National Healthcare Quality and Disparities Report
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Topics
- Access to Care (15)
- Ambulatory Care and Surgery (2)
- Behavioral Health (3)
- Cancer (3)
- Cancer: Cervical Cancer (1)
- Cancer: Colorectal Cancer (4)
- Care Coordination (1)
- Caregiving (1)
- Care Management (1)
- Children/Adolescents (4)
- Chronic Conditions (1)
- Clinical Decision Support (CDS) (1)
- Community-Based Practice (2)
- Critical Care (1)
- Dental and Oral Health (1)
- Diabetes (2)
- Disparities (5)
- Elderly (3)
- Emergency Medical Services (EMS) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (5)
- Healthcare Delivery (7)
- Healthcare Utilization (8)
- Health Information Technology (HIT) (1)
- Health Insurance (17)
- Health Status (1)
- Home Healthcare (3)
- Hospitals (1)
- Implementation (2)
- Intensive Care Unit (ICU) (1)
- Kidney Disease and Health (1)
- Long-Term Care (2)
- Low-Income (3)
- Maternal Care (3)
- (-) Medicaid (45)
- Medical Expenditure Panel Survey (MEPS) (2)
- Medicare (9)
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- Policy (19)
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- Pregnancy (3)
- Prevention (6)
- Primary Care (3)
- Quality of Care (1)
- Racial and Ethnic Minorities (4)
- Rural Health (2)
- Screening (4)
- Sexual Health (1)
- Social Determinants of Health (3)
- Substance Abuse (4)
- Surgery (2)
- Tobacco Use (1)
- Tobacco Use: Smoking Cessation (1)
- Transitions of Care (1)
- Uninsured (4)
- Vulnerable Populations (5)
- Women (3)
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
26 to 45 of 45 Research Studies DisplayedKhandelwal N, White L, Curtis JR
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
The objective of this study was to estimate out-of-pocket costs in the last year of life for individuals who required intensive care in the months prior to death and to examine how these costs vary by insurance coverage. Results showed that, across all categories of insurance coverage, out-of-pocket spending in the last 12 months of life was high and represented a significant portion of assets for many patients requiring intensive care and their families. Medicare fee-for-service alone did not insulate individuals from the financial burden of high-intensity care. Medicaid was found to provide the most complete hospital coverage of all the insurance groups, as well as significantly financing long-term care.
AHRQ-funded; HS022982.
Citation: Khandelwal N, White L, Curtis JR .
Health insurance and out-of-pocket costs in the last year of life among decedents utilizing the ICU.
Crit Care Med 2019 Jun;47(6):749-56. doi: 10.1097/ccm.0000000000003723..
Keywords: Critical Care, Elderly, Health Insurance, Healthcare Costs, Intensive Care Unit (ICU), Medicaid, Medicare
Londhe S, Ritter G, Schlesinger M
Medicaid expansion in social context: examining relationships between Medicaid enrollment and county-level food insecurity.
This study examined the relationship between states’ expansion of Medicaid and county-level food insecurity. They examined county Medicaid enrollment in early expansion states and found that increased Medicaid enrollment was associated with lower food insecurity during two expansion periods (2009-2012; 2012-2014). In California the most pronounced associations were evident in counties with the largest Medicaid expansions.
AHRQ-funded; HS017589.
Citation: Londhe S, Ritter G, Schlesinger M .
Medicaid expansion in social context: examining relationships between Medicaid enrollment and county-level food insecurity.
J Health Care Poor Underserved 2019;30(2):532-46. doi: 10.1353/hpu.2019.0033..
