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
101 to 125 of 1208 Research Studies DisplayedCerda M, Wheeler-Martin K, Bruzelius E
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
The authors investigated the impact of pain management clinic laws. They analyzed data on county-level, opioid overdose deaths via the National Vital Statistics System and patients filling long-duration or high-dose opioid prescriptions in the US 2010-2018. Their findings suggested that laws with criminal penalties were associated with intended reductions in high-risk opioid prescribing and some opioid overdoses but raised concerns regarding unintended consequences on heroin/synthetic overdoses.
AHRQ-funded; HS023258.
Citation: Cerda M, Wheeler-Martin K, Bruzelius E .
Spatiotemporal analysis of the association between pain management clinic laws and opioid prescribing and overdose deaths.
Am J Epidemiol 2021 Dec;190(12):2592-603. doi: 10.1093/aje/kwab192..
Keywords: Opioids, Pain, Chronic Conditions, Medication, Practice Patterns, Policy
Hayden EM, Davis C, Clark S
Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
Through the 2020 Society for Academic Emergency Medicine's annual consensus conference, experts in emergency medicine (EM) and telehealth created a research agenda to explore how EM should intersect with telehealth. The multiyear process resulted in consensus with a final set of 24 important research questions. The primary finding from the process was the breadth of gaps in the evidence for telehealth in EM and telehealth in general. The consensus process identified priority research questions for the use of and evaluation of telehealth in EM to fill the current knowledge gaps.
AHRQ-funded; HS027528.
Citation: Hayden EM, Davis C, Clark S .
Telehealth in emergency medicine: a consensus conference to map the intersection of telehealth and emergency medicine.
Acad Emerg Med 2021 Dec;28(12):1452-74. doi: 10.1111/acem.14330..
Keywords: Telehealth, Health Information Technology (HIT), Emergency Department, COVID-19
Rasooly IR, Makeneni S, Khan AN
The alarm burden of excess continuous pulse oximetry monitoring among patients with bronchiolitis.
This study’s objective was to quantify alarm burden of excess continuous pulse oximetry monitoring among hospitalized infants with bronchiolitis who are not receiving supplemental oxygen. The authors evaluated admissions of 201 children (aged 0-24 months) with bronchiolitis. They categorized time ≥60 minutes following discontinuation of supplemental oxygen as "continuously monitored (guideline-discordant)," "intermittently measured (guideline-concordant)," or "unable to classify." Among 4402 classifiable hours, 77% of alarms occurred during periods of guideline-discordant monitoring. Patients experienced a median of 35 alarms during guideline-discordant, continuously monitored time, representing a rate of 6.7 alarms per hour. When the monitoring was guideline-concordant, median hourly alarm rate was 0.5 alarms per hour.
AHRQ-funded; HS026620.
Citation: Rasooly IR, Makeneni S, Khan AN .
The alarm burden of excess continuous pulse oximetry monitoring among patients with bronchiolitis.
J Hosp Med 2021 Dec;16(12):727-29. doi: 10.12788/jhm.3731..
Keywords: Newborns/Infants, Respiratory Conditions, Inpatient Care
Heller CG, Rehm CD, Parsons AH
The association between social needs and chronic conditions in a large, urban primary care population.
This study sought to understand the association between social needs and chronic health conditions using a screening tool and clinical data from Electronic Health Records. From April 2018 to December 2019, 33,550 adult patients completed a 10-item social needs screening tool during primary visits in Bronx and Westchester Counties, NY. A positive, cumulative association between social needs and each of the eight outcomes asked about was found. The relationship was strongest for elevated PHQ-2 (depression screening), alcohol/drug use disorder, and smoking. Those with 3 or greater social needs were 3.9 times more likely to have an elevated PHQ-2 than those without needs. Healthcare transportation challenges was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. Examples included those with an alcohol/drug use disorder (84% more likely), and smokers (41% more likely).
AHRQ-funded; HS026396.
Citation: Heller CG, Rehm CD, Parsons AH .
The association between social needs and chronic conditions in a large, urban primary care population.
Prev Med 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752..
Keywords: Chronic Conditions, Urban Health, Primary Care, Low-Income, Social Determinants of Health, Screening
Winter SG, Bartel AP, de Cordova PB
The effect of data aggregation on estimations of nurse staffing and patient outcomes.
The objective of this study was to examine how estimates of the association between nurse staffing and patient length of stay (LOS) d with data aggregation over varying time periods and settings, and statistical controls for unobserved heterogeneity. The investigators concluded that estimating the association between nurse staffing and LOS was contingent on the time period of analysis and specific methodology.
