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
51 to 75 of 219 Research Studies DisplayedVyas A, Madhavan SS, Sambamoorthi U
Differences in Medicare expenditures between Appalachian and nationally representative cohorts of elderly women with breast cancer: an application of decomposition technique.
The objective of this study was to determine Medicare expenditures during the initial phase of care among women in West Virginia (WV) who were Medicare beneficiaries with BC and compare them with national estimates. It found that the difference in average Medicare expenditures between the elderly beneficiaries with BC from a rural state (WV) and their national counterparts narrowed but remained significantly lower after multivariate adjustment.
AHRQ-funded; HS018622.
Citation: Vyas A, Madhavan SS, Sambamoorthi U .
Differences in Medicare expenditures between Appalachian and nationally representative cohorts of elderly women with breast cancer: an application of decomposition technique.
J Natl Compr Canc Netw 2017 May;15(5):578-87.
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Keywords: Cancer: Breast Cancer, Elderly, Healthcare Costs, Medicare, Rural Health
Roberts ET, Mehrotra A, McWilliams JM
High-price and low-price physician practices do not differ significantly on care quality or efficiency.
The researchers examined the relationship between physician practice prices for outpatient services and practices' quality and efficiency of care. Patients of high-price practices reported significantly higher scores on some measures of care coordination and management but did not differ meaningfully in their overall care ratings, receipt of preventive services, acute care use, or total Medicare spending.
AHRQ-funded; HS024072.
Citation: Roberts ET, Mehrotra A, McWilliams JM .
High-price and low-price physician practices do not differ significantly on care quality or efficiency.
Health Aff 2017 May;36(5):855-64. doi: 10.1377/hlthaff.2016.1266.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Healthcare Costs, Practice Patterns
Lee BY, Adam A, Zenkov E
Modeling the economic and health impact of increasing children's physical activity in the United States.
Using a computational simulation model that was developed to represent all US children ages 8-11 years, the researchers estimated that if 50 percent of children would exercise, the number of obese and overweight youth would decrease by 4 percent, averting $8.1 billion in direct medical costs and $13.8 billion in lost productivity.
AHRQ-funded; HS023317.
Citation: Lee BY, Adam A, Zenkov E .
Modeling the economic and health impact of increasing children's physical activity in the United States.
Health Aff 2017 May;36(5):902-08. doi: 10.1377/hlthaff.2016.1315.
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Keywords: Children/Adolescents, Lifestyle Changes, Healthcare Costs, Obesity
Frean M, Gruber J, Sommers BD
Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. Win this study, the investigators provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time.
AHRQ-funded; HS021291.
Citation: Frean M, Gruber J, Sommers BD .
Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.
J Health Econ 2017 May;53:72-86. doi: 10.1016/j.jhealeco.2017.02.004..
Keywords: Healthcare Costs, Health Insurance, Policy, Medicaid
Adamson BJS, Carlson JJ, Kublin JG
The potential cost-effectiveness of pre-exposure prophylaxis combined with HIV vaccines in the United States.
This economic evaluation found that at current prices, pre-exposure prophylaxis (PrEP) was not cost-effective alone or in combination. A combination strategy had the greatest health benefit but was not cost-effective as compared to vaccination alone. Vaccine durability and PrEP drug prices were key drivers of cost-effectiveness.
AHRQ-funded; HS013853.
Citation: Adamson BJS, Carlson JJ, Kublin JG .
The potential cost-effectiveness of pre-exposure prophylaxis combined with HIV vaccines in the United States.
Vaccines 2017 May 24;5(2). doi: 10.3390/vaccines5020013.
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Keywords: Human Immunodeficiency Virus (HIV), Vaccination, Healthcare Costs, Prevention
Haidari LA, Brown ST, Wedlock P
When are solar refrigerators less costly than on-grid refrigerators: a simulation modeling study.
Gavi the Vaccine Alliance recommends solar refrigerators for vaccine storage in areas with less than eight hours of electricity per day, and World Health Organization guidelines are more conservative. This study investigated whether solar refrigerators provide value where electrical outages are less frequent. It identified the frequency and duration at which electrical outages need to occur for solar refrigerators to provide savings in total cost per dose administered over electric refrigerators at different solar refrigerator prices.
