformin therapy for type 2 diabetes.
This paper studied whether persistence and adherence to initial release (IR) metformin was at the same levels as extended release (ER) metform for adults with type 2 diabetes. A study was conducted using merged de-identified claims data from commercial insurance carriers in the US from 2012 to 2016. The cohort used was identified as patients aged 18 years or older who filled an initial 30-day prescription for metformin monotherapy with a baseline type 2 diabetes diagnosis, at least 1 year of baseline and follow-up data, and no prior antidiabetes drug use. “Persistence” was defined as at least one metformin prescription claim during the 6-12 month window after the initial prescription. “Adherence” was defined as the percentage of days for which the patient had filled sufficient prescriptions to be taking it “as prescribed”. The final study population was 81,406 patients, with 78% having commercial insurance, 19% Medicare Advantage, and 2.5% were dual-eligible for Medicare and Medicare. Persistence was slightly higher for ER metformin than for IR metformin, as was adherence and adequate adherence (80% or more). Despite the slightly higher cost, initial use of ER metformin was associated with better adherence.
AHRQ-funded; HS023898.
Citation: Flory JH, Mushlin AI .
Effect of cost and formulation on persistence and adherence to initial metformin therapy for type 2 diabetes.
Diabetes Care 2020 Jun;43(6):e66-e67. doi: 10.2337/dc19-2426..
Keywords: Diabetes, Chronic Conditions, Healthcare Costs, Medication, Patient Adherence/Compliance
Mszar R, Grandhi GR, Valero-Elizondo J
Cumulative burden of financial hardship from medical bills across the spectrum of diabetes mellitus and atherosclerotic cardiovascular disease among non-elderly adults in the United States.
This study looked at the rates of financial hardship from medical bills with non-elderly adults diagnosed with diabetes mellitus (DM) and diagnosed with and without atherosclerotic cardiovascular disease (ASCVD). ASCVD with DM accounts for approximately two-thirds of deaths in this patient population. Data from the National Health Interview Survey from 2013 to 2017 was used, with a total study population of 121,672 individuals. Approximately 3.1% of the population had ASCVD, 5.6% had DM, and 1.3% had both. Almost half of individuals with both conditions reported financial hardship from medical bills, with 23% unable to pay medical bills at all, compared to around 28% of those with neither ASCVD and DM reporting financial hardship with 8% being unable to pay at all.
AHRQ-funded; HS023000.
Citation: Mszar R, Grandhi GR, Valero-Elizondo J .
Cumulative burden of financial hardship from medical bills across the spectrum of diabetes mellitus and atherosclerotic cardiovascular disease among non-elderly adults in the United States.
J Am Heart Assoc 2020 May 18;9(10):e015523. doi: 10.1161/jaha.119.015523..
Keywords: Diabetes, Cardiovascular Conditions, Chronic Conditions, Healthcare Costs
Tabano DC, Anderson ML, Ritzwoller DP
Estimating the impact of diabetes mellitus on worker productivity using self-report, electronic health record and human resource data.
In this study, the investigators assessed the relationship between diabetes mellitus (DM) and measures of worker productivity, direct health care costs, and costs associated with lost productivity (LP) among health care industry workers across two integrated health care systems. They concluded that the impact of DM was reflected in higher rates of LP and higher indirect costs for employers related to LP and higher health care resource use.
AHRQ-funded; HS018913.
Citation: Tabano DC, Anderson ML, Ritzwoller DP .
Estimating the impact of diabetes mellitus on worker productivity using self-report, electronic health record and human resource data.
J Occup Environ Med 2018 Nov;60(11):e569-e74. doi: 10.1097/jom.0000000000001441..
Keywords: Diabetes, Healthcare Costs, Workforce
Kang H, Lobo JM, Kim S
Cost-related medication non-adherence among U.S. adults with diabetes.
The purpose of this study is to examine factors that affect cost-related medication non-adherence (CRN), defined as taking medication less than as prescribed because of cost, among adults with diabetes and to determine their relative contribution in explaining CRN. Among other results, the study found that Insulin users had 1.24 times higher risk of CRN compared to those not on insulin.
