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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 22 of 22 Research Studies DisplayedCreedon TB, Zuvekas SH, Hill SC
AHRQ Author: Zuvekas SH, Hill SC, McClellan C
Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid.
The purpose of this study was to explore the impact of Affordable Care Act (ACA) Medicaid expansion on insurance coverage and health services use for adults with disabilities newly eligible for Medicaid. The researchers utilized the 2008-2018 Medical Expenditure Panel Survey data and the Agency for Healthcare Research and Quality (AHRQ) PUBSIM model to identify adults between the ages of 26-64 years with disabilities who were newly Medicaid-eligible in expansion states or would have been eligible in non-expansion states if those states had opted in to ACA Medicaid expansion. The study found that among adults with disabilities who were newly eligible for Medicaid, Medicaid expansion was associated with significant increases in full-year Medicaid coverage, receipt of primary care, receipt of flu shots and a significant decrease in out-of-pocket spending. There were greater improvements for adults with disabilities compared to those without disabilities in full-year Medicaid coverage and receipt of flu shots. The researchers concluded that Medicaid expansion was associated with improvements in full-year insurance coverage, receipt of primary and preventive care, and out-of-pocket spending for adults with disabilities who were newly eligible for Medicaid, and there were greater improvements for adults with disabilities than for adults without disabilities.
AHRQ-authored.
Citation: Creedon TB, Zuvekas SH, Hill SC .
Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid.
Health Serv Res 2022 Dec;57(suppl 2):183-94. doi: 10.1111/1475-6773.14034..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicaid, Health Insurance, Disabilities, Policy, Access to Care
James TG, Miller MD, McKee MM
Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: a retrospective chart review.
This study assessed emergency department (ED) condition acuity, length of stay (LOS), and acute ED revisits among deaf and hard-of-hearing (DHH) patients. Findings identified that DHH American Sign Language users have longer ED LOS than non-DHH English-speakers.
AHRQ-funded; HS027537.
Citation: James TG, Miller MD, McKee MM .
Emergency department condition acuity, length of stay, and revisits among deaf and hard-of-hearing patients: a retrospective chart review.
Acad Emerg Med 2022 Nov;29(11):1290-300. doi: 10.1111/acem.14573..
Keywords: Emergency Department, Disabilities, Vulnerable Populations
Valdez RS, Lyon SE, Wellbeloved-Stone C
Engaging the disability community in informatics research: rationales and practical steps.
There is an opportunity for the informatics community to expand its impact by focusing on the disability community as a health disparity population. Digital health technologies can be enhanced by approaching disability from a more holistic framework, simultaneously accounting for multiple forms of disability and the ways that disability intersects with other forms of identity. The authors offer a set of guidelines for effective engagement and argue that such engagement is critical to creating digital health technologies which more fully meet the needs of all disabled individuals.
AHRQ-funded; HS023849.
Citation: Valdez RS, Lyon SE, Wellbeloved-Stone C .
Engaging the disability community in informatics research: rationales and practical steps.
J Am Med Inform Assoc 2022 Oct 7;29(11):1989-95. doi: 10.1093/jamia/ocac136..
Keywords: Patient and Family Engagement, Disabilities, Health Information Technology (HIT)
Horner-Johnson W, Garg B, Darney BG BG
Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities.
The authors assessed differences in severe maternal morbidity (SMM) and other perinatal complications by presence and type of disability in a retrospective cohort study of California births from 2000-2012. They found that SMM and other perinatal complications were more common among women with disabilities than among women without disabilities.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Garg B, Darney BG BG .
Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities.
Paediatr Perinat Epidemiol 2022 Sep;36(5):759-68. doi: 10.1111/ppe.12873..
Keywords: Maternal Care, Disabilities, Adverse Events, Pregnancy, Women
Herb J, Holmes M, Stitzenberg K
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
The purpose of this study was to assess trends over time in rural and urban disparities in the supply of surgeons treating patients with cancer. The researchers utilized the Area Health Resource File to conduct a retrospective observational study of medical workforce changes from 2004-2017. The study found that the density of surgical specialists in rural areas declined from 16 to 14 per 100,000 population and in urban areas from 33 to 31 per 100,000 population for a rural-urban disparity increase of 8%. The percentage increase in the supply disparity between the rural and urban workforce was largest for colorectal surgeons (66%) and general surgeons (72%). The study concluded that temporal changes in the rural-urban physician workforce depend on community factors, region, and area of specialization.
