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 91 Research Studies DisplayedMurugiah K, Wang Y, Desai NR
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
The researchers studied hospital performance on transcatheter aortic valve replacement (TAVR) using data from all Medicare fee-for-service (FFS) beneficiaries 65 years of age and older who underwent TAVR from January 1, 2011, to December 31, 2013. They found that for an individual patient, the between-hospital variation translates to a great than 2-fold higher risk of dying within 30 days for a patient undergoing TAVR at a hospital 1 SD above the national average compared with undergoing TAVR at a hospital 1 SD below; the between-hospital variation was
AHRQ-funded; HS023000.
Citation: Murugiah K, Wang Y, Desai NR .
Hospital variation in outcomes for transcatheter aortic valve replacement among Medicare beneficiaries, 2011 to 2013.
J Am Coll Cardiol 2015 Dec 15;66(23):2678-79. doi: 10.1016/j.jacc.2015.10.008.
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Keywords: Cardiovascular Conditions, Hospitals, Medicare, Patient-Centered Outcomes Research, Surgery
Johnson SL, Palta M, Bartels CM
Examining systemic steroid use in older inflammatory bowel disease patients using hurdle models: a cohort study.
In order to evaluate the relationship between patient characteristics and the frequency and duration of incident steroid use, the researchers applied a 2-part hurdle model to Medicare data. Their study identified differences in predictors of frequency and duration of medication use and suggests the utility of two-part models to examine drug utilization patterns.
AHRQ-funded; HS022786.
Citation: Johnson SL, Palta M, Bartels CM .
Examining systemic steroid use in older inflammatory bowel disease patients using hurdle models: a cohort study.
BMC Pharmacol Toxicol 2015 Dec 8;16:34. doi: 10.1186/s40360-015-0034-9..
Keywords: Elderly, Medicare, Medication
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
AHRQ-funded; HS018546.
Citation: Layton TJ, Ryan AM .
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Health Services Research (HSR), Quality Improvement, Quality of Care
Lepore M, Leland NE
Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents.
The authors examined nationwide facility-level nursing home data for the period 2007-2010. They found that increasing the proportion of Medicare-covered patient days in a nursing home was significantly associated with improvements in the quality of daily pain, pressure ulcers, and performing activities of daily living.
AHRQ-funded; HS022907.
Citation: Lepore M, Leland NE .
Nursing homes that increased the proportion of Medicare days saw gains in quality outcomes for long-stay residents.
Health Aff 2015 Dec;34(12):2121-8. doi: 10.1377/hlthaff.2015.0303.
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Keywords: Long-Term Care, Medicare, Nursing Homes, Patient-Centered Outcomes Research, Quality Improvement
Yun H, Xie F, Delzell E
The comparative effectiveness of biologics among older adults and disabled rheumatoid arthritis patients in the Medicare population.
Older and disabled rheumatoid arthritis (RA) patients are often not present in large numbers in clinical trials or registries. Using a novel, claims-based clinical effectiveness algorithm with the potential to compare the effectiveness of different biologics among this population using large administrative databases, researchers found that abatacept, adalimumab and etanercept are more effective than infliximab among RA patients initiating biologics.
AHRQ-funded; HS021694; HS023009; HS018517.
Citation: Yun H, Xie F, Delzell E .
The comparative effectiveness of biologics among older adults and disabled rheumatoid arthritis patients in the Medicare population.
Br J Clin Pharmacol 2015 Dec;80(6):1447-57. doi: 10.1111/bcp.12709.
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Keywords: Comparative Effectiveness, Patient-Centered Outcomes Research, Elderly, Arthritis, Medicare
Sanghavi P, Jena Newhouse, JP
Outcomes of basic versus advanced life support for out-of-hospital medical emergencies.
The researchers compared outcomes after advanced life support (ALS) and basic life support (BLS) in out-of-hospital medical emergencies. They found that advanced life support is associated with substantially higher mortality for several acute medical emergencies than BLS.
