National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (2)
- Brain Injury (1)
- Cardiovascular Conditions (2)
- Communication (1)
- Elderly (1)
- Evidence-Based Practice (3)
- Health Information Technology (HIT) (1)
- Inpatient Care (1)
- Orthopedics (5)
- Outcomes (1)
- Patient-Centered Healthcare (2)
- Patient-Centered Outcomes Research (1)
- Quality Improvement (1)
- Quality of Care (1)
- (-) Rehabilitation (11)
- Research Methodologies (1)
- Shared Decision Making (1)
- Surgery (5)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
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 DisplayedReistetter TA, Dean JM, Haas AM
Development and evaluation of rehabilitation service areas for the United States.
The purpose of this study was to develop and characterize post-acute care Rehabilitation Service Areas (RSAs) in the US that reflect rehabilitation use by Medicare beneficiaries. Data was accessed from Medicare claims 2013-2015 and included patient records across all diagnostic groups. RSAs were described by provider type, population, and traveling patterns among beneficiaries. The authors conclude that RSAs as a tool for measurement can provide policy makers, researchers, and administrators with small-area boundaries to assess access, resources, and understanding of financing to improve practice and policy for post-acute care.
AHRQ-funded; HS024711.
Citation: Reistetter TA, Dean JM, Haas AM .
Development and evaluation of rehabilitation service areas for the United States.
BMC Health Serv Res 2023 Mar 1;23(1):204. doi: 10.1186/s12913-023-09184-2.
Keywords: Rehabilitation, Access to Care
Duncan MS, Robbins NN, Wernke SA
Geographic variation in access to cardiac rehabilitation.
Considerable regional disparities exist in the commencement of cardiac rehabilitation (CR), with only 10% to 40% of eligible patients at the state level participating. The potential factors contributing to these discrepancies, such as accessibility to CR facilities, remain insufficiently explored. The purpose of this study was to assess the impact of CR center availability on CR initiation among Medicare beneficiaries. The researchers utilized Medicare records to pinpoint CR-eligible Medicare beneficiaries and compute CR initiation rates at the hospital referral region (HRR) level. Linear regression was applied to evaluate the percentage variance in CR initiation explained by CR accessibility across HRRs. Geospatial hotspot analysis was performed to detect CR deserts, or counties where the patient-to-CR center ratio is notably high. The study found that between 2014 and 2017, 1,133,657 Medicare beneficiaries were eligible for CR, with 263,310 (23%) initiating CR. The West North Central Census Division exhibited the highest adjusted CR initiation rate (35.4%) and the greatest concentration of CR programs (6.58 per 1,000 CR-eligible Medicare beneficiaries). CR program density accounted for 21.2% of the regional variation in CR initiation at the HRR level. A total of 40 predominantly urban counties, encompassing 14% of the U.S. population aged ≥65 years, were identified as CR deserts due to limited CR access.
AHRQ-funded; HS022990
Citation: Duncan MS, Robbins NN, Wernke SA .
Geographic variation in access to cardiac rehabilitation.
J Am Coll Cardiol 2023 Mar 21;81(11):1049-60. doi: 10.1016/j.jacc.2023.01.016.
Keywords: Rehabilitation, Access to Care, Cardiovascular Conditions
Konnyu KJ, Thoma LM, Cao W
Prehabilitation for total knee or total hip arthroplasty: a systematic review.
This systematic review sought to examine evidence on the benefits and harms of prehabilitation interventions for patients scheduled to undergo elective, unilateral total knee arthroplasty or total hip arthroplasty surgery for the treatment of primary osteoarthritis. Evidence from 13 total knee arthroplasty studies suggested that prehabilitation may result in increased strength and reduced length of hospital stays and may not lead to increased harms; it may be comparable in terms of pain, range of motion, and activities of daily living. No evidence or insufficient evidence was found for all other outcomes after total knee arthroplasty. No evidence or insufficient evidence was found for all total hip arthroplasty outcomes.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Thoma LM, Cao W .
Prehabilitation for total knee or total hip arthroplasty: a systematic review.
Am J Phys Med Rehabil 2023 Jan;102(1):1-10. doi: 10.1097/phm.0000000000002006..
Keywords: Rehabilitation, Orthopedics, Evidence-Based Practice, Surgery
Konnyu KJ, Pinto D, Cao W
Rehabilitation for total hip arthroplasty: a systematic review.
