National Healthcare Quality and Disparities Report
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Topics
- (-) Access to Care (11)
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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 11 of 11 Research Studies DisplayedAmu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Nguyen KH, Oronce CIA, Adia AC
Inability to access needed medical care among Asian American, Native Hawaiian, and Pacific Islander Medicaid enrollees.
Researchers examined self-reported inability to access needed medical care and patients’ reasons for not accessing medical care among adult Medicaid enrollees, disaggregated across Asian American, Native Hawaiian, and Pacific Islander ethnic groups. Their findings indicated that Chinese, Other Asian, Native Hawaiian enrollees were significantly less likely to report being unable to access needed medical care compared with non-Hispanic White enrollees. The most common reason given was that health plans would not approve, cover, or pay for care. The researchers concluded that different interventions specific to certain ethnic groups may be needed to mitigate inequities.
AHRQ-funded; HS022241.
Citation: Nguyen KH, Oronce CIA, Adia AC .
Inability to access needed medical care among Asian American, Native Hawaiian, and Pacific Islander Medicaid enrollees.
J Ambul Care Manage 2024 Apr-Jun; 47(2):96-103. doi: 10.1097/jac.0000000000000489..
Keywords: Access to Care, Racial and Ethnic Minorities, Medicaid
Meille G, Koch T, Wendling B
AHRQ Author: Meille G, Zuvekas S
The consequences of firm scope and scale on patient access to healthcare.
The objective of this study was to quantify changes in the market structure of primary care physicians and to examine its relationship with access to care. Researchers created measures of market structure from a 5% sample of Medicare fee-for-service claims and examined access to care using MEPS data. The findings showed that respondents in highly concentrated ZIP codes were less likely to report having access to immediate care than respondents in unconcentrated ZIP codes; the association was largest among Medicaid beneficiaries. No association between HHI and indicators for having a usual source of care and annual checkups were found. Multispecialty market share was negatively associated with checkups, but not other measures of access.
AHRQ-authored.
Citation: Meille G, Koch T, Wendling B .
The consequences of firm scope and scale on patient access to healthcare.
Health Serv Res 2024 Apr; 59(2):e14228. doi: 10.1111/1475-6773.14228..
Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Healthcare Delivery, Medicare
Daw JR, MacCallum-Bridges CL, Kozhimannil KB
Continuous Medicaid eligibility during the COVID-19 pandemic and postpartum coverage, health care, and outcomes.
This study’s objective was to evaluate the association of continuous Medicaid eligibility due to the Families First Coronavirus Response Act (FFCRA) during the COVID-19 public health emergency (PHE) with postpartum health insurance, health care use, breastfeeding, and depressive symptoms. This cohort study included 47,716 respondents from the Pregnancy Risk Assessment Monitoring System (PRAMS) comparing 21 states with continuous prepolicy (2017-2019) and postpolicy (2020-2021) participation. Based on adjusted estimates, a 100% federal poverty level (FPL) increase in postpartum Medicaid eligibility was associated with a 5.1 percentage point (pp) increase in reported postpartum Medicaid enrollment, no change in commercial coverage, and a 6.6 pp decline in uninsurance, which represents a 40% reduction in postpartum uninsurance after a Medicaid-paid birth compared with the prepolicy baseline of 16.7%. Continuous Medicaid eligibility during the COVID-19 PHE was associated with significantly reduced postpartum uninsurance for people with Medicaid-paid births, but was not associated with postpartum visit attendance, contraception use, breastfeeding, or depressive symptoms at approximately 4 months postpartum. Uninsurance reductions were observed only among White and Black non-Hispanic individuals and Hispanic individuals had no change with no policy-associated changes in other outcomes.
AHRQ-funded; HS029159.
Citation: Daw JR, MacCallum-Bridges CL, Kozhimannil KB .
Continuous Medicaid eligibility during the COVID-19 pandemic and postpartum coverage, health care, and outcomes.
JAMA Health Forum 2024 Mar; 5(3):e240004. doi: 10.1001/jamahealthforum.2024.0004..
Keywords: COVID-19, Medicaid, Maternal Care, Women, Access to Care
Feinberg E, Eilenberg JS
Role of community health workers in promoting health equity in pediatrics.
