National Healthcare Quality and Disparities Report
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- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Disparities (1)
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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 8 of 8 Research Studies DisplayedGanguli I, Mackwood MB, Yang CW
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
The objective of this retrospective cohort study was to characterize racial differences in receipt of low-value care among older Medicare beneficiaries overall and within U.S. health systems. Medicare fee-for-service administrative data was used for Black and White Medicare patients who were at least 65 as of 2016. Findings showed that, of the 40 low value services examined, Black patients had a higher adjusted receipt of 9 services and lower receipt of 20 services than White patients. Differences were generally small and largely due to differential care within health systems, but the authors concluded that their findings suggested potential factors that researchers, policymakers, and health system leaders might investigate to improve health care quality and equity.
AHRQ-funded; HS024930.
Citation: Ganguli I, Mackwood MB, Yang CW .
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
BMJ 2023 Oct 25; 383:e074908. doi: 10.1136/bmj-2023-074908..
Keywords: Elderly, Racial and Ethnic Minorities, Medicare, Health Systems
Chhabra KR, Sheetz KH, Regenbogen SE
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Researchers sought to measure the extent of variation in episode spending around total hip replacement for fee-for-service Medicare patients within and across hospital systems identified in the American Hospital Association Annual Survey. They found that average episode payments varied nearly as much within hospital systems as they did between the lowest- and highest-cost quintiles of systems, with variation driven by post-acute care utilization.
AHRQ-funded; HS000053.
Citation: Chhabra KR, Sheetz KH, Regenbogen SE .
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Ann Surg 2021 Dec 1;274(6):e1078-e84. doi: 10.1097/sla.0000000000003741..
Keywords: Surgery, Health Systems, Medicare, Healthcare Costs, Hospitals
Kranz AM, DeYoreo M, shete-Roesler B
Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.
The goal of this study was to test the hypothesis that health systems provide better care to patients with high needs compared to nonaffiliated physician organizations (POs). The 2015 Medicare Data on Provider Practice and Specialty linked physicians’ database was linked to POs Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and IRS Form 990 data to identify health system affiliations. Among 2,323,301 beneficiaries with high needs, 52.3% received care from system-affiliated practices. The emergency department (ED) visit rate was statistically significantly different in system-affiliated POs and nonaffiliated POs. There were small differences for the remaining five of six quality measures examined: continuity of care, follow-up visits, all-cause readmissions, and ambulatory care-sensitive hospitalizations. Within systems there was substantial variation for rates of continuity of care and follow-up after ED visits.
AHRQ-funded; HS024067.
Citation: Kranz AM, DeYoreo M, shete-Roesler B .
Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.
Health Serv Res 2020 Dec;55(Suppl 3):1118-28. doi: 10.1111/1475-6773.13570..
Keywords: Health Systems, Medicare, Quality of Care, Healthcare Delivery
Colla C, Yang W, Mainor AJ
Organizational integration, practice capabilities, and outcomes in clinically complex Medicare beneficiaries.
This study examines the association between clinical integration and financial integration, quality-focused care delivery processes, and beneficiary utilization and outcomes. Data was used from multiphysician practices in the 2017-2018 National Survey of Healthcare Organizations and Systems and 2017 Medicare claims data. Out of 1.6M fee-for-service Medicare beneficiaries aged 66 or older attributed to 2113 practices, 414,209 were considered clinically complex (frailty or 2 or more chronic conditions). Financial and clinical integration were weakly correlated. Clinical integration was significantly associated with greater adoption of quality-focused care delivery processes, while financial integration was associated with the opposite. Integration was not associated with reduced utilization or better beneficiary-level health-related outcomes, but both integration types were associated with lower spending.
AHRQ-funded; HS024075.
Citation: Colla C, Yang W, Mainor AJ .
Organizational integration, practice capabilities, and outcomes in clinically complex Medicare beneficiaries.
Health Serv Res 2020 Dec;55(Suppl 3):1085-97. doi: 10.1111/1475-6773.13580..
Keywords: Medicare, Health Systems, Healthcare Delivery
Timbie JW, Kranz AM, DeYoreo M
Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations.
The purpose of this study was to assess racial and ethnic disparities in care for Medicare fee-for-service (FFS) beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs. The investigators found no evidence that system-affiliated POs had smaller racial and ethnic disparities than nonaffiliated POs. Where differences existed, disparities were slightly larger in affiliated POs.
AHRQ-funded; HS024067.
Citation: Timbie JW, Kranz AM, DeYoreo M .
Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations.
Health Serv Res 2020 Dec;55(Suppl 3):1107-17. doi: 10.1111/1475-6773.13581..
Keywords: Racial and Ethnic Minorities, Disparities, Medicare, Health Systems
Short MN, Ho V
Weighing the effects of vertical integration versus market concentration on hospital quality.
Provider organizations are increasing in complexity, as hospitals acquire physician practices and physician organizations grow in size. At the same time, hospitals are merging with each other to improve bargaining power with insurers. In this study, the investigators analyzed 29 quality measures reported to the Center for Medicare and Medicaid Services' Hospital Compare database for 2008 to 2015 to test whether vertical integration between hospitals and physicians or increases in hospital market concentration influenced patient outcomes.
AHRQ-funded; HS024727.
Citation: Short MN, Ho V .
Weighing the effects of vertical integration versus market concentration on hospital quality.
Med Care Res Rev 2020 Dec;77(6):538-48. doi: 10.1177/1077558719828938.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Patient Experience, Hospitals, Medicare, Provider Performance, Health Systems
Sheetz KH, Chhabra K, Nathan H
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
The objective of this study was to assess whether the quality of surgical care changes as hospitals form networks with established, high-quality medical centers. The investigators concluded that network formation was not associated with a significant improvement in quality or reduction in Medicare expenditures across all procedures studied for hospitals joining the networks of America’s highest rated medical centers.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Chhabra K, Nathan H .
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
Ann Surg 2020 May;271(5):862-67. doi: 10.1097/sla.0000000000003195..
Keywords: Surgery, Hospitals, Quality of Care, Medicare, Health Systems
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.
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Keywords: Healthcare Costs, Payment, Health Systems, Medicaid, Medicare