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
AHRQ Research Studies Date
Topics
- Blood Clots (2)
- Cancer (1)
- Cancer: Colorectal Cancer (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (1)
- Central Line-Associated Bloodstream Infections (CLABSI) (1)
- Children/Adolescents (2)
- Diagnostic Safety and Quality (1)
- Dialysis (1)
- Elderly (1)
- Emergency Department (2)
- Healthcare-Associated Infections (HAIs) (3)
- Healthcare Costs (16)
- Healthcare Delivery (1)
- Healthcare Utilization (3)
- Health Insurance (7)
- Health Services Research (HSR) (3)
- Health Systems (1)
- Heart Disease and Health (1)
- Hospital Discharge (1)
- Hospitalization (2)
- Hospitals (10)
- Imaging (1)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Long-Term Care (1)
- Medicaid (5)
- Medicare (17)
- Newborns/Infants (1)
- Nursing Homes (2)
- Orthopedics (1)
- Patient Experience (2)
- Patient Safety (1)
- (-) Payment (37)
- Policy (10)
- Practice Patterns (1)
- Prevention (2)
- Primary Care (1)
- Provider: Health Personnel (1)
- Provider Performance (13)
- Public Reporting (2)
- Quality Improvement (10)
- Quality Indicators (QIs) (2)
- Quality of Care (13)
- Sepsis (1)
- Shared Decision Making (1)
- Surgery (3)
- Urinary Tract Infection (UTI) (1)
- Vaccination (1)
- Vulnerable Populations (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 25 of 37 Research Studies DisplayedNathan H, Dimick JB
Opportunities for surgical leadership in managing population health costs.
The concept of population health management—long a mainstay in primary care and chronic disease management—is taking root in surgery. The 2010 Affordable Care Act (ACA) ushered in the implementation of several innovative payment models that shift accountability for population costs to health systems and providers. The authors discuss the implications of th trends for the surgical profession.
AHRQ-funded; HS024763.
Citation: Nathan H, Dimick JB .
Opportunities for surgical leadership in managing population health costs.
Ann Surg 2016 Dec;264(6):909-10. doi: 10.1097/sla.0000000000001759.
.
.
Keywords: Healthcare Costs, Payment, Provider: Health Personnel, Surgery
Peiris D, Phipps-Taylor MC, Stachowski CA
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
The researchers examined differences between commercial accountable care organizations (ACOs) and noncommercial ACOs. They found that among all ACOs, there was low uptake of quality and efficiency activities; commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods; and about two-thirds of the ACOs had established processes for distributing any savings accrued. They concluded that ACO delivery systems remain at a nascent stage.
AHRQ-funded; HS024075.
Citation: Peiris D, Phipps-Taylor MC, Stachowski CA .
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
Health Aff 2016 Oct;35(10):1849-56. doi: 10.1377/hlthaff.2016.0387.
.
.
Keywords: Healthcare Costs, Payment, Health Systems, Medicaid, Medicare
Lau BD, Haut ER, Hobson DB
ICD-9 code-based venous thromboembolism performance targets fail to measure up.
Suboptimal prevention practices have prompted payers to consider hospital-associated Venous thromboembolism (VTE) as a potentially preventable condition for which financial incentives or penalties exist to drive practice improvement. The authors reviewed a subset of hospital-associated VTE that were identified by ICD-9 codes used by a state-run pay-for-performance quality improvement program and discuss their findings.
AHRQ-funded; HS017952.
Citation: Lau BD, Haut ER, Hobson DB .
ICD-9 code-based venous thromboembolism performance targets fail to measure up.
Am J Med Qual 2016 Sep;31(5):448-53. doi: 10.1177/1062860615583547.
.
.
Keywords: Healthcare-Associated Infections (HAIs), Quality Indicators (QIs), Prevention, Hospitals, Quality Improvement, Blood Clots, Payment, Provider Performance
Ellimoottil C, Ryan AM, Hou H
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Using Medicare claims for patients in Michigan who underwent lower extremity joint replacement in the period 2011-13, the researchers applied payment methods analogous to those CMS intends to use in determining annual bonuses or penalties (reconciliation payments) to hospitals. Their findings suggest that CMS should include risk adjustment in the Comprehensive Care for Joint Replacement program and in future bundled payment programs.
