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
1 to 25 of 31 Research Studies DisplayedBayliss WS, Bushnell CD, Halladay JR
The cost of implementing and sustaining the COMprehensive Post-Acute Stroke Services model.
This study compares the outcomes of using the COMprehensive Post-Acute Stroke Services (COMPASS) model, a transitional care intervention for stroke patients discharged to home against status quo postacute stroke care in a cluster-randomized trial in 40 hospitals in North Carolina. Hospital-level costs associated with implementing and sustaining COMPASS were examined during a 1-year period. Out of 40 hospitals, 22 hospitals were actively engaged in COMPASS. A 10% higher stroke patient volume was associated with 5.1% lower COMPASS costs per patient. About half of hospitals (N = 10) reported postacute clinic visits as their highest cost activity, while 7 hospitals reported case ascertainment as their highest cost activity. The authors estimated that based on average costs of COMPASS and readmissions, COMPASS could lower net costs if the model can prevent about 6 readmissions per year.
AHRQ-funded; HS025723.
Citation: Bayliss WS, Bushnell CD, Halladay JR .
The cost of implementing and sustaining the COMprehensive Post-Acute Stroke Services model.
Med Care 2021 Feb;59(2):163-68. doi: 10.1097/mlr.0000000000001462..
Keywords: Stroke, Cardiovascular Conditions, Healthcare Costs, Outcomes, Patient-Centered Outcomes Research, Evidence-Based Practice
Greenhawt M, Shaker M
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
The authors sought to identify scenarios in which current early peanut introduction guidelines would be cost-effective. They found that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, skin prick test sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to achieve realistically. They recommend further research to define the health state utility associated with reaction location.
AHRQ-funded; HS024599.
Citation: Greenhawt M, Shaker M .
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
JAMA Netw Open 2019 Dec 2;2(12):e1918041. doi: 10.1001/jamanetworkopen.2019.18041..
Keywords: Patient-Centered Outcomes Research, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Skin Conditions, Screening, Healthcare Costs, Evidence-Based Practice, Guidelines
Shaker M, Wallace D, Golden DBK
Simulation of health and economic benefits of extended observation of resolved anaphylaxis.
The objective of this study was to characterize the cost-effectiveness of short vs prolonged medical observation times after resolved anaphylaxis. The authors suggested that the study indicated prolonged medical observation (6-24 hours) for resolved anaphylaxis may not be cost-effective for patients at low risk for biphasic anaphylaxis; however, in particular clinical circumstances of low observation costs, high postdischarge risk of biphasic anaphylaxis, or large incremental fatality risk reduction associated with extended observation, longer medical observation could be justified.
AHRQ-funded; HS024599.
Citation: Shaker M, Wallace D, Golden DBK .
Simulation of health and economic benefits of extended observation of resolved anaphylaxis.
JAMA Netw Open 2019 Oct 2;2(10):e1913951. doi: 10.1001/jamanetworkopen.2019.13951..
Keywords: Healthcare Costs, Patient-Centered Outcomes Research
McGinn T, Cohen S, Khan S
The high cost of low value care.
The main focus of this study was bridging the "evidence gap" between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From their work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, the investigators integrated the highly validated Wells' criteria into the electronic health record at two of their major academic tertiary hospitals.
AHRQ-funded; HS022061.
Citation: McGinn T, Cohen S, Khan S .
The high cost of low value care.
Trans Am Clin Climatol Assoc 2019;130:60-70..
Keywords: Healthcare Costs, Evidence-Based Practice, Patient-Centered Outcomes Research, Shared Decision Making, Comparative Effectiveness
Bateni SB, Gingrich AA, Jeon SY
Clinical outcomes and costs following unplanned excisions of soft tissue sarcomas in the elderly.
This study’s goal was to analyze the costs and outcomes of planned vs. unplanned soft tissue sarcoma (STS) excisions in the Medicare population. The authors analyzed 3913 surgical patients with STS >/=66 y old from 1992 to 2011 using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) datafiles. Planned excision rates were classified from preoperative MRI or biopsy records. There was no difference in survival rates between planned vs. unplanned excisions. Planned excisions costs were higher than unplanned excision with the first resection contributing to the majority of costs.
AHRQ-funded; HS022236.
Citation: Bateni SB, Gingrich AA, Jeon SY .
