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
Topics
- (-) Access to Care (12)
- (-) Ambulatory Care and Surgery (12)
- Behavioral Health (2)
- Children/Adolescents (3)
- Community-Based Practice (1)
- COVID-19 (1)
- Depression (1)
- Disparities (1)
- Emergency Department (1)
- Healthcare Costs (1)
- Healthcare Delivery (3)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (1)
- Health Insurance (3)
- Hospitalization (2)
- Hospitals (1)
- Maternal Care (1)
- Medicaid (3)
- Medical Expenditure Panel Survey (MEPS) (1)
- Patient-Centered Healthcare (1)
- Policy (3)
- Pregnancy (1)
- Primary Care (2)
- Provider (1)
- Respiratory Conditions (1)
- Substance Abuse (1)
- Surgery (1)
- Telehealth (1)
- Uninsured (1)
- Women (1)
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 12 of 12 Research Studies DisplayedLevine DM, Chalasani R, Linder JA
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
The national impact of the Patient Protection and Affordable Care Act (ACA) continues to be debated. The purpose of this cross-sectional study was to determine the relationship between the ACA and ambulatory quality, patient experience, utilization, and cost by comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation. The study focused on United States adults between 18 and 64 years of age with income less than and greater than or equal to 400% of the federal poverty level (FPL), who had responded to the annual Medical Expenditure Panel Survey. Researchers conducted analysis of data from a sample of 123,171 individuals between January 2021 and March 2022. The study found that after the implementation of ACA, adults with income levels less than 400% of the FPL received increased high value care such as diagnostic and preventive testing when compared with adults with income 400% or higher of the FPL, and there were no differences in the other quality measures. Individuals with income less than 400% of the FPL had greater improvements in access, experience, and communication measures compared with those who had income greater than or equal to 400% of the FPL. Receipt of primary care services increased for individuals with lower income compared to individuals with higher income and for those with lower income compared to those with higher income, total out-of-pocket expenditures decreased. There were no other differences in utilization or cost between those groups. The researchers concluded that in this study, the ACA was not associated with changes in utilization, quality, or cost, but was related to decreased out-of-pocket expenditures and improved patient access, communication, and experience.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Levine DM, Chalasani R, Linder JA .
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
JAMA Netw Open 2022 Jun 1;5(6):e2218167. doi: 10.1001/jamanetworkopen.2022.18167..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Healthcare Utilization, Ambulatory Care and Surgery, Health Insurance, Access to Care
Yang J, Landrum MB, Zhou L
Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts.
The purpose of this study was to examine changes in outpatient visits for mental health and/or substance use disorders (MH/SUD) in an integrated healthcare organization during the initial Massachusetts COVID-19 surge and partial state reopening. The investigators concluded that MH/SUD visit volume increased during the COVID surge and was supported by rapidly-scaled telemedicine.
AHRQ-funded; HS025375.
Citation: Yang J, Landrum MB, Zhou L .
Disparities in outpatient visits for mental health and/or substance use disorders during the COVID surge and partial reopening in Massachusetts.
Gen Hosp Psychiatry 2020 Nov-Dec;67:100-06. doi: 10.1016/j.genhosppsych.2020.09.004..
Keywords: Behavioral Health, Substance Abuse, COVID-19, Disparities, Access to Care, Ambulatory Care and Surgery, Telehealth, Health Information Technology (HIT)
Gordon SH, Sommers BD, Wilson IB
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Timely postpartum care is associated with lower maternal morbidity and mortality, yet fewer than half of Medicaid beneficiaries attend a postpartum visit. Using Medicaid claims data for 2013-2015 from Colorado, which expanded Medicaid under the Affordable Care Act, and Utah, which did not, the authors conclude that expansion may promote the stability of postpartum coverage and increase the use of postpartum outpatient care in the Medicaid program.
AHRQ-funded; HS025560.
Citation: Gordon SH, Sommers BD, Wilson IB .
Effects of Medicaid expansion on postpartum coverage and outpatient utilization.
Health Aff 2020 Jan;39(1):77-84. doi: 10.1377/hlthaff.2019.00547..