AHRQ-funded; HS024339.
Citation: Winter SG, Bartel AP, de Cordova PB .
The effect of data aggregation on estimations of nurse staffing and patient outcomes.
Health Serv Res 2021 Dec;56(6):1262-70. doi: 10.1111/1475-6773.13866..
Keywords: Provider: Nurse
Liao JM, Chatterjee P, Wang E
The effect of hospital safety net status on the association between bundled payment participation and changes in medical episode outcomes.
This study evaluated whether hospital safety net status affected the association between bundled payment participation and medical outcomes. The hospitals included were participants in Medicare’s Bundled Payments for Care Improvement (BCPI) program from 2011-2016. Data from Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease were used. Among BCPI hospitals, safety net status was not associated with differential postdischarge spending or quality. However, BPCI safety net hospitals had differentially greater discharge due to institutional post-acute care and lower discharge home with home health than BPCI non-safety net hospitals.
AHRQ-funded; HS027595.
Citation: Liao JM, Chatterjee P, Wang E .
The effect of hospital safety net status on the association between bundled payment participation and changes in medical episode outcomes.
J Hosp Med 2021 Dec;16(12):716-23. doi: 10.12788/jhm.3722..
Keywords: Medicare, Payment, Hospitals
Neprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
AHRQ-funded; HS024455.
Citation: Neprash HT, Zink A, Sheridan B .
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
J Health Econ 2021 Dec;80:102541. doi: 10.1016/j.jhealeco.2021.102541..
Keywords: Medicare, Healthcare Utilization, Primary Care, Workforce, Health Insurance
Zuvekas SH, Kashihara D
AHRQ Author: Zuvekas SH
The impacts of the COVID-19 pandemic on the Medical Expenditure Panel Survey.
The COVID-19 pandemic caused substantial disruptions in the field operations of all 3 major components of the Medical Expenditure Panel Survey (MEPS). In this study, the investigators described how the MEPS program successfully responded to these challenges by reengineering field operations, including survey modes, to complete data collection and maintain data release schedules.
AHRQ-authored.
Citation: Zuvekas SH, Kashihara D .
The impacts of the COVID-19 pandemic on the Medical Expenditure Panel Survey.
Am J Public Health 2021 Dec;111(12):2157-66. doi: 10.2105/ajph.2021.306534..
Keywords: Medical Expenditure Panel Survey (MEPS), COVID-19, Healthcare Costs, Data
Markovitz AA, Ayanian JZ, Sukul ED
The Medicare Advantage Quality Bonus Program has not improved plan quality.
The authors analyzed insurance claims from the period 2009-2018 from the nation's largest Medicare Advantage (MA) claims database. They evaluated changes in performance on nine claims-based measures of quality before and after the start of the bonus program and with adjustment for differential pre-period trends. They found that program participation was associated with significant quality improvements among MA beneficiaries on four measures, significant declines on four other measures, and no significant change in overall quality performance, suggesting that the quality bonus program did not produce the intended improvement in overall quality performance of MA plans.
AHRQ-funded; HS000053.
Citation: Markovitz AA, Ayanian JZ, Sukul ED .
The Medicare Advantage Quality Bonus Program has not improved plan quality.
Health Aff 2021 Dec;40(12):1918-25. doi: 10.1377/hlthaff.2021.00606..
Keywords: Medicare, Health Insurance
Meyers DJ, Rahman M, Wilson IB
The relationship between Medicare Advantage Star Ratings and enrollee experience.
Medicare Advantage plans, private managed care plans that enrolled 34% of Medicare beneficiaries in 2019, received $6 billion in annual bonus payments on the basis of their performance on a 5-star rating system. Little is known, however, as to the extent these ratings adequately capture enrollee experience. The objective of this study was to measure the effect of exposure to higher rated Medicare Advantage contracts on enrollee experience.
AHRQ-funded; HS027051.
Citation: Meyers DJ, Rahman M, Wilson IB .
The relationship between Medicare Advantage Star Ratings and enrollee experience.
J Gen Intern Med 2021 Dec;36(12):3704-10. doi: 10.1007/s11606-021-06764-y..
Keywords: Medicare, Patient Experience
Greenzang KA, Kelly CA, Al-Sayegh H
Thinking ahead: parents' worries about late effects of childhood cancer treatment.
This study examined parental perceived likelihood, impact, and worry about late effects of treatment for childhood cancer. The authors surveyed 96 parents of pediatric cancer patients at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center within a year of diagnosis. Most parents (96%) valued information about late effects, and 93% considered late effects in their treatment decision-making. However, 24% could not recall receiving information about late effects, and only 51% felt well-prepared for potential late effects. Only one-fifth of parents consider late effects to be likely for their child, while 61% were extremely/very worried about late effects.
