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 88 Research Studies DisplayedGoldberg EM, Trivedi AN, Mor V
Favorable risk selection in Medicare Advantage: trends in mortality and plan exits among nursing home beneficiaries.
This study uses mortality differences, nursing home utilization, and switch rates to assess whether the 2003 Medicare Modernization Act (MMA) successfully decreased risk selection from 2000 to 2012. The study found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA.
AHRQ-funded; HS000011.
Citation: Goldberg EM, Trivedi AN, Mor V .
Favorable risk selection in Medicare Advantage: trends in mortality and plan exits among nursing home beneficiaries.
Med Care Res Rev 2017 Dec;74(6):736-49. doi: 10.1177/1077558716662565..
Keywords: Healthcare Costs, Medicare, Mortality, Nursing Homes
Niznik J, Zhao X, Jiang T
Anticholinergic prescribing in Medicare Part D beneficiaries residing in nursing homes: results from a retrospective cross-sectional analysis of Medicare data.
The primary objective of this study was to identify factors associated with low- and high-level anticholinergic burden in nursing home residents. Overall, 29.6 percent of subjects had a high anticholinergic burden and 35.2 percent had a low burden. High burden was most often (72 percent) due to one highly anticholinergic medication rather than a cumulative effect.
AHRQ-funded; HS023779.
Citation: Niznik J, Zhao X, Jiang T .
Anticholinergic prescribing in Medicare Part D beneficiaries residing in nursing homes: results from a retrospective cross-sectional analysis of Medicare data.
Drugs Aging 2017 Dec;34(12):925-39. doi: 10.1007/s40266-017-0502-6.
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Keywords: Elderly, Medicare, Medication, Nursing
Adams AS, Madden JM, Zhang F
Effects of transitioning to Medicare Part D on access to drugs for medical conditions among dual enrollees with cancer.
This study evaluated the impact of transitioning from Medicaid to Medicare Part D drug coverage on the use of noncancer treatments among dual enrollees with cancer. Its findings suggest that the removal of drug caps under Part D had a modest impact on the treatment of hypercholesterolemia overall and may have reduced white-black gaps in the use of lipid-lowering and antidepressant therapies.
AHRQ-funded; HS018577.
Citation: Adams AS, Madden JM, Zhang F .
Effects of transitioning to Medicare Part D on access to drugs for medical conditions among dual enrollees with cancer.
Value Health 2017 Dec;20(10):1345-54. doi: 10.1016/j.jval.2017.05.023.
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Keywords: Access to Care, Cancer, Medicare, Medication, Racial and Ethnic Minorities
Adrion ER, Kocher KE, Nallamothu BK
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Using multipayer commercial claims for the period 2009-13, the investigators evaluated utilization and spending among patients admitted for six conditions that are commonly managed with either observation care or short-stay hospitalizations. In their study period, the use of observation care increased relative to that of short-stay hospitalizations. In addition, total and out-of-pocket spending were substantially lower for observation care, though both grew rapidly--and at rates much higher than spending in the inpatient setting--over the study period.
AHRQ-funded; HS000053.
Citation: Adrion ER, Kocher KE, Nallamothu BK .
Rising use of observation care among the commercially insured may lead to total and out-of-pocket cost savings.
Health Aff 2017 Dec;36(12):2102-09. doi: 10.1377/hlthaff.2017.0774..
Keywords: Health Insurance, Healthcare Costs, Healthcare Delivery, Healthcare Utilization, Hospitalization, Hospitals, Medicare
Taira DA, Shen C, King M
Access to medications for Medicare enrollees related to race/ethnicity: results from the 2013 Medicare Current Beneficiary Survey.
Prescription medications are taken by millions of Americans to manage chronic conditions and treat acute conditions. These medications, however, are not equally accessible to all. The purpose of this study was to examine medication access by race/ethnicity among Medicare beneficiaries. The authors found that possible interventions for non-Hispanic blacks might include assisting them in finding the best drug plan to meeting their needs, connecting them to medication assistance programs, and discussing convenience of pharmacy with patients.