Clinical outcomes and costs following unplanned excisions of soft tissue sarcomas in the elderly.
J Surg Res 2019 Jul;239:125-35. doi: 10.1016/j.jss.2019.01.055..
Keywords: Healthcare Costs, Cancer, Elderly, Surgery, Outcomes, Patient-Centered Outcomes Research
Nguyen OK, Vazquez MA, Charles MA
Association of scheduled vs emergency-only dialysis with health outcomes and costs in undocumented immigrants with end-stage renal disease.
This paper discusses costs and mortality associated with undocumented immigrants with end-stage renal disease (ESRD). If the patient has insurance, the costs and mortality rates are much lower than those who receive emergency-only dialysis.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Vazquez MA, Charles MA .
Association of scheduled vs emergency-only dialysis with health outcomes and costs in undocumented immigrants with end-stage renal disease.
JAMA Intern Med 2019 Feb;179(2):175-83. doi: 10.1001/jamainternmed.2018.5866..
Keywords: Dialysis, Kidney Disease and Health, Healthcare Costs, Mortality, Patient-Centered Outcomes Research
Amin AP, Pinto D, House JA
Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes.
The purpose of this study was to examine (1) the incidence and trends in same day discharge (SDD); (2) hospital variation in SDD; (3) the association between SDD and readmissions for bleeding, acute kidney injury (AKI), acute myocardial infarction (AMI), or mortality at 30, 90, and 365 days after PCI; and (4) hospital costs of SDD and its drivers.
AHRQ-funded; HS022418.
Citation: Amin AP, Pinto D, House JA .
Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes.
JAMA Cardiol 2018 Nov;3(11):1041-49. doi: 10.1001/jamacardio.2018.3029..
Keywords: Healthcare Costs, Hospital Discharge, Patient-Centered Outcomes Research, Heart Disease and Health
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Shen NT, Schneider Y, Congly SE
Cost effectiveness of early insertion of transjugular intrahepatic portosystemic shunts for recurrent ascites.
Treatment options for recurrent ascites resulting from decompensated cirrhosis include serial large-volume paracentesis and albumin infusion (LVP+A) or insertion of a transjugular intrahepatic portosystemic shunt (TIPS). In this study, the investigators examined whether TIPS insertion was cost effective. The investigators concluded that based on Markov model analysis, early placement of TIPSs appeared to be a cost-effective strategy for management of specific patients with cirrhosis and recurrent ascites.
AHRQ-funded; HS000066.
Citation: Shen NT, Schneider Y, Congly SE .
Cost effectiveness of early insertion of transjugular intrahepatic portosystemic shunts for recurrent ascites.
Clin Gastroenterol Hepatol 2018 Sep;16(9):1503-10.e3. doi: 10.1016/j.cgh.2018.03.027..
Keywords: Healthcare Costs, Surgery, Patient-Centered Outcomes Research, Treatments
Khandelwal N, Hough CL, Downey L
Prevalence, risk factors, and outcomes of financial stress in survivors of critical illness.
The objective was to describe the prevalence of financial stress among critically ill patients and their families and explore associations between financial stress and psychologic distress. It found that factors associated with financial stress included female sex, young children at home, and baseline financial discomfort. Also, financial stress after critical illness was common and associated with symptoms of anxiety and depression.
AHRQ-funded; HS022982.
Citation: Khandelwal N, Hough CL, Downey L .
Prevalence, risk factors, and outcomes of financial stress in survivors of critical illness.
Crit Care Med 2018 Jun;46(6):e530-e39. doi: 10.1097/ccm.0000000000003076.
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Keywords: Critical Care, Healthcare Costs, Risk, Patient-Centered Outcomes Research, Stress
Mahmoud L, Zullo AR, Thompson BB
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Researchers conducted a retrospective cohort study of 1197 mechanically ventilated patients admitted to a 12-bed neurocritical care unit (NCCU) over four years in order to evaluate the effect of an analgesia-based sedation protocol on medication use and costs in the NCCU. The protocol resulted in increased in fentanyl use and decreased in propofol use, but their findings indicate no effect on healthcare utilization, healthcare costs, or in-hospital mortality. Based on these results, the researchers suggest that similar NCCUs should consider using population-specific protocols to manage analgesia and sedation.
AHRQ-funded; HS022998.
