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
26 to 50 of 54 Research Studies DisplayedSilber JH, Satopaa VA, Mukherjee N
Improving Medicare's Hospital Compare mortality model.
The researchers sought to improve the predictions provided by Medicare's Hospital Compare (HC) to facilitate better informed decisions regarding hospital choice by the public. Their model produces very different predictions from the current HC model, with higher predicted mortality rates at hospitals with lower volume and worse characteristics. The expanded model would advise patients against seeking treatment at the smallest hospitals with worse technology and staffing.
AHRQ-funded; HS021854.
Citation: Silber JH, Satopaa VA, Mukherjee N .
Improving Medicare's Hospital Compare mortality model.
Health Serv Res 2016 Jun;51 Suppl 2:1229-47. doi: 10.1111/1475-6773.12478.
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Keywords: Hospitals, Mortality, Medicare
Goedken AM, Lund BC, Cook EA
Application of a framework for determining number of drugs.
The purpose of the study was to propose a framework and illustrate how that framework can be used to create and succinctly describe various approaches to counting the number of drugs used by patients and to examine the impact of varying individual components of the framework on the resulting drug count.
AHRQ-funded; HS018381.
Citation: Goedken AM, Lund BC, Cook EA .
Application of a framework for determining number of drugs.
BMC Res Notes 2016 May 13;9:272. doi: 10.1186/s13104-016-2076-5.
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Keywords: Medication, Research Methodologies, Heart Disease and Health, Medicare
Das A, Norton EC, Miller DC
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
In fiscal year 2015 the Centers for Medicare and Medicaid Services expanded its Hospital Value-Based Purchasing program by rewarding or penalizing hospitals for their performance on both spending and quality. Using data from 2,679 US hospitals that participated in the program in fiscal years 2014 and 2015, researchers found that the new emphasis on spending rewarded not only low-spending hospitals but some low-quality hospitals as well.
AHRQ-funded; HS020671.
Citation: Das A, Norton EC, Miller DC .
Adding a spending metric to Medicare's value-based purchasing program rewarded low-quality hospitals.
Health Aff 2016 May;35(5):898-906. doi: 10.1377/hlthaff.2015.1190.
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Keywords: Medicare, Provider Performance, Payment, Hospitals, Healthcare Costs, Quality of Care
Kim EH, Vetter JM, Kuxhausen AN
Limited use of surveillance imaging following nephrectomy for renal cell carcinoma.
The researchers evaluated the utilization of follow-up imaging after nephrectomy for renal cell carcinoma (RCC) in nationally representative data. Using Surveillance, Epidemiology, End Results (SEER) data, they found that, in the Medicare population, surveillance imaging is performed in a limited number of patients following nephrectomy for RCC but that increasing tumor stage is predictive of both increased chest and abdominal imaging surveillance.
AHRQ-funded; HS019455.
Citation: Kim EH, Vetter JM, Kuxhausen AN .
Limited use of surveillance imaging following nephrectomy for renal cell carcinoma.
Urol Oncol 2016 May;34(5):237.e11-8. doi: 10.1016/j.urolonc.2015.11.017.
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Keywords: Cancer, Healthcare Utilization, Imaging, Medicare
Callaghan BC, Burke JF, Skolarus LE
Medicare's reimbursement reduction for nerve conduction studies: effect on use and payments.
The purpose of this research letter was to investigate the effect of the sharp reduction in Medicare reimbursement for electromyography (EMG) while the reimbursement for nerve conduction studies (NCS) remained unchanged. They found that the use of EMG by neurologists and physiatrists changed little, whereas a decrease in its use among other health care providers was observed. They concluded that the pattern of change in use of EMG and NCS suggests findings similar to those in past studies of Medicare reimbursement with regard to reducing inappropriate, but not appropriate, testing and treatment.
AHRQ-funded; HS022258.
Citation: Callaghan BC, Burke JF, Skolarus LE .
Medicare's reimbursement reduction for nerve conduction studies: effect on use and payments.
