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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 10 of 10 Research Studies DisplayedZachrison KS, Hsia RY, Schwamm LH
Insurance-based disparities in stroke center access in california: a network science approach.
The purpose of this study was to examine whether there is a relationship between ischemic stroke patient insurance and probability of transfer to a stroke center overall as well as whether hospital cluster modified the relationship between insurance and likelihood of stroke center transfer. The study included 332,995 total ischemic stroke encounters, with 3.5% transferred from the initial ED. The study found that of 52,316 participants presenting to a non-stroke center, 7.1% were transferred. Compared to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups. Within the 14 identified hospital clusters, there was variation in insurance-based disparities in transfer. The largest hospital was also the lowest performing cluster which fully explained the insurance-based disparity in odds of stroke center transfer. The study concluded that uninsured patients had lower stroke center access through transfer than patients with insurance, with the variation primarily explained by patterns in 1 specific hospital cluster.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hsia RY, Schwamm LH .
Insurance-based disparities in stroke center access in california: a network science approach.
Circ Cardiovasc Qual Outcomes 2023 Oct; 16(10):e009868. doi: 10.1161/circoutcomes.122.009868..
Keywords: Access to Care, Stroke, Cardiovascular Conditions, Disparities, Health Insurance, Uninsured
Duncan MS, Robbins NN, Wernke SA
Geographic variation in access to cardiac rehabilitation.
Considerable regional disparities exist in the commencement of cardiac rehabilitation (CR), with only 10% to 40% of eligible patients at the state level participating. The potential factors contributing to these discrepancies, such as accessibility to CR facilities, remain insufficiently explored. The purpose of this study was to assess the impact of CR center availability on CR initiation among Medicare beneficiaries. The researchers utilized Medicare records to pinpoint CR-eligible Medicare beneficiaries and compute CR initiation rates at the hospital referral region (HRR) level. Linear regression was applied to evaluate the percentage variance in CR initiation explained by CR accessibility across HRRs. Geospatial hotspot analysis was performed to detect CR deserts, or counties where the patient-to-CR center ratio is notably high. The study found that between 2014 and 2017, 1,133,657 Medicare beneficiaries were eligible for CR, with 263,310 (23%) initiating CR. The West North Central Census Division exhibited the highest adjusted CR initiation rate (35.4%) and the greatest concentration of CR programs (6.58 per 1,000 CR-eligible Medicare beneficiaries). CR program density accounted for 21.2% of the regional variation in CR initiation at the HRR level. A total of 40 predominantly urban counties, encompassing 14% of the U.S. population aged ≥65 years, were identified as CR deserts due to limited CR access.
AHRQ-funded; HS022990
Citation: Duncan MS, Robbins NN, Wernke SA .
Geographic variation in access to cardiac rehabilitation.
J Am Coll Cardiol 2023 Mar 21;81(11):1049-60. doi: 10.1016/j.jacc.2023.01.016.
Keywords: Rehabilitation, Access to Care, Cardiovascular Conditions
Coburn SB, Lang R, Zhang J
Statins utilization in adults with HIV: the treatment gap and predictors of statin initiation.
The purpose of this study was to describe trends in statin eligibility and subsequent statin initiation among people with HIV (PWH) from and identify the predictors of statin initiation. The researchers collected data from 12 United States cohorts between 2001 and 2017. The study found that among 16,409 PWH, 45% met statin eligibility criteria per guidelines for the time period from 2001 to 2017. Statin eligibility ranged from 22% to 25% from 2001 to 2013, and initiation increased from 13% to 45%. In 2014, 51% were statin-eligible, among whom 25% initiated statins, which increased to 32% by 2017. The researchers concluded that there is a substantial statin treatment gap, expanded by the 2013 ACC/AHA guidelines.
AHRQ-funded; 90047713.
Citation: Coburn SB, Lang R, Zhang J .
Statins utilization in adults with HIV: the treatment gap and predictors of statin initiation.
J Acquir Immune Defic Syndr 2022 Dec 15;91(5):469-78. doi: 10.1097/qai.0000000000003083..
Keywords: Medication, Human Immunodeficiency Virus (HIV), Access to Care, Practice Patterns, Cardiovascular Conditions
KS Cash, RE Adeoye, O
AHRQ Author: Zachrison
Estimated population access to acute stroke and telestroke centers in the US, 2019.
In order to provide an update on population-level access to stroke care, the investigators estimated the proportion of the US population with access to an ED with acute stroke capabilities and assessed the specific contribution of telestroke services to US population access. They observed a substantial increase in population access to acute stroke care in this cross-sectional study relative to previous reports using alternative methods, likely due to the extensive and ongoing work to improve stroke systems of care, including greater stroke center accreditation and expansion of telestroke capacity.
AHRQ-funded; HS024561.
Citation: KS Cash, RE Adeoye, O .
Estimated population access to acute stroke and telestroke centers in the US, 2019.
JAMA Netw Open 2022 Feb;5(2):e2145824. doi: 10.1001/jamanetworkopen.2021.45824..
Keywords: Telehealth, Health Information Technology (HIT), Stroke, Cardiovascular Conditions, Critical Care, Access to Care
Freno DR, Shipe ME, Levack MM
Modeling the impact of delaying transcatheter aortic valve replacement for the treatment of aortic stenosis in the era of COVID-19.
The objective of this study was to model the short term and 2-year overall survival for intermediate-risk and low-risk patients with severe symptomatic aortic stenosis (AS) undergoing timely or delayed transcatheter aortic valve replacement during the 2019 novel coronavirus (COVID-19) pandemic. Findings showed that prompt transcatheter aortic valve replacement for both intermediate-risk and low-risk patients with severe symptomatic AS resulted in improved 2-year survival when local healthcare system resources were not significantly constrained by COVID-19.