Keywords: Medicaid, Pregnancy, Women, Access to Care, Maternal Care, Ambulatory Care and Surgery, Policy, Healthcare Delivery
Holderness H, Angier H, Huguet N
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
The purpose of this study was to understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act Medicaid expansion (emergency department, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization. Results showed that most newly and returning-insured Medicaid enrollees sought primary care rather than emergency department services and most became established with primary care, suggesting that both insurance and primary care continuity play a role in where patients seek health care services.
AHRQ-funded; HS024270.
Citation: Holderness H, Angier H, Huguet N .
Where do Oregon Medicaid Enrollees seek outpatient care post-Affordable Care Act Medicaid expansion?
Med Care 2019 Oct;57(10):788-94. doi: 10.1097/mlr.0000000000001189..
Keywords: Access to Care, Ambulatory Care and Surgery, Health Insurance, Healthcare Utilization, Medicaid, Policy
Huguet N, Valenzuela S, Marino M
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
The authors assessed ambulatory care use and diagnosed health conditions among a cohort of community health center (CHC) patients uninsured before enactment of the Affordable Care Act (ACA) and followed them after enactment. They found that, post-ACA, 20.9% of patients remained uninsured, 15.0% gained Medicaid, 12.4% gained other insurance, and 51.7% did not have a visit. The authors concluded that a significant percentage of CHC patients remained uninsured; that many who remained uninsured had diagnosed health conditions; and that one-half continued to have three or more visits to CHCs, which continue to be essential providers for uninsured patients.
AHRQ-funded; HS024270.
Citation: Huguet N, Valenzuela S, Marino M .
Following uninsured patients through Medicaid expansion: ambulatory care use and diagnosed conditions.
Ann Fam Med 2019 Jul;17(4):336-44. doi: 10.1370/afm.2385..
Keywords: Access to Care, Ambulatory Care and Surgery, Community-Based Practice, Health Insurance, Healthcare Delivery, Medicaid, Policy, Uninsured
Kenyon CC, Gruschow SM, Haaland WL
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
The authors’ goal was to assess the relationship between perceived access to timely office-based care and subsequent 30-day pediatric revisits following hospital discharge for asthma, bronchiolitis, croup, and pneumonia. They found that perceived access to timely office-based care was associated with significantly greater odds of subsequent emergency department revisit. They concluded that focusing solely on enhancing timely access to care following discharge for common respiratory illnesses may be insufficient to prevent repeat utilization.
AHRQ-funded; HS024299.
Citation: Kenyon CC, Gruschow SM, Haaland WL .
Kenyon CC, Gruschow SM, Haaland WL, Desai AD, Adams SA, Hitt TA, Williams DJ, et al. Perceived access to outpatient care and hospital reutilization following acute respiratory illnesses.
Acad Pediatr 2019 May - Jun;19(4):370-77. doi: 10.1016/j.acap.2018.07.001..
Keywords: Children/Adolescents, Respiratory Conditions, Ambulatory Care and Surgery, Emergency Department, Access to Care, Hospitals
Wallace DJ, Ray KN, Degan A
Transportation characteristics associated with non-arrivals to paediatric clinic appointments: a retrospective analysis of 51 580 scheduled visits.
The researchers’ objectives were: (1) to evaluate transportation characteristics and patient factors associated with clinic non-arrival, (2) to evaluate the comparability of bus and car drive time estimates, and (3) to evaluate the combined effects of transportation accessibility and income on scheduled appointment non-arrival. They concluded that clinic non-arrival is associated with the interaction of longer travel time and lower income.
AHRQ-funded; HS022989.
Citation: Wallace DJ, Ray KN, Degan A .
Transportation characteristics associated with non-arrivals to paediatric clinic appointments: a retrospective analysis of 51 580 scheduled visits.
BMJ Qual Saf 2018 Jun;27(6):437-44. doi: 10.1136/bmjqs-2017-007168.
.
.
Keywords: Access to Care, Children/Adolescents, Ambulatory Care and Surgery, Patient-Centered Healthcare
Ray KN, Martsolf GR, Mehrotra A
Trends in visits to specialist physicians involving nurse practitioners and physician assistants, 2001 to 2013.