AHRQ-funded; HS024193; HS018546.
Citation: Ellimoottil C, Ryan AM, Hou H .
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Health Aff 2016 Sep;35(9):1651-7. doi: 10.1377/hlthaff.2016.0263.
.
.
Keywords: Medicare, Payment, Healthcare Costs, Orthopedics, Provider Performance
Rosenthal MB, Landrum MB, Robbins JA
Pay for performance in Medicaid: evidence from three natural experiments.
This study examined the impact of pay for performance in Medicaid on the quality and utilization of care. Primary outcomes of interest were Healthcare Effectiveness Data and Information Set (HEDIS)-like process measures of quality, utilization by service category, and ambulatory care-sensitive admissions and emergency department visits. Its findings were mixed, with no measurable quality improvements across the three states (Pennsylvania, Minnesota, Alabama), but reductions in hospital admissions in two programs.
AHRQ-funded.
Citation: Rosenthal MB, Landrum MB, Robbins JA .
Pay for performance in Medicaid: evidence from three natural experiments.
Health Serv Res 2016 Aug;51(4):1444-66. doi: 10.1111/1475-6773.12426.
.
.
Keywords: Medicaid, Payment, Provider Performance, Healthcare Utilization, Quality of Care, Hospitalization, Emergency Department
Colla CH, Lewis VA, Kao LS
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
The purpose of this cohort study was to examine the effect of Medicare accountable care organization (ACO) contracts on both spending and high-cost institutional utilization for all Medicare beneficiaries and for clinically vulnerable beneficiaries. The main outcomes and measures for this study were total spending per beneficiary-quarter, spending categories, utilization of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. The study found that total spending decreased by $34 per beneficiary-quarter after implementation of ACO contracts across the overall Medicare population and decreased $114 in clinically vulnerable patients. In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively. Hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively. Variations in total spending related with ACOs did not differ by clinical condition of beneficiaries.
AHRQ-funded; HS024075.
Citation: Colla CH, Lewis VA, Kao LS .
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
JAMA Intern Med 2016 Aug;176(8):1167-75. doi: 10.1001/jamainternmed.2016.2827.
.
.
Keywords: Medicare, Policy, Healthcare Costs, Payment, Vulnerable Populations
Erickson KF, Winkelmayer WC, Chertow GM
Effects of physician payment reform on provision of home dialysis.
The investigators evaluated whether Medicare payment reform influenced dialysis modality assignment. They concluded that transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis.
AHRQ-funded; HS019178.
Citation: Erickson KF, Winkelmayer WC, Chertow GM .
Effects of physician payment reform on provision of home dialysis.
Am J Manag Care 2016 Jun;22(6):e215-23.
.
.
Keywords: Dialysis, Healthcare Costs, Kidney Disease and Health, Payment, Practice Patterns
Brown TT, Robinson JC
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
The authors extended reference pricing (RP) models to a hospital context focusing on insurer and consumer payments. They found that, for 2 years following RP implementation, insurer payments to high-price and low-price hospitals moved downward, consistent with endogenous RP. When the reference price was not reset to account for changes in market prices, insurer payments to low-price hospitals reverted to pre-implementation levels, consistent with exogenous RP.
AHRQ-funded; HS022098.
Citation: Brown TT, Robinson JC .
Reference pricing with endogenous or exogenous payment limits: impacts on insurer and consumer spending.
Health Econ 2016 Jun;25(6):740-9. doi: 10.1002/hec.3181.
.
.
Keywords: Payment, Healthcare Costs, Health Insurance, Hospitals
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.
.
.
Keywords: Medicare, Provider Performance, Payment, Hospitals, Healthcare Costs, Quality of Care
Hu T, Decker SL, Chou SY
AHRQ Author: Decker SL
Medicaid pay for performance programs and childhood immunization status.