Keywords: Medicaid, Nutrition, Policy
O'Leary MC, Lich KH, Gu Y
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
The goal of this study was to determine the impact of national and state policies enacted to increase access to Medicaid and to promote colorectal cancer (CRC) screening on newly enrolled, age-eligible Oregon Medicaid beneficiaries. 2010 - 2015 Oregon Medicaid claims data was used to conduct a cohort analysis of enrollees who turned 50 and became age-eligible for CRC screening. Individuals newly enrolled in Medicaid in 2013 or 2014 were more likely to initiate CRC screening than those enrolled by 2010, associated with the timing of policies such as Medicaid expansion and federal matching for preventive services. A primary care visit during the calendar year, one or more chronic conditions, and Hispanic ethnicity were also associated with CRC screening initiation.
AHRQ-funded; HS022981.
Citation: O'Leary MC, Lich KH, Gu Y .
Colorectal cancer screening in newly insured Medicaid members: a review of concurrent federal and state policies.
BMC Health Serv Res 2019 May 9;19(1):298. doi: 10.1186/s12913-019-4113-2..
Keywords: Access to Care, Cancer, Cancer: Colorectal Cancer, Medicaid, Policy, Prevention, Screening
Seo V, Baggett TP, Thorndike AN
Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act.
This study assessed differences in access to care for patients at Community Health Centers (CHCs) between those with continuous Medicaid coverage and those with gaps in insurance coverage, in order to examine the role of Medicaid coverage on care patterns for those with available safety net care. Data on adult patients with continuous Medicaid coverage and those with a period without insurance coverage in the last 12 months was gathered from the 2014 Health Center Patient Survey. Reported need for various types of care, prescription drugs, or referrals to care outside of the CHC, and reports of being delayed or unable to get needed care by insurance status were examined. Patients with insurance gaps were significantly more likely to report having difficulty obtaining medical care, prescription drugs, dental care, and completing outside referrals. The authors conclude that continuous Medicaid coverage appears to mitigate barriers to care for CHC patients when compared to those who have intermittent or no insurance coverage. Policies that increase disruptions in coverage could adversely impact access to care, even among those with available safety net care.
AHRQ-funding; HS025378.
Citation: Seo V, Baggett TP, Thorndike AN .
Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act.
BMC Health Serv Res 2019 May 8;19(1):291. doi: 10.1186/s12913-019-4124-z..
Keywords: Access to Care, Health Insurance, Medicaid, Policy, Uninsured
Fabius CD, Robison J
Differences in living arrangements among older adults transitioning into the community: examining the impact of race and choice.
The federal Money Follows the Person Rebalancing Demonstration program allows nursing home residents to use Medicaid funds for home and community-based services rather than institutional care. Race, choice in housing, and challenges faced prior to transitioning may impact living arrangements following a discharge into the community. This study examined the influence of these factors on living arrangements for 659 program participants age 65 or older.
AHRQ-funded; HS000011.
Citation: Fabius CD, Robison J .
Differences in living arrangements among older adults transitioning into the community: examining the impact of race and choice.
J Appl Gerontol 2019 Apr;38(4):454-78. doi: 10.1177/0733464816687496..
Keywords: Elderly, Transitions of Care, Racial and Ethnic Minorities, Medicaid, Nursing Homes, Home Healthcare, Healthcare Delivery
Feinstein JA, Hall M, Antoon JW
Chronic medication use in children insured by Medicaid: a multistate retrospective cohort study.
This retrospective cohort study examined the use of chronic medication (CM) use in children insured by Medicaid. The cohort included children ages 1 to 18 years from 10 states in 2014. It was grouped by the annual number of CMs (0, 1, 2-4, 5-9, and >=10). Of the over 4.5 million subjects, 18.8% used CMs, and 44% in children with a complex chronic condition. The most common CM therapeutic class was neurologic (28.8%). For children prescribed only 1 CM, the most common class is amphetamine stimulants. For children with 10 or greater CMs prescribed, antiepileptics were the most common. Increased CM use was associated with increased hospitalization and emergency department use.
AHRQ-funded; HS025138.
Citation: Feinstein JA, Hall M, Antoon JW .
Chronic medication use in children insured by Medicaid: a multistate retrospective cohort study.
