National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (4)
- Adverse Drug Events (ADE) (3)
- Adverse Events (1)
- Antibiotics (1)
- Antimicrobial Stewardship (1)
- Asthma (1)
- Behavioral Health (8)
- Cancer (1)
- Cancer: Breast Cancer (2)
- Care Management (1)
- Children/Adolescents (9)
- Chronic Conditions (3)
- Community-Based Practice (1)
- Depression (1)
- Diabetes (1)
- Disparities (1)
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- Hospitalization (1)
- (-) Medicaid (27)
- Medicare (1)
- (-) Medication (27)
- Opioids (5)
- Outcomes (1)
- Pain (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (2)
- Patient Adherence/Compliance (1)
- Policy (4)
- Practice Patterns (2)
- Pregnancy (2)
- Provider: Pharmacist (2)
- Quality Measures (1)
- Racial and Ethnic Minorities (1)
- Respiratory Conditions (1)
- Risk (1)
- Sickle Cell Disease (1)
- Substance Abuse (4)
- Tobacco Use (1)
- Tobacco Use: Smoking Cessation (1)
- Vulnerable Populations (3)
- Women (1)
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 27 Research Studies DisplayedAkincigil A, Mackie TI, Cook S
Effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children.
This retrospective observation study examined the effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children. Data was analyzed from Medicaid Analytical eXtracts (MAX) with administrative claims from 2006-2011 in Washington State. Within two years of policy implementation, prescription prevalence decreased from 6.17 to 4.04 while the synthetic control group remained stable at 6.47. The results show the effectiveness of the peer review program.
AHRQ-funded; HS026001.
Citation: Akincigil A, Mackie TI, Cook S .
Effectiveness of mandatory peer review to reduce antipsychotic prescriptions for Medicaid-insured children.
Health Serv Res 2020 Aug;55(4):596-603. doi: 10.1111/1475-6773.13297..
Keywords: Children/Adolescents, Medication, Medicaid, Policy
Maclean JC, Halpern MT, Hill SC
AHRQ Author: Hill SC
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
The purpose of this study was to quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees. Data from the Medicaid State Drug Utilization Database was used. Findings showed that Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer.
AHRQ-authored.
Citation: Maclean JC, Halpern MT, Hill SC .
The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.
Health Serv Res 2020 Jun;55(3):399-410. doi: 10.1111/1475-6773.13289..
Keywords: Medicaid, Cancer: Breast Cancer, Cancer, Medication, Policy, Women, Healthcare Utilization, Access to Care, Health Insurance
Bailey SR, Marino M, Ezekiel-Herrera D
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
This study examined whether states that expanded Medicaid eligibility under the ACA had increased smoking quit rates, tobacco cessation medication orders, and greater health care utilization compared to patients in non-expansion states. The researchers used electronic health record (EHR) data from 219 community health centers (CHCs) in 10 states that expanded Medicaid as of January 2014. They identified patients aged 19-64 with tobacco use status in their records within six months prior to ACA Medicaid expansion and 1 or more visits. They found that patients in expansion states had increased adjusted odds of quitting, having a medication ordered and having follow-up visits compared to patients in non-expansion states.
AHRQ-funded; HS024270.
Citation: Bailey SR, Marino M, Ezekiel-Herrera D .
Tobacco cessation in Affordable Care Act Medicaid expansion states versus non-expansion states.
Nicotine Tob Res 2020 Jun;22(6):1016-22. doi: 10.1093/ntr/ntz087..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Substance Abuse, Medication, Medicaid, Policy, Healthcare Utilization, Access to Care, Health Insurance
Samples H, Williams AR, Crystal S
Impact of long-term buprenorphine treatment on adverse health care outcomes In Medicaid.
The optimal, or even minimum, duration of medication treatment for opioid use disorder (OUD) needed to improve long-term outcomes has not been established empirically. As a result, health plans set potentially restrictive treatment standards to guide benefits and payment. To address this gap, the investigators used a National Quality Forum measure for OUD medication treatment duration (180 days) to examine the impact of longer treatment on health care outcomes within a key population of Medicaid enrollees.
AHRQ-funded; HS023258; HS021112.
Citation: Samples H, Williams AR, Crystal S .
Impact of long-term buprenorphine treatment on adverse health care outcomes In Medicaid.
Impact of long-term buprenorphine treatment on adverse health care outcomes In Medicaid..