AHRQ-funded; HS022986.
Citation: Greenzang KA, Kelly CA, Al-Sayegh H .
Thinking ahead: parents' worries about late effects of childhood cancer treatment.
Pediatr Blood Cancer 2021 Dec;68(12):e29335. doi: 10.1002/pbc.29335..
Keywords: Children/Adolescents, Cancer, Education: Patient and Caregiver, Health Literacy, Caregiving
McClure JB, Lapham G
Tobacco quitline engagement and outcomes among primary care patients reporting use of tobacco or dual tobacco and cannabis: an observational study.
Researchers examined dual users of tobacco and cannabis and how this use impacts individuals' interest in or ability to stop smoking. They found that, although dual use of tobacco and cannabis is common among smokers seen in primary care and those enrolling in quitline care, it may not undermine tobacco quitline engagement or smoking cessation. They concluded that tobacco quitline care was equally engaging and effective among tobacco users and dual users of tobacco and cannabis.
AHRQ-funded; HS026369.
Citation: McClure JB, Lapham G .
Tobacco quitline engagement and outcomes among primary care patients reporting use of tobacco or dual tobacco and cannabis: an observational study.
Subst Abus 2021;42(4):417-22. doi: 10.1080/08897077.2020.1846665..
Keywords: Tobacco Use, Tobacco Use: Smoking Cessation, Primary Care
Duvalyan A, Pandey A, Vaduganathan M
Trends in anticoagulation prescription spending among Medicare Part D and Medicaid beneficiaries between 2014 and 2019.
Researchers examined contemporary direct oral anticoagulant (DOAC) spending patterns within Medicare Part D and Medicaid between 2014 and 2019. They found that, although overall DOAC spending is increasing, DOAC use may be associated with lower downstream medical expenditures compared with warfarin stemming from decreased risk of major bleeding and stroke and reduced drug monitoring.
AHRQ-funded; HS022418.
Citation: Duvalyan A, Pandey A, Vaduganathan M .
Trends in anticoagulation prescription spending among Medicare Part D and Medicaid beneficiaries between 2014 and 2019.
J Am Heart Assoc 2021 Dec 21;10(24):e022644. doi: 10.1161/jaha.121.022644..
Keywords: Blood Thinners, Medication, Medicare, Medicaid, Healthcare Costs
Abdus S
AHRQ Author: Abdus S
Trends in differences across subgroups of adults in preventive services utilization.
This study examines whether preventive services utilization changed over time, across subgroups of adults defined by race/ethnicity, insurance coverage, poverty status, Census region, and urbanicity. Using MEPS data and examining general checkups, blood cholesterol screening, mammograms, and colorectal cancer screening, findings showed modest increases in utilization between 2008/2009 and 2015/2016 for blood cholesterol and colorectal cancer screenings. Large gaps in utilization across income groups and between those with and without coverage persisted. Disparities across racial/ethnic groups in general checkups persisted over time as well.
AHRQ-authored.
Citation: Abdus S .
Trends in differences across subgroups of adults in preventive services utilization.
Med Care 2021 Dec;59(12):1059-66. doi: 10.1097/mlr.0000000000001634..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Utilization, Prevention
Werner RM, Templeton Z, Apathy N
Trends in post-acute care in US nursing homes: 2001-2017.
The purpose of this retrospective cohort study was to describe recent trends in post-acute care provision within nursing homes, focusing specifically on nursing homes' degree of specialization in post-acute care. The investigators concluded that over the last 2 decades, post-acute care has become increasingly concentrated in a subset of nursing homes, which tend to be for-profit, part of a chain, and less likely to serve racial and ethnic minorities and persons on Medicaid.
AHRQ-funded; HS026116.
Citation: Werner RM, Templeton Z, Apathy N .
Trends in post-acute care in US nursing homes: 2001-2017.
J Am Med Dir Assoc 2021 Dec;22(12):2491-95.e2. doi: 10.1016/j.jamda.2021.06.015..
Keywords: Elderly, Nursing Homes, Racial and Ethnic Minorities
Schirle L, Jeffery A, Yaqoob A
Two data-driven approaches to identifying the spectrum of problematic opioid use: a pilot study within a chronic pain cohort.
Although electronic health records (EHR) have significant potential for the study of opioid use disorders (OUD), detecting OUD in clinical data is challenging. Models using EHR data to predict OUD often rely on case/control classifications focused on extreme opioid use. IN this study, the investigators discussed two data-driven approaches to identifying the spectrum of problematic opioid use. The investigators concluded that risk scores comprising comorbidities and text offer differing but synergistic insights into characterizing problematic opioid use.