AHRQ-funded; HS023185.
Citation: Taira DA, Shen C, King M .
Access to medications for Medicare enrollees related to race/ethnicity: results from the 2013 Medicare Current Beneficiary Survey.
Res Social Adm Pharm 2017 Nov;13(6):1208-13. doi: 10.1016/j.sapharm.2016.10.021..
Keywords: Access to Care, Medicare, Medication, Racial and Ethnic Minorities, Social Determinants of Health
Kazi DS, Lu CY, Lin GA
Nationwide coverage and cost-sharing for PCSK9 inhibitors among Medicare Part D plans.
In this research letter the investigators analyzed the June 2016 Centers for Medicare and Medicaid Services Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files for all Part D plans (except special-needs plans that may have had specialized formularies) and out-of-pocket cost requirements for PCSK9is (alirocumab and evolocumab) averaged across all plans by counties and states. The authors asserted that their findings suggest a need to lower out-of pocket costs to ensure affordability of PCSK9is for Medicare beneficiaries covered by Part D.
AHRQ-funded; HS016772.
Citation: Kazi DS, Lu CY, Lin GA .
Nationwide coverage and cost-sharing for PCSK9 inhibitors among Medicare Part D plans.
JAMA Cardiol 2017 Oct;2(10):1164-66. doi: 10.1001/jamacardio.2017.3051..
Keywords: Healthcare Costs, Medicare, Medication, Policy
Keohane LM, Trivedi AN, Mor V
Recent health care use and Medicaid entry of Medicare beneficiaries.
The purpose of this study was to examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi AN, Mor V .
Recent health care use and Medicaid entry of Medicare beneficiaries.
Gerontologist 2017 Oct 1;57(5):977-86. doi: 10.1093/geront/gnw189..
Keywords: Elderly, Healthcare Utilization, Health Services Research (HSR), Medicaid, Medicare
Arbaje AI, Yu Q, Wang J J
Senior services in US hospitals and readmission risk in the Medicare population.
The purpose of this study was to determine whether hospitals' Senior Care Services Scale (SCSS) scores were associated with risk of readmission among Medicare beneficiaries. The study concluded that senior services at the hospital-level represented a modifiable risk factor with important impact. Employing organization-level characteristics in readmission risk prediction tools should be expanded.
AHRQ-funded; HS022916
Citation: Arbaje AI, Yu Q, Wang J J .
Senior services in US hospitals and readmission risk in the Medicare population.
Int J Qual Health Care 2017 Oct 1;29(6):845-52. doi: 10.1093/intqhc/mzx112..
Keywords: Elderly, Health Services Research (HSR), Hospital Readmissions, Hospitals, Medicare
Hoffman GJ, Hays RD, Shapiro MF
The costs of fall-related injuries among older adults: annual per-faller, service component, and patient out-of-pocket costs.
The researchers estimated expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries. Estimated FRI expenditures were $9,389. Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363. Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622.
AHRQ-funded; HS000046.
Citation: Hoffman GJ, Hays RD, Shapiro MF .
The costs of fall-related injuries among older adults: annual per-faller, service component, and patient out-of-pocket costs.
Health Serv Res 2017 Oct;52(5):1794-816. doi: 10.1111/1475-6773.12554.
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Keywords: Elderly, Falls, Healthcare Costs, Medicare, Patient Safety
Xue Y, Goodwin JS, Adhikari D
Trends in primary care provision to Medicare beneficiaries by physicians, nurse practitioners, or physician assistants: 2008-2014.
This study documented the temporal trends in alternative primary care models in which physicians, nurse practitioners (NPs), or physician assistants (PAs) engaged in care provision to the elderly, and examined the role of these models in serving elders with multiple chronic conditions. It found a decrease in the physician model and an increase in the shared care model and NP/PA model from 2008 to 2014.
AHRQ-funded; HS020642; HS022134.
Citation: Xue Y, Goodwin JS, Adhikari D .
Trends in primary care provision to Medicare beneficiaries by physicians, nurse practitioners, or physician assistants: 2008-2014.
