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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.
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1 to 19 of 19 Research Studies DisplayedKakara M, Venkataramani AS
Earnings of US physicians with and without disabilities.
The researchers report that across industries, workers with disabilities earn less than workers without disabilities. As greater numbers of people with disabilities enter medicine, they face substantial challenges in medical education and higher risks of mistreatment at work. As physicians in older age groups grows, the incidence of disability increases. The purpose of this study was to explore possible disability earnings gaps in medicine. The study cohort included 92,469 physicians, 2.0% of whom reported having a disability. The study found that in the adjusted analyses of employed physicians, annual earned income was 20.8% lower and hourly earned income was 13.3% lower among physicians with disabilities. Physicians reporting disabilities worked an average of 110 hours fewer per year compared with those without disabilities. Estimated differences in annual income by disability status were similar after adjusting for hours worked and surgical specialty status and across age groups; estimates were much greater for disabilities affecting cognitive function, ambulation, independent living, and self-care than vision or hearing.
AHRQ-funded; HS026116.
Citation: Kakara M, Venkataramani AS .
Earnings of US physicians with and without disabilities.
JAMA Health Forum 2023 Dec; 4(12):e233954. doi: 10.1001/jamahealthforum.2023.3954..
Keywords: Provider: Physician, Disabilities
James TG, Sullivan MK, McKee MM
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
The objectives of this qualitative study were to describe emergency department (ED) care-seeking and patient-centered care perspectives among deaf and hard-of-hearing (DHH) patients and to explain quantitative findings related to ED outcomes among DHH and non-DHH patients. Researchers conducted semi-structured interviews with four DHH American Sign Language (ASL)-users and six DHH English speakers from north central Florida. Two themes emerged: DHH patients engage in complex decisionmaking processes to determine ED utilization and patient-centered ED care differs between DHH ASL-users and English speakers. The researchers concluded that their study underscores the importance of better understanding and intervention in DHH patient ED care seeking and delivery to improve patient outcomes.
AHRQ-funded; HS027537.
Citation: James TG, Sullivan MK, McKee MM .
Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients.
Health Expect 2023 Dec; 26(6):2374-86. doi: 10.1111/hex.13842..
Keywords: Emergency Department, Patient-Centered Healthcare, Disabilities, Vulnerable Populations
Frehn JL, Li JN, Liu KR
Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.
This study assessed the results of implementing an intervention to increase screening of developmental delays in children at six federally qualified health center (FQHC) sites in Northern California from April 2014 to April 2017. The goals of the intervention were to increase (a) standardized developmental screening at recommended intervals and (b) follow-up care and support for early intervention services. The aim was to optimize each site's screening processes, supported by an automated electronic tablet-based system. Social workers were hired to conduct follow-up clinical assessments, provide psychosocial education and treatment, provide referrals, provide case management support, and collaborate with service partners. During the last year of the intervention, when tablet-based screening was adopted, the sites screened an estimated 6,550 children ages 0-18 at 23 intervals in three domains (developmental, autism, and psychosocial/behavioral), compared to a baseline where they screened children ages 0-3 at four intervals in one domain. Screening rates increased from 65.3% to 75.5% after automation was extended from the first to the second site and continued its’ increase to 91.8% after automation was expanded to the remaining sites. Ranges for follow-up visits were between 74% and 88%.
AHRQ-funded; HS000046.
Citation: Frehn JL, Li JN, Liu KR .
Implementation of a universal screening and follow-up care system for pediatric developmental and behavioral health in federally qualified health center sites.
Fam Syst Health 2023 Dec; 41(4):454-66. doi: 10.1037/fsh0000803..
Keywords: Children/Adolescents, Disabilities, Screening, Implementation
Grove LR, Berkowitz SA, Cuddeback G
Permanent supportive housing receipt and health care use among adults with disabilities.