Keywords: Medication, Substance Abuse, Opioids, Medicaid, Adverse Drug Events (ADE), Adverse Events, Patient-Centered Outcomes Research, Evidence-Based Practice, Outcomes
Kayle M, Valle J, Paulukonis S
Impact of Medicaid expansion on access and healthcare among individuals with sickle cell disease.
The purpose of this study was to examine whether Medicaid expansion in California, increased Medicaid enrollment, increased hydroxyurea prescriptions filled, and decreased acute healthcare utilization in sickle cell disease (SCD). Findings showed that Medicaid expansion did not appear to have improved enrollment or acute healthcare utilization among individuals with SCD in California. Recommendations included future studies exploring whether individuals with SCD transitioned to other insurance plans or became uninsured post-expansion, the underlying reasons for low hydroxyurea utilization, and the lack of effect on hospital admissions despite a modest effect on emergency department visits.
AHRQ-funded; HS023011; HS025297.
Citation: Kayle M, Valle J, Paulukonis S .
Impact of Medicaid expansion on access and healthcare among individuals with sickle cell disease.
Pediatr Blood Cancer 2020 May;67(5):e28152. doi: 10.1002/pbc.28152..
Keywords: Sickle Cell Disease, Medicaid, Access to Care, Healthcare Utilization, Medication, Hospitalization, Health Insurance
Fischer MA, Mahesri M, Lii J
Non-Infection-related and non-visit-based antibiotic prescribing is common among Medicaid patients.
This study examined antibiotic prescribing by clinicians when there was no visit or without clear indications for use. The authors discuss the fact that current ambulatory antibiotic stewardship policies do not capture prescribing outside of clinician visits or clear indications for use. They measured the frequency for all filled antibiotic prescriptions in Medicaid patients in the period 2004-2013. They found that out of 298 million antibiotic fills for 53 million patients (62% for children), 55% were for clinician visits with an infection-related diagnosis, 17% were for visits without an infection-related diagnosis, and 28% were not associated with a visit.
AHRQ-funded; HS024930; HS023236; HS024651; HS026506; 2332015000201.
Citation: Fischer MA, Mahesri M, Lii J .
Non-Infection-related and non-visit-based antibiotic prescribing is common among Medicaid patients.
Health Aff 2020 Feb;39(2):280-88. doi: 10.1377/hlthaff.2019.00545..
Keywords: Antimicrobial Stewardship, Medicaid, Antibiotics, Medication, Practice Patterns, Children/Adolescents
Mackie TI, Cook S, Crystal S
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
This study examined a multimodal antipsychotic intervention implemented by a specialized Medicaid managed care organization (MMCO) for youths in foster care with routine mental health screening, health passports, elective psychiatric consultation line, and retrospective drug utilization reviews to determine whether this multimodal intervention significantly reduced antipsychotic dispensing for youths with conditions without US Food and Drug Administration (FDA)-approved indications. Findings showed that MMCO implementation significantly reduced antipsychotic medications without FDA-indicated conditions prescribed to youths, while not significantly affecting antipsychotic medications prescribed to youths with FDA-indicated conditions.
AHRQ-funded; HS026001.
Citation: Mackie TI, Cook S, Crystal S .
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
J Am Acad Child Adolesc Psychiatry 2020 Jan;59(1):166-76.e3. doi: 10.1016/j.jaac.2019.04.022..
Keywords: Children/Adolescents, Behavioral Health, Medication, Vulnerable Populations, Medicaid, Health Insurance
Samples H, Williams AR, Olfson M
Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees.
The purpose of this study was to examine duration of buprenorphine treatment for opioid use disorder (OUD) following the initiation of treatment in order to identify risk factors for early discontinuation. Researchers analyzed insurance claims from the MarketScan multi-state Medicaid database for 2013 through 2015; their sample included adults aged 18-64 years who had an OUD diagnosis 6 months before initiating buprenorphine treatment. More than 1/4 of the sample discontinued buprenorphine in the first month of treatment, and most of the sample discontinued before 180 days. Risk factors for discontinuation were associated with significantly lower odds of treatment retention for at least 180 days. The study concludes that there is need to implement treatment models that address barriers to treatment retention more effectively.
AHRQ-funded; HS021112.
Citation: Samples H, Williams AR, Olfson M .
Risk factors for discontinuation of buprenorphine treatment for opioid use disorders in a multi-state sample of Medicaid enrollees.
J Subst Abuse Treat 2018 Dec;95:9-17. doi: 10.1016/j.jsat.2018.09.001..
Keywords: Medicaid, Medication, Opioids, Risk, Substance Abuse
Myerson R, Lu T, Tonnu-Mihara I
Medicaid eligibility expansions may address gaps in access to diabetes medications.