AHRQ-funded; HS022798.
Citation: Sanghavi P, Jena Newhouse, JP .
Outcomes of basic versus advanced life support for out-of-hospital medical emergencies.
Ann Intern Med 2015 Nov 3;163(9):681-90. doi: 10.7326/m15-0557..
Keywords: Elderly, Medicare, Emergency Medical Services (EMS), Outcomes
Dinan MA, Mi X, Reed SD
Association between use of the 21-gene recurrence score assay and receipt of chemotherapy among Medicare beneficiaries with early-stage breast cancer, 2005-2009.
The researchers examined whether adoption of the 21-Gene Recurrence Score (RS) assay in a nationally representative sample of patients with early-stage breast cancer was associated with use of chemotherapy. They found that the impact of the adoption of the RS assay on receipt of chemotherapy was strongly population dependent and was associated with relatively lower chemotherapy use in groups with high-risk disease and relatively higher chemotherapy use in patients with low-risk disease.
AHRQ-funded; HS022189.
Citation: Dinan MA, Mi X, Reed SD .
Association between use of the 21-gene recurrence score assay and receipt of chemotherapy among Medicare beneficiaries with early-stage breast cancer, 2005-2009.
JAMA Oncol 2015 Nov 1;1(8):1098-109. doi: 10.1001/jamaoncol.2015.2722..
Keywords: Cancer, Cancer: Breast Cancer, Treatments, Genetics, Medicare, Women
Goyal A, de Lemos JA, Peng SA
Association of patient enrollment in Medicare Part D with outcomes after acute myocardial infarction.
The researchers investigated whether enrollment versus nonenrollment in Medicare's prescription drug plan (Part D) is associated with better outcomes after acute myocardial infarction (AMI). They found that only half of Medicare-insured patients with AMI were enrolled in Part D by hospital discharge, and their 30-day and 1-year adjusted outcomes did not differ substantially from nonenrollees.
AHRQ-funded; HS021092.
Citation: Goyal A, de Lemos JA, Peng SA .
Association of patient enrollment in Medicare Part D with outcomes after acute myocardial infarction.
Circ Cardiovasc Qual Outcomes 2015 Nov;8(6):567-75. doi: 10.1161/circoutcomes.115.001650.
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Keywords: Heart Disease and Health, Medicare, Patient-Centered Outcomes Research, Medication, Patient Adherence/Compliance
Stuart BC, Davidoff AJ, Erten MZ
AHRQ Author: Davidoff AJ
Changes in medication management after a diagnosis of cancer among Medicare beneficiaries with diabetes.
The researchers sought to determine whether a new cancer diagnosis is associated with changes in medication adherence among Medicare beneficiaries with diabetes. They concluded that cancer diagnosis among patients with diabetes reduced adherence with evidence-based medications, particularly if patients’ life expectancy was short.
Citation: Stuart BC, Davidoff AJ, Erten MZ .
Changes in medication management after a diagnosis of cancer among Medicare beneficiaries with diabetes.
J Oncol Pract 2015 Nov;11(6):429-34. doi: 10.1200/jop.2014.003046..
Keywords: Medication, Medicare, Cancer, Diabetes, Patient Adherence/Compliance
Pfoh E, Mojtabai R, Bailey J
Impact of Medicare annual wellness visits on uptake of depression screening.
This study assessed whether patients with an initial annual wellness visit (AWV) were more likely to be screened for depression than those with a primary care visit. Fifteen percent of patients with non-AWVs and 10 percent of patients with AWVs received depression screening. After accounting for clustering, there was no statistically significant difference in depression screening by visit type.
AHRQ-funded; HS000029.
Citation: Pfoh E, Mojtabai R, Bailey J .
Impact of Medicare annual wellness visits on uptake of depression screening.
Psychiatr Serv 2015 Nov;66(11):1207-12. doi: 10.1176/appi.ps.201400524.