Citation: Mahmoud L, Zullo AR, Thompson BB .
Outcomes of protocolised analgesia and sedation in a neurocritical care unit.
Brain Inj 2018;32(7):941-47. doi: 10.1080/02699052.2018.1469167..
Keywords: Care Management, Brain Injury, Critical Care, Healthcare Costs, Intensive Care Unit (ICU), Medication, Neurological Disorders, Outcomes, Patient-Centered Outcomes Research
Rahman F, Guan J, Glazier RH
AHRQ Author: Bierman AS
Association between quality domains and health care spending across physician networks.
One of the more fundamental health policy questions is the relationship between health care quality and spending. Researchers measured 65 validated quality indicators (QI) across Ontario physician networks. Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations and higher rates of timely hospital-community transitions and moderately associated with lower readmission rates.
AHRQ-authored.
Citation: Rahman F, Guan J, Glazier RH .
Association between quality domains and health care spending across physician networks.
PLoS One 2018 Apr 3;13(4):e0195222. doi: 10.1371/journal.pone.0195222.
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Keywords: Healthcare Costs, Quality of Care, Patient-Centered Outcomes Research, Quality Indicators (QIs)
Misra-Hebert AD, Hu B, Le PH
Effect of health plan financial incentive offering on employees with prediabetes.
Researchers studied the effect of employee health plan financial incentives on health outcomes for employees with prediabetes. They found that employees who participated in disease management lost more weight than those who did not. A worksite wellness program offering health plan financial incentives for participation and outcomes was associated with improvements not only in weight but also in HbA1c.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Hu B, Le PH .
Effect of health plan financial incentive offering on employees with prediabetes.
Am J Med 2018 Mar;131(3):293-99. doi: 10.1016/j.amjmed.2017.09.024.
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Keywords: Healthcare Costs, Patient-Centered Outcomes Research, Patient Self-Management, Obesity: Weight Management, Diabetes, Health Status
Narla S, Silverberg JI
Association between atopic dermatitis and serious cutaneous, multiorgan and systemic infections in US adults.
This study sought to determine whether adults with atopic dermatitis (AD) have an unusually large number of serious infections and related outcomes. Using data from the 2002 to 2012 National Inpatient Sample Adults, it found that adults with AD had increased cutaneous, respiratory, multiorgan, and systemic infections, which were associated with a considerable cost burden.
AHRQ-funded; HS023011.
Citation: Narla S, Silverberg JI .
Association between atopic dermatitis and serious cutaneous, multiorgan and systemic infections in US adults.
Ann Allergy Asthma Immunol 2018 Jan;120(1):66-72.e11. doi: 10.1016/j.anai.2017.10.019.
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Keywords: Healthcare Costs, Healthcare Cost and Utilization Project (HCUP), Infectious Diseases, Patient-Centered Outcomes Research
Albrecht JS, Slejko JF, Stein DM
Treatment charges for traumatic brain injury among older adults at a trauma center.
The objective of this study was to provide charge estimates of treatment for traumatic brain injury (TBI), including both hospital and physician charges, among adults 65 years and older treated at a trauma center. The study provided the first estimates of hospital and physician charges associated with hospitalization for TBI among older adults at a trauma center that will aid in resource allocation, triage decisions, and healthcare policy.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Slejko JF, Stein DM .
Treatment charges for traumatic brain injury among older adults at a trauma center.
J Head Trauma Rehabil 2017 Nov/Dec;32(6):E45-e53. doi: 10.1097/htr.0000000000000297..
Keywords: Brain Injury, Elderly, Healthcare Costs, Hospitalization, Patient-Centered Outcomes Research
Berger BA, Cossio A, Saravia NG
Cost-effectiveness of meglumine antimoniate versus miltefosine caregiver DOT for the treatment of pediatric cutaneous leishmaniasis.
The researchers performed a cost-effectiveness analysis comparing Miltefosine administered via in-home caregiver Directly Observed Therapy (cDOT) versus injectable meglumine antimoniate (MA) for pediatric cutaneous leishmaniasis (CL) in southwest Colombia. Treatment of pediatric CL miltefosine via cDOT was found to be cost saving from patient and societal perspectives, and moderately more costly from the government payer perspective compared to treatment with MA.
AHRQ-funded; HS022433.