This national study examined the effects of pay for performance (P4P) programs on childhood immunization rates. It found no overall effect of Medicaid P4P on the chance that children aged 19-35 months had completed the 4:3:1:3:3:1 vaccination series. However, there was a 4 percentage point increase in the chance that a child 19-23 months had completed the series.
AHRQ-authored.
Citation: Hu T, Decker SL, Chou SY .
Medicaid pay for performance programs and childhood immunization status.
Am J Prev Med 2016 May;50(5 Suppl 1):S51-7. doi: 10.1016/j.amepre.2016.01.012.
.
.
Keywords: Newborns/Infants, Children/Adolescents, Medicaid, Vaccination, Payment, Health Insurance
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.
.
.
Keywords: Diagnostic Safety and Quality, Healthcare Costs, Payment, Medicare
Kondo KK, Damberg CL, Mendelson A
Implementation processes and pay for performance in healthcare: A systematic review.
The authors conducted a systematic review and key informant (KI) interviews to better understand the implementation factors that modify the effectiveness of pay for performance (P4P). They concluded that P4P programs should undergo regular evaluation and should target areas of poor performance, and also that measures and incentives should align with organizational priorities, and programs should allow for changes over time in response to data and provider input.
AHRQ-funded; HS022981.
Citation: Kondo KK, Damberg CL, Mendelson A .
Implementation processes and pay for performance in healthcare: A systematic review.
J Gen Intern Med 2016 Apr;31 Suppl 1:61-9. doi: 10.1007/s11606-015-3567-0.
.
.
Keywords: Healthcare Delivery, Provider Performance, Payment, Quality of Care
Sommers BD, Stone J, Kane N
Predictors of payer mix and financial performance among safety net hospitals prior to the Affordable Care Act.
The objective of this study was to use audited hospital financial statements to identify predictors of payer mix and financial performance in safety net hospitals prior to the Affordable Care Act. It found that university governance was the strongest positive predictor of operating margin. Safety net hospital financial performance varied considerably. Academic hospitals had higher operating margins, while more generous Medicaid eligibility and reimbursement policies improved hospitals' ability to recoup costs.
AHRQ-funded; HS021291.
Citation: Sommers BD, Stone J, Kane N .
Predictors of payer mix and financial performance among safety net hospitals prior to the Affordable Care Act.
Int J Health Serv 2016;46(1):166-84. doi: 10.1177/0020731415586408.
.
.
Keywords: Hospitals, Policy, Medicaid, Payment
Zuvekas SH, Cohen JW
AHRQ Author: Zuvekas SH, Cohen JW
Fee-for-service, while much maligned, remains the dominant payment method for physician visits.
Recent concerted efforts have sought to shift provider payment away from fee-for-service and toward risk-based alternatives. Despite these efforts, fee-for-service not only remains the dominant payment method but has continued to grow, with nearly 95 percent of all physician office visits in 2013 reimbursed in this fashion.
AHRQ-authored.
Citation: Zuvekas SH, Cohen JW .
Fee-for-service, while much maligned, remains the dominant payment method for physician visits.
Health Aff 2016 Mar;35(3):411-4. doi: 10.1377/hlthaff.2015.1291.
.
.
Keywords: Health Insurance, Payment, Primary Care
Chien AT, Schiavoni KH, Sprecher E
How accountable care organizations responded to pediatric incentives in the alternative quality contract.
The authors characterized the pediatric infrastructure of adult-oriented accountable care organizations (ACOs) and obtained leaders' perspectives on their ACOs' response to pediatric incentives. They found that most ACOs augmented their pediatric quality improvement and spending reduction efforts when faced with pediatric incentives.
AHRQ-funded; HS017146.
Citation: Chien AT, Schiavoni KH, Sprecher E .
How accountable care organizations responded to pediatric incentives in the alternative quality contract.
Acad Pediatr 2016 Mar;16(2):200-7. doi: 10.1016/j.acap.2015.10.008.
.
.
Keywords: Children/Adolescents, Health Insurance, Quality of Care, Payment, Quality Indicators (QIs)
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.