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Keywords: Depression, Screening, Medicare, Elderly, Primary Care
Liu H, Mattke S, Predmore ZS
Medicare coverage of anesthesia services during screening colonoscopies for patients at low risk of sedation-related complications.
The authors examined the costs and potential benefit of the Medicare rule change that waived patient cost sharing for anesthesia services during screening colonoscopies. Their results cast doubt on the value associated with Medicare coverage of anesthesia services during screening colonoscopies for patients at low risk of sedation-related complications. They recommended that payers create payment bundles for endoscopy procedures that include anesthesia services in a fixed fee.
AHRQ-funded; HS000029.
Citation: Liu H, Mattke S, Predmore ZS .
Medicare coverage of anesthesia services during screening colonoscopies for patients at low risk of sedation-related complications.
JAMA Intern Med 2015 Nov;175(11):1848-50. doi: 10.1001/jamainternmed.2015.4585.
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Keywords: Adverse Drug Events (ADE), Cancer: Colorectal Cancer, Colonoscopy, Medicare, Medication
Chen LM, Meara E, Birkmeyer JD
Medicare's Bundled Payments for Care Improvement initiative: expanding enrollment suggests potential for large impact.
The researchers examined the cross-sectional association between Bundled Payments for Care Improvement (BPCI) participation and providers' structural and cost characteristics. Overall participation in BPCI increased from about 400 in October 2013 to more than 2000 in June 2014. The authors concluded that growing participation in BPCI suggests strong interest in bundled payments.
AHRQ-funded; HS020671.
Citation: Chen LM, Meara E, Birkmeyer JD .
Medicare's Bundled Payments for Care Improvement initiative: expanding enrollment suggests potential for large impact.
Am J Manag Care 2015 Nov;21(11):814-20.
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Keywords: Healthcare Costs, Payment, Medicare, Quality Improvement
He D, Konetzka RT
Public reporting and demand rationing: evidence from the nursing home industry.
The authors examined a consequence of public reporting: the potential for demand rationing. They found that high-quality nursing homes facing capacity constraints reduced admissions of less profitable Medicaid residents while increasing the more profitable Medicare and private-pay admissions, relative to low-quality nursing homes facing no capacity constraints.
AHRQ-funded; HS021877.
Citation: He D, Konetzka RT .
Public reporting and demand rationing: evidence from the nursing home industry.
Health Econ 2015 Nov;24(11):1437-51. doi: 10.1002/hec.3097.
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Keywords: Public Reporting, Medicare, Nursing Homes
Ndumele CD, Sommers BD, Trivedi AN
The ACA's 65th birthday challenge: moving from Medicaid to Medicare.
Following the Affordable Care Act’s coverage expansion, many newly-insured older enrollees will lose Medicaid coverage on their 65th birthday and transition from Medicaid to Medicare as their primary insurer. This article discusses the transition in primary health insurance coverage that includes changes to benefits, patient cost-sharing, and provider reimbursement, which could have profound consequences on the use of health services and associated health outcomes for low-income seniors.
AHRQ-funded; HS021291.
Citation: Ndumele CD, Sommers BD, Trivedi AN .
The ACA's 65th birthday challenge: moving from Medicaid to Medicare.
J Gen Intern Med 2015 Nov;30(11):1704-6. doi: 10.1007/s11606-015-3328-0..
Keywords: Health Insurance, Medicare, Elderly, Low-Income
Singh S, Lin YL, Nattinger AB
Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge.
This study of Texas acute-care hospitals and ED facilities has found that the risk of readmission varies by ED provider caring for patients after discharge. A large part of this variation is explained by the ED facility in which the ED providers practice. Thus, ED provider practices patterns and ED facility systems of care may be a target for interventions to reduce readmissions.
AHRQ-funded; HS022134.
Citation: Singh S, Lin YL, Nattinger AB .
Variation in readmission rates by emergency departments and emergency department providers caring for patients after discharge.
J Hosp Med 2015 Nov;10(11):705-10. doi: 10.1002/jhm.2407.
