National Healthcare Quality and Disparities Report
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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 25 of 48 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
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
Coburn SB, Lang R, Zhang J
Statins utilization in adults with HIV: the treatment gap and predictors of statin initiation.
The purpose of this study was to describe trends in statin eligibility and subsequent statin initiation among people with HIV (PWH) from and identify the predictors of statin initiation. The researchers collected data from 12 United States cohorts between 2001 and 2017. The study found that among 16,409 PWH, 45% met statin eligibility criteria per guidelines for the time period from 2001 to 2017. Statin eligibility ranged from 22% to 25% from 2001 to 2013, and initiation increased from 13% to 45%. In 2014, 51% were statin-eligible, among whom 25% initiated statins, which increased to 32% by 2017. The researchers concluded that there is a substantial statin treatment gap, expanded by the 2013 ACC/AHA guidelines.
AHRQ-funded; 90047713.
Citation: Coburn SB, Lang R, Zhang J .
Statins utilization in adults with HIV: the treatment gap and predictors of statin initiation.
J Acquir Immune Defic Syndr 2022 Dec 15;91(5):469-78. doi: 10.1097/qai.0000000000003083..
Keywords: Medication, Human Immunodeficiency Virus (HIV), Access to Care, Practice Patterns, Cardiovascular Conditions
Herb J, Friedman H, Shrestha S
Prevalence and risk factors associated with readmission with acute kidney injury in patients receiving vancomycin outpatient parenteral antimicrobial therapy.
The purpose of this study was to understand barriers to early-stage lung cancer care at high-volume academic centers in the US. Researchers conducted semi-structured interviews with patients with suspected or diagnosed early-stage non-small cell lung cancer who had presented to a multidisciplinary clinic at academic institutions over a 6-month period; a qualitative content analysis was then performed using the framework method. Six themes relating to barriers and facilitators to lung-cancer care were identified, and the authors concluded that these factors must be addressed to improve quality of care among lung cancer patients.
AHRQ-funded; HS000032.
Citation: Herb J, Friedman H, Shrestha S .
Prevalence and risk factors associated with readmission with acute kidney injury in patients receiving vancomycin outpatient parenteral antimicrobial therapy.
Support Care Cancer 2022 Dec 14;31(1):21. doi: 10.1007/s00520-022-07465-w..
Keywords: Cancer: Lung Cancer, Cancer, Access to Care
Lock LJ, Channa R, Brennan MB
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
The goal of this retrospective cohort study was to determine the role of level of disadvantage in diabetic eye screening to explain the effect of health systems on rural and urban disparities. Researchers used an all-payer, statewide claims database to include adult Wisconsin residents with diabetes who had claims billed throughout the baseline and measurement years. Results indicated that patients from urban underserved clinics were more likely to receive screening than those from rural underserved clinics; similar findings emerged for both Medicare and non-Medicare subgroups. The researchers concluded that health systems, especially those that serve urban underserved populations, have an opportunity to increase screening rates by leveraging health system-level interventions and supporting patients in overcoming barriers.
AHRQ-funded; HS026279.
Citation: Lock LJ, Channa R, Brennan MB .
Effect of health system on the association of rurality and level of disadvantage with receipt of diabetic eye screening.
BMJ Open Diabetes Res Care 2022 Dec;10(6):e003174. doi: 10.1136/bmjdrc-2022-003174..
Keywords: Rural Health, Access to Care, Screening, Diabetes, Eye Disease and Health, Disparities, Chronic Conditions, Health Systems
Creedon 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
Chu J, Roby DH, Boudreaux MH
Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access.
The purpose of this study was to estimate the effects of the Children's Health Insurance Reauthorization Act (CHIPRA) on insurance coverage, access, utilization, and health outcomes among immigrant children. The researchers utilized the restricted use 2000-2016 National Health Interview Survey (NHIS)with a sample which included immigrant children between the ages of 0 and 18 born outside the United States, with family income below 300% of the Federal Poverty Level (FPL). The study found that CHIPRA was related with a decrease in uninsured rates and an increase in public insurance enrollment for immigrant children. The effects of CHIPRA became small and statistically not significant 3 years after adoption. The researchers found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. The researchers concluded that the eligibility expansion of CHIPRA was related with increases in public insurance coverage for low-income children. However, no effect of CHIPRA on access to care and health was found.