The purpose of this study is to examine trends in specialist physician visits where nurse practitioners (NPs) and physician assistants (PAs) provide care, based on the hypothesis that NPs and PAs provide care to patients of specialist physicians in increasing numbers, primarily for routine follow-up visits. Using the National Ambulatory Medical Care Survey (NAMCS) information on samples office visits, researchers identified visits to specialist physicians, divided these into surgical and medical specialists and examined unadjusted trends from 2001 - 2013 in the percentage of visits with NP or PA involvement. Visit characteristics associated with higher likelihood of NP or PA involvement were examined.
AHRQ-funded; HS022989.
Citation: Ray KN, Martsolf GR, Mehrotra A .
Trends in visits to specialist physicians involving nurse practitioners and physician assistants, 2001 to 2013.
JAMA Intern Med 2017 Aug;177(8):1213-16. doi: 10.1001/jamainternmed.2017.1630..
Keywords: Access to Care, Ambulatory Care and Surgery, Healthcare Delivery, Primary Care, Provider
Gallo KP, Olin SS, Storfer-Isser A
Parent burden in accessing outpatient psychiatric services for adolescent depression in a large state system.
This study examined barriers facing parents who seek outpatient psychiatric care in a large state system for adolescents with depression. It found that virtually all clinics required at least one intake or therapy appointment before receipt of a psychiatry appointment. Parental burden did not differ by region, urbanicity, clinic type, seasonality (spring or summer), or insurance status.
AHRQ-funded; HS020503.
Citation: Gallo KP, Olin SS, Storfer-Isser A .
Parent burden in accessing outpatient psychiatric services for adolescent depression in a large state system.
Psychiatr Serv 2017 Apr;68(4):411-14. doi: 10.1176/appi.ps.201600111.
.
.
Keywords: Access to Care, Children/Adolescents, Depression, Behavioral Health, Ambulatory Care and Surgery
Geissler K, Stearns SC, Becker C
The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.
The authors quantified associations between violence in Mexico and decreases in access to care for border county residents. They found that increased homicide rates in Mexico were associated with increased hospitalizations for ambulatory care sensitive (ACS) conditions in the USA, although residence in a border county was associated with decreased probability of being hospitalized for an ACS condition.
AHRQ-funded; HS021074.
Citation: Geissler K, Stearns SC, Becker C .
The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.
J Public Health 2016 Mar;38(1):14-23. doi: 10.1093/pubmed/fdv012.
.
.
Keywords: Access to Care, Hospitalization, Ambulatory Care and Surgery
Suskind AM, Zhang Y, Dunn RL
Understanding the diffusion of ambulatory surgery centers.
The objective of this study was to understand potential facilitators and/or barriers to the introduction of freestanding ambulatory surgical centers (ASCs) in the United States. It found that ASCs were more likely to open in hospital service areas that were urban, had higher per capita income, and less competition for outpatient surgery.
AHRQ-funded; HS020927; HS018726.
Citation: Suskind AM, Zhang Y, Dunn RL .
Understanding the diffusion of ambulatory surgery centers.
Surg Innov 2015 Jun;22(3):257-65. doi: 10.1177/1553350614546004..
Keywords: Ambulatory Care and Surgery, Access to Care, Surgery
Basu J, Mobley LR, Thumula V
AHRQ Author: Basu J
The small area predictors of ambulatory care sensitive hospitalizations: a comparison of changes over time.
The investigators examined the predictors of ambulatory care sensitive conditions (ACSCs) admissions in small geographic areas in two cross-sections spanning an 11-year time interval (1995-2005). They found that ACSC admission rates were inversely related to the availability of local primary care physicians, and managed care was associated with declines in ACSC admissions for the elderly. Additionally, minorities, aged elderly, and percent under federal poverty level were found to be associated with higher ACSC rates. They concluded that improvements in socioeconomic conditions and geographic access may have helped improve the quality of primary care received by the elderly over the last decade, particularly among some minority groups.
AHRQ-authored.
Citation: Basu J, Mobley LR, Thumula V .
The small area predictors of ambulatory care sensitive hospitalizations: a comparison of changes over time.
Soc Work Public Health 2014;29(2):176-88. doi: 10.1080/19371918.2013.776316.
.
.
Keywords: Access to Care, Hospitalization, Ambulatory Care and Surgery, Primary Care