This progress report describes 2 pilot RCTs that examined the feasibility and acceptability of using a community health worker (CHW) implemented intervention as a strategy to improve timely completion of autism diagnostic evaluations among young children from historically marginalized communities. The authors describe the research that has been published on the topic since they submitted their original study report on November 17, 2019. Their team conducted a subsequent large multisite RCT (“Project EARLY”) as part of National Institute of Mental Health’s Autism Spectrum Disorder Pediatric Early Detection, Engagement and Services Network, whose aim was to develop and test interventions that coordinate early autism screening, evaluation, and engagement in services. Their findings confirmed the efficacy of family navigation to reduce time to autism diagnostic resolution while also uncovering family navigation’s differential impact by ethnicity. Positive effects of using a CHW were significantly greater for Hispanic families compared to non-Hispanic families, suggesting that the intervention may be an effective strategy to reduce disparities by minoritized subgroups. The authors also discussed recent funding through grants, and the fact that Medicaid reimburses CHWs for patient education and health care navigation in 29 US states. They also discuss future directions for investigating the impact of CHWs on autism outcomes specifically, and child well-being more generally.
AHRQ-funded; HS022155.
Citation: Feinberg E, Eilenberg JS .
Role of community health workers in promoting health equity in pediatrics.
Acad Pediatr 2024 Mar; 24(2):199-200. doi: 10.1016/j.acap.2023.09.005..
Keywords: Children/Adolescents, Disparities, Access to Care
Mullens Hernandez, JA JA, Murthy J
Understanding the impacts of rural hospital closures: a scoping review.
Researchers conducted a scoping literature review to understand the impact of rural hospital closure in order to inform ongoing federal policy debates and research. Key categories of adverse impacts that emerged included: emergency medical service transport; availability of emergency care, hospital services, and outpatient services; changes in quality of care: effects on workforce and community members and the local economy. The researchers concluded that a synthesis of their findings will permit policymakers and researchers to understand, and mitigate, the harms of rural hospital closure. They also recommended a tailored approach and discussed crucial knowledge gaps in the evidence base.
AHRQ-funded; HS028672; HS027788; HS028606; HS028963.
Citation: Mullens Hernandez, JA JA, Murthy J .
Understanding the impacts of rural hospital closures: a scoping review.
J Rural Health 2024 Mar; 40(2):227-37. doi: 10.1111/jrh.12801..
Keywords: Rural Health, Rural/Inner-City Residents, Hospitals, Access to Care
King CA, Beetham T, Smith N
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
This study examined adolescent residential addiction treatment facilities in the United States, and their accessibility and cost. The authors used the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data to identify 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. They called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose to inquire about policies and costs. A little over half (54.5%) had a bed immediately available. The mean wait time for a bed was 28.4 days among sites with a waitlist. Of the facilities that provided cost information, the mean cost of treatment per day was $878, with daily costs among for-profit facilities triple of nonprofit facilities. Half of facilities required up-front payments by noninsured patients, with a mean up-front cost of $28,731. They were unable to identify any facilities for adolescents in ten states or Washington, D.C.
AHRQ-funded; HS017589.
Citation: King CA, Beetham T, Smith N .
Adolescent residential addiction treatment in the US: uneven access, waitlists, and high costs.
Health Aff 2024 Jan; 43(1):64-71. doi: 10.1377/hlthaff.2023.00777..
Keywords: Children/Adolescents, Substance Abuse, Healthcare Costs, Access to Care
Adams DR
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
The goal of this study was to assess the availability of outpatient mental health services for children and adolescents at safety-net health centers in a large metropolitan county. A comprehensive sample of Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs) received a 5-minute survey approximately one year after the beginning of the COVID-19 pandemic. The response indicated that 10% of health centers had closed and 20% reported that they were not offering outpatient mental health services. Reported wait times were longer at CMHCs than FQHCs. The author concluded that these findings suggested that online directories such as the SAMHSA Treatment Locator are often inaccurate or out-of-date.
AHRQ-funded; HS000084.
Citation: Adams DR .