Pediatrics 2019 Apr;143(4). doi: 10.1542/peds.2018-3397..
Keywords: Children/Adolescents, Chronic Conditions, Medicaid, Medication
Dy CJ, Brown DS, Maryam H
Two-state comparison of total joint arthroplasty utilization following Medicaid expansion.
The aim of this study was to determine whether Medicaid expansion was associated with increased utilization rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Illinois (which expanded Medicaid) relative to Missouri (which did not expand Medicaid). The investigators concluded that their study demonstrated that Medicaid expansion in Illinois was associated with increased utilization of THA and TKA. They suggested that further study is needed to understand the impact of Medicaid expansion in other states and for other procedures.
AHRQ-funded; HS019455.
Citation: Dy CJ, Brown DS, Maryam H .
Two-state comparison of total joint arthroplasty utilization following Medicaid expansion.
J Arthroplasty 2019 Apr;34(4):619-25.e1. doi: 10.1016/j.arth.2018.12.019..
Keywords: Healthcare Utilization, Medicaid, Orthopedics, Surgery
Angier H, Ezekiel-Herera D, Marino M
Racial/ethnic disparities in health insurance and differences in visit type for a population of patients with diabetes after Medicaid Expansion.
Racial/ethnic disparities in health insurance and differences in visit type for a population of patients with diabetes after Medicaid Expansion.
AHRQ-funded; HS024270.
Citation: Angier H, Ezekiel-Herera D, Marino M .
Racial/ethnic disparities in health insurance and differences in visit type for a population of patients with diabetes after Medicaid Expansion.
J Health Care Poor Underserved 2019;30(1):116-30. doi: 10.1353/hpu.2019.0011.
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Keywords: Access to Care, Diabetes, Disparities, Health Insurance, Medicaid, Racial and Ethnic Minorities
Timbie JW, Kranz AM, Mahmud A
Specialty care access for Medicaid enrollees in expansion states.
The goal of this study was to assess current levels of difficulty accessing specialty care for patients at community health centers (CHCs) by insurance type, in order to identify specific barriers and the strategies that CHCs use to overcome these barriers. A cross-sectional survey was administered to medical directors at CHCs in nine states as well as the District of Columbia, all of which had expanded Medicaid. Among the barriers reported by CHCs were few specialists in Medicaid managed care organization (MCO) networks accepting new patients and MCO administrative requirements for obtaining specialist consults. Strategies to enhance access to specialists included entering into referral agreements, developing appointment reminder systems, and participation in data exchange and other community-based initiatives. The authors conclude that payment policies and network adequacy rules may need to be reexamined to address these challenges.
AHRQ-funded; HS024067.
Citation: Timbie JW, Kranz AM, Mahmud A .
Specialty care access for Medicaid enrollees in expansion states.
Am J Manag Care 2019 Mar;25(3):e83-e87..
Keywords: Access to Care, Community-Based Practice, Healthcare Delivery, Medicaid
Mehra R, Cunningham SD, Lewis JB
Recommendations for the pilot expansion of Medicaid coverage for doulas in New York state.
AHRQ-funded; HS017589.
Citation: Mehra R, Cunningham SD, Lewis JB .
Recommendations for the pilot expansion of Medicaid coverage for doulas in New York state.
Am J Public Health 2019 Feb;109(2):217-19. doi: 10.2105/ajph.2018.304797..
Keywords: Medicaid, Pregnancy, Maternal Care, Health Insurance, Healthcare Costs, Prevention, Women, Disparities
Davis MM, Shafer P, Renfro S
Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?
This study investigated whether Medicaid expansion due to the Affordable Care Act (ACA) increased the number of patients who tested for colorectal cancer (CRC). Results in Oregon showed that there was an increased in statewide fecal testing mainly in Coordinated Care Organizations (CCOs).
AHRQ-funded; HS022981.
Citation: Davis MM, Shafer P, Renfro S .
Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?