JAMA Intern Med 2016 May;176(5):697-9. doi: 10.1001/jamainternmed.2016.0162.
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Keywords: Diagnostic Safety and Quality, Healthcare Costs, Payment, Medicare
Singh G, Zhang W, Kuo YF
Association of psychological disorders with 30-day readmission rates in patients with COPD.
Using a 5 percent sample of Medicare beneficiaries, the researchers examined the association of psychological disorders such as depression, anxiety, psychosis, alcohol abuse and drug abuse with early readmission for patients with COPD. They found that psychological disorders like depression, anxiety, psychosis, alcohol abuse and drug abuse are independently associated with higher all-cause 30-day readmission rates for Medicare beneficiaries with COPD.
AHRQ-funded; HS020642; HS022134.
Citation: Singh G, Zhang W, Kuo YF .
Association of psychological disorders with 30-day readmission rates in patients with COPD.
Chest 2016 Apr;149(4):905-15. doi: 10.1378/chest.15-0449..
Keywords: Behavioral Health, Hospital Readmissions, Medicare, Respiratory Conditions
Mukamel DB, White LM, Nocon RS
AHRQ Author: Ngo-Metzger Q
Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings.
The purpose of this study was to compare total annual costs for Medicare beneficiaries receiving primary care in federally funded health centers (HCs) to Medicare beneficiaries in physician offices and outpatient clinics. It found that total median annual costs (at $2,370) for HC Medicare patients were lower by 10 percent compared to patients in physician offices ($2,667) and by 30 percent compared to patients in outpatient clinics ($3,580).
AHRQ-authored.
Citation: Mukamel DB, White LM, Nocon RS .
Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings.
Health Serv Res 2016 Apr;51(2):625-44. doi: 10.1111/1475-6773.12339..
Keywords: Medicare, Healthcare Costs, Primary Care
Farris KB, Salgado TM, Aneese N
Effect of clinical and attitudinal characteristics on obtaining comprehensive medication reviews.
The researchers sought to quantify the association between attitudinal and clinical factors with intention and predict future behavior to obtain a comprehensive medication reviews (CMR) among Medicare Part D beneficiaries. They found that worrying about medications doing more harm than good, number of pharmacies where participants obtained their medications from, number of medications, and number of medical conditions predicted intention to obtain a CMR.
AHRQ-funded; HS018353.
Citation: Farris KB, Salgado TM, Aneese N .
Effect of clinical and attitudinal characteristics on obtaining comprehensive medication reviews.
J Manag Care Spec Pharm 2016 Apr;22(4):388-95. doi: 10.18553/jmcp.2016.22.4.388.
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Keywords: Medication, Medicare, Elderly, Medication: Safety, Patient Adherence/Compliance
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
Nguyen OK, Makam AN, Halm EA
National use of safety-net clinics for primary care among adults with non-Medicaid insurance in the United States.
This study described the prevalence, characteristics, and predictors of safety-net use for primary care among non-Medicaid insured adults (i.e., those with private insurance or Medicare). It concluded that safety net clinics are important primary care delivery sites for non-Medicaid insured minority and low-income populations with a high burden of chronic illness.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Makam AN, Halm EA .
National use of safety-net clinics for primary care among adults with non-Medicaid insurance in the United States.
PLoS One 2016 Mar 30;11(3):e0151610. doi: 10.1371/journal.pone.0151610.
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Keywords: Primary Care, Health Insurance, Medicare, Low-Income, Healthcare Delivery
Fonarow GG, Liang L, Thomas L
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
The researchers evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. They concluded that in a population of older patients with ischemic stroke, home-time was readily available from administrative data and associated with mRS at 90 days and 1 year.
AHRQ-funded; HS019479; HS016964.
Citation: Fonarow GG, Liang L, Thomas L .
Assessment of home-time after acute ischemic stroke in Medicare beneficiaries.
Stroke 2016 Mar;47(3):836-42. doi: 10.1161/strokeaha.115.011599.