This systematic review sought to determine the comparative benefits and harms of rehabilitation interventions for patients who had undergone elective, unilateral total hip arthroplasty (THA) for the treatment of primary osteoarthritis. Evidence from 15 studies suggested that individual rehabilitation programs may not differ in terms of risk of harm, outcomes of pain, strength, activities of daily living, or quality of life. No differences in outcomes were found between different rehabilitation programs after THA. The authors concluded that further evidence is needed to inform decisions on which rehabilitation program attributes are most effective for various outcomes.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Pinto D, Cao W .
Rehabilitation for total hip arthroplasty: a systematic review.
Am J Phys Med Rehabil 2023 Jan;102(1):11-18. doi: 10.1097/phm.0000000000002007..
Keywords: Rehabilitation, Orthopedics, Surgery, Evidence-Based Practice
Konnyu KJ, Thoma LM, Cao W
Rehabilitation for total knee arthroplasty: a systematic review.
This systematic review sought to determine comparative benefits and harms of rehabilitation interventions for patients had undergone elective, unilateral total knee arthroplasty for the treatment of primary osteoarthritis. Evidence from 53 studies suggested that diverse rehabilitation programs may lead to comparable improvements in pain, range of motion, and activities of daily living. No studies reported evidence of risk of harms due to rehabilitation delivered in the acute period nor among various postacute rehabilitation programs. All findings were of low strength of evidence.
AHRQ-funded; 75Q80120D00001.
Citation: Konnyu KJ, Thoma LM, Cao W .
Rehabilitation for total knee arthroplasty: a systematic review.
Am J Phys Med Rehabil 2023 Jan;102(1):19-33. doi: 10.1097/phm.0000000000002008..
Keywords: Rehabilitation, Surgery, Orthopedics, Evidence-Based Practice
Graber J, Juarez-Colunga E, Thigpen C
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
This retrospective analysis’ purpose was to develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD). The authors analyzed post-TKA quadriceps strength recovery using a longitudinal dataset consisting of both clinical and research HHD data. They created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape and reference charts from the models to display the recovery of population centiles over the first six postoperative months. They analyzed a total of 588 patient records with 1176 observations. There was a rapid increase in quadriceps strength for both sexes over the first 60 postoperative days followed by a more gradual increase over the next 120 days. They found that males appeared to demonstrate faster recovery and greater strength on average compared to females. The reference charts may aid clinicians’ ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Juarez-Colunga E, Thigpen C .
Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty.
Disabil Rehabil 2022 Dec;44(24):7535-42. doi: 10.1080/09638288.2021.1995054..
Keywords: Surgery, Orthopedics, Rehabilitation
Morrow EL, Duff MC, Mayberry LS
Mediators, moderators, and covariates: matching analysis approach for improved precision in cognitive-communication rehabilitation research.
This tutorial’s goals were to (a) increase awareness and use of mediation and moderation models in cognitive-communication rehabilitation research by describing options, benefits, and attainable analytic approaches for researchers with limited resources and sample sizes and (b) describe how these findings may be interpreted for clinicians consuming research to inform clinical care. The authors discuss the potential of mediation and moderation analyses to reduce the research-to-practice gap and describe how researchers may begin to implement these models, even in smaller sample sizes. They describe how researchers may begin to implement these models, even in smaller sample sizes. They believe it is critical to harness new approaches to advance clinical-translational research results for complex, heterogeneous groups with cognitive-communication disorders.
AHRQ-funded; HS026122.
Citation: Morrow EL, Duff MC, Mayberry LS .
Mediators, moderators, and covariates: matching analysis approach for improved precision in cognitive-communication rehabilitation research.
J Speech Lang Hear Res 2022 Nov 17;65(11):4159-71. doi: 10.1044/2022_jslhr-21-00551..
Keywords: Communication, Rehabilitation, Research Methodologies
Thompson MP, Yaser JM, Forrest A
Evaluating the feasibility of a statewide collaboration to improve cardiac rehabilitation participation: the Michigan Cardiac Rehab Network.