AHRQ-funded; HS018542.
Citation: Kang H, Lobo JM, Kim S .
Cost-related medication non-adherence among U.S. adults with diabetes.
Diabetes Res Clin Pract 2018 Sep;143:24-33. doi: 10.1016/j.diabres.2018.06.016..
Keywords: Diabetes, Healthcare Costs, Medication, Patient Adherence/Compliance
Nuckols TK, Keeler E, Anderson LJ
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
This study systematically reviewed economic evaluations of quality improvement (QI) interventions for glycemic control among adults with type 1 or type 2 diabetes. Using English-language studies from high-income countries that evaluated organizational changes and reported program and utilization-related costs, the researchers extracted data regarding intervention, study design, change in HbA1c, time horizon, perspective, incremental net cost, incremental cost-effectiveness ratio, and study quality. They conclude that diverse and multifaceted QI interventions which lower HbA1c appear to be a fair-to-good value, relative to usual care.
AHRQ-funded; HS022644.
Citation: Nuckols TK, Keeler E, Anderson LJ .
Economic evaluation of quality improvement interventions designed to improve glycemic control in diabetes: a systematic review and weighted regression analysis.
Diabetes Care 2018 May;41(5):985-93. doi: 10.2337/dc17-1495..
Keywords: Diabetes, Healthcare Costs, Quality of Care, Quality Improvement
Karter AJ, Parker MM, Solomon MD
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
This study estimated the effect of out-of-pocket (OOP) cost on nonadherence to classes of cardiometabolic medications among patients with diabetes. Primary nonadherence (never dispensed) increased monotonically with OOP cost after adjusting for demographics, neighborhood socioeconomic status, Medicare, medical financial assistance, OOP maximum, deductibles, mail order pharmacy incentive and use, drug type, generic or brand, day's supply, and comorbidity index.
AHRQ-funded; HS022408.
Citation: Karter AJ, Parker MM, Solomon MD .
Effect of out-of-pocket cost on medication initiation, adherence, and persistence among patients with type 2 diabetes: the Diabetes Study of Northern California (DISTANCE).
Health Serv Res 2018 Apr;53(2):1227-47. doi: 10.1111/1475-6773.12700.
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Keywords: Diabetes, Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance
Misra-Hebert AD, Hu B, Le PH
Effect of health plan financial incentive offering on employees with prediabetes.
Researchers studied the effect of employee health plan financial incentives on health outcomes for employees with prediabetes. They found that employees who participated in disease management lost more weight than those who did not. A worksite wellness program offering health plan financial incentives for participation and outcomes was associated with improvements not only in weight but also in HbA1c.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Le PH .
Effect of health plan financial incentive offering on employees with prediabetes.
Am J Med 2018 Mar;131(3):293-99. doi: 10.1016/j.amjmed.2017.09.024.
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Keywords: Healthcare Costs, Patient-Centered Outcomes Research, Patient Self-Management, Obesity: Weight Management, Diabetes, Health Status
Leung MY, Carlsson NP, Colditz GA
The burden of obesity on diabetes in the United States: Medical Expenditure Panel Survey, 2008 to 2012.
The researchers analyzed the risk of developing diabetes and the annual cost of diabetes for a US general population. Their results suggested that the annual health care expenditure differentials between those with and without diabetes of age 50 years were the highest for individuals with class II ($12,907) and class III ($9,703) obesity.
AHRQ-funded; HS022330.
Citation: Leung MY, Carlsson NP, Colditz GA .
The burden of obesity on diabetes in the United States: Medical Expenditure Panel Survey, 2008 to 2012.
Value Health 2017 Jan;20(1):77-84. doi: 10.1016/j.jval.2016.08.735.
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Keywords: Medical Expenditure Panel Survey (MEPS), Obesity, Diabetes, Healthcare Costs, Risk
Lyles CR, Seligman HK, Parker MM
Financial strain and medication adherence among diabetes patients in an integrated health care delivery system: The Diabetes Study of Northern California (DISTANCE).