AHRQ-funded; HS023317.
Citation: Haidari LA, Brown ST, Wedlock P .
When are solar refrigerators less costly than on-grid refrigerators: a simulation modeling study.
Vaccine 2017 Apr 19;35(17):2224-28. doi: 10.1016/j.vaccine.2016.11.103.
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Keywords: Healthcare Costs, Medication, Vaccination
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
Carey K
Ambulatory surgery centers and prices in hospital outpatient departments.
Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25 percent to 5.15 percent lower for each additional ASC per 100,000 persons in a market.
AHRQ-funded; HS023780.
Citation: Carey K .
Ambulatory surgery centers and prices in hospital outpatient departments.
Med Care Res Rev 2017 Apr;74(2):236-48. doi: 10.1177/1077558716633010.
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Keywords: Ambulatory Care and Surgery, Healthcare Costs, Payment, Hospitals
Waljee JF, Cron DC, Steiger RM
Effect of preoperative opioid exposure on healthcare utilization and expenditures following elective abdominal surgery.
The researchers examined the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures. They found that compared with non-users, patients using opioids preoperatively were more likely to have a longer hospital stay and were more likely to be discharged to a rehabilitation facility , adjusting for covariates.
AHRQ-funded; HS023313.
Citation: Waljee JF, Cron DC, Steiger RM .
Effect of preoperative opioid exposure on healthcare utilization and expenditures following elective abdominal surgery.
Ann Surg 2017 Apr;265(4):715-21. doi: 10.1097/sla.0000000000002117.
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Keywords: Opioids, Surgery, Healthcare Delivery, Healthcare Costs, Adverse Drug Events (ADE)
Zullo AR, Howe CJ, Galarraga O
Estimating the effect of health insurance on personal prescription drug importation.
Personal prescription drug importation occurs in the United States because of the high cost of U.S. medicines and lower cost of foreign equivalents. The investigators used inverse probability weighted marginal structural models and data on 87,494 individuals from the 2011-2013 National Health Interview Survey to estimate the marginal association between no health insurance and importation within U.S. subpopulations.
AHRQ-funded; HS022998.
Citation: Zullo AR, Howe CJ, Galarraga O .
Estimating the effect of health insurance on personal prescription drug importation.
Med Care Res Rev 2017 Apr;74(2):178-207. doi: 10.1177/1077558716629039..
Keywords: Health Insurance, Healthcare Costs, Medication
Haidari LA, Brown ST, Constenla D
Geospatial planning and the resulting economic impact of human papillomavirus vaccine introduction in Mozambique.
Researchers developed the Strategic Integrated Geo-temporal Mapping Application) to determine the potential economic impact of HPV immunization in Mozambique. If each health center covers a catchment area with a 5-km radius, then 40 percent of the target population could be reached to prevent 50 cases, 178 disability-adjusted life years, and US $202,854 in health care costs and lost productivity.
AHRQ-funded; HS023317.
Citation: Haidari LA, Brown ST, Constenla D .
Geospatial planning and the resulting economic impact of human papillomavirus vaccine introduction in Mozambique.
Sex Transm Dis 2017 Apr;44(4):222-26. doi: 10.1097/olq.0000000000000574.
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Keywords: Cancer, Healthcare Costs, Infectious Diseases, Sexual Health, Vaccination
Jacobs PD, Cohen ML, Keenan P
AHRQ Author: Jacobs PD; Keenan P
Risk adjustment, reinsurance improved financial outcomes for individual market insurers with the highest claims.
To assess the impact of a risk adjustment program and a temporary reinsurance program, the researchers compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. They found that both programs were relatively well targeted in the first two years.
AHRQ-authored.
Citation: Jacobs PD, Cohen ML, Keenan P .
Risk adjustment, reinsurance improved financial outcomes for individual market insurers with the highest claims.
Health Aff 2017 Apr;36(4):755-63. doi: 10.1377/hlthaff.2016.1456.
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Keywords: Health Insurance, Healthcare Costs, Policy
Biener A, Cawley J, Meyerhoefer C
AHRQ Author: Biener A
The high and rising costs of obesity to the US health care system.