This study’s objective was to assess whether permanent supportive housing (PSH) participation is associated with health service use among a population of adults with disabilities, including people transitioning into PSH from community and institutional settings. Primary data sources used were 2014 to 2018 secondary data from a PSH program in North Carolina linked to Medicaid claims. The authors used propensity score weighting to estimate the average treatment effect on the treated of PSH participation. Using weighted analysis, they found that among individuals who were institutionalized prior to PSH, PSH participation was associated with greater hospitalizations and emergency department (ED) visits and fewer primary care visits during the follow-up period, compared with similar individuals who largely remained institutionalized. There was no significantly different health service use from similar comparison group members for individuals who entered PSH from community settings during the 12-month follow-up period.
AHRQ-funded; HS000032.
Citation: Grove LR, Berkowitz SA, Cuddeback G .
Permanent supportive housing receipt and health care use among adults with disabilities.
Med Care Res Rev 2023 Dec; 80(6):596-607. doi: 10.1177/10775587231183192..
Keywords: Disabilities, Vulnerable Populations, Access to Care
Fabius CD, Okoye SM, Wu MMJ
The role of place in person- and family-oriented long-term services and supports.
The authors developed a conceptual framework to identify environmental domains contributing to the use, care quality, and care experiences of long-term services and supports (LTSS). They found that LTSS-relevant environmental characteristics are differentially relevant to the care experiences of older adults with disabilities. Measures of neighborhood social and economic deprivation were highly associated with adverse consequences due to unmet care needs. Measures of health care and social services delivery environment were inversely associated with participation restrictions in valued activities. The authors concluded that greater attention should be given to strengthening state- and community-based policies and practices that support aging in place.
AHRQ-funded; HS000029.
Citation: Fabius CD, Okoye SM, Wu MMJ .
The role of place in person- and family-oriented long-term services and supports.
Milbank Q 2023 Dec; 101(4):1076-138. doi: 10.1111/1468-0009.12664..
Keywords: Long-Term Care, Elderly, Disabilities
Zondlak AN, Oh EJ, Neiman PU
Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery.
Individuals with intellectual disabilities may be at higher risk of delayed presentation and worse outcomes for emergency general surgery (EGS) conditions. The purpose of this study was to explore the relationship between intellectual disability and both severity of disease and clinical outcomes in patients presenting with typical EGS conditions. The study found that of 1,317,572 adult EGS admissions, 0.38% of patients had an ICD-9/-10 code consistent with current intellectual disability. EGS patients with intellectual disabilities had 31% greater odds of more severe disease at presentation when compared with neurotypical patients. Intellectual disability was also related with a higher likelihood of complications and mortality, longer lengths of stay, lower rate of discharge to home, and higher inpatient costs.
AHRQ-funded; HS028672; HS027788.
Citation: Zondlak AN, Oh EJ, Neiman PU .
Association of intellectual disability with delayed presentation and worse outcomes in emergency general surgery.
Ann Surg 2023 Nov 1; 278(5):e1118-e22. doi: 10.1097/sla.0000000000005863..
Keywords: Healthcare Cost and Utilization Project (HCUP), Disabilities, Surgery, Outcomes
Barnett S, Matthews K, DeWindt L
Deaf Weight Wise: a novel randomized clinical trial with Deaf sign language users.
The purpose of this research was to address the lack of scientifically supported weight management programs specifically designed for the Deaf population. The researchers developed the Deaf Weight Wise (DWW) trial and intervention which was informed by community-based participatory research. The primary focus of DWW is promoting a healthy lifestyle and weight management through dietary adjustments and physical activity. A total of 104 Deaf adults aged 40 to 70 years, with a BMI ranging from 25 to 45, were recruited from community settings in Rochester, New York. Participants were randomized into either immediate intervention (n = 48) or a 1-year delayed intervention group (n = 56). The latter group served as a no-intervention control until the trial's midpoint. Data were collected at five time points (every six months) from baseline to 24 months. All DWW intervention leaders and participants were Deaf individuals using American Sign Language (ASL). The study found that at the 6-month mark, the average weight change difference between the immediate-intervention group and the delayed-intervention group (no intervention yet) was -3.4 kg. A majority (61.6%) of those in the immediate intervention group lost ≥5% of their baseline weight, compared to 18.1% in the no-intervention-yet group. Indicators of participant engagement included an average attendance of 11/16 sessions (69%), and 92% completed the 24-month data collection. The researchers concluded that the DWW program, which is community-engaged, culturally tailored, and provides language accessibility, successfully supported weight loss among Deaf ASL users.