BMC Health Serv Res 2019 Jan 21;19(1):54. doi: 10.1186/s12913-018-3864-5..
Keywords: Cancer: Colorectal Cancer, Healthcare Utilization, Medicaid, Prevention, Screening
Weech-Maldonado R, Lord J, Pradhan R
High Medicaid nursing homes: organizational and market factors associated with financial performance.
The purpose of this study was to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. Higher financial performing facilities were characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets.
AHRQ-funded; HS023345; HS013852.
Citation: Weech-Maldonado R, Lord J, Pradhan R .
High Medicaid nursing homes: organizational and market factors associated with financial performance.
Inquiry 2019 Jan-Dec;56:46958018825061. doi: 10.1177/0046958018825061..
Keywords: Nursing Homes, Medicaid, Medicare
Abdus S, Decker SL
AHRQ Author: Abdus S, Decker SL
Association between Medicaid adult nonemergency dental benefits and dental services use and expenditures.
AHRQ researchers compared nonemergency dental services use in states with and without Medicaid adult nonemergency dental benefits. Dental use increased in states with the Medicaid dental benefit. Out-of-pocket expenses decreased approximately 19 percent in covered states.
AHRQ-authored.
Citation: Abdus S, Decker SL .
Association between Medicaid adult nonemergency dental benefits and dental services use and expenditures.
J Am Dent Assoc 2019 Jan;150(1):24-33. doi: 10.1016/j.adaj.2018.08.010..
Keywords: Dental and Oral Health, Healthcare Costs, Healthcare Utilization, Medicaid, Medical Expenditure Panel Survey (MEPS)
Anderson VR, Ouyang F, Tu W
Medicaid coverage and continuity for juvenile justice-involved youth.
This retrospective cohort study examined Medicaid coverage and continuity for youth with varying levels of justice system involvement and the impact of a policy change allowing Medicaid suspension, rather than termination. The study highlighted the importance of maximizing opportunities to keep youth enrolled, as gaps in coverage likely affect juveniles' access to physical, mental, and behavioral health care.
AHRQ-funded; HS022681.
Citation: Anderson VR, Ouyang F, Tu W .
Medicaid coverage and continuity for juvenile justice-involved youth.
J Correct Health Care 2019 Jan;25(1):45-54. doi: 10.1177/1078345818820043..
Keywords: Access to Care, Children/Adolescents, Medicaid, Policy, Vulnerable Populations
Liu X, Shah V, Kubilis P
Psychotropic treatment pattern in Medicaid pediatric patients with concomitant ADHD and ODD/CD.
This study analyzed the use of psychotropic treatments in children with concomitant ADHD and oppositional defiant disorder/conduct disorder (ODD/CD). The data from a cross-sectional drug utilization study based on Medicaid fee-for-service programs in 26 U.S. states from 1999 to 2006. Children ages 4 to 18 were included, with a total of 121,740 children identified. There was a period prevalence of 38.1% for “no psychotropic therapy”, 44.7% for psychotropic monotherapy, and 9% for psychotropic dual therapy. Stimulants were the most common drug class prescribed. Psychotropic combination therapy was used most with whites, males, and children in foster care.
AHRQ-funded; HS0185606.
Citation: Liu X, Shah V, Kubilis P .
Psychotropic treatment pattern in Medicaid pediatric patients with concomitant ADHD and ODD/CD.
J Atten Disord 2019 Jan;23(2):140-48. doi: 10.1177/1087054715596574..
Keywords: Children/Adolescents, Behavioral Health, Medicaid, Medication
Ghosh A, Simon K, Sommers BD
The effect of health insurance on prescription drug use among low-income adults: evidence from recent Medicaid expansions.
This study examined how subsidized coverage affected prescription drug utilization among low-income non-elderly adults. Among other results, the investigators found that within the first 15 months of new health insurance availability, aggregate Medicaid-paid prescriptions increased 19 percent, amounting to nearly 9 new prescriptions a year, per new enrollee. They also found no evidence of reductions in uninsured or privately-insured prescriptions, suggesting that new coverage did not simply substitute for other payment sources.