AHRQ-funded; HS028532.
Citation: Chu J, Roby DH, Boudreaux MH .
Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access.
Health Serv Res 2022 Dec;57(suppl 2):315-25. doi: 10.1111/1475-6773.14061..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Health Insurance, Access to Care, Vulnerable Populations, Uninsured
Auty SG, Griffith KN, Shafer PR
Improving access to high-value, high-cost medicines: the use of subscription models to treat hepatitis C using direct acting antivirals in the United States.
This paper discusses the use of state-sponsored subscription models to support increased access to high-value medications such as direct acting antivirals (DAAs) which can cure chronic Hepatitis C virus (HCV). The authors discuss the use of subscription models, a type of advanced purchase commitment (APC), to support increased access to high-value DAAs to treat HCV. They provide background information on HCV, its treatment, and state financing of prescription medications. They review the implementation of HCV subscription models in two states, Louisiana and Washington, and early evidence of their impact, as DAAs can cost upwards of $90,000 for treatment course.
AHRQ-funded; HS026395.
Citation: Auty SG, Griffith KN, Shafer PR .
Improving access to high-value, high-cost medicines: the use of subscription models to treat hepatitis C using direct acting antivirals in the United States.
J Health Polit Policy Law 2022 Dec 1;47(6):691-708. doi: 10.1215/03616878-10041121..
Keywords: Hepatitis, Medication, Chronic Conditions, Access to Care
Strauss AT, Sidoti CN, Purnell TS
Multicenter study of racial and ethnic inequities in liver transplantation evaluation: understanding mechanisms and identifying solutions.
This multicenter study examined racial and ethnic inequities in liver transplantation. The authors recruited participants from the liver transplantation (LT) teams including coordinators, advanced practice providers, physicians, social workers, dieticians, pharmacists, leadership at 2 major LT centers. They conducted 54 interviews and had 49 observation hours. They created a conceptual framework describing how transplant work system characteristics and other external factors may improve equity in the LT evaluation process. They proposed transplant center-level solutions (i.e., including but not limited to training of staff on health equity) to modifiable barriers in the clinical work system that could help patient navigation, reduce disparities, and improve access to care. Their findings call for an urgent need for transplant centers, national societies, and policy makers to focus efforts on improving equity (tailored, patient-centered resources) using the science of human factors and systems engineering.
AHRQ-funded; HS024600.
Citation: Strauss AT, Sidoti CN, Purnell TS .
Multicenter study of racial and ethnic inequities in liver transplantation evaluation: understanding mechanisms and identifying solutions.
Liver Transpl 2022 Dec;28(12):1841-56. doi: 10.1002/lt.26532..
Keywords: Racial and Ethnic Minorities, Transplantation, Disparities, Access to Care
Eliason EL, Daw JR
Presumptive eligibility for pregnancy Medicaid and timely prenatal care access.
The purpose of this study was to evaluate the relationship between the adoption of presumptive eligibility for pregnancy Medicaid in Kansas in 2016 and timely prenatal care access. The researchers utilized 2012-2019 National Center for Health Statistics natality files of all live births in adults aged 20 or older in Kansas, Idaho, Missouri, Nebraska, Tennessee, Utah, Wisconsin, and Wyoming, with outcomes of first-trimester prenatal care, the month of first prenatal visit, and adequate prenatal care. The study found no evidence that presumptive eligibility in Kansas resulted in changes in prenatal care use. Among individuals with high school education or less, presumptive eligibility was associated with an increase in first-trimester prenatal care, driven by earlier month of first prenatal care visit. The researchers concluded that in individuals with lower education, presumptive eligibility in Medicaid non-expansion states may lead to small improvements in early prenatal care.