AHRQ-funded; HS026395.
Citation: Schirle L, Jeffery A, Yaqoob A .
Two data-driven approaches to identifying the spectrum of problematic opioid use: a pilot study within a chronic pain cohort.
Int J Med Inform 2021 Dec;156:104621. doi: 10.1016/j.ijmedinf.2021.104621..
Keywords: Opioids, Pain, Chronic Conditions, Medication, Health Information Technology (HIT)
Dykes PC, KhasnabishE S, Adkison LE
Use of a perceived efficacy tool to evaluate the FallTIPS program.
The authors assessed nurses' opinions of the efficacy of using the FallTIPS (Tailoring Interventions for Patient Safety) fall prevention program. They found that the nurses who used FallTIPS perceived that efficiencies in patient care compensated for the time spent on FallTIPS. Nurses valued the program, and findings confirmed the importance of patient and family engagement with staff in the fall prevention process.
AHRQ-funded; HS025128.
Citation: Dykes PC, KhasnabishE S, Adkison LE .
Use of a perceived efficacy tool to evaluate the FallTIPS program.
J Am Geriatr Soc 2021 Dec;69(12):3595-601. doi: 10.1111/jgs.17436..
Keywords: Falls, Patient Safety, Prevention, Provider: Nurse, Adverse Events
Abraham CM, Zheng K, Norful AA
Use of multifunctional electronic health records and burnout among primary care nurse practitioners.
This study investigated whether there is an association with the use of multifunctional electronic health records (EHRs) with nurse practitioner (NP) burnout in primary care practices. The study used cross-sectional survey data secondary analysis collected from NPs in Pennsylvania and New Jersey. The NPs completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Of 396 NPs included, 25.3% reported burnout, but the use of multifunctional EHRs did not increase primary care NP burnout.
AHRQ-funded; HS027290.
Citation: Abraham CM, Zheng K, Norful AA .
Use of multifunctional electronic health records and burnout among primary care nurse practitioners.
J Am Assoc Nurse Pract 2021 Dec;33(12):1182-89. doi: 10.1097/jxx.0000000000000533..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Nurse, Primary Care
Giardina TD, Korukonda S, Shahid U
Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation.
This retrospective cohort study evaluated the use of patient complaint data to identify patient safety concerns related to diagnosis as an initial step to using this information to facilitate learning and improvement. Patient complaints submitted to the Geisinger healthcare system were reviewed with 2 cohorts from August to December 2017 (cohort 1) and January to June 2018 (cohort 2). The authors selected complaints more likely to be associated with diagnostic concerns in Geisinger’s existing complaint taxonomy. In cohort 1, 1865 complaint summaries were reviewed and 177 (9.5%) were identified as concerning. The review identified 39 diagnostic errors. In cohort 2, 2423 patient complaints were reviewed and 310 (12.8%) concerning reports were identified. A 10% sample contained give diagnostic errors. Most errors were categorized as “Clinical Care” issues.
AHRQ-funded; HS025474; HS027363.
Citation: Giardina TD, Korukonda S, Shahid U .
Use of patient complaints to identify diagnosis-related safety concerns: a mixed-method evaluation.
BMJ Qual Saf 2021 Dec;30(12):996-1001. doi: 10.1136/bmjqs-2020-011593..
Keywords: Diagnostic Safety and Quality, Patient Safety, Medical Errors, Adverse Events
Xiong KZ, Shah S, Stone JA
Using a scenario-based hybrid approach to understand participant health behavior.
This study described a scenario-based hybrid approach that included a simulation exercise and a situational interview to understand how older adults first select and then take OTC medication. The authors concluded that the scenario-based hybrid approach not only yielded detailed information about behavior, but also allowed investigators to discern participants' decision-making, influences, and the rationales they used when selecting and taking OTC medications.
AHRQ-funded; HS024490.
Citation: Xiong KZ, Shah S, Stone JA .
Using a scenario-based hybrid approach to understand participant health behavior.
Res Social Adm Pharm 2021 Dec;17(12):2070-74. doi: 10.1016/j.sapharm.2021.02.020..
Keywords: Elderly, Medication, Shared Decision Making
Morris AO, Gilson A, Chui MA
Utilizing a cognitive engineering approach to conduct a hierarchical task analysis to understand complex older adult decision-making during over-the-counter medication selection.