The researchers examined self-reported financial strain in relation to pharmacy utilization adherence data. Their analysis of survey, administrative, and electronic medical data from Kaiser Permanente Northern California found that 8 percent and 9 percent reported general and medication-specific financial strain. In adjusted models, general strain was significantly associated with primary nonadherence and refilling late and medication-specific strain was ssociated with primary nonadherence.
AHRQ-funded; HS022408.
Citation: Lyles CR, Seligman HK, Parker MM .
Financial strain and medication adherence among diabetes patients in an integrated health care delivery system: The Diabetes Study of Northern California (DISTANCE).
Health Serv Res 2016 Apr;51(2):610-24. doi: 10.1111/1475-6773.12346.
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Keywords: Diabetes, Medication, Patient Adherence/Compliance, Healthcare Costs, Healthcare Delivery
Sathe NA, Nocon RS, Hughes B
The costs of participating in a diabetes quality improvement collaborative: Variation among five clinics.
The costs over the first four years-from June 2009 through May 2013-of an ongoing diabetes Quality improvement collaborative were characterized by activities and over time. Cost/diabetic patient/year ranged across clinic sites from $6 (largest clinic) to $68 (smallest clinic).
AHRQ-funded; HS000084.
Citation: Sathe NA, Nocon RS, Hughes B .
The costs of participating in a diabetes quality improvement collaborative: Variation among five clinics.
Jt Comm J Qual Patient Saf. 2016 Jan;42(1):18-25..
Keywords: Diabetes, Quality Improvement, Healthcare Costs, Health Services Research (HSR)
Sathe NA, Nocon RS, Hughes B
The costs of participating in a diabetes quality improvement collaborative: Variation among five clinics.
The costs over the first four years-from June 2009 through May 2013-of an ongoing diabetes Quality improvement collaborative were characterized by activities and over time. Cost/diabetic patient/year ranged across clinic sites from $6 (largest clinic) to $68 (smallest clinic).
AHRQ-funded; HS000084.
Citation: Sathe NA, Nocon RS, Hughes B .
The costs of participating in a diabetes quality improvement collaborative: Variation among five clinics.
Jt Comm J Qual Patient Saf 2016 Jan;42(1):18-25..
Keywords: Diabetes, Quality Improvement, Healthcare Costs, Health Services Research (HSR)
Quan J, Lee AK, Handley MA
Automated telephone self-management support for diabetes in a low-income health plan: a health care utilization and cost analysis.
The objective was to determine whether automated telephone self-management support for low-income, linguistically diverse health plan members with diabetes affects health care utilization or cost. It found no significant differences in emergency department visits and hospitalizations or in costs.
AHRQ-funded; HS020684; HS017261; HS022561.
Citation: Quan J, Lee AK, Handley MA .
Automated telephone self-management support for diabetes in a low-income health plan: a health care utilization and cost analysis.
Popul Health Manag 2015 Dec;18(6):412-20. doi: 10.1089/pop.2014.0154.
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Keywords: Diabetes, Chronic Conditions, Patient Self-Management, Low-Income, Healthcare Costs
Miller GE, Sarpong EM, Hill SC
AHRQ Author: Miller GE, Sarpong EM, Hill SC
Does increased adherence to medications change health care financial burdens for adults with diabetes?
The aim of the present study was to investigate increased out-of-pocket drug costs and financial burdens of achieving adherence to oral antidiabetic medications and medications for prevalent comorbidities. The researchers found that the mean simulated additional out-of-pocket drug costs of achieving adherence were $310 for uninsured adults treated for diabetes. These additional drug costs would increase the percentage of uninsured adults with financial burden.
AHRQ-authored.
Citation: Miller GE, Sarpong EM, Hill SC .
Does increased adherence to medications change health care financial burdens for adults with diabetes?
J Diabetes 2015 Nov;7(6):872-80. doi: 10.1111/1753-0407.12292..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Diabetes, Patient Adherence/Compliance, Medication
Sentell TL, Ahn HJ, Miyamura J
Cost burden of potentially preventable hospitalizations for cardiovascular disease and diabetes for Asian Americans, Pacific Islanders, and Whites in Hawai'i.