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Keywords: Medicare, Stroke, Elderly, Home Healthcare, Patient-Centered Outcomes Research
Chen LM, Norton EC, Birkmeyer JD
Comparing approaches to controlling Medicare spending.
For 3 common surgical procedures (coronary artery bypass grafting (CABG), prostatectomy, and hip replacement), the researchers compared the relative influence of procedure rates versus episode payments (among those with procedures) on total Medicare expenditures. Using complete Part A and B Medicare claims data, they found that reducing procedure rates lowers total Medicare spending substantially more than reducing episode payments.
AHRQ-funded; HS020671.
Citation: Chen LM, Norton EC, Birkmeyer JD .
Comparing approaches to controlling Medicare spending.
J Hosp Med 2016 Mar;11(3):215-6. doi: 10.1002/jhm.2527.
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Keywords: Medicare, Healthcare Costs, Surgery
Driessen J, Baik SH, Zhang Y
Explaining improved use of high-risk medications in Medicare between 2007 and 2011.
The researchers explored the reasons for the great decline in the use of high-risk medications between 2007 and 2011. They found that the FDA’s ban on propoxyphene beginning in 2010 led to the huge decrease in high-risk prescribing. For non-propoxyphene drugs included in the high-risk measure, the rate of prescribing showed minimal improvement, decreasing from 21.0 percent to 18.6 percent from 2007 to 2011.
AHRQ-funded; HS018657.
Citation: Driessen J, Baik SH, Zhang Y .
Explaining improved use of high-risk medications in Medicare between 2007 and 2011.
J Am Geriatr Soc 2016 Mar;64(3):674-6. doi: 10.1111/jgs.14000.
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Keywords: Medication, Medicare
DeVore AD, Hammill BG, Hardy NC
Has public reporting of hospital readmission rates affected patient outcomes?: Analysis of Medicare claims data.
Following the implementation of Centers for Medicare & Medicaid Services (CMS) public reporting, this study assessed trends of 30-day readmission rates and post-discharge care for patients discharged with acute myocardial infarction (MI), heart failure (HF), or pneumonia. It found that the release of the CMS public reporting of hospital readmission rates did not change 30-day readmission trends for MI, HF, or pneumonia, but it was associated with less hospital-based acute care for HF.
AHRQ-funded; HS021092.
Citation: DeVore AD, Hammill BG, Hardy NC .
Has public reporting of hospital readmission rates affected patient outcomes?: Analysis of Medicare claims data.
J Am Coll Cardiol 2016 Mar 1;67(8):963-72. doi: 10.1016/j.jacc.2015.12.037.
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Keywords: Public Reporting, Hospital Readmissions, Outcomes, Medicare, Patient-Centered Outcomes Research
Berry SA, Fleishman JA, Moore RD
AHRQ Author: Fleishman JA
Thirty-day hospital readmissions for adults with and without HIV infection.
This study compared 30-day readmission rates by HIV status in a multi-state sample with planned subgroup comparisons by insurance and diagnostic categories. After adjustment for age, gender, race, insurance, and diagnostic category, HIV infection was associated with 1.5 times higher odds of readmission. Predicted, adjusted readmission rates were higher for persons living with HIV within every insurance category, including Medicaid.
AHRQ-authored.
Citation: Berry SA, Fleishman JA, Moore RD .
Thirty-day hospital readmissions for adults with and without HIV infection.
HIV Med 2016 Mar;17(3):167-77. doi: 10.1111/hiv.12287.
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Keywords: Healthcare Cost and Utilization Project (HCUP), Human Immunodeficiency Virus (HIV), Hospital Readmissions, Medicaid, Medicare
Wang SY, Hall J, Pollack CE
Trends in end-of-life cancer care in the Medicare program.
The researchers sought to examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. They found that the proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased in repeated hospitalization, repeated ED visits, ICU admissions, and late hospice enrollment but declined in in-hospital death. End-of-life chemotherapy use did not change significantly over time. They concluded that despite growing focus on providing appropriate end-of-life care, there has not been an improvement in aggressive end-of-life cancer care in the Medicare program.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Trends in end-of-life cancer care in the Medicare program.