AHRQ-funded; HS015700
Citation: Barnett S, Matthews K, DeWindt L .
Deaf Weight Wise: a novel randomized clinical trial with Deaf sign language users.
Obesity 2023 Apr;31(4):965-76. doi: 10.1002/oby.23702.
Keywords: Obesity: Weight Management, Disabilities, Obesity
Zuckerman KE, Chavez AE, Regalado Murillo C
Disparities in familiarity with developmental disabilities among low-income parents.
Parent knowledge about developmental disabilities (DDs) may facilitate access to DD care; however, parents may vary in their knowledge and familiarity with common DDs. The objective of this study was to assess racial/ethnic and language differences in low-income families' familiarity, knowledge, and personal experience with DDs. The investigators concluded that low-income Latino-LEP and other race parents have less familiarity or personal experience with DDs and are less aware of early signs of DDs compared to low-income white parents.
AHRQ-funded; HS000063.
Citation: Zuckerman KE, Chavez AE, Regalado Murillo C .
Disparities in familiarity with developmental disabilities among low-income parents.
Acad Pediatr 2018 Nov - Dec;18(8):944-51. doi: 10.1016/j.acap.2018.06.011..
Keywords: Disabilities, Children/Adolescents, Caregiving, Health Literacy, Low-Income, Vulnerable Populations, Racial and Ethnic Minorities
Perez Jolles M, Thomas KC
Disparities in self-reported access to patient-centered medical home care for children with special health care needs.
The purpose of this study was to examine variation in caregiver service experience concordant with care in patient-centered medical home (PCMH) over time and by the characteristics of separate groups of children with special health care needs (CSHCNs). Researchers used 2003-2012 Medical Expenditures Panel Survey data for CSHCNs for cross-sectional pooled data analysis. Their conclusions suggest that disparities remain among high-need CSHCNs. Future research that focuses on a better understanding of how clinical settings tailor this care model, particularly to provide increased access and patient-centered care, is recommended.
AHRQ-funded; HS000032.
Citation: Perez Jolles M, Thomas KC .
Disparities in self-reported access to patient-centered medical home care for children with special health care needs.
Med Care 2018 Oct;56(10):840-46. doi: 10.1097/mlr.0000000000000978..
Keywords: Access to Care, Children/Adolescents, Disabilities, Disparities, Medical Expenditure Panel Survey (MEPS), Patient-Centered Healthcare, Vulnerable Populations
Jolles MP, Lee PJ, Javier JR
Shared decision-making and parental experiences with health services to meet their child's special health care needs: racial and ethnic disparities.
This study investigated the relationship between shared decision-making (SDM) and parents’ frustrations in getting health needs met for their special needs child. Secondary analysis was done on data from the 2009-2010 National Survey of Children with Special Health Care Needs. More Whites than Blacks engaged in SDM, and when Blacks did engage they had a higher odds of negative experiences than Whites. Researchers weren’t sure what the cause was of that, but speculated it was due to increased awareness of service challenges.
AHRQ-funded; HS000032.
Citation: Jolles MP, Lee PJ, Javier JR .
Shared decision-making and parental experiences with health services to meet their child's special health care needs: racial and ethnic disparities.
Patient Educ Couns 2018 Oct;101(10):1753-60. doi: 10.1016/j.pec.2018.05.022..