Citation: Berger BA, Cossio A, Saravia NG .
Cost-effectiveness of meglumine antimoniate versus miltefosine caregiver DOT for the treatment of pediatric cutaneous leishmaniasis.
PLoS Negl Trop Dis 2017 Apr 6;11(4):e0005459. doi: 10.1371/journal.pntd.0005459.
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Keywords: Patient-Centered Outcomes Research, Healthcare Costs, Medication, Healthcare Costs, Children/Adolescents
Sinaiko AD, Landrum MB, Meyers DJ
Synthesis of research on patient-centered medical homes brings systematic differences into relief.
This study evaluated the impact of patient-centered medical home (PCMH) initiatives on utilization, cost, and quality, by conducting a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and four quality measures.
AHRQ-funded; HS021385.
Citation: Sinaiko AD, Landrum MB, Meyers DJ .
Synthesis of research on patient-centered medical homes brings systematic differences into relief.
Health Aff 2017 Mar;36(3):500-08. doi: 10.1377/hlthaff.2016.1235.
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Keywords: Patient-Centered Healthcare, Patient-Centered Outcomes Research, Health Services Research (HSR), Healthcare Costs
Curtis JR, Chen L, Greenberg JD
The clinical status and economic savings associated with remission among patients with rheumatoid arthritis: leveraging linked registry and claims data for synergistic insights.
Treat to target guidelines recommend achieving remission or low disease activity in rheumatoid arthritis (RA). However, the reduction in adverse events and costs associated with lower disease activity is unclear. This study found that leveraging the benefits of linking registry and administrative data together, lower disease activity in RA was associated with incrementally reduced risks of all-cause hospitalization, ED visits, mortality, and medical costs in a dose-dependent fashion.
AHRQ-funded; HS021694.
Citation: Curtis JR, Chen L, Greenberg JD .
The clinical status and economic savings associated with remission among patients with rheumatoid arthritis: leveraging linked registry and claims data for synergistic insights.
Pharmacoepidemiol Drug Saf 2017 Mar;26(3):310-19. doi: 10.1002/pds.4126.
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Keywords: Patient-Centered Outcomes Research, Registries, Arthritis, Healthcare Costs, Guidelines
Lindly OJ, Zuckerman KE, Mistry KB
AHRQ Author: Mistry KB
Clarifying the predictive value of family-centered care and shared decision making for pediatric healthcare outcomes using the Medical Expenditure Panel Survey.
The researchers estimated (1) family-centered care (FCC) and shared decision-making (SDM) prevalence, and (2) associations of FCC and SDM (FCC/SDM) with health care outcomes among U.S. children. FCC/SDM prevalence in year 1 varied from 38.6 to 93.7 percent, and it was lower for composites with more stringent scoring approaches. FCC/SDM composites with stringent scoring approaches in year 1 were associated with reduced unmet needs in year 2.
AHRQ-authored.
Citation: Lindly OJ, Zuckerman KE, Mistry KB .
Clarifying the predictive value of family-centered care and shared decision making for pediatric healthcare outcomes using the Medical Expenditure Panel Survey.
Health Serv Res 2017 Feb;52(1):313-45. doi: 10.1111/1475-6773.12488.
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Keywords: Medical Expenditure Panel Survey (MEPS), Shared Decision Making, Patient-Centered Outcomes Research, Children/Adolescents, Healthcare Costs
Wang S, Hsu SH, Huang S
Longer periods of hospice service associated with lower end-of-life spending in regions with high expenditures.
Hospice use is expected to decrease end-of-life expenditures, yet evidence for its financial impact remains inconclusive. This study found that longer periods of hospice service were associated with decreased end-of-life expenditures for patients residing in regions with high average expenditures but not for those in regions with low average expenditures.
AHRQ-funded; HS023900.
Citation: Wang S, Hsu SH, Huang S .
Longer periods of hospice service associated with lower end-of-life spending in regions with high expenditures.
Health Aff 2017 Feb;36(2):328-36. doi: 10.1377/hlthaff.2016.0683.
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Keywords: Healthcare Costs, Palliative Care, Patient-Centered Outcomes Research
Krakovitz PR, Boss EF
Intraoperative nerve monitoring during thyroidectomy-more complex than cost alone.
This brief invited commentary discussed intraoperative nerve monitoring and surgery.