J Geriatr Oncol 2016 Mar;7(2):116-25. doi: 10.1016/j.jgo.2015.11.007.
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Keywords: Cancer, Care Management, Elderly, Medicare, Palliative Care, Outcomes, Patient-Centered Outcomes Research, Practice Patterns
Dubberke ER, Olsen MA, Stwalley D
Identification of Medicare recipients at highest risk for Clostridium difficile infection in the US by population attributable risk analysis.
This study determined the population attributable risk percent (PAR%) for Clostridium difficile infection (CDI) in various subpopulations in the Medicare 5% random sample. It found that small and identifiable subpopulations that account for relatively large proportions of CDI cases in the elderly were identified. These data can be used to target specific subpopulations for CDI prevention interventions.
AHRQ-funded; HS019455.
Citation: Dubberke ER, Olsen MA, Stwalley D .
Identification of Medicare recipients at highest risk for Clostridium difficile infection in the US by population attributable risk analysis.
PLoS One 2016 Feb 9;11(2):e0146822. doi: 10.1371/journal.pone.0146822.
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Keywords: Medicare, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Risk
Raval AD, Madhavan S, Mattes MD
Impact of prostate cancer diagnosis on noncancer hospitalizations among elderly Medicare Beneficiaries with incident prostate cancer.
The authors analyzed the impact of cancer diagnosis on noncancer hospitalizations (NCHs) by comparing these hospitalizations between the precancer and postcancer periods. They found that the rate of NCHs was higher during the postcancer period compared with the precancer period. They suggested that their study highlights the need to design interventions for reducing the excess NCHs after prostate cancer diagnosis among elderly men.
AHRQ-funded; HS018622.
Citation: Raval AD, Madhavan S, Mattes MD .
Impact of prostate cancer diagnosis on noncancer hospitalizations among elderly Medicare Beneficiaries with incident prostate cancer.
J Natl Compr Canc Netw 2016 Feb;14(2):186-94.
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Keywords: Elderly, Hospitalization, Medicare, Cancer: Prostate Cancer
Hays RD, Mallett JS, Gaillot S
Performance of the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) physical functioning items.
This study evaluated physical functioning items in Medicare beneficiaries. It concluded that the physical functioning items target relatively easy activities, providing information for a minority of people in the sample with the lowest levels of physical functioning. Items representing higher levels of physical functioning are needed for the majority of the Medicare beneficiaries.
AHRQ-funded; HS016980.
Citation: Hays RD, Mallett JS, Gaillot S .
Performance of the Medicare Consumer Assessment of Health Care Providers and Systems (CAHPS) physical functioning items.
Med Care 2016 Feb;54(2):205-9. doi: 10.1097/mlr.0000000000000475..
Keywords: Medicare, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Status, Quality Improvement
Grenda TR, Krell RW, Dimick JB
Reliability of hospital cost profiles in inpatient surgery.
This study sought to discover whether Medicare payments for surgery can reliably compare hospital costs. It found that episode payments for inpatient surgery are a reliable measure of hospital costs for commonly performed procedures, but are less reliable for lower volume operations. These findings suggest that hospital cost profiles based on Medicare claims data may be used to benchmark efficiency, especially for more common procedures.
AHRQ-funded; HS000053.
Citation: Grenda TR, Krell RW, Dimick JB .
Reliability of hospital cost profiles in inpatient surgery.
Surgery 2016 Feb;159(2):375-80. doi: 10.1016/j.surg.2015.06.043..
Keywords: Inpatient Care, Surgery, Healthcare Costs, Medicare, Data
Kuo YF, Raji MA, Chen NW
Trends in opioid prescriptions among Part D Medicare recipients From 2007 to 2012.