Keywords: Access to Care, Caregiving, Children/Adolescents, Shared Decision Making, Disabilities, Disparities, Racial and Ethnic Minorities
Crossman MK, Parish SL, Hauser-Cram P
The influence of early intervention, informal support and the family environment on trajectories of competence for fathers raising children with developmental disabilities.
The aims of this study are: (1) To determine the trajectory of parental competence for fathers of children with developmental disabilities from age 3 to age 15; (2) Controlling for child and family characteristics, determine the main effects of the family environment, informal support, and early intervention (EI) services on paternal competence when their child with a developmental disability was age 3; and (3) To determine whether there were lasting effects of the family environment, informal support, and the EI service system on differences in paternal competence over time.
AHRQ-funded; HS000063.
Citation: Crossman MK, Parish SL, Hauser-Cram P .
The influence of early intervention, informal support and the family environment on trajectories of competence for fathers raising children with developmental disabilities.
Res Dev Disabil 2018 Oct;81:122-33. doi: 10.1016/j.ridd.2018.04.025..
Keywords: Caregiving, Children/Adolescents, Disabilities, Family Health and History
Zuckerman KE, Lindly OJ, Reyes NM
Parent perceptions of community autism spectrum disorder stigma: measure validation and associations in a multi-site sample.
In this study, the investigators developed a brief, English/Spanish bilingual parent-reported scale of perceived community autism spectrum disorder (ASD) stigma and tested it in a multi-site sample of Latino and non-Latino white parents of children with ASD.
AHRQ-funded; HS000063.
Citation: Zuckerman KE, Lindly OJ, Reyes NM .
Parent perceptions of community autism spectrum disorder stigma: measure validation and associations in a multi-site sample.
J Autism Dev Disord 2018 Sep;48(9):3199-209. doi: 10.1007/s10803-018-3586-x..
Keywords: Autism, Disabilities, Social Stigma, Social Determinants of Health, Behavioral Health
Sen AP, Chen LM, Wong Samson L
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
The purpose of this study was to examine performance by accountable care organizations (ACOs) in the top quintile of their proportion of beneficiaries who were dually enrolled in Medicare and Medicaid (high-dual), and the top quintile of disabled beneficiaries (high-disabled). Measures used were quality scores, savings per beneficiary, whether or not the ACO shared savings and the amount of shared savings. The researchers found that high-dual and high-disabled ACOs had similar or higher spending than other ACOs at baseline, but achieved greater savings and were equally or more likely to earn shared savings; alternative payment models can have positive financial outcomes for providers serving vulnerable populations.
AHRQ-funded; HS024698.
Citation: Sen AP, Chen LM, Wong Samson L .
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
Med Care 2018 Sep;56(9):805-11. doi: 10.1097/mlr.0000000000000968..
Keywords: Disabilities, Medicare, Healthcare Costs, Provider Performance, Payment, Low-Income, Vulnerable Populations
Skolasky RL, Scherer EA, Wegener ST
Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial.
This study aimed to evaluate pathways for improvements in quality of life during the first year after surgery for IDH by studying temporal relationships between sciatica symptoms, pain-related disability, and physical health. Investigators found that three months after surgery, patients reported reduced sciatica and pain-related disability. Early reduction in pain-related disability is important because path analysis indicated that disability at 3 months was predictive of sciatica and physical health at 1 year.
AHRQ-funded; HS017990; HS016106.
Citation: Skolasky RL, Scherer EA, Wegener ST .
Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial.
Spine J 2018 Aug;18(8):1318-24. doi: 10.1016/j.spinee.2017.11.016.
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Keywords: Disabilities, Outcomes, Pain, Patient-Centered Outcomes Research, Quality of Life, Surgery
Lindly OJ, Thorburn S, Heisler K
Parents' use of complementary health approaches for young children with autism spectrum disorder.