AHRQ-funded; HS000011.
Citation: Eliason EL, Daw JR .
Presumptive eligibility for pregnancy Medicaid and timely prenatal care access.
Health Serv Res 2022 Dec;57(6):1288-94. doi: 10.1111/1475-6773.14035..
Keywords: Pregnancy, Maternal Care, Access to Care, Medicaid, Women
Grove LR, Rao N, Domino ME
Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?
This study’s goal was to inform efforts to increase prescriptions of medications for opioid use disorder (MOUD) among Medicaid beneficiaries. A retrospective study of North Carolina licensed physicians, physician assistants, and nurse practitioners was conducted to estimate Medicaid participation prevalence among clinicians authorized to prescribe buprenorphine and to estimate the association between clinician characteristics and OUD care delivery to Medicaid beneficiaries. Outcomes looked for were indicators of any Medicaid professional claims and Medicaid claims data for buprenorphine and naltrexone. Licensure data from 2018 was merged with 2019 US Drug Enforcement Administration to identify clinicians who used the DEA waiver required to prescribe buprenorphine (n = 1714). Services by waivered clinicians to Medicare beneficiaries ranged from 67% of behavioral health clinicians to 82.9% of specialist physicians. Prevalence of prescribing buprenorphine to Medicaid beneficiaries ranged from 30.3% among specialist physicians to 51.6% among behavioral health clinicians.
AHRQ-funded; HS000032.
Citation: Grove LR, Rao N, Domino ME .
Are North Carolina clinicians delivering opioid use disorder treatment to Medicaid beneficiaries?
Addiction 2022 Nov;117(11):2855-63. doi: 10.1111/add.15854..
Keywords: Opioids, Substance Abuse, Behavioral Health, Vulnerable Populations, Medication, Access to Care, Medicaid
Yabroff KR, Han X, Zhao J
AHRQ Author: Kirby J
Association of health insurance coverage disruptions with mortality risk among US working-age adults.
This cohort study assessed associations of a prior coverage disruption with mortality risk among large, nationally representative cohorts of working-age adults aged 18 to 64 with public or private health insurance coverage. Most research had previously been conducted among Medicaid enrollees, and little is known about insurance disruption among privately insured adults. The study used data from the 2000 to 2018 National Health Interview Survey (NIHS), specifically from the NHIS Linked Mortality files which contain data from the National Death Index. All data was deidentified and publicly available. The authors found that disruptions were associated with a higher mortality risk in either publicly or privately insured adults.
AHRQ-authored.
Citation: Yabroff KR, Han X, Zhao J .
Association of health insurance coverage disruptions with mortality risk among US working-age adults.
JAMA Health Forum 2022 Nov;3(11):e224258. doi: 10.1001/jamahealthforum.2022.4258..
Keywords: Health Insurance, Mortality, Risk, Access to Care
Semere W, Kaplan L, Valle K
Caregiving needs are unmet for many older homeless adults: findings from the Hope Home study.
Researchers described characteristics of older homeless-experienced adults with caregiving need and determined factors associated with having unmet need. Using data from the longitudinal study, Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME), they found that better self-rated health and being a man were associated with higher odds of unmet need. Moderate or high-risk substance use was associated with lower odds of unmet need. They recommended interventions that increase caregiving access for homeless-experienced individuals in order to avoid poor health outcomes and costly long-term-care needs due to untreated disabilities.
AHRQ-funded; HS027844.
Citation: Semere W, Kaplan L, Valle K .
Caregiving needs are unmet for many older homeless adults: findings from the Hope Home study.
J Gen Intern Med 2022 Nov;37(14):3611-19. doi: 10.1007/s11606-022-07438-z..