The purpose of this study as to assess the feasibility of the Michigan Cardiac Rehab Network to improve Cardiac Rehabilitation (CR) participation. The researchers utilized Multipayer claims data from the Michigan Value Collaborative to identify 95 hospitals and 84 CR facilities and convene a multidisciplinary group of advisors. Three CR facilities were selected for virtual site visits to identify areas of success and barriers to improvement. The study found that 51% of hospitals provided interventional cardiology services and 35% provided cardiac surgical services. The multidisciplinary group of advisors was convened and represented a broad range of roles within 13 institutions. CR enrollment statewide among eligible admissions was 33.4%, with broad differences in CR performance measures among participating hospitals and eligible admissions. Virtual site visits highlighted successes in increasing CR participation but an array of barriers to participation associated with referrals, capacity and staffing constraints, and geographic and financial barriers.
AHRQ-funded; HS027830.
Citation: Thompson MP, Yaser JM, Forrest A .
Evaluating the feasibility of a statewide collaboration to improve cardiac rehabilitation participation: the Michigan Cardiac Rehab Network.
J Cardiopulm Rehabil Prev 2022 Nov 1;42(6):e75-e81. doi: 10.1097/hcr.0000000000000706..
Keywords: Cardiovascular Conditions, Rehabilitation, Quality Improvement, Quality of Care
Keeney T, Kumar A, Erler KS
Making the case for patient-reported outcome measures in big-data rehabilitation research: implications for optimizing patient-centered care.
This article discussed the potential of patient-reported outcome measures (PROMs) to transform clinical practice. It also provided examples of health systems that use PROMs to guide care and identified barriers to aggregating data from PROMs in conducting health services research. The authors proposed two priority areas which could help advance rehabilitation health services research: standardization of collecting PROMs data in electronic health records and increased partnerships between rehabilitation providers, researchers, and payors.
AHRQ-funded; HS000011.
Citation: Keeney T, Kumar A, Erler KS .
Making the case for patient-reported outcome measures in big-data rehabilitation research: implications for optimizing patient-centered care.
Arch Phys Med Rehabil 2022 May; 103(5s):S140-s45. doi: 10.1016/j.apmr.2020.12.028..
Keywords: Rehabilitation, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Health Information Technology (HIT), Outcomes
Evans E, Krebill C, Gutman R
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
This retrospective cohort study’s goal was to describe the proportion of older adults with traumatic brain injury (TBI) who exhibited minimal detectable change (MDC) and a minimally clinically important difference (MCID) in motor function from inpatient rehabilitation facility (IRF) admission to discharge; and to identify characteristics associated with clinically meaningful improvement in motor function and better discharge functional status. This study used Medicare administrative data probabilistically linked to the National Trauma Data Bank. The authors found that from IRF admission to discharge 84% of patients achieved the MDC threshold, and 68% of patients achieved the MCID threshold for FIM-M scores. A higher probability of achieving the MCID for IM-M scores included better admission motor and cognitive function, lower comorbidity burden, and a length of stay longer than 10 days but only among individuals with lower admission motor function. Older age was associated with a lower FIM-M discharge score but was not associated with the probability of achieving the MCID in FIM-M score.
AHRQ-funded; HS000011.
Citation: Evans E, Krebill C, Gutman R .
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
PM R 2022 Apr; 14(4):417-27. doi: 10.1002/pmrj.12644..
Keywords: Elderly, Rehabilitation, Brain Injury, Inpatient Care
Graber J, Lockhart S, Matlock DD
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
In this qualitative study, researchers sought to understand patients' and physical therapists' perspectives related to decision making during outpatient rehabilitation after total knee arthroplasty (TKA) and further to describe potential barriers and opportunities for shared decision making (SDM) in this setting. They found that physical therapists described using decision-making strategies with varying levels of patient involvement, while both patients and physical therapists described barriers to routine use of SDM in the outpatient setting. They also presented actionable strategies for overcoming these barriers for providers and organizations seeking consistently to use SDM in outpatient TKA rehabilitation.
AHRQ-funded; HS025692.
Citation: Graber J, Lockhart S, Matlock DD .
"This is not negotiable. You need to do this…": a directed content analysis of decision making in rehabilitation after knee arthroplasty.
J Eval Clin Pract 2022 Feb;28(1):99-107. doi: 10.1111/jep.13591..
Keywords: Shared Decision Making, Rehabilitation, Orthopedics, Surgery, Patient-Centered Healthcare