The purpose of this study was to examine the impacts of Medicaid expansion on access to diabetes medications, researchers analyzed data on over ninety-six million prescription fills using Medicaid insurance in the period January 2008-December 2015. The researchers found that the increase in prescription fills grew significantly over time. Overall, fills for insulin and for newer medications increased by 40 percent and 39 percent, respectively.
AHRQ-funded; HS023964.
Citation: Myerson R, Lu T, Tonnu-Mihara I .
Medicaid eligibility expansions may address gaps in access to diabetes medications.
Health Aff 2018 Aug;37(8):1200-07. doi: 10.1377/hlthaff.2018.0154..
Keywords: Access to Care, Diabetes, Policy, Medicaid, Medication
Leckman-Westin E, Finnerty M, Scholle SH
Differences in Medicaid antipsychotic medication measures among children with SSI, foster care, and income-based aid.
This study examined the application of 6 quality measures for antipsychotic medication prescribing in children and adolescents receiving Medicaid. While indicators of overuse were more common in those with Supplemental Security Income and foster care groups, access to follow-up, metabolic monitoring, and psychosocial services was somewhat better for these children. However, substantial quality shortfalls existed for all groups, particularly metabolic screening and monitoring.
AHRQ-funded; HS020503; HS019937; HS021112.
Citation: Leckman-Westin E, Finnerty M, Scholle SH .
Differences in Medicaid antipsychotic medication measures among children with SSI, foster care, and income-based aid.
J Manag Care Spec Pharm 2018 Mar;24(3):238-46. doi: 10.18553/jmcp.2018.24.3.238.
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Keywords: Children/Adolescents, Medicaid, Medication, Quality Measures, Vulnerable Populations
Ajmera M, Sambamoorthi U, Metzger A
Multimorbidity and COPD Medication receipt among Medicaid beneficiaries with newly diagnosed COPD.
The aim of this study was to examine the association between multimorbidity and chronic obstructive pulmonary disease ( COPD) medication receipt among Medicaid beneficiaries with newly diagnosed COPD. It found that in this group 81.9 percen had at least one co-occurring chronic condition. After controlling for subject characteristics, adults with multimorbidity were less likely to receive COPD medications compared with those without any inflammation-related multimorbidity.
AHRQ-funded; HS022444.
Citation: Ajmera M, Sambamoorthi U, Metzger A .
Multimorbidity and COPD Medication receipt among Medicaid beneficiaries with newly diagnosed COPD.
Respir Care 2015 Nov;60(11):1592-602. doi: 10.4187/respcare.03788.
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Keywords: Chronic Conditions, Respiratory Conditions, Medication, Medicaid
Palmsten K, Hernandez-Diaz S, Chambers CD
The most commonly dispensed prescription medications among pregnant women enrolled in the U.S. Medicaid program.
The researchers characterize the 20 most common prescription medications and the 10 most common prescription medications classified in the former U.S. Food and Drug Administration categories D or X dispensed to pregnant women enrolled in the U.S. Medicaid program. They found that medications used to treat infections were the most commonly dispensed prescription medications.
AHRQ-funded; HS018533.
Citation: Palmsten K, Hernandez-Diaz S, Chambers CD .
The most commonly dispensed prescription medications among pregnant women enrolled in the U.S. Medicaid program.
Obstet Gynecol 2015 Sep;126(3):465-73. doi: 10.1097/aog.0000000000000982..
Keywords: Medicaid, Pregnancy, Medication
Ringwalt C, Roberts AW, Gugelmann H
Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic noncancer pain.
The purpose of this study was to examine differences across providers’ specialties in prescriptions filled by white and black Medicaid beneficiaries with chronic noncancer pain (CNCP). It found that race-based differences in beneficiaries’ dispensed opioid prescriptions were more prominent among patients of specialists in obstetrics and gynecology and internal medicine, as well as general practitioners/family medicine physicians.
AHRQ-funded; HS000032.
Citation: Ringwalt C, Roberts AW, Gugelmann H .
Racial disparities across provider specialties in opioid prescriptions dispensed to Medicaid beneficiaries with chronic noncancer pain.
Pain Med 2015 Apr;16(4):633-40. doi: 10.1111/pme.12555..
Keywords: Chronic Conditions, Disparities, Medicaid, Medication, Opioids, Pain, Racial and Ethnic Minorities
Garfield LD, Brown DS, Allaire BT
Psychotropic drug use among preschool children in the Medicaid program from 36 states.