AHRQ-funded; HS021291.
Citation: Ghosh A, Simon K, Sommers BD .
The effect of health insurance on prescription drug use among low-income adults: evidence from recent Medicaid expansions.
J Health Econ 2019 Jan;63:64-80. doi: 10.1016/j.jhealeco.2018.11.002..
Keywords: Health Insurance, Healthcare Utilization, Low-Income, Medicaid, Medication
Hartung DM, Middleton L, McFarland BH
Use of administrative data to identify off-label use of second-generation antipsychotics in a Medicaid population.
The researchers sought to determine the accuracy of administrative claims for identifying off-label use of second-generation antipsychotics (SGAs) in a Medicaid population. They found that Medicaid claims data had high predictive ability for identifying users of SGAs who did not have documentation of schizophrenia or bipolar disorder in the medical record.
AHRQ-funded; HS019456
Citation: Hartung DM, Middleton L, McFarland BH .
Use of administrative data to identify off-label use of second-generation antipsychotics in a Medicaid population.
Psychiatr Serv. 2013 Dec;64(12):1236-42. doi: 10.1176/appi.ps.005482012..
Keywords: Medicaid, Behavioral Health, Medication
Sommers BD, Arntson E, Kenney GM
Lessons from early Medicaid expansions under health reform: interviews with Medicaid officials.
The impending 2014 Medicaid expansion features numerous policy challenges and unanswered questions. The researchers conducted in-depth interviews with high-ranking Medicaid officials in six early expanding states to glean important lessons from their experiences. They concluded that while the context of each state’s expansion is unique, key shared experiences were significant implementation challenges and opportunities for expanding access to needed services.
AHRQ-funded; HS021291.
Citation: Sommers BD, Arntson E, Kenney GM .
Lessons from early Medicaid expansions under health reform: interviews with Medicaid officials.
Medicare Medicaid Res Rev 2013 Nov 22;3(4). doi: 10.5600/mmrr.003.04.a02..
Keywords: Medicaid, Policy
Bobo WV, Cooper WO, Stein CM
Antipsychotics and the risk of type 2 diabetes mellitus in children and youth.
This study found that in a group of 25, 834 Medicaid-enrolled children and youth who had recently initiated use of either an antipsychotic or a control psychotropic drug, antipsychotic users had a risk of a newly diagnosed type 2 diabetes 3 times greater than the propensity-score matched controls. This group was confined to those who had not been diagnosed with conditions for which antipsychotics were the only recognized pharmacotherapy.
AHRQ-funded; HS0116974
Citation: Bobo WV, Cooper WO, Stein CM .
Antipsychotics and the risk of type 2 diabetes mellitus in children and youth.
JAMA Psychiatry. 2013 Oct;70(10):1067-75. doi: 10.1001/jamapsychiatry.2013.2053..
Keywords: Children/Adolescents, Behavioral Health, Diabetes, Medication, Medicaid
Lobach DF, Kawamoto K, Anstrom KJ
A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.
This study tested the impact of 3 clinical decision support modalities (emails to care managers, printed reports to clinic administrators, and letters to patients) on the use and cost of medical services for Medicaid patients. It found that some modalities can significantly reduce emergency department use and medical costs, while other interventions may have had detrimental consequences.
AHRQ-funded; HS015057
Citation: Lobach DF, Kawamoto K, Anstrom KJ .
A randomized trial of population-based clinical decision support to manage health and resource use for Medicaid beneficiaries.
J Med Syst. 2013 Feb;37(1):9922. doi: 10.1007/s10916-012-9922-3..
Keywords: Clinical Decision Support (CDS), Health Information Technology (HIT), Medicaid, Emergency Medical Services (EMS), Quality of Care