.
.
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.
.
.
Keywords: Healthcare Costs, Medicare, Hospitals, Provider Performance, Hospitalization, Payment, Hospital Discharge
Calderwood MS, Vaz LE, Tse Kawai A
Impact of hospital operating margin on central line-associated bloodstream infections following Medicare's hospital-acquired conditions payment policy.
In October 2008, Medicare ceased additional payment for hospital-acquired conditions not present on admission. The researchers evaluated the policy's differential impact in hospitals with high vs low operating margins. They concluded that Medicare's payment policy may have had an impact on reducing central line-associated bloodstream infections in hospitals with low operating margins.
AHRQ-funded; HS018414.
Citation: Calderwood MS, Vaz LE, Tse Kawai A .
Impact of hospital operating margin on central line-associated bloodstream infections following Medicare's hospital-acquired conditions payment policy.
Infect Control Hosp Epidemiol 2016 Jan;37(1):100-3. doi: 10.1017/ice.2015.250.
.
.
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Medicare, Quality of Care, Payment, Sepsis
Hawken SR, Ryan AM, Miller DC
Surgery and Medicare shared savings program accountable care organizations.
The researchers investigated the degree to which surgeons and other specialists are participating in Medicare Shared Savings Programs, and whether such specialist integration influences accountable care organization (ACO) performance. They found that participation by surgeons and other specialists in Medicare ACO programs is highly variable. Some ACOs include many specialists who are tightly integrated with primary care physicians, while others consist solely of primary care physicians.
AHRQ-funded; HS018546.
Citation: Hawken SR, Ryan AM, Miller DC .
Surgery and Medicare shared savings program accountable care organizations.
JAMA Surg 2016 Jan;151(1):5-6. doi: 10.1001/jamasurg.2015.2772.
.
.
Keywords: Surgery, Medicare, Payment, Healthcare Costs
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
AHRQ-authored.
Citation: Kronick R, Casalino LP, Bindman AB .
Apple pickers or federal judges: strong versus weak incentives in physician payment.
Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
.
.
Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
AHRQ-funded
Citation: Berenson RA, Rice T .
Beyond measurement and reward: methods of motivating quality improvement and accountability.
Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
.
.
Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Payment
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
Berdahl C, Schuur JD, Fisher NL
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
In May 2015, Academic Emergency Medicine convened a consensus conference titled "Diagnostic Imaging in the Emergency Department: A Research Agenda to Optimize Utilization." As part of the conference, a panel of health care policy leaders and emergency physicians discussed the effect of the Affordable Casre Act and other quality programs on ED diagnostic imaging. This article discusses the content of the panel's presentations.
AHRQ-funded; HS023498.
Citation: Berdahl C, Schuur JD, Fisher NL .
Policy measures and reimbursement for emergency medical imaging in the era of payment reform: proceedings from a panel discussion of the 2015 Academic Emergency Medicine Consensus Conference.
Acad Emerg Med 2015 Dec;22(12):1393-9. doi: 10.1111/acem.12829.
.
.
Keywords: Emergency Department, Healthcare Costs, Payment, Policy, Imaging, Policy, Quality Improvement
Luft HS
Policy-oriented research on improved physician incentives for higher value health care.
Policy makers (both public and private) are seeking ways to improve the value delivered within our health care system. To inform such policy changes, this paper identifies areas in which little is known about the effects of specific incentives (FFS, salary, etc.) on the two components of value: resource use and quality. Specific suggestions are offered focusing on fundamental "building block" studies.
AHRQ-funded.
Citation: Luft HS .
Policy-oriented research on improved physician incentives for higher value health care.
Health Serv Res 2015 Dec;50 Suppl 2:2187-215. doi: 10.1111/1475-6773.12423.
.
.
Keywords: Policy, Health Insurance, Payment, Health Services Research (HSR)
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
AHRQ-funded.
Citation: Schlesinger M, Grob R, Shaller D .
Using patient-reported information to improve clinical practice.
Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
.
.
Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Payment, Public Reporting