Keywords: Elderly, Vulnerable Populations, Caregiving, Access to Care
Eliason Gordon, Gordon SH
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
This study assessed the association between postpartum insurance instability and access to postpartum mental health services. The authors used data from the 2018-2019 Colorado Health eMoms survey, which sampled mothers from the 2018 birth certificate files at 3-6 months and 12-14 months postpartum. Respondents were classified at each time point as stably insured or unstable insured based on postpartum insurance status. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage. Respondents were more likely to experience unstable postpartum insurance if they were younger, had incomes of less than $50,000, and were of Hispanic ethnicity. Respondents who experienced postpartum insurance instability had lower odds of reporting that they discussed mental health at a postpartum check-up and received postpartum mental health services.
AHRQ-funded; HS000011.
Citation: Eliason Gordon, Gordon SH .
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
Womens Health Issues 2022 Nov-Dec;32(6):550-56. doi: 10.1016/j.whi.2022.06.010..
Keywords: Maternal Care, Access to Care, Women, Behavioral Health, Health Insurance
Abdus S, Selden TM
AHRQ Author: Abdus S, Selden TM
Well-child visit adherence.
This article presents updated evidence on well-child visit adherence, using MEPS data to conduct a cross-sectional study. The results indicate that average adherence increased between 2006-07 and 2016-17, but the authors note that large gaps remain in such areas as race and ethnicity, poverty level, insurance coverage, and geographic region.
AHRQ-authored.
Citation: Abdus S, Selden TM .
Well-child visit adherence.
JAMA Pediatr 2022 Nov;176(11):1143-45. doi: 10.1001/jamapediatrics.2022.2954..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Healthcare Utilization, Access to Care
Friedman HR, Holmes GM
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
This study looked at trends in admission to urban hospitals by rural Medicare FFS beneficiaries from 2010 to 2018. The authors combined data from the 2010 to 2018 Hospital Service Area File (HSAF) and the 2010-2017 American Hospital Association (AHA) survey. They found that controlling for distance to the nearest hospitals, an increase of 1 year was associated with a 2.0% increase in the number of admissions to urban hospitals from each rural ZIP code. New system affiliation of the nearest rural hospital was associated with an increase of 1.7%.
AHRQ-funded; HS000032.
Citation: Friedman HR, Holmes GM .
Rural Medicare beneficiaries are increasingly likely to be admitted to urban hospitals.
Health Serv Res 2022 Oct;57(5):1029-34. doi: 10.1111/1475-6773.14017..
Keywords: Medicare, Rural Health, Hospitals, Access to Care
Kim N, Jacobson M
Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference?
In the United States seniors aged 65 and older have Medicare and almost-universal coverage, and in South Korea all residents have national health insurance. The purpose of this study was to compare catastrophic out-of-pocket medical spending (defined as out-of-pocket medical spending over the past two years that exceeded 50% of household income) among adults 65 and older in the United States with the same senior-aged population in South Korea. The study found that the proportion of participants with catastrophic out-of-pocket medical expenditures was 5.8% in the US and 3.0% in South Korea. The researchers concluded that exposure to that level of expenditures was significantly higher in the US than South Korea, with the difference attributed to unobservable system level factors rather than observable sociodemographic characteristics.
AHRQ-funded; HS026488.
Citation: Kim N, Jacobson M .
Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference?
BMC Health Serv Res 2022 Sep 26;22(1):1202. doi: 10.1186/s12913-022-08575-1..
Keywords: Elderly, Healthcare Costs, Access to Care, Low-Income
Eliason EL, A Spishak-Thomas, Steenland MW
Association of the Affordable Care Act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy.
The purpose of this study was to assess the relationship of the Affordable Care Act (ACA) Medicaid expansion with postpartum contraception use and pregnancy. The researchers found that Medicaid expansion was associated with a 7.0 percentage point increase in postpartum use of the contraceptive implant and intrauterine device LARC, a 3.1 percentage point decrease in short-acting contraception, and a 3.9 percentage point decrease in non-prescription contraceptive use overall. Increases in LARC use were concentrated among non-Hispanic, White, and Black respondents. Medicaid expansion was associated with a decrease in early postpartum pregnancy only among non-Hispanic Black respondents. The researchers concluded that the ACA Medicaid expansion improved postpartum contraceptive access and led to shifts from methods with a lower upfront out-of-pocket cost for people without insurance towards methods with the higher upfront out-of-pocket cost for people without insurance. These changes suggest that Medicaid expansions increased access to the full range of contraceptive methods.
