National Healthcare Quality and Disparities Report
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- Access to Care (3)
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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 12 of 12 Research Studies DisplayedDanielson EC, Li W, Suleiman L
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
The objective of this study was to determine if county- or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the CDC Social Vulnerability Index. The findings indicated that patient-reported race, education, and income were associated with patient-reported pain or functional scores; pain improvement was negatively associated with Black race and positively associated with higher annual incomes. The authors concluded that these findings suggested that patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
Citation: Danielson EC, Li W, Suleiman L .
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
Health Serv Res 2024 Feb; 59(1):e14215. doi: 10.1111/1475-6773.14215.
Keywords: Surgery, Orthopedics, Medicare, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
Roberts ET, Mehrotra A
Assessment of disparities in digital access among Medicare beneficiaries and implications for telemedicine.
In this study, the investigators examined disparities in digital access (ie, access at home to technology that enables video telemedicine visits) among Medicare beneficiaries by socioeconomic and demographic characteristics. The investigators concluded that the proportion of beneficiaries who lacked digital access was higher among those with low socioeconomic status, those 85 years or older, and in communities of color.
AHRQ-funded; HS026727.
Citation: Roberts ET, Mehrotra A .
Assessment of disparities in digital access among Medicare beneficiaries and implications for telemedicine.
JAMA Intern Med 2020 Oct;180(10):1386-89. doi: 10.1001/jamainternmed.2020.2666..
Keywords: Elderly, Medicare, Telehealth, Health Information Technology (HIT), Disparities, Access to Care, Social Determinants of Health, Low-Income, Racial and Ethnic Minorities
Lee JT, Polsky D, Fitzsimmons R
Proportion of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining accountable care organizations.
The purpose of this study was to test for changes in the percentage of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining an accountable care organization (ACO). This cohort study’s subjects consisted of a 15% random sample of Medicare fee-for-service beneficiaries attributed to physician groups. ACO file were used to determine Medicare Shared Savings Program (MSSP) participation. No changes were found in the proportions of vulnerable patients cared for by ACO-participating physician groups after joining an ACO compared with changes among nonparticipating groups.
AHRQ-funded; HS025184.
Citation: Lee JT, Polsky D, Fitzsimmons R .
Proportion of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining accountable care organizations.
JAMA Netw Open 2020 May;3():e204439. doi: 10.1001/jamanetworkopen.2020.4439.
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Keywords: Social Determinants of Health, Racial and Ethnic Minorities, Medicare
Fahrenbach J, Chin MH, Huang ES
Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program.
This study examined the relationship between neighborhood social risk factors (SRFs) and hospital ratings in Medicare's Hospital Compare Program. Results showed that lower hospital summary scores were associated with caring for neighborhoods with higher social risk. Associations between neighborhood SRFs and hospital ratings were largest in the timeliness of care, patient experience, and hospital readmission groups and smallest in the safety, efficiency, and effectiveness of care groups. Failing to account for neighborhood social risk in hospital rating systems may reinforce hidden disincentives to care for medically underserved areas in the United States.
AHRQ-funded; HS023007.
Citation: Fahrenbach J, Chin MH, Huang ES .
Neighborhood disadvantage and hospital quality ratings in the Medicare Hospital Compare Program.
Med Care 2020 Apr;58(4):376-83. doi: 10.1097/mlr.0000000000001283..
Keywords: Quality of Care, Hospitals, Medicare, Quality Indicators (QIs), Patient Experience, Social Determinants of Health
French DD, Wang A, Prager AJ
Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare ocular hospitalizations: a cross sectional data analysis.
The purpose of this paper was to determine whether social determinants of health are associated with ocular hospitalizations. Results showed that, compared to an all-condition hospitalized population, ocular hospitalizations tended to have small, yet statistically significant, associations with health behaviors, socioeconomic, and physical environment factors. Further research is recommended on how these variables affect ocular health relative to all-cause hospitalizations.
AHRQ-funded; HS000078; HS000084.
Citation: French DD, Wang A, Prager AJ .
Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare ocular hospitalizations: a cross sectional data analysis.
Ophthalmol Ther 2019 Dec;8(4):611-22. doi: 10.1007/s40123-019-00220-1..
Keywords: Social Determinants of Health, Eye Disease and Health, Hospitalization, Medicare
Roberts ET, Mellor JM, McInerney M
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
The purpose of this study was to examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. The investigators concluded that characteristics of dual enrollees differed substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM, McInerney M .
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
Health Serv Res 2019 Dec;54(6):1233-45. doi: 10.1111/1475-6773.13205..
Keywords: Medicare, Medicaid, Social Determinants of Health
Chatterjee P, Qi M, Coe NB
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
The authors sought to determine whether patterns of skilled nursing facility (SNF) discharge are associated with the change in Medicare payment responsibility on day 20. They found that Medicare beneficiaries were more often discharged from SNFs on benefit day 20 than on benefit days 19 or 21. Those discharged on day 20 were more likely to be racial/ethnic minorities and to live in areas of lower socioeconomic status compared with those discharged before or after day 20. Their findings suggested an association between disproportionately high SNF discharge rates of vulnerable patients and existing Medicare payment policies. The authors recommended that payment policies be designed with consideration of the potential for such unintended consequences, and that any potential consequences be mitigated by balancing existing payment structures with incentives to provide optimal patient care.
AHRQ-funded; HS024266.
Citation: Chatterjee P, Qi M, Coe NB .