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Keywords: Emergency Department, Elderly, Hospital Discharge, Hospital Readmissions, Medicare
Rahman M, Keohane L, Trivedi AN
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
The investigators examined the rates at which participants who used three high-cost services switched between Medicare Advantage and traditional Medicare. They found that the switching rate from 2010 to 2011 away from Medicare Advantage and to traditional Medicare exceeded the switching rate in the opposite direction for participants who used long-term nursing home care, short-term nursing home care, and home health care. These results were magnified among people who were enrolled in both Medicare and Medicaid.
AHRQ-funded; HS000011.
Citation: Rahman M, Keohane L, Trivedi AN .
High-cost patients had substantial rates of leaving Medicare Advantage and joining traditional Medicare.
Health Aff 2015 Oct;34(10):1675-81. doi: 10.1377/hlthaff.2015.0272.
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Keywords: Healthcare Costs, Home Healthcare, Long-Term Care, Medicare, Nursing Homes
Jung HY, Trivedi AN, Grabowski DC
Integrated Medicare and Medicaid managed care and rehospitalization of dual eligibles.
The objective of this study was to conduct an early evaluation of an innovative program that coordinates benefits for elderly dual eligibles. The authors found no statistically significant effect of senior care options on rehospitalization. They concluded that coordinating the financing and delivery of services through an integrated managed program may not sufficiently address the problems of inefficiency and fragmentation in care for hospitalized dual eligible enrollees.
AHRQ-funded; HS020756.
Citation: Jung HY, Trivedi AN, Grabowski DC .
Integrated Medicare and Medicaid managed care and rehospitalization of dual eligibles.
Am J Manag Care 2015 Oct;21(10):711-7.
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Keywords: Healthcare Delivery, Care Management, Medicaid, Medicare, Hospital Readmissions
Zhang Y, Talisa V, Baik SH
Part D plan switching among Medicare beneficiaries with schizophrenia.
The authors examined Medicare plan switching and factors affecting switching among beneficiaries with schizophrenia. They found several factors that affected the likelihood of switching, including age, geographic region, and proportion of prescriptions filled by beneficiaries who were covered or whose prescriptions required utilization review in the original plan. They concluded that plan switching among Medicare beneficiaries with schizophrenia was relatively infrequent but may be driven by the need for better drug coverage and less restrictive utilization policies.
AHRQ-funded; HS018657.
Citation: Zhang Y, Talisa V, Baik SH .
Part D plan switching among Medicare beneficiaries with schizophrenia.
Psychiatr Serv 2015 Oct;66(10):1105-8. doi: 10.1176/appi.ps.201400476.
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Keywords: Healthcare Costs, Medicare, Behavioral Health
Toth M, Holmes M, Van Houtven C
Rural Medicare beneficiaries have fewer follow-up visits and greater emergency department use postdischarge.
This study tested whether rural Medicare beneficiaries have a lower likelihood of follow-up care and greater likelihood of a readmission and ED visit within 30 days postdischarge, compared with urban beneficiaries. The results provide evidence of lower quality postdischarge care for Medicare beneficiaries in rural settings.
AHRQ-funded; HS000032.
Citation: Toth M, Holmes M, Van Houtven C .
Rural Medicare beneficiaries have fewer follow-up visits and greater emergency department use postdischarge.
Med Care 2015 Sep;53(9):800-8. doi: 10.1097/mlr.0000000000000401..
Keywords: Rural Health, Elderly, Medicare, Hospital Readmissions, Emergency Department, Hospital Discharge
Abdelsattar ZM, Birkmeyer JD, Wong SL
Variation in Medicare payments for colorectal cancer surgery.
The researchers assessed the contributions of index hospitalization, physician services, readmissions, and postacute care to the overall variation in payment for colorectal cancer surgery (CRC). They concluded that Medicare spending in the first year after CRC surgery varies across hospitals even after case-mix adjustment and price standardization. Variation is largely driven by postacute care and not the index surgical hospitalization.