The purpose of this editorial is to provide new information on the medical care costs of obesity that help motivate various weight loss interventions. The editorial is a part of a special issue with articles examining behavioral, pharmacotherapy, and surgical interventions for weight loss, based on a 2016 conference on state-of-the-art weight management hosted by the Veterans Health Administration.
AHRQ-authored.
Citation: Biener A, Cawley J, Meyerhoefer C .
The high and rising costs of obesity to the US health care system.
J Gen Intern Med 2017 Apr;32(Suppl 1):6-8. doi: 10.1007/s11606-016-3968-8.
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Keywords: Obesity, Healthcare Costs, Obesity: Weight Management, Lifestyle Changes, Nutrition
Krinsky S, Ryan AM, Mijanovich T
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
The researchers measured variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identified the main payment adjustments that drive variation. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations.
AHRQ-funded; HS018546.
Citation: Krinsky S, Ryan AM, Mijanovich T .
Variation in payment rates under Medicare's Inpatient Prospective Payment System.
Health Serv Res 2017 Apr;52(2):676-96. doi: 10.1111/1475-6773.12490.
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Keywords: Payment, Medicare, Healthcare Costs, Hospitals
Fritz JM, Kim M, Magel JS
Cost-effectiveness of primary care management with or without early physical therapy for acute low back pain: economic evaluation of a randomized clinical trial.
The objective of this study was to compare costs and cost-effectiveness of usual primary care management for patients with acute low back pain with or without the addition of early physical therapy. The authors suggest that their results support early physical therapy as cost-effective relative to usual primary care after 1 year for patients with acute, nonspecific lower back pain.
AHRQ-funded; HS018672.
Citation: Fritz JM, Kim M, Magel JS .
Cost-effectiveness of primary care management with or without early physical therapy for acute low back pain: economic evaluation of a randomized clinical trial.
Spine 2017 Mar;42(5):285-90. doi: 10.1097/brs.0000000000001729..
Keywords: Back Health and Pain, Healthcare Costs, Pain, Primary Care
Ouayogode MH, Colla CH, Lewis VA
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
This study examined Accountable Care Organization (ACO) and market factors associated with superior financial performance in Medicare ACO programs. No characteristic of organizational structure was significantly associated with both outcomes of savings per beneficiary and likelihood of achieving shared savings. ACO prior experience with risk-bearing contracts was positively correlated with savings and significantly increased the likelihood of receiving shared savings payments.
AHRQ-funded; HS024075.
Citation: Ouayogode MH, Colla CH, Lewis VA .
Determinants of success in shared savings programs: an analysis of ACO and market characteristics.
Healthc 2017 Mar;5(1-2):53-61. doi: 10.1016/j.hjdsi.2016.08.002.
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Keywords: Healthcare Costs, Payment, Policy, Medicare
Schlitz NK, Warner DF, Sun J
Identifying specific combinations of multimorbidity that contribute to health care resource utilization: an analytic approach.
The objective was to identify specific combinations of chronic conditions, functional limitations, and geriatric syndromes associated with direct medical costs and inpatient utilization. The multimorbid population is heterogeneous and there is considerable variation in how specific combinations of morbidity influence resource use. Functional limitations were more important than many chronic diseases in explaining resource use.
AHRQ-funded; HS023113.
Citation: Schlitz NK, Warner DF, Sun J .
Identifying specific combinations of multimorbidity that contribute to health care resource utilization: an analytic approach.
Med Care 2017 Mar;55(3):276-84. doi: 10.1097/mlr.0000000000000660.
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Keywords: Elderly, Chronic Conditions, Healthcare Utilization, Hospitalization, Healthcare Costs
Yeung K, Basu A, Marcum ZA
Impact of a value-based formulary in three chronic disease cohorts.
This study assessed the impact of a value based formulary (VBF) on medication adherence and patient and health plan expenditures on 3 chronic disease states: diabetes, hypertension, and hyperlipidemia. The investigators measured medication expenditures from member, health plan, and member-plus-health plan (overall) perspectives and medication adherence as proportion of days covered. They conducted an exploratory analysis of medication utilization classifying medications according to whether co-payments moved up or down in the year following VBF implementation.
AHRQ-funded; HS022982.
Citation: Yeung K, Basu A, Marcum ZA .