J Prim Care Community Health 2017 Oct;8(4):256-63. doi: 10.1177/2150131917736634.
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Keywords: Chronic Conditions, Elderly, Healthcare Delivery, Primary Care, Medicare
Jubelt LE, Goldfeld KS, Blecker SB
Early lessons on bundled payment at an academic medical center.
This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery. It examined total episode costs and costs by service category. It concluded that opportunities for savings under bundled payment may be greater for lower extremity joint arthroplasty than for other conditions.
AHRQ-funded; HS023683.
Citation: Jubelt LE, Goldfeld KS, Blecker SB .
Early lessons on bundled payment at an academic medical center.
J Am Acad Orthop Surg 2017 Sep;25(9):654-63. doi: 10.5435/jaaos-d-16-00626.
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Keywords: Healthcare Costs, Payment, Medicare
Zhang M, Silverberg JI, Kaffenberger BH
Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty.
The researchers described the medications used for treating acne/rosacea in the Medicare population and evaluated differences in costs between specialties. They concluded that costs of prescriptions for acne/rosacea from specialists are higher than those from primary care physicians and could be reduced by choosing generic and less expensive options.
AHRQ-funded; HS023011.
Citation: Zhang M, Silverberg JI, Kaffenberger BH .
Prescription patterns and costs of acne/rosacea medications in Medicare patients vary by prescriber specialty.
J Am Acad Dermatol 2017 Sep;77(3):448-55.e2. doi: 10.1016/j.jaad.2017.04.1127.
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Keywords: Medication, Skin Conditions, Healthcare Costs, Medicare, Elderly
Chen LM, Epstein AM, Orav EJ
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
The objective of this cross-sectional observational study was to compare performance in the Physician Value-Based Payment Modifier (PVBM) Program by practice characteristics. The investigators found that during the first year of the Medicare Physician Value-Based Payment Modifier Program, physician practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.
AHRQ-funded; HS024698.
Citation: Chen LM, Epstein AM, Orav EJ .
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
JAMA 2017 Aug 1;318(5):453-61. doi: 10.1001/jama.2017.9643..
Keywords: Healthcare Costs, Medicaid, Medicare, Payment, Quality of Care
Hatfield LA, Zaslavsky AM
Implications of variation in the relationships between beneficiary characteristics and Medicare Advantage CAHPS measures.
The researchers studied how differences in quality score adjustments across Medicare Advantage contracts change comparisons for individuals and contracts. They found that, for average consumers, standard adjustment is sufficient to represent variation in contract quality standardized to a common population. For people with characteristics far from average, personalized reporting using their characteristics and contract-specific coefficients can substantially change the expected quality measures across contracts.
AHRQ-funded; HS016978.
Citation: Hatfield LA, Zaslavsky AM .
Implications of variation in the relationships between beneficiary characteristics and Medicare Advantage CAHPS measures.
Health Serv Res 2017 Aug;52(4):1310-29. doi: 10.1111/1475-6773.12544.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Medicare, Health Status, Patient Experience, Quality of Care, Quality Improvement, Quality Measures
Metersky ML, Eldridge N, Wang Y
AHRQ Author: Eldridge N
National trends in the frequency of bladder catheterization and physician-diagnosed catheter-associated urinary tract infections: results from the Medicare Patient Safety Monitoring System.
The researchers assessed bladder catheterization frequency (percentage of patients catheterized) and risk-adjusted catheter-associated urinary tract infection (CAUTI frequency (percentage of catheterized patients developing CAUTI) from 2009-2014. They found statistically significant declines in observed bladder catheterization frequency and adjusted CAUTI frequency in some patient populations between 2009 and 2014.
AHRQ-authored; AHRQ-funded; 290201200003C; HS019767; HS024385; HS018334.
Citation: Metersky ML, Eldridge N, Wang Y .
National trends in the frequency of bladder catheterization and physician-diagnosed catheter-associated urinary tract infections: results from the Medicare Patient Safety Monitoring System.