AHRQ-funded; HS000032.
Citation: Herb J, Holmes M, Stitzenberg K .
Trends in rural-urban disparities among surgical specialties treating cancer, 2004-2017.
J Rural Health 2022 Sep;38(4):838-44. doi: 10.1111/jrh.12658..
Keywords: Rural Health, Disabilities, Surgery, Cancer, Workforce
Chao GF, Chhabra KR, Yang J
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
The purpose of this study was to compare safety and healthcare use after sleeve gastrectomy versus Roux-en-Y gastric bypass in a national Medicare cohort. The researchers analyzed Medicare claims from 2012-2017 for 30,105 bariatric surgery patients receiving benefits due to age or disability and compared all outcomes between sleeve and bypass for each benefit group at 30 days, 1 year, and 3 years. The study found that among the disabled patients (n = 21,595), sleeve gastrectomy was associated with lower 3-year ED utilization, complications, reinterventions, rehospitalizations, and mortality. Cumulative expenditures were $46,277 after sleeve gastrectomy and $48,211 after gastric bypass. Among the elderly (n = 8510), sleeve was associated with lower 3-year ED utilization, complications, reinterventions, and rehospitalizations. Expenditures were $38,632 after sleeve gastrectomy and $39,270 after gastric bypass. Procedure treatment effect significantly differed by benefit group for paraesophageal hernia repair, revision, and mortality. The study concluded that healthcare utilization benefits of sleeve over bypass are maintained across Medicare elderly populations and Medicare disabled subpopulations.
AHRQ-funded; HS025778.
Citation: Chao GF, Chhabra KR, Yang J .
Bariatric surgery in Medicare patients: examining safety and healthcare utilization in the disabled and elderly.
Ann Surg 2022 Jul 1;276(1):133-39. doi: 10.1097/sla.0000000000004526..
Keywords: Obesity: Weight Management, Obesity, Surgery, Medicare, Elderly, Disabilities
James TG, McKee MM, Miller MD
Emergency department utilization among deaf and hard-of-hearing patients: a retrospective chart review.
This retrospective study investigated the differences in emergency department (ED) utilization among deaf and hard-of-hearing (DHH) patients compared to non-DHH patients. A chart review was conducted using data from a large academic medical center in the southeastern United States. A total of 277 DHH ASL-users, 1000 DHH English speakers, and 1000 non-DHH English speakers were included. DHH ASL users and DHH English speakers had higher adjusted odds ratio of using the ED in the past 36 months than non-DHH English speakers. Abdominal pain was the most common principal diagnosis code for DHH English speakers.
AHRQ-funded; HS027537.
Citation: James TG, McKee MM, Miller MD .
Emergency department utilization among deaf and hard-of-hearing patients: a retrospective chart review.
Disabil Health J 2022 Jul;15(3):101327. doi: 10.1016/j.dhjo.2022.101327..
Keywords: Emergency Department, Disabilities
Adolphe S, Fernandez-Pastrana I, Scott H
EASE-ing the way for pediatric providers and parents: the Engagement and Access to Special Education (EASE) Clinic.
Primary Care Providers (PCPs) are tasked by the American Academy of Pediatrics to identify children who need special education and ensure that those children receive appropriate related services provided by the Individuals with Disabilities Education Act (IDEA). The IDEA entitles children between the ages of 3 and 21 to free education through individualized education programs (IEPs), and other related supports. The extent of PCP knowledge about the IDEA, special education, and available related support services and how to assess them, is largely unknown. Existing research indicates there is a lack of knowledge, training, and confidence in providers about special education. Boston Medical Center’s (BMC) Engagement and Access to Special Education (EASE) clinic was developed to provide support to the parents and PCPs of children with special education needs. The purpose of this article was to introduce and describe the EASE clinical model as a useful method for PCPs to strengthen their ability to provide appropriate and available comprehensive care to their patients requiring special education. The authors reported that of the 14,000 pediatric patients at the Boston Medical Center, 308 children were referred to the EASE clinic between its inception in 2017 and May 2021. The majority of children were Black non-Hispanic, English-speaking, and male, with an average age of 8.3 at first clinic. During that same time 452 total visits were completed, with a waiting list of less than 90 days. The authors conclude that for primary care practices with patients with special education needs, the BMC EASE clinic can serve as a useful model for improving their ability to provide care.
AHRQ-funded; HS022242.
Citation: Adolphe S, Fernandez-Pastrana I, Scott H .