Association between high discharge rates of vulnerable patients and skilled nursing facility copayments.
JAMA Intern Med 2019 Sep;179(9):1296-98. doi: 10.1001/jamainternmed.2019.1209.
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Keywords: Vulnerable Populations, Nursing Homes, Medicare, Payment, Policy, Social Determinants of Health
Sentell TL, Shen C, Landsittel D
Racial/ethnic differences in those accompanying Medicare patients to the doctor: insights from the 2013 Medicare current beneficiary's survey.
This study used multivariable models applied to Medicare Current Beneficiary's Survey Access to Care public use data in order to predict companion accompaniment to health care providers among Medicare beneficiaries; Chi square analyses compared, by race/ethnicity, who was accompanying patients and why. Black and Hispanic patients were more likely to be accompanied than whites. In all three groups, more than a third of patients brought someone with them to ‘take notes,’ ‘ask questions,’ and/or ‘explain things,’ but significantly more Hispanic patients brought a companion to ‘explain instructions,’ ‘translate,’ and/or to provide ‘moral support.’ The authors conclude that many Medicare beneficiaries are accompanied to doctors' appointments, particularly among minority racial/ethnic groups, and that this should be taken in consideration in healthcare policy and practice.
AHRQ-funded; HS023185.
Citation: Sentell TL, Shen C, Landsittel D .
Racial/ethnic differences in those accompanying Medicare patients to the doctor: insights from the 2013 Medicare current beneficiary's survey.
J Immigr Minor Health 2018 Aug;20(4):776-83. doi: 10.1007/s10903-017-0582-8..
Keywords: Caregiving, Elderly, Medicare, Racial and Ethnic Minorities, Social Determinants of Health
Taira DA, Shen C, King M
Access to medications for Medicare enrollees related to race/ethnicity: results from the 2013 Medicare Current Beneficiary Survey.
Prescription medications are taken by millions of Americans to manage chronic conditions and treat acute conditions. These medications, however, are not equally accessible to all. The purpose of this study was to examine medication access by race/ethnicity among Medicare beneficiaries. The authors found that possible interventions for non-Hispanic blacks might include assisting them in finding the best drug plan to meeting their needs, connecting them to medication assistance programs, and discussing convenience of pharmacy with patients.
AHRQ-funded; HS023185.
Citation: Taira DA, Shen C, King M .
Access to medications for Medicare enrollees related to race/ethnicity: results from the 2013 Medicare Current Beneficiary Survey.
Res Social Adm Pharm 2017 Nov;13(6):1208-13. doi: 10.1016/j.sapharm.2016.10.021..
Keywords: Access to Care, Medicare, Medication, Racial and Ethnic Minorities, Social Determinants of Health
Harrison KL, Adrion ER, Ritchie CS
Low completion and disparities in advance care planning activities among older Medicare beneficiaries.
The researchers investigated the strength and magnitude of the relationship between sociodemographic and health characteristics of older adults and engagement in advance care planning (ACP)using logistic regression analysis and predicted probabilities. Their findings suggest that, in 2012, more than a quarter of older Medicare beneficiaries had not engaged in ACP. Those who were Latino, African American, poorly educated, or low income were at highest risk.
AHRQ-funded; HS000053.
Citation: Harrison KL, Adrion ER, Ritchie CS .
Low completion and disparities in advance care planning activities among older Medicare beneficiaries.
JAMA Intern Med 2016 Oct 31;176(12):1872-75. doi: 10.1001/jamainternmed.2016.6751.
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Keywords: Elderly, Medicare, Disparities, Social Determinants of Health
Keohane LM, Rahman M, Mor V
Reforming access: trends in Medicaid enrollment for new Medicare beneficiaries, 2008-2011.
This study evaluated whether aligning the Part D low-income subsidy and Medicaid program enrollment pathways in 2010 increased Medicaid participation among new Medicare beneficiaries. It found that the percentage of beneficiaries enrolling in limited Medicaid at the start of Medicare coverage increased in 2010 by 0.3 percentage points for individuals aging into Medicare and by 1.3 percentage points for those qualifying due to disability.
AHRQ-funded; HS000011.
Citation: Keohane LM, Rahman M, Mor V .
Reforming access: trends in Medicaid enrollment for new Medicare beneficiaries, 2008-2011.
Health Serv Res 2016 Apr;51(2):550-69. doi: 10.1111/1475-6773.12349.
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Keywords: Medicare, Medicaid, Policy, Access to Care, Social Determinants of Health
Wright KD, Pepper GA, Caserta M
Factors that influence physical function and emotional well-being among Medicare-Medicaid enrollees.
The researchers examined the associations between race, gender, age, neighborhood poverty, education, and health behaviors (i.e., smoking, exercise, and physical activity) with physical function and emotional well-being in Medicare-Medicaid enrollees. They determined that race, neighborhood poverty, education, and income did not influence physical function or emotional well-being; however, physical activity was associated both with an increased self-report of physical function and emotional well-being.
AHRQ-funded; HS014539.
Citation: Wright KD, Pepper GA, Caserta M .
Factors that influence physical function and emotional well-being among Medicare-Medicaid enrollees.
Geriatr Nurs 2015 Mar-Apr;36(2 Suppl):S16-20. doi: 10.1016/j.gerinurse.2015.02.022..
Keywords: Social Determinants of Health, Medicare, Medicaid, Lifestyle Changes, Health Status