AHRQ-funded; HS020937; HS000053.
Citation: Abdelsattar ZM, Birkmeyer JD, Wong SL .
Variation in Medicare payments for colorectal cancer surgery.
J Oncol Pract 2015 Sep;11(5):391-5. doi: 10.1200/jop.2015.004036.
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Keywords: Cancer, Cancer: Colorectal Cancer, Payment, Medicare, Surgery
Gill LE, Bartels SJ, Batsis JA
Weight management in older adults.
This overview highlights the challenges and implications of measuring adiposity in older adults and the dangers and benefits of weight loss in this population and provides an overview of the new Medicare Obesity Benefit. In addition, it provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice.
AHRQ-funded; HS0217695.
Citation: Gill LE, Bartels SJ, Batsis JA .
Weight management in older adults.
Curr Obes Rep 2015 Sep;4(3):379-88. doi: 10.1007/s13679-015-0161-z.
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Keywords: Elderly, Obesity: Weight Management, Obesity, Medicare
Kawai AT, Calderwood MS, Jin R
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
The 2008 Centers for Medicare & Medicaid Services (CMS) hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable. This study examined whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI). The CMS policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates.
AHRQ-funded; HS018414.
Citation: Kawai AT, Calderwood MS, Jin R .
Impact of the Centers for Medicare and Medicaid services hospital-acquired conditions policy on billing rates for 2 targeted healthcare-associated infections.
Infect Control Hosp Epidemiol 2015 Aug;36(8):871-7. doi: 10.1017/ice.2015.86.
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Keywords: Healthcare-Associated Infections (HAIs), Policy, Medicare, Payment, Hospitals, Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Healthcare Costs
Schulz J, DeCamp M, Berkowitz SA
Medicare Shared Savings Program: public reporting and shared savings distributions.
The objectives of this paper are to determine if Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) are meeting public reporting requirements related to shared savings plans, to quantitate the composition of shared savings distribution plans, and to investigate whether early ACO success is associated with specific plan or ACO characteristics. The authors found that just over one-half of MSSP ACOs report detailed shared savings distribution plans online, and these plans vary widely. They concluded that there appears to be no single shared savings distribution plan determinate of ACO success.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz SA .
Medicare Shared Savings Program: public reporting and shared savings distributions.
Am J Manag Care 2015 Aug;21(8):546-53.
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Keywords: Quality of Care, Payment, Policy, Medicare, Public Reporting
Jacobs PD, Buntin MB
AHRQ Author: Jacobs PD
Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?
This study evaluated the sensitivity of Medicare beneficiaries to premiums and benefits when selecting healthcare plans after the introduction of Part D. It found that Medicare Advantage enrollees are relatively insensitive to premiums, but more responsive to reductions in medical cost sharing in their benefit packages.
AHRQ-authored.
Citation: Jacobs PD, Buntin MB .
Determinants of Medicare plan choices: are beneficiaries more influenced by premiums or benefits?
Am J Manag Care 2015 Jul;21(7):498-504..
Keywords: Medicare, Health Insurance, Healthcare Costs
Holden TR, Smith MA, Bartels CM
Hospice enrollment, local hospice utilization patterns, and rehospitalization in Medicare patients.
The study objective was to examine the association between hospice enrollment, local hospice utilization patterns and 30-day rehospitalization in Medicare patients. It found that area-level hospice utilization is inversely proportional to rehospitalization rates. This relationship is not fully explained by direct hospice enrollment, and may reflect a spillover effect of the benefits of hospice extending to nonenrollees.
AHRQ-funded; HS000083.
Citation: Holden TR, Smith MA, Bartels CM .
Hospice enrollment, local hospice utilization patterns, and rehospitalization in Medicare patients.
J Palliat Med 2015 Jul;18(7):601-12. doi: 10.1089/jpm.2014.0395..
Keywords: Long-Term Care, Palliative Care, Hospital Readmissions, Medicare, Healthcare Utilization