EASE-ing the way for pediatric providers and parents: the Engagement and Access to Special Education (EASE) Clinic.
Acad Pediatr 2022 May-Jun;24(4):705-07. doi: 10.1016/j.acap.2022.02.011..
Keywords: Children/Adolescents, Caregiving, Patient and Family Engagement, Vulnerable Populations, Disabilities
Grove LR, Berkowitz SA, Cuddeback G
Permanent supportive housing tenure among a heterogeneous population of adults with disabilities.
This study analyzed the permanent supportive housing (PSH) tenure among a heterogenous population of 2093 adults with disabilities participating in a North Carolina PSH program between 2015 and 2018. Participants had a 71% probability of remaining in the housing after 2 years. A lower hazard of PSH departure was associated with older age, female gender, and non-Hispanic/Black race/ethnicity. Severe mental illness was associated with greater departure hazard.
AHRQ-funded; HS000032.
Citation: Grove LR, Berkowitz SA, Cuddeback G .
Permanent supportive housing tenure among a heterogeneous population of adults with disabilities.
Popul Health Manag 2022 Apr;25(2):227-34. doi: 10.1089/pop.2021.0348..
Keywords: Disabilities, Vulnerable Populations
Kenney MK, Chanlongbutra A, Fanflick PL
AHRQ Author: Chanlongbutra A
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
The purpose of the study was to compare Children and Youth with Special Health Care Needs (CYSHCN) with non-CYSHCN in the likelihood of experiencing Adverse Childhood Events (ACEs), and then document the differences in receiving recommended and needed health care services among CYSHCS with and without ACEs. The researchers studied a sample of 16,304 CYSHCN from the 2016 and 2017 National Survey of Children’s Health (N=71,181). The study found that CYHSCN had a greater likelihood of having each of the measured Adverse Childhood Events, and greater likelihood of experiencing aggregated levels of ACE’s than non-CYSHCN. In addition, an increase in ACEs was related to a decrease in the likelihood of a CYSHCN having a medical home with family-centered and coordinated care. Having one or greater ACEs increased the likelihood of having unmet mental health care needs. The study concluded that the researcher’s findings extend the current understanding of the relationship between CYSHCN and ACEs, and that the need for additional work to establish care systems for this vulnerable population continues.
AHRQ-authored.
Citation: Kenney MK, Chanlongbutra A, Fanflick PL .
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
Disabil Health J 2022 Apr;15(2):101226. doi: 10.1016/j.dhjo.2021.101226..
Keywords: Children/Adolescents, Disabilities, Healthcare Delivery, Vulnerable Populations
Davidson L, Haynes SC, Favila-Meza A
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
This study investigated patient and therapist experience and cost savings from the payer perspective associated with a novel tele-physiatry program for children living in rural and underserved communities. Study setting was four school-based clinics in Northern California with a total of 268 encounters (124 telemedicine and 144 in-person). Parent and therapists reported no difference in experience and perceived quality of care between telemedicine and in-person encounters. For parents whose children received a telemedicine encounter, 54.8% reported no preference for their child’s subsequent encounter, 28.8% preferred a physiatrist telemedicine visit, and 12 preferred a physiatrist in-person visit. There was also an average cost savings of $100 per clinic owing to physician milage for in-person visits.
AHRQ-funded; HS025714.
Citation: Davidson L, Haynes SC, Favila-Meza A .
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
Arch Phys Med Rehabil 2022 Jan;103(1):8-13. doi: 10.1016/j.apmr.2021.07.807..
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Healthcare Costs, Rural Health, Vulnerable Populations, Disabilities, Rural/Inner-City Residents
Lindly O, Eaves MC, Xu Y
Therapy use for U.S. school-aged children with developmental disabilities: state variation and determinants.
This study’s objective was to determine geographic variability and determinants of therapy use among school-aged U.S. children with development disabilities (DD). The authors aimed to (1) determine if therapy use varies significantly by state and (2) examine associations of health determinants with therapy use among U.S. school-aged children with DD. They conducted a secondary analysis of 2016 and 2017 National Survey of Children's Health data, with the sample including 9984 children with DD ages 6-17 years old. They found that overall, 34.6% of children used therapy services, with therapy use varying significantly across states. There were higher adjusted odds of therapy access associated with younger age, public insurance, functional limitations, individualized education program, frustration accessing services, and care coordination need. There were higher estimated annual Medicaid Home and Community-Based Service waiver costs associated with lower adjusted odds of therapy use in states with those waivers.