AHRQ-funded; HS026122.
Citation: Freno DR, Shipe ME, Levack MM .
Modeling the impact of delaying transcatheter aortic valve replacement for the treatment of aortic stenosis in the era of COVID-19.
JTCVS Open 2021 Sep;7:63-71. doi: 10.1016/j.xjon.2021.06.006..
Keywords: COVID-19, Heart Disease and Health, Cardiovascular Conditions, Access to Care
Dean JM, Hreha K, Hong I
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
This study examined post-stroke acute care patterns across Hospital Service Areas among a national stroke cohort of Medicare beneficiaries to determine drivers of variation in post-acute care service utilization. Data was extracted from 2013 to 2014 (174,498 total records across 3232 Hospital Service Areas). Patients’ residence ZIP codes were linked to the facility ZIP code where care was received. Patients were considered a “traveler” if they did not live in the Hospital Service Area where they received care. Only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas although 73.4% of all Hospital Service Areas were skilled nursing-only. Thirty-five percent of all patients traveled to a different Hospital Service Area from their residence. Patients living in skilled nursing-only Hospital Service Areas had more than 5 times the odds of traveling compared to those living in Hospital Service Areas with skilled nursing, inpatient rehabilitation, and long-term care hospital services.
AHRQ-funded; HS026133; HS024711.
Citation: Dean JM, Hreha K, Hong I .
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
BMC Health Serv Res 2021 Feb 25;21(1):176. doi: 10.1186/s12913-021-06159-z..
Keywords: Elderly, Hospitals, Access to Care, Stroke, Cardiovascular Conditions, Healthcare Utilization, Rehabilitation, Nursing Homes
Govindarajan P, Shiboski S, Grimes B
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Investigators sought to determine whether increasing access to primary stroke centers (regionalization) led to an increase in intravenous alteplase use in acute ischemic stroke patients. Studying two urban counties in the western region of US that regionalized acute stroke care, they found that in Santa Clara County, intravenous alteplase was administered to 1.7% of patients in the pre-regionalization period and 2.1% in the post-regionalization period, while in San Mateo County, the numbers were 1.3% and 3.2%, respectively. In the post-regionalization phase, San Mateo County had greater change in paramedic stroke detection, higher number of transports to primary stroke centers, and more frequent use of intravenous alteplase at stroke centers. They concluded that greater post-regionalization improvements in San Mateo County contributed to significantly improved county-level thrombolysis use than Santa Clara County.
AHRQ-funded; HS026207; HS017965.
Citation: Govindarajan P, Shiboski S, Grimes B .
Effect of acute stroke care regionalization on intravenous alteplase use in two urban counties.
Prehosp Emerg Care 2020 Jul-Aug;24(4):505-14. doi: 10.1080/10903127.2019.1679303..
Keywords: Stroke, Cardiovascular Conditions, Urban Health, Access to Care, Emergency Medical Services (EMS), Critical Care
Bernard D, Fang Z
AHRQ Author: Bernard D
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
Researchers examined the prevalence of high burdens and barriers to care among adults with heart disease treatment. Using MEPS data, they found that public insurance provides protection against high burdens but not against forgoing or delaying care. They recommended that future research investigate whether, and to what extent, barriers to care are associated with worse health outcomes and higher costs in the long term.
AHRQ-authored.
Citation: Bernard D, Fang Z .
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
J Am Heart Assoc 2019 Dec 17;8(24):e008831. doi: 10.1161/jaha.118.008831..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Heart Disease and Health, Cardiovascular Conditions, Access to Care
Capo-Lugo CE, Askew RL, Naidech A
Patients with greater stroke severity and premorbid disability are less likely to receive therapist consultations and intervention during acute care hospitalization.
The goal of this single-center longitudinal observational study was to estimate the proportion of and factors associated with receipt of therapist consultations and interventions during acute care hospitalization following ischemic and hemorrhagic stroke. Findings showed that approximately 1 in 4 study participants with acute stroke received neither a consultation nor an intervention. The authors conclude that efforts to improve the delivery of acute care therapy services are needed to optimize care for these people.
AHRQ-funded; HS000078.
Citation: Capo-Lugo CE, Askew RL, Naidech A .
Patients with greater stroke severity and premorbid disability are less likely to receive therapist consultations and intervention during acute care hospitalization.
Phys Ther 2019 Nov 25;99(11):1431-42. doi: 10.1093/ptj/pzz116..
Keywords: Disabilities, Stroke, Cardiovascular Conditions, Access to Care
Likosky DS, Sukul D, Seth M
Association between Medicaid expansion and cardiovascular interventions in Michigan.
This study evaluated Michigan’s Medicaid expansion as it relates to access and outcomes for 7,558 coronary artery bypass grafting operations at 33 hospitals and 45,183 percutaneous coronary interventions at 47 hospitals. Most of the change in access to revascularization occurred within the first quarter following expansion. Michigan’s Medicaid expansion was associated with changes in the demographic of those using specialty cardiovascular services (i.e., reduction in uninsured patients undergoing coronary rrevascularization).
AHRQ-funded; HS022535.
Citation: Likosky DS, Sukul D, Seth M .
Association between Medicaid expansion and cardiovascular interventions in Michigan.
J Am Coll Cardiol 2018 Mar 6;71(9):1050-51. doi: 10.1016/j.jacc.2017.12.044.
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Keywords: Access to Care, Cardiovascular Conditions, Heart Disease and Health, Surgery, Uninsured