Researchers conducted a study to better understand factors influencing parents' decision to use complementary health approaches (CHA) for children with autism spectrum disorder (ASD). CHA use was negatively associated with older child age and positively associated with parents' belief ASD has major consequences and medication use. Nine themes help explain these results.
AHRQ-funded; HS000063.
Citation: Lindly OJ, Thorburn S, Heisler K .
Parents' use of complementary health approaches for young children with autism spectrum disorder.
J Autism Dev Disord 2018 May;48(5):1803-18. doi: 10.1007/s10803-017-3432-6.
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Keywords: Autism, Children/Adolescents, Complementary and Alternative Medicine, Shared Decision Making, Disabilities
Crossman MK, Warfield ME, Kotelchuck M
Associations between early intervention home visits, family relationships and competence for mothers of children with developmental disabilities.
The researchers examined the association between intensity of home visits in early intervention (EI), perceived helpfulness of home visits in EI, and positive family relationships as predictors of maternal competence at age 3, as well as moderating effects of predictors, controlling for child characteristics, family demographics, and negative life events. They found that the intensity of home visits was not significantly associated with maternal competence at age 3.
AHRQ-funded; HS000063.
Citation: Crossman MK, Warfield ME, Kotelchuck M .
Associations between early intervention home visits, family relationships and competence for mothers of children with developmental disabilities.
Matern Child Health J 2018 Apr;22(4):599-607. doi: 10.1007/s10995-018-2429-x.
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Keywords: Children/Adolescents, Disabilities, Family Health and History, Patient and Family Engagement
Lindly O, Thorburn S, Zuckerman K
Use and nondisclosure of complementary health approaches among US children with developmental disabilities.
The researchers aimed to profile the use and nondisclosure of complementary health approaches (CHAs) among US children with developmental disabilities (DDs). They found that nearly one-quarter (23 percent) of US children with DDs used CHAs. Among those with a personal health provider, 42 percent of parents did not disclose some or all CHAs used to the child's provider.
AHRQ-funded; HS000063.
Citation: Lindly O, Thorburn S, Zuckerman K .
Use and nondisclosure of complementary health approaches among US children with developmental disabilities.
J Dev Behav Pediatr 2018 Apr;39(3):217-27. doi: 10.1097/dbp.0000000000000536.
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Keywords: Children/Adolescents, Complementary and Alternative Medicine, Shared Decision Making, Disabilities
Lewis AH, Chugh A, Sobotka SA
Behavioral outbursts in a child with a deletion syndrome, generalized epilepsy, global developmental delay, and failure to thrive.
This paper presents the case of a 7-year-old girl with 20q13.33 deletion and a history of generalized convulsive epilepsy who presented to the Developmental and Behavioral Pediatrics Clinic due to concerns about her behavioral outbursts in the context of overall delayed development.
AHRQ-funded; HS023007.
Citation: Lewis AH, Chugh A, Sobotka SA .
Behavioral outbursts in a child with a deletion syndrome, generalized epilepsy, global developmental delay, and failure to thrive.
Pediatr Ann 2018 Mar;47(3):e130-e34. doi: 10.3928/19382359-20180223-01..
Keywords: Case Study, Children/Adolescents, Disabilities, Genetics, Neurological Disorders
Graham JE, Middleton A, Roberts P
Health services research in rehabilitation and disability-the time is now.
In this Special Communication, the authors discuss the role of rehabilitation researchers in health services research (HSR). They also provide information on current resources available in our field for conducting HSR and identify gaps for capacity building and future research. Health care reforms are a reality, and through HSR, researchers can give rehabilitation a strong voice during these transformative times.
AHRQ-funded; HS022134.
Citation: Graham JE, Middleton A, Roberts P .
Health services research in rehabilitation and disability-the time is now.
Arch Phys Med Rehabil 2018 Jan;99(1):198-203. doi: 10.1016/j.apmr.2017.06.026.
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Keywords: Disabilities, Health Services Research (HSR), Patient-Centered Healthcare, Rehabilitation