Impact of a value-based formulary in three chronic disease cohorts.
Am J Manag Care 2017 Mar; 23(3 Suppl):S46-s53..
Keywords: Chronic Conditions, Health Insurance, Patient Adherence/Compliance, Medication, Healthcare Costs
Rees MA, Dunn TB, Kuhr CS
Kidney exchange to overcome financial barriers to kidney transplantation.
Organ shortage is the major limitation to kidney transplantation in the developed world. This proposal leverages the cost savings achieved through earlier transplantation over dialysis to fund the cost of kidney exchange between developed-world patient-donor pairs with immunological barriers and developing-world patient-donor pairs with financial barriers.
AHRQ-funded; HS020610.
Citation: Rees MA, Dunn TB, Kuhr CS .
Kidney exchange to overcome financial barriers to kidney transplantation.
Am J Transplant 2017 Mar;17(3):782-90. doi: 10.1111/ajt.14106.
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Keywords: Transplantation, Healthcare Costs, Policy, Kidney Disease and Health, Kidney Disease and Health
Robinson JC, Brown TT, Whaley C
Reference pricing changes the 'choice architecture' of health care for consumers.
This article summarizes reference pricing's impacts to date on patient choice, provider prices, surgical complications, and employer spending and estimates its potential impacts if expanded to more services and a broader population. Reference pricing induces consumers to select lower-price alternatives for all of the forms of care studied, leading to significant reductions in prices paid and spending incurred by insurers and employers.
AHRQ-funded; HS022098.
Citation: Robinson JC, Brown TT, Whaley C .
Reference pricing changes the 'choice architecture' of health care for consumers.
Health Aff 2017 Mar;36(3):524-30. doi: 10.1377/hlthaff.2016.1256.
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Keywords: Decision Making, Education: Patient and Caregiver, Healthcare Costs, Healthcare Delivery
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
Kass AE, Balantekin KN, Fitzsimmons-Craft EE
The economic case for digital interventions for eating disorders among United States college students.
This article aimed to estimate the costs, in United States (US) dollars, of a stepped care model for online prevention and treatment among US college students to inform meaningful decisions regarding resource allocation and adoption of efficient care delivery models for EDs on college campuses. A stepped care model was estimated to achieve modest cost savings compared to standard care, but these estimates need to be tested with sensitivity analyses.
AHRQ-funded; HS000078.
Citation: Kass AE, Balantekin KN, Fitzsimmons-Craft EE .
The economic case for digital interventions for eating disorders among United States college students.
Int J Eat Disord 2017 Mar;50(3):250-58. doi: 10.1002/eat.22680.
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Keywords: Behavioral Health, Healthcare Delivery, Healthcare Costs, Prevention, Primary Care: Models of Care, Telehealth, Young Adults, Web-Based
Adamson B, Dimitrov D, Devine B
The potential cost-effectiveness of HIV vaccines: a systematic review.
The aim of this paper was to review and compare HIV vaccine uncertainty in model, methodology, and parameterization. Model assumptions about vaccine price, HIV treatment costs, epidemic context, and willingness to pay influenced results more consistently than assumptions on HIV transmission dynamics.
AHRQ-funded; HS013853.
Citation: Adamson B, Dimitrov D, Devine B .
The potential cost-effectiveness of HIV vaccines: a systematic review.
Pharmacoeconom Open 2017 Mar;1(1):1-12. doi: 10.1007/s41669-016-0009-9.
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Keywords: Human Immunodeficiency Virus (HIV), Healthcare Costs, Vaccination
Schlesinger M, Grob R
Treating, fast and slow: Americans' understanding of and responses to low-value care.
This article explores Americans’ understanding of low-value care in 2015, assesses the impact of media messaging, and tests alternative message framing. The study concluded that the public’s awareness of low-value care is incomplete, with substantial disparities related to race, ethnicity, and socioeconomic status.
AHRQ-funded; HS021858; HS016978.
Citation: Schlesinger M, Grob R .
Treating, fast and slow: Americans' understanding of and responses to low-value care.
Milbank Q 2017 Mar;95(1):70-116. doi: 10.1111/1468-0009.12246..
Keywords: Healthcare Delivery, Decision Making, Healthcare Costs, Quality of Care