Availability and accessibility of mental health services for youth: a descriptive survey of safety-net health centers during the COVID-19 pandemic.
Community Ment Health J 2024 Jan; 60(1):88-97. doi: 10.1007/s10597-023-01127-9..
Keywords: Children/Adolescents, Behavioral Health, Access to Care, COVID-19, Public Health
Eliason EL, Agostino J, Vivier P
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
This cross-sectional study examined the impact that the COVID-19 pandemic had on infant health care, and broke it down by race and ethnicity, income, and insurance type. This study used the Pregnancy Risk Assessment Monitoring System COVID-19 supplement with data from 29 jurisdictions to examine infant health care disruptions due to the pandemic: 1) well visits/checkups canceled or delayed, 2) well visits/checkups changed to virtual appointments, and 3) postponed immunizations. The authors found that among 12,053 parental respondents with infants born from April to December 2020, 7.25% reported cancelations or delays in infant well visits/checkups, 5.49% reported changes to virtual infant care appointments, and 5.33% reported postponing immunizations, with significant differences by race and ethnicity, income, and insurance type. They found higher odds of canceling/delaying visits and postponing immunizations among non-Hispanic Black infants and infants whose parents were uninsured or had Medicaid-paid deliveries. The odds of switching to virtual appointments was also significantly higher among Hispanic infants and infants whose parents had Medicaid-paid deliveries.
AHRQ-funded; HS000011.
Citation: Eliason EL, Agostino J, Vivier P .
Infant health care disruptions by race and ethnicity, income, and insurance during the COVID-19 pandemic.
Acad Pediatr 2024 Jan-Feb; 24(1):105-10. doi: 10.1016/j.acap.2023.07.005..
Keywords: Newborns/Infants, Racial and Ethnic Minorities, COVID-19, Access to Care, Uninsured, Health Insurance, Healthcare Delivery
Cron DC, Braun HJ, Ascher NL
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
The objective of this study was to determine association of sex with access to liver transplantation among candidates with the highest possible model for end-stage liver disease score (MELD 40). Using national transplant registry data, researchers compared liver offer acceptance and waitlist outcomes by sex for waitlisted liver transplant candidates who reached MELD 40. Results showed that even among candidates with high disease severity and equally high MELD scores, women have reduced access to liver transplantation and worse outcomes compared with men. The researchers concluded that policies addressing this disparity should consider factors beyond MELD score adjustments.
AHRQ-funded; HS028476.
Citation: Cron DC, Braun HJ, Ascher NL .
Sex-based disparities in access to liver transplantation for waitlisted patients with model for end-stage liver disease score of 40.
Ann Surg 2024 Jan; 279(1):112-18. doi: 10.1097/sla.0000000000005933..
Keywords: Disparities, Access to Care, Sex Factors, Transplantation
Mitchell JM, Kranz AM, Steiner ED
Barriers and strategies used to continue school-based health services during the COVID-19 pandemic.
This study examined perceived barriers and strategies adopted to continue the delivery of school-based health services when schools reopened in Fall of 2021 during the COVID-19 pandemic and to assess whether these barriers and strategies varied by locality. The authors developed and subsequently conducted an online survey of school nurses who worked at the 1178 public elementary schools in Virginia in May 2021 to describe the impact of the COVID-19 pandemic on the delivery of school-based health services. They compared perceived barriers, strategies adopted and the effectiveness of strategies to continue the delivery of school-based health services by geographic locality (city vs. rural; suburban vs. rural and city vs. suburban). More than half of urban schools expected nine of ten potential barriers to affect the delivery of school-based health services during Fall 2021. More than half of responding schools located in urban, suburban, and rural areas indicated that external barriers outside of their control, including insufficient funding and families not able to bring students to school, were likely to be barriers to delivering care. There was no variation in strategies identified as “very effective” by locality.
AHRQ-funded; HS025430.
Citation: Mitchell JM, Kranz AM, Steiner ED .
Barriers and strategies used to continue school-based health services during the COVID-19 pandemic.
Matern Child Health J 2024 Jan; 28(1):155-64. doi: 10.1007/s10995-023-03824-z.
Keywords: COVID-19, Children/Adolescents, Access to Care