The researchers examined utilization of the most commonly used psychotropic medications among children aged 4 years and younger. They determined the prevalence of and indications for psychotropic medication among preschool children in Medicaid. Their study found that preschoolers are receiving psychotropic medications despite limited evidence supporting safety or efficacy. Medications for attention-deficit disorder/attention-deficit hyperactivity disorder treatment were most common.
AHRQ-funded; HS020269.
Citation: Garfield LD, Brown DS, Allaire BT .
Psychotropic drug use among preschool children in the Medicaid program from 36 states.
Am J Public Health 2015 Mar;105(3):524-9. doi: 10.2105/ajph.2014.302258..
Keywords: Children/Adolescents, Medication, Medicaid, Behavioral Health
Madden JM, Adams AS, LeCates RF
Changes in drug coverage generosity and untreated serious mental illness: transitioning from Medicaid to Medicare Part D.
This study examined the effects of transitioning to Part D coverage among disabled dual enrollees with schizophrenia or a bipolar disorder, comparing enrollees in states with strict Medicaid cap policies with enrollees in states without caps. It found significant reductions in the number of people with a serious mental illness who were not treated owing to the transition to Part D from strictly capped Medicaid coverage.
AHRQ-funded; HS018577.
Citation: Madden JM, Adams AS, LeCates RF .
Changes in drug coverage generosity and untreated serious mental illness: transitioning from Medicaid to Medicare Part D.
JAMA Psychiatry 2015 Feb;72(2):179-88. doi: 10.1001/jamapsychiatry.2014.1259..
Keywords: Behavioral Health, Medication, Medicare, Medicaid, Depression
Beadles CA, Farley JF, Ellis AR
Do medical homes increase medication adherence for persons with multiple chronic conditions?
The goal of this study was to assess the association between medical homes and adherence to newly initiated medications among Medicaid enrollees with multiple chronic conditions (MCC). The researchers examined data from North Carolina Medicaid enrollees with MCC and found that adherence to new medications is greater for those enrolled in medical homes.
AHRQ-funded; HS000032; HS019659.
Citation: Beadles CA, Farley JF, Ellis AR .
Do medical homes increase medication adherence for persons with multiple chronic conditions?
Med Care 2015 Feb;53(2):168-76. doi: 10.1097/mlr.0000000000000292..
Keywords: Chronic Conditions, Medication, Medicaid, Patient Adherence/Compliance, Patient-Centered Healthcare
Valet RS, Gebretsadik T, Minton PA
Prevalence and characteristics of medication sharing behavior in a pediatric Medicaid population with asthma.
The researchers described features surrounding the sharing and borrowing of nonprescription medications and examine the effects of this behavior on adverse asthma outcomes among children with asthma. They found a trend toward decreased Asthma Control Test (ACT) score and a higher proportion of patients with ACT scores of 19 or lower among those who shared or borrowed medication.
AHRQ-funded; HS019669.
Citation: Valet RS, Gebretsadik T, Minton PA .
Prevalence and characteristics of medication sharing behavior in a pediatric Medicaid population with asthma.
Ann Allergy Asthma Immunol 2015 Feb;114(2):151-3. doi: 10.1016/j.anai.2014.11.007..
Keywords: Medication, Children/Adolescents, Medicaid, Asthma, Adverse Drug Events (ADE)
Wheeler SB, Kohler RE, Reeder-Hayes KE
Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors.
The researchers sought to characterize endocrine therapy (ET) use in a low-income Medicaid-insured population in North Carolina. They found that, of 222 women meeting the inclusion criteria, only 50 percent filled a prescription for ET. Results suggest substantial underutilization of ET in this population.
AHRQ-funded; HS019468.
Citation: Wheeler SB, Kohler RE, Reeder-Hayes KE .
Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors.
J Cancer Surviv 2014 Dec;8(4):603-10. doi: 10.1007/s11764-014-0365-3..
Keywords: Cancer: Breast Cancer, Healthcare Utilization, Medicaid, Medication, Patient-Centered Outcomes Research
Raghavan R, Brown DS, Allaire BT
Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States.
The authors aimed to quantify the magnitude of Medicaid expenditures incurred in the purchase of psychotropic drugs for children with histories of abuse or neglect. They concluded that Medicaid agencies should focus their cost containment strategies on antidepressants and antimanic drugs, consider expanding primary care case management arrangements, and expand use of instruments such as the Child Behavior Checklist to identify and treat high-need children.
AHRQ-funded; HS020269.
Citation: Raghavan R, Brown DS, Allaire BT .
Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States.