The authors compared the cost burdens of potentially preventable hospitalizations for cardiovascular disease and diabetes for Asian Americans, Pacific Islanders, and Whites using Hawai'i statewide 2007-2012 inpatient data. They found that costs for preventable diabetes-related amputations were significantly higher for Native Hawaiians, Japanese, and other Pacific Islanders compared with Whites.
AHRQ-funded; HS019990.
Citation: Sentell TL, Ahn HJ, Miyamura J .
Cost burden of potentially preventable hospitalizations for cardiovascular disease and diabetes for Asian Americans, Pacific Islanders, and Whites in Hawai'i.
J Health Care Poor Underserved 2015 May;26(2 Suppl):63-82. doi: 10.1353/hpu.2015.0068.
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Keywords: Cardiovascular Conditions, Diabetes, Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities
Adams AS, Soumerai SB, Zhang F
Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression.
This study aimed to evaluate the impact of removing a significant financial barrier to prescription medications (drug caps) on existing black-white disparities in antidepressant treatment rates among patients with diabetes and comorbid depression. It found that policies that remove financial barriers to medications may increase depression treatment rates among patients with diabetes overall while exacerbating treatment disparities.
AHRQ-funded; HS018577; HS018072.
Citation: Adams AS, Soumerai SB, Zhang F .
Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression.
Clin Ther 2015 Mar;37(3):597-609. doi: 10.1016/j.clinthera.2014.12.011..
Keywords: Medication, Disparities, Depression, Diabetes, Healthcare Costs
Leung MY, Pollack LM, Colditz GA
Life years lost and lifetime health care expenditures associated with diabetes in the U.S., National Health Interview Survey, 1997-2000.
The authors analyzed the lifetime health care expenditures and life years lost associated with diabetes in the U.S. Their results showed that diabetes is associated with large decreases in life expectancy and large increases in lifetime health care expenditures, with the life years and expenditures depending on age-race-sex-BMI classification groups.
AHRQ-funded; HS022330.
Citation: Leung MY, Pollack LM, Colditz GA .
Life years lost and lifetime health care expenditures associated with diabetes in the U.S., National Health Interview Survey, 1997-2000.
Diabetes Care 2015 Mar;38(3):460-8. doi: 10.2337/dc14-1453.
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Keywords: Diabetes, Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Mortality
Prentice JC, Conlin PR, Gellad WF
Long-term outcomes of analogue insulin compared with NPH for patients with type 2 diabetes mellitus.
The researchers compared the effects of neutral protamine Hagedorn (NPH) and long-acting insulin analogues on long-term outcomes. They found no consistent difference in long-term health outcomes when comparing use of long-acting insulin analogues and NPH insulin. The higher cost of analogue insulin without demonstrable clinical benefit raises questions of its cost effectiveness in the treatment of patients with diabetes.
AHRQ-funded; HS019708.
Citation: Prentice JC, Conlin PR, Gellad WF .
Long-term outcomes of analogue insulin compared with NPH for patients with type 2 diabetes mellitus.
Am J Manag Care 2015 Mar;21(3):e235-43..
Keywords: Comparative Effectiveness, Diabetes, Healthcare Costs, Medication, Outcomes
Pershing S, Enns EA, Matesic B
Cost-effectiveness of treatment of diabetic macular edema.
The researchers sought to determine the cost-effectiveness of different treatments of diabetic macular edema (DME). They found that vascular endothelial growth factor (VEGF) inhibitors with or without laser treatment provide important health benefits with favorable cost-effectiveness, costing less per QALY gained than many accepted therapies.
AHRQ-funded; HS000028.
Citation: Pershing S, Enns EA, Matesic B .
Cost-effectiveness of treatment of diabetic macular edema.
Ann Intern Med 2014 Jan 7;160(1):18-29. doi: 10.7326/m13-0768..
Keywords: Diabetes, Eye Disease and Health, Healthcare Costs, Quality of Life, Treatments