Am J Infect Control 2017 Aug;45(8):901-04. doi: 10.1016/j.ajic.2017.03.008.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Urinary Tract Infection (UTI), Patient Safety, Adverse Events, Medicare
Shih YT, Xu Y, Liu L
Rising prices of targeted oral anticancer medications and associated financial burden on Medicare beneficiaries.
This study examined trends in targeted oral anticancer medication (TOAM) prices and patient out-of-pocket (OOP) payments in Medicare Part D and estimated the actual effects on patient OOP payments of partial filling of the coverage gap by 2012. It concluded that rising TOAM prices threaten the financial relief patients have begun to experience under closure of the coverage gap in Medicare Part D.
AHRQ-funded; HS020263.
Citation: Shih YT, Xu Y, Liu L .
Rising prices of targeted oral anticancer medications and associated financial burden on Medicare beneficiaries.
J Clin Oncol 2017 Aug 1;35(22):2482-89. doi: 10.1200/jco.2017.72.3742.
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Keywords: Cancer, Medication, Healthcare Costs, Medicare, Elderly
Wang SY, Aldridge MD, Gross CP
End-of-life care transition patterns of Medicare beneficiaries.
The researchers characterized the patterns of transitions in care and factors associated with multiple transitions in the last 6 months of life of U.S. decedents (N = 660,132). They found that 218,731 had four or more transitions within the last 6 months of life. Women, blacks, individuals younger than 85, and individuals without dementia were more likely to have four or more transitions.
AHRQ-funded; HS023900.
Citation: Wang SY, Aldridge MD, Gross CP .
End-of-life care transition patterns of Medicare beneficiaries.
J Am Geriatr Soc 2017 Jul;65(7):1406-13. doi: 10.1111/jgs.14891.
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Keywords: Elderly, Medicare, Palliative Care, Transitions of Care
Schuler MS, Joyce NR, Huskamp HA
Medicare beneficiaries with advanced lung cancer experience diverse patterns of care from diagnosis to death.
Using Medicare claims data for patients diagnosed with extensive-stage small-cell lung cancer, the authors used latent class analysis to identify classes of people with different care patterns. The findings showed substantial heterogeneity in patterns of care for patients with advanced cancer, which should be accounted for in efforts to improve end-of-life care.
AHRQ-funded; HS022998.
Citation: Schuler MS, Joyce NR, Huskamp HA .
Medicare beneficiaries with advanced lung cancer experience diverse patterns of care from diagnosis to death.
Health Aff 2017 Jul;36(7):1193-200. doi: 10.1377/hlthaff.2017.0448..
Keywords: Cancer, Cancer: Lung Cancer, Care Management, Elderly, Medicare, Palliative Care
Dharmarajan K, Qin L, Bierlein M
Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study.
This study characterized rates and trends over time of emergency department treatment-and-discharge stays, repeat observation stays, inpatient stays, any hospital revisit, and death within 30 days of discharge from observation stays. Hospital revisits are common after discharge from observation stays, frequently result in inpatient hospitalizations, and have increased over time among Medicare beneficiaries.
AHRQ-funded; HS023000.
Citation: Dharmarajan K, Qin L, Bierlein M .
Outcomes after observation stays among older adult Medicare beneficiaries in the USA: retrospective cohort study.
BMJ 2017 Jun 20;357:j2616. doi: 10.1136/bmj.j2616.
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Keywords: Elderly, Emergency Department, Hospital Discharge, Hospital Readmissions, Medicare
Woodworth L, Romano PS, Holmes JF
Does insurance status influence a patient's hospital charge?
The objective of this study was to determine whether hospitals charge patients differently based on their insurance status. It concluded that conditional on patient characteristics, length of stay, and expected intensity of resource utilization, patients with private insurance and patients with Medicare were charged more (before discounting) than their uninsured counterparts within the same hospital.
AHRQ-funded; HS022236.
Citation: Woodworth L, Romano PS, Holmes JF .
Does insurance status influence a patient's hospital charge?
Appl Health Econ Health Policy 2017 Jun;15(3):353-62. doi: 10.1007/s40258-017-0308-z.