Psychiatr Serv 2014 Dec;65(12):1445-51. doi: 10.1176/appi.ps.201400028.
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Keywords: Children/Adolescents, Healthcare Costs, Medicaid, Medication, Behavioral Health
Saloner B, Matone M, Kreider AR
Second-generation antipsychotic use among stimulant-using children, by organization of Medicaid mental health.
The authors compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures. They found that carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use.
AHRQ-funded; HS020269; HS018550.
Citation: Saloner B, Matone M, Kreider AR .
Second-generation antipsychotic use among stimulant-using children, by organization of Medicaid mental health.
Psychiatr Serv 2014 Dec;65(12):1458-64. doi: 10.1176/appi.ps.201300574.
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Keywords: Children/Adolescents, Healthcare Utilization, Medicaid, Medication, Behavioral Health
Finnerty M, Neese-Todd S, Bilder S
Best practices: MEDNET: a multistate policy maker-researcher collaboration to improve prescribing practices.
The authors describe the Medicaid/ Mental Health Network for Evidence-Based Treatment (MEDNET), the first multistate Medicaid QI collaborative to focus on improving psychotropic prescribing. In particular, this article includes the development, infrastructure challenges, and early evidence of success of this public-academic partnership.
AHRQ-funded; HSO19937; HS021112.
Citation: Finnerty M, Neese-Todd S, Bilder S .
Best practices: MEDNET: a multistate policy maker-researcher collaboration to improve prescribing practices.
Psychiatr Serv 2014 Nov 1;65(11):1297-9. doi: 10.1176/appi.ps.201400343..
Keywords: Behavioral Health, Evidence-Based Practice, Medication, Medicaid, Practice Patterns
Werth SR, Sachdeva N, Roberts AW
North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.
The objectives of this study were (a) evaluate pharmacists’ perceptions of the implementation of the North Carolina (NC) recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success. It concluded that, although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists’ medication gate-keeping role, while minimizing the effort required for successful implementation.
AHRQ-funded; HS000032.
Citation: Werth SR, Sachdeva N, Roberts AW .
North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.
J Manag Care Spec Pharm 2014 Nov;20(11):1122-9..
Keywords: Medicaid, Medication, Opioids, Provider: Pharmacist, Substance Abuse
Vanderwerker L, Akincigil A, Olfson M
Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.
The researchers investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths. They found that foster care youths had higher rates of externalizing disorders than the comparison group and greater antipsychotic use. Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates.
AHRQ-funded; HS017918; HS019937; HS021112.
Citation: Vanderwerker L, Akincigil A, Olfson M .
Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.
Psychiatr Serv 2014 Oct;65(10):1281-4. doi: 10.1176/appi.ps.201300455.
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Keywords: Children/Adolescents, Medication, Medicaid, Vulnerable Populations, Behavioral Health
Snyder ME, Frail CK, Jaynes H
Predictors of medication-related problems among Medicaid patients participating in a pharmacist-provided telephonic medication therapy management program.
The objective of this study was to identify predictors of medication-related problems (MRPs) among Medicaid patients participating in a telephonic medication therapy management (MTM) program. The analysis of study results supports the relative importance of number of medications as a predictor of MRPs in the Medicaid population and identifies other predictors.
AHRQ-funded; HS022119.
Citation: Snyder ME, Frail CK, Jaynes H .
Predictors of medication-related problems among Medicaid patients participating in a pharmacist-provided telephonic medication therapy management program.
Pharmacotherapy 2014 Oct;34(10):1022-32. doi: 10.1002/phar.1462..
Keywords: Adverse Drug Events (ADE), Care Management, Community-Based Practice, Medicaid, Medication, Provider: Pharmacist
Desai RJ, Hernandez-Diaz S, Bateman BT
Increase in prescription opioid use during pregnancy among Medicaid-enrolled women.
The researchers reported the prevalence of prescription opioid use and evaluated the trends in a large cohort of Medicaid-enrolled pregnant women. They observed high and increasing number of filled prescriptions for opioids during pregnancy among Medicaid-enrolled women and recommended further safety evaluations of these drugs and their effects on the developing fetus.
AHRQ-funded; HS018533.
Citation: Desai RJ, Hernandez-Diaz S, Bateman BT .
Increase in prescription opioid use during pregnancy among Medicaid-enrolled women.
Obstet Gynecol 2014 May;123(5):997-1002. doi: 10.1097/aog.0000000000000208.
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Keywords: Healthcare Utilization, Medicaid, Medication, Opioids, Pregnancy