AHRQ-funded; HS027464; HS000011
Citation: Eliason EL, A Spishak-Thomas, Steenland MW .
Association of the Affordable Care Act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy.
Contraception 2022 Sep;113:42-48. doi: 10.1016/j.contraception.2022.02.012..
Keywords: Sexual Health, Pregnancy, Maternal Care, Women, Medicaid, Access to Care, Policy
Schwartz HEM, Abel MK, Lin JA, et al. HEM, Abel MK, Lin JA
Barriers to colorectal cancer screening and surveillance in homeless patients: a case report and policy recommendations.
Researchers described the barriers encountered by a homeless patient with a history of colorectal cancer who was lost to follow up and presented 11 years later with a new primary colon cancer. They provided policy solutions to increase the use of primary and secondary screening, including essential private bathroom access for colonoscopy preparation in patients who had a positive screening or who require surveillance after diagnosis and treatment. They concluded that increasing early detection and treatment may be cost-effective and could reduce disparities in morbidity and mortality in homeless patients.
AHRQ-funded; HS024532.
Citation: Schwartz HEM, Abel MK, Lin JA, et al. HEM, Abel MK, Lin JA .
Barriers to colorectal cancer screening and surveillance in homeless patients: a case report and policy recommendations.
Ann Surg Open 2022 Sep;3(3):e183. doi: 10.1097/as9.0000000000000183..
Keywords: Cancer: Colorectal Cancer, Colonoscopy, Vulnerable Populations, Screening, Access to Care, Case Study
Griffith KN, Asfaw DA, Childers RG
Changes in US veterans' access to specialty care during the COVID-19 pandemic.
This research letter examined changes in US veterans’ access to specialty care during the COVID-19 pandemic through October 2021. The Veterans Health Administration (VHA) completed 14,516,937 internal referrals and purchased an additional 9,904,132 referrals to community-based specialists during the study period. Before the pandemic VHA specialists completed a mean 452,148 referrals each month. Volume dropped starting in March 2020 and did not fully until recover until March 2021. Peak decline was in April 2020 by 70.7% to 132,481 referrals. Community care referrals declined by 32.9% in June 2020, but rebounded thereafter and exceeded the prepandemic baseline by March 2021. Waits for VHA specialists began rising in June 2020, peaked in July 2020 and returned to prepandemic levels by spring 2021. Mean waits for community specialists peaked in June 2020 and returned to prepandemic baseline levels by August 2020.
AHRQ-funded; HS026395.
Citation: Griffith KN, Asfaw DA, Childers RG .
Changes in US veterans' access to specialty care during the COVID-19 pandemic.
JAMA Netw Open 2022 Sep;5(9):e2232515. doi: 10.1001/jamanetworkopen.2022.32515..
Keywords: COVID-19, Access to Care
Roberts ET, Mellor JM
Differences in care between special needs plans and other Medicare coverage for dual eligibles.
This study compared access to, use of, and satisfaction with care among dual eligibles enrolled in Dual Eligible Special Needs Plans (D-SNPs) versus those enrolled in Medicare Advantage (MA) plans and traditional Medicare. Findings showed that, compared with those in traditional Medicare, dual eligibles generally reported greater access to care, preventive service use, and satisfaction with care in D-SNPs. There were, however, fewer differences in these outcomes among dual eligibles in D-SNPs versus other MA plans. Overall, these findings suggested that D-SNPs altogether have not provided consistently superior or more equitable care, and they highlight areas where federal and state policy could strengthen incentives for D-SNPs to improve care.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM .
Differences in care between special needs plans and other Medicare coverage for dual eligibles.
Health Aff 2022 Sep;41(9):1238-47. doi: 10.1377/hlthaff.2022.00463..
Keywords: Medicare, Medicaid, Health Insurance, Access to Care