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Keywords: Healthcare Costs, Health Insurance, Hospitals, Medicare, Uninsured
Loresto FL, Jr., Jupiter D, Kuo YF
Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.
There is a perception that nurse practitioners (NPs), as compared with primary care medical doctors (PCMDs), tend to provide care to healthier patients. In this study, patients utilizing NP-only or PCMD-only models for primary care were characterized and compared in terms of functional, cognitive, and psychological factors. The results were contrary to the initial perception. In terms of health status, NP-only patients were similar to PCMD-only patients.
AHRQ-funded; HS020642.
Citation: Loresto FL, Jr., Jupiter D, Kuo YF .
Examining differences in characteristics between patients receiving primary care from nurse practitioners or physicians using Medicare Current Beneficiary Survey data and Medicare claims data.
J Am Assoc Nurse Pract 2017 Jun;29(6):340-47. doi: 10.1002/2327-6924.12465.
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Keywords: Provider: Health Personnel, Medicare, Primary Care, Workforce
Jacobs PD, Molloy E
AHRQ Author: Jacobs PD
How do Medicare Advantage beneficiary payments vary with tenure?
This study compared how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. Beneficiaries who remained in their plans for 6 or more years were paying $786 more than they would have spent in the lowest-cost plan compared with $552 for beneficiaries in their first year of enrollment.
AHRQ-authored.
Citation: Jacobs PD, Molloy E .
How do Medicare Advantage beneficiary payments vary with tenure?
Am J Manag Care 2017 Jun;23(6):372-77.
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Keywords: Medicare, Payment, Healthcare Costs, Health Insurance
Schulz J, DeCamp M, Berkowitz SA
Regional cost and experience, not size or hospital inclusion, helps predict ACO success.
This study investigated the extent to which organizational characteristics, regional cost of care, or experience in the Medicare Shared Savings Program (MSSP) are associated with the ability to achieve shared savings. It found that experience, as measured by years in the MSSP program, was associated with success and the ability to earn shared savings varied regionally. This variation was strongly associated with differences in regional Medicare fee-for-service per capita costs.
AHRQ-funded; HS023684.
Citation: Schulz J, DeCamp M, Berkowitz SA .
Regional cost and experience, not size or hospital inclusion, helps predict ACO success.
Medicine 2017 Jun;96(24):e7209. doi: 10.1097/md.0000000000007209.
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Keywords: Healthcare Costs, Medicare, Payment
Rocque GB, Pisu M, Jackson BE
Resource use and Medicare costs during lay navigation for geriatric patients with cancer.
This study examined the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network. It found that, compared with a matched comparison group, the mean total costs declined by $781.29 more per quarter per navigated patient, for an estimated $19 million decline per year across the network.
AHRQ-funded; HS023009.
Citation: Rocque GB, Pisu M, Jackson BE .
Resource use and Medicare costs during lay navigation for geriatric patients with cancer.
JAMA Oncol 2017 Jun;3(6):817-25. doi: 10.1001/jamaoncol.2016.6307.
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Keywords: Elderly, Cancer, Healthcare Costs, Medicare, Patient and Family Engagement, Patient-Centered Healthcare, Healthcare Delivery
Albrecht JS, Peters ME, Smith GS
Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury.
This study estimated rates of anxiety and posttraumatic stress disorder (PTSD) diagnoses after traumatic brain injury (TBI) among Medicare beneficiaries. After TBI, 16,519 (17 percent) beneficiaries were diagnosed with anxiety and 269 (0.3 percent) were diagnosed with PTSD. Rates of anxiety and PTSD diagnoses were highest in the first 5 months post-TBI and decreased over time.
AHRQ-funded; HS024560.
Citation: Albrecht JS, Peters ME, Smith GS .
Anxiety and posttraumatic stress disorder among Medicare beneficiaries after traumatic brain injury.
J Head Trauma Rehabil 2017 May/Jun;32(3):178-84. doi: 10.1097/htr.0000000000000266.
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Keywords: Anxiety, Brain Injury, Medicare, Behavioral Health, Trauma