The researchers used national Medicare data from 2007-2012 to assess temporal and geographic trends in rates of opioid prescription and relationship to opioid toxicity and different state regulations in Part D Medicare recipients. Their analyses of the Medicare data demonstrated substantial growth in opioid prescriptions from 2007 to 2011 and large variation in opioid prescriptions across states.
AHRQ-funded; HS022134.
Citation: Kuo YF, Raji MA, Chen NW .
Trends in opioid prescriptions among Part D Medicare recipients From 2007 to 2012.
Am J Med 2016 Feb;129(2):221.e21-30. doi: 10.1016/j.amjmed.2015.10.002..
Keywords: Chronic Conditions, Elderly, Medicare, Medication, Opioids, Pain
Zanwar P, Lin YL, Kuo YF
Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort
The investigators assessed the tests, treatments, and payments for prostate cancer care in men aged 75 or older who have primary care physicians (PCPs) with high or low prostate specific antigen (PSA) testing rates. They found that older men seeing PCPs with high rates of PSA testing undergo more testing and treatments for prostate cancer, with higher Medicare insurance payments.
AHRQ-funded; HS022134.
Citation: Zanwar P, Lin YL, Kuo YF .
Downstream tests, treatments, and annual direct payments in older men cared for by primary care providers with high or low prostate-specific antigen screening rates using 100 percent Texas U.S. Medicare public insurance claims data: a retrospective cohort
BMC Health Serv Res 2016 Jan 15;16:17. doi: 10.1186/s12913-016-1265-1.
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Keywords: Elderly, Medicare, Primary Care, Cancer: Prostate Cancer, Screening
Sjoding MW, Valley TS, Prescott HC
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
This study characterized trends in intermediate care use among U.S. hospitals. Only 8.2 percent of Medicare hospitalizations in 1996 were billed for intermediate care, but billing steadily increased to 22.8 percent by 2010, whereas the percentage billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients.
AHRQ-funded; HS020672.
Citation: Sjoding MW, Valley TS, Prescott HC .
Rising billing for intermediate intensive care among hospitalized Medicare bbetween 1996 and 2010.
Am J Respir Crit Care Med 2016 Jan 15;193(2):163-70. doi: 10.1164/rccm.201506-1252OC.
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Keywords: Payment, Hospitals, Intensive Care Unit (ICU), Healthcare Costs, Medicare
Das A, Norton EC, Miller DC
Association of postdischarge spending and performance on new episode-based spending measure.
The Centers for Medicare and Medicaid Services recently added the Medicare Spending per Beneficiary (MSPB) metric to its Hospital Value-Based Purchasing (HVBP) program. The researchers evaluated whether hospital performance was driven by spending before, during, or after hospitalization. They found that compared with low-cost hospitals, high-cost hospitals had significantly higher preadmission and index admission spending, but the largest differences were in postdischarge spending.
AHRQ-funded; HS020671.
Citation: Das A, Norton EC, Miller DC .
Association of postdischarge spending and performance on new episode-based spending measure.
JAMA Intern Med 2016 Jan;176(1):117-9. doi: 10.1001/jamainternmed.2015.6261.
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Keywords: Healthcare Costs, Medicare, Hospitals, Provider Performance, Hospitalization, Payment, Hospital Discharge
Jubelt LE, Goldfeld KS, Chung WY
Changes in discharge location and readmission rates under Medicare bundled payment.
To control costs, NYU Langone Medical Center attempted to shift referrals from facility-based to home-based postacute care. In the context of this shift in referrals, the researchers examined the change in hospital readmission rates. Their findings suggest that institutions may be able to shift some patients from facility-based to home-based postacute care without adversely affecting hospital readmission rates or the length of hospital stay.
AHRQ-funded; HS023683; HS022882.
Citation: Jubelt LE, Goldfeld KS, Chung WY .
Changes in discharge location and readmission rates under Medicare bundled payment.
JAMA Intern Med 2016 Jan;176(1):115-7. doi: 10.1001/jamainternmed.2015.6265.
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Keywords: Medicare, Hospital Discharge, Hospital Readmissions, Home Healthcare, Healthcare Costs