AHRQ-funded; HS000063.
Citation: Lindly O, Eaves MC, Xu Y .
Therapy use for U.S. school-aged children with developmental disabilities: state variation and determinants.
Disabil Health J 2022 Jan; 15(1):101198. doi: 10.1016/j.dhjo.2021.101198..
Keywords: Children/Adolescents, Disabilities
Capo-Lugo CE, Askew RL, Naidech A
Patients with greater stroke severity and premorbid disability are less likely to receive therapist consultations and intervention during acute care hospitalization.
The goal of this single-center longitudinal observational study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke. Findings showed that approximately 1 in 4 study participants with acute stroke received neither a consultation nor an intervention. The authors conclude that efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.
AHRQ-funded; HS000078.
Citation: Capo-Lugo CE, Askew RL, Naidech A .
Patients with greater stroke severity and premorbid disability are less likely to receive therapist consultations and intervention during acute care hospitalization.
Phys Ther 2019 Nov 25;99(11):1431-42. doi: 10.1093/ptj/pzz116..
Keywords: Disabilities, Stroke, Cardiovascular Conditions, Access to Care
Sobotka SA, Lynch E, Quinn MT
Unmet respite needs of children with medical technology dependence.
Children with medical technology dependency (MTD) require a medical device to compensate for a vital body function and substantial nursing care. As such, they require constant high-level supervision. Respite care provides caregivers with a temporary break, and is associated with reduced stress; however, there are often barriers. The study utilizes mixed methodology with the National Survey of Children with Special Health Care Needs (NS-CSHCN) and semistructured interviews with state-wide care coordinators to understand the gap for respite care services.
AHRQ-funded; HS023007.
Citation: Sobotka SA, Lynch E, Quinn MT .
Unmet respite needs of children with medical technology dependence.
Clin Pediatr 2019 Oct;58(11-12):1175-86. doi: 10.1177/0009922819870251..
Keywords: Children/Adolescents, Medical Devices, Disabilities, Caregiving, Home Healthcare, Care Coordination
Sonik RA, Parish SL, Mitra M
Food insecurity patterns before and after initial receipt of Supplemental Security Income.
The objective of this study was to assess patterns of food insecurity before and after initial receipt of Supplemental Security Income (SSI) benefits. The investigators concluded that food insecurity rose prior to SSI entry but may be alleviated by programme benefits. They suggest that greater nutritional supports for SSI applicants awaiting decisions may reduce the burden of food insecurity in this population and improve health outcomes.
AHRQ-funded; HS026317.
Citation: Sonik RA, Parish SL, Mitra M .
Food insecurity patterns before and after initial receipt of Supplemental Security Income.
Public Health Nutr 2019 Jul;22(10):1909-13. doi: 10.1017/s1368980019000570..
Keywords: Nutrition, Low-Income, Disabilities, Vulnerable Populations, Social Determinants of Health
Sonik RA, Parish SL, Mitra M
Association of health status with receipt of supplemental security income among individuals with severe disabilities and very low income and assets.
Supplemental Security Income (SSI) is a cash-transfer program for individuals with severe disabilities and very low incomes and assets. The investigators analyzed data from the first 12 waves of the 2008 panel of the Survey of Income and Program Participation. They found that there was a sharp decline in health status among eventual SSI recipients in the year before program entry and a modest improvement and stabilization in health status after entry. The investigators also discuss the limitations and implications of their study.
AHRQ-funded; HS026317.
Citation: Sonik RA, Parish SL, Mitra M .
Association of health status with receipt of supplemental security income among individuals with severe disabilities and very low income and assets.
JAMA Intern Med 2019 Jun;179(6):842-43. doi: 10.1001/jamainternmed.2018.8609..
Keywords: Health Status, Vulnerable Populations, Nutrition, Disabilities, Social Determinants of Health
Arana E, Carroll-Scott A, Massey PM
Racial/ethnic disparities in mammogram frequency among women with intellectual disability.
The purpose of this study was to collect survey and medical record data to examine associations between intellectual disability (ID) and race/ethnicity on mammogram frequency. Hispanic and Black women with ID are more likely than White women with ID to have mammograms every 2 years. Women who live in State-funded residences, are aged 50 and over, and had a mild or moderate level of ID impairment were more likely to have mammograms compared to those who lived with family or alone, were under 50, or who had severe ID impairment. The authors conclude that further research is needed to understand the mechanisms that explain these disparities.