AHRQ-funded; HS022932.
Citation: Krakovitz PR, Boss EF .
Intraoperative nerve monitoring during thyroidectomy-more complex than cost alone.
JAMA Otolaryngol Head Neck Surg 2016 Dec;142(12):1206-07. doi: 10.1001/jamaoto.2016.3116.
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Keywords: Shared Decision Making, Healthcare Costs, Patient-Centered Outcomes Research, Quality of Life, Surgery
Raol N, Zogg CK, Boss EF
Inpatient pediatric tonsillectomy: Does hospital type affect cost and outcomes of care?
The researchers ascertained whether hospital type is associated with differences in total cost and outcomes for inpatient tonsillectomy. They found that significant differences in costs, outcomes, and patient factors exist for inpatient tonsillectomy based on hospital type. Reasons for these differences are not discernable using isolated claims data.
AHRQ-funded; HS022932.
Citation: Raol N, Zogg CK, Boss EF .
Inpatient pediatric tonsillectomy: Does hospital type affect cost and outcomes of care?
Otolaryngol Head Neck Surg 2016 Mar;154(3):486-93. doi: 10.1177/0194599815621739..
Keywords: Healthcare Cost and Utilization Project (HCUP), Patient-Centered Outcomes Research, Healthcare Costs, Surgery, Children/Adolescents
Dinan MA, Li Y, Zhang Y
Resource use in the last year of life among patients who died with versus of prostate cancer.
The researchers conducted a retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data of men with prostate cancer. Patients who died of prostate cancer rather than from other causes had more hospice and outpatient use, less inpatient and ICU use, and lower overall costs. Efforts to shift care toward outpatient settings might provide more efficient and judicious care for patients during the end of life.
AHRQ-funded; HS022189.
Citation: Dinan MA, Li Y, Zhang Y .
Resource use in the last year of life among patients who died with versus of prostate cancer.
Clin Genitourin Cancer 2016 Feb;14(1):28-37.e2. doi: 10.1016/j.clgc.2015.07.006.
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Keywords: Cancer, Cancer: Prostate Cancer, Healthcare Costs, Healthcare Utilization, Men's Health, Mortality, Palliative Care, Patient-Centered Outcomes Research
Roth JA, Ramsey SD, Carlson JJ
Cost-effectiveness of a biopsy-based 8-protein prostate cancer prognostic assay to optimize treatment decision making in Gleason 3 + 3 and 3 + 4 early stage prostate cancer.
A novel 8-protein prognostic assay generates a risk score at time of biopsy that is predictive of prostate cancer aggressiveness and can inform treatment decisions. The objective of this study was to evaluate the cost-effectiveness of using the assay to inform treatment decisions compared with usual care. The 8-protein assay strategy resulted in 0.04 more quality-adjusted life years and $700 less in costs compared with usual care.
AHRQ-funded; HS022982.
Citation: Roth JA, Ramsey SD, Carlson JJ .
Cost-effectiveness of a biopsy-based 8-protein prostate cancer prognostic assay to optimize treatment decision making in Gleason 3 + 3 and 3 + 4 early stage prostate cancer.
Oncologist 2015 Dec;20(12):1355-64. doi: 10.1634/theoncologist.2015-0214.
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Keywords: Cancer, Cancer: Prostate Cancer, Patient-Centered Outcomes Research, Healthcare Costs, Shared Decision Making
Smith MJ, Gerber JS, Hersh AL
Inpatient antimicrobial stewardship in pediatrics: a systematic review.
The purpose of this paper was to describe the clinical and economic outcomes associated with pediatric antimicrobial stewardship programs and other supplemental antimicrobial stewardship interventions. The authors concluded that the studies researched demonstrated reductions in antimicrobial utilization, cost, and prescribing errors with no apparent negative impact on patient safety.
AHRQ-funded; HS023320.
Citation: Smith MJ, Gerber JS, Hersh AL .
Inpatient antimicrobial stewardship in pediatrics: a systematic review.
J Pediatric Infect Dis Soc 2015 Dec;4(4):e127-35. doi: 10.1093/jpids/piu141.
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Keywords: Antimicrobial Stewardship, Children/Adolescents, Healthcare Costs, Patient-Centered Outcomes Research, Children/Adolescents