This study characterized older adults' cognitive decision-making process when seeking to self-medicate with over-the-counter (OTC) medications from their community pharmacy, and demonstrated how hierarchical task analysis (HTA) can be used to evaluate a pharmacy intervention's impact on their decision-making. Findings showed that, while selecting an OTC, older adults considered quantity, cost, form, regimen, safety, strength, appropriateness of OTC safety, generic/name-brand, past experiences, and ingredients. The study intervention reduced by half the number of factors considered. Findings suggested that HTA-informed decision profiles may provide pharmacists with critical insights into safety issues that older adults may not be considering so that pharmacists can support their decision-making.
AHRQ-funded; HS024490.
Citation: Morris AO, Gilson A, Chui MA .
Utilizing a cognitive engineering approach to conduct a hierarchical task analysis to understand complex older adult decision-making during over-the-counter medication selection.
Res Social Adm Pharm 2021 Dec;17(12):2116-26. doi: 10.1016/j.sapharm.2021.07.005..
Keywords: Elderly, Shared Decision Making, Medication
Silverberg JI
Validity and reliability of a novel numeric rating scale to measure skin-pain in adults with atopic dermatitis.
Little is known about the measurement properties of numeric rating scales (NRS) for pain in AD. In this study, the investigators evaluated a novel NRS for skin-pain and existing NRS for average overall-pain in adults with AD. Self-administered questionnaires and skin-examination were performed in 463 AD patients (age 18-97 years) in a dermatology practice setting.
AHRQ-funded; HS023011.
Citation: Silverberg JI .
Validity and reliability of a novel numeric rating scale to measure skin-pain in adults with atopic dermatitis.
Arch Dermatol Res 2021 Dec;313(10):855-61. doi: 10.1007/s00403-021-02185-3..
Keywords: Skin Conditions, Pain, Quality of Life
McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
The authors examined whether Medicaid participation by low-income adults age 65 and up increased as a result of Medicaid expansions to working-age adults under the Affordable Care Act (ACA). Using American Community Survey data and state variation in ACA Medicaid expansions, they found that Medicaid expansions to working-age adults increased Medicaid participation among low-income older adults by 4.4 percent. They also found evidence of an “on-ramp” effect, which is an important mechanism behind welcome mat effects among some older adults.
AHRQ-funded; HS025422.
Citation: McInerney M, Mellor JM, Sabik LM. M, Mellor JM, Sabik LM .
Welcome mats and on-ramps for older adults: the impact of the Affordable Care Act's Medicaid Expansions on Dual Enrollment in Medicare and Medicaid.
J Policy Anal Manage 2021 Win;40(1):12-41. doi: 10.1002/pam.22259..
Keywords: Elderly, Medicaid, Medicare, Low-Income, Health Insurance, Policy
Rasmussen PW, Anderson D
When all that glitters is gold: dominated plan choice on Covered California for the 2018 plan year.
The Affordable Care Act (ACA) individual health insurance marketplaces rely on purchasers to make informed choices to impose price and quality discipline on a complex array of insurance products. A sudden and minimally expected policy shock in the fall of 2017-the termination of direct federal payment for cost-sharing reduction (CSR) subsidies-led to a substantial change in the relative prices of silver and gold plans on the Covered California insurance marketplace. In this study, the investigators used the Covered California enrollment and product files from 2014 to 2018 in a retrospective data analysis of plan choice.
AHRQ-funded; HS026835.
Citation: Rasmussen PW, Anderson D .
When all that glitters is gold: dominated plan choice on Covered California for the 2018 plan year.
Milbank Q 2021 Dec;99(4):1059-87. doi: 10.1111/1468-0009.12518..
Keywords: Health Insurance
Tandan M, Zimmerman S, Sloane PD
Which nursing home residents with pneumonia are managed on-site and which are hospitalized? Results from 2 years' surveillance in 14 US homes.
Pneumonia is a frequent cause of hospitalization among nursing home (NH) residents, but little information is available as to how clinical presentation and other characteristics relate to hospitalization, and the differential use of antimicrobials based on hospitalization status. This study examined how hospitalized and nonhospitalized NH residents with pneumonia differ. The investigators concluded that respiratory rate was associated with hospitalization but was not documented for more than a quarter of residents.
AHRQ-funded; HS022298.
Citation: Tandan M, Zimmerman S, Sloane PD .
Which nursing home residents with pneumonia are managed on-site and which are hospitalized? Results from 2 years' surveillance in 14 US homes.
J Am Med Dir Assoc 2020 Dec;21(12):1862-68.e3. doi: 10.1016/j.jamda.2020.07.028..
Keywords: Elderly, Nursing Homes, Pneumonia, Respiratory Conditions, Hospitalization