AHRQ-funded; HS023966.
Citation: Arana E, Carroll-Scott A, Massey PM .
Racial/ethnic disparities in mammogram frequency among women with intellectual disability.
Intellect Dev Disabil 2019 Jun;57(3):177-87. doi: 10.1352/1934-9556-57.3.177..
Keywords: Disabilities, Disparities, Imaging, Prevention, Racial and Ethnic Minorities, Screening, Women
Wu J, Braunschweig Y, Harris LH
Looking back while moving forward: a justice-based, intersectional approach to research on contraception and disability.
This paper discusses the higher use of female sterilization than long-acting reversible contraception use among women with disabilities compared to women without disabilities. The reasons for that were discussed and the authors advocate for a justice-based intersectional approach to research on contraception and disability.
AHRQ-funded; HS022981.
Citation: Wu J, Braunschweig Y, Harris LH .
Looking back while moving forward: a justice-based, intersectional approach to research on contraception and disability.
Contraception 2019 May;99(5):267-71. doi: 10.1016/j.contraception.2019.01.006..
Keywords: Disabilities, Sexual Health, Vulnerable Populations, Women
Chien AT, Toomey SL, Kuo DZ
Care quality and spending among commercially insured children with disabilities.
Researchers examined the prevalence of children with disabilities (CWD) within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. The cross-sectional study comprised over 1M person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged from 1 to 19 years. The researchers found that CWD were prevalent in the commercially insured population, with these children experiencing suboptimal levels of care which were comparable to non-CWD groups. They concluded that improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
AHRQ-funded; HS025299.
Citation: Chien AT, Toomey SL, Kuo DZ .
Care quality and spending among commercially insured children with disabilities.
Acad Pediatr 2019 Apr;19(3):291-99. doi: 10.1016/j.acap.2018.06.004..
Keywords: Quality of Care, Children/Adolescents, Disabilities, Healthcare Costs, Health Insurance
Horner-Johnson W, Moe EL, Stoner RC
Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: a systematic review.
The objective of this study was to systematically review published literature on women with disabilities and: 1) contraceptive knowledge; 2) attitudes and preferences regarding contraception; 3) contraceptive use; 4) barriers and facilitators to informed contraceptive use; and 5) effectiveness of interventions to improve informed contraceptive decision-making and use. The investigators concluded that women with disabilities may use a more narrow mix of contraceptive methods and were often less knowledgeable about contraceptives than women without disabilities.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Moe EL, Stoner RC .
Contraceptive knowledge and use among women with intellectual, physical, or sensory disabilities: a systematic review.
Disabil Health J 2019 Apr;12(2):139-54. doi: 10.1016/j.dhjo.2018.11.006..
Keywords: Disabilities, Sexual Health, Women
Horner-Johnson W, Biel FM, Caughey AB
Differences in prenatal care by presence and type of maternal disability.
This study examined timing and frequency of prenatal care of women with disabilities by disability type. A retrospective cohort study was done of all births in California from 2000-2012. Women with intellectual/developmental disabilities, or limited hearing had the most significant risk of receiving less prenatal care compared to women with physical disabilities. However women with intellectual/developmental or physical disabilities may have a higher than normal number of prenatal visits. Delays in prenatal care may result in poorer birth outcomes.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Biel FM, Caughey AB .
Differences in prenatal care by presence and type of maternal disability.
Am J Prev Med 2019 Mar;56(3):376-82. doi: 10.1016/j.amepre.2018.10.021..
Keywords: Disabilities, Healthcare Utilization, Pregnancy, Vulnerable Populations, Women
Burgdorf J, Mulcahy J, Amjad H
Family caregiver factors associated with emergency department utilization among community-living older adults with disabilities.
This study examined characteristics of family caregivers of older community-living adults with disabilities that use emergency departments (EDs). They found in their sample of 2521 community-living older adults that have visited the ED one or more times within 12 months of their interview that the primary caregivers provided greater than 40 hours of care per week, helped with health care tasks, or experienced physical strain.
AHRQ-funded; HS000029.
Citation: Burgdorf J, Mulcahy J, Amjad H .
Family caregiver factors associated with emergency department utilization among community-living older adults with disabilities.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719875636. doi: 10.1177/2150132719875636..
Keywords: Elderly, Emergency Department, Disabilities, Healthcare Utilization, Caregiving