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
101 to 125 of 219 Research Studies DisplayedGiordano SH, Niu J, Chavez-MacGregor M
Estimating regimen-specific costs of chemotherapy for breast cancer: observational cohort study.
The objective of the current study was to generate cost estimates for guideline-concordant adjuvant chemotherapy regimens from payers' and patients' perspectives in a large, insured US population. It concluded that the costs of breast cancer chemotherapy vary widely across regimens, and patients bear a substantial out-of-pocket burden.
AHRQ-funded; HS020263.
Citation: Giordano SH, Niu J, Chavez-MacGregor M .
Estimating regimen-specific costs of chemotherapy for breast cancer: observational cohort study.
Cancer 2016 Nov 15; 122(2):3447-3455. doi: 10.1002/cncr.30274.
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Keywords: Cancer, Cancer: Breast Cancer, Treatments, Healthcare Costs
O'Shea L, Bindman AB
AHRQ Author: Bindman AB
Personal health budgets for patients with complex needs.
Some of the highest cost patients have functional impairments and social needs that necessitate long-term services and supports. One approach from England entails the creation of “personal health budgets,” a model for self-directed support that may be worth considering in the United States. The authors discuss this approach and conclude that the evidence from England suggests that patients themselves can help to design higher-value care.
AHRQ-authored.
Citation: O'Shea L, Bindman AB .
Personal health budgets for patients with complex needs.
N Engl J Med 2016 Nov 10;375(19):1815-17. doi: 10.1056/NEJMp1606040.
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Keywords: Healthcare Costs, Policy, Policy
Michaelidis CI, Fine MJ, Lin CJ
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
This study estimated the hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States. It concluded that each ambulatory antibiotic prescription is associated with a hidden societal cost of antibiotic resistance (SCAR) that substantially increases the cost of an antibiotic prescription in the United States. This finding raises concerns regarding the magnitude of misalignment between individual and societal antibiotic costs.
AHRQ-funded; HS024930.
Citation: Michaelidis CI, Fine MJ, Lin CJ .
The hidden societal cost of antibiotic resistance per antibiotic prescribed in the United States: an exploratory analysis.
BMC Infect Dis 2016 Nov 8;16(1):655. doi: 10.1186/s12879-016-1990-4.
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Keywords: Medication, Primary Care, Hospitalization, Healthcare Costs, Ambulatory Care and Surgery
Nocon RS, Lee SM, Sharma R
AHRQ Author: Ngo-Metzger Q
Health care use and spending for medicaid enrollees in federally qualified health centers versus other primary care settings.
This study compared health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non-health center settings in a context of significant growth. It found that health center patients had lower use and spending than did non-health center patients across all services, with 22 percent fewer visits and 33 percent lower spending on specialty.
AHRQ-authored.
Citation: Nocon RS, Lee SM, Sharma R .
Health care use and spending for medicaid enrollees in federally qualified health centers versus other primary care settings.
Am J Public Health 2016 Nov;106(11):1981-89. doi: 10.2105/ajph.2016.303341.
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Keywords: Medicaid, Healthcare Costs, Primary Care, Healthcare Utilization
Pradarelli JC, Healy MA, Osborne NH
Variation in Medicare expenditures for treating perioperative complications: the cost of rescue.
The researchers evaluated differences across hospitals in the costs of care for patients surviving perioperative complications after major inpatient surgery. After 4 selected inpatient operations, substantial variation was observed across hospitals regarding Medicare episode payments for patients rescued from perioperative complications. Notably, higher Medicare payments were not associated with improved clinical performance.
AHRQ-funded; HS017765.
Citation: Pradarelli JC, Healy MA, Osborne NH .
Variation in Medicare expenditures for treating perioperative complications: the cost of rescue.
JAMA Surg 2016 Oct 5:e163340. doi: 10.1001/jamasurg.2016.3340.
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Keywords: Medicare, Adverse Events, Surgery, Healthcare Costs, Patient Safety
Peiris D, Phipps-Taylor MC, Stachowski CA
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
The researchers examined differences between commercial accountable care organizations (ACOs) and noncommercial ACOs. They found that among all ACOs, there was low uptake of quality and efficiency activities; commercial ACOs reported more use of disease monitoring tools, patient satisfaction data, and quality improvement methods; and about two-thirds of the ACOs had established processes for distributing any savings accrued. They concluded that ACO delivery systems remain at a nascent stage.
AHRQ-funded; HS024075.
Citation: Peiris D, Phipps-Taylor MC, Stachowski CA .
ACOs holding commercial contracts are larger and more efficient than noncommercial ACOs.
Health Aff 2016 Oct;35(10):1849-56. doi: 10.1377/hlthaff.2016.0387.
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Keywords: Healthcare Costs, Payment, Health Systems, Medicaid, Medicare
Schulz R, Beach SR, Matthews JT
Caregivers' willingness to pay for technologies to support caregiving.
The authors reported the results of a study designed to assess whether and how much informal caregivers are willing to pay for technologies designed to help monitor and support care recipients (CRs) in performing kitchen and personal care tasks. By web survey, they found that about 20% of caregivers were not willing to pay anything for kitchen and self-care technologies. Among those willing to pay, the mean amount was approximately $50 per month for monitoring technologies and $70 per month for technologies that both monitored and provided some assistance. Younger caregivers, those caring for a person with Alzheimer's disease, and caregivers with more positive attitudes toward and experience with technology were willing to pay more. Most caregivers felt that the government or private insurance should help pay for these technologies.
AHRQ-funded; HS022889.
Citation: Schulz R, Beach SR, Matthews JT .
Caregivers' willingness to pay for technologies to support caregiving.
Gerontologist 2016 Oct;56(5):817-29. doi: 10.1093/geront/gnv033.
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Keywords: Caregiving, Healthcare Costs, Health Information Technology (HIT)
Murray MT, Heitkempber E, Jackson O
Direct costs of acute respiratory infections in a pediatric long-term care facility.
Acute respiratory tract infections (ARI) are a major burden in pediatric long-term care. The researchers analyzed the financial impact of ARI in 2012-2013. Costs associated with ARI during the respiratory viral season were ten times greater than during the non-respiratory viral season, $31,224 and $3,242 per 1000 patient-days, respectively.
AHRQ-funded; HS021470.
Citation: Murray MT, Heitkempber E, Jackson O .
Direct costs of acute respiratory infections in a pediatric long-term care facility.
Influenza Other Respir Viruses 2016 Jan;10(1):34-6. doi: 10.1111/irv.12350.
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Keywords: Children/Adolescents, Respiratory Conditions, Long-Term Care, Healthcare Costs, Children/Adolescents
Beckman AL, Bilinski A, Boyko R
New hepatitis C drugs are very costly and unavailable to many state prisoners.
This study found that in the forty-one states whose departments of corrections reported data, 106,266 inmates (10 percent of their prisoners) were known to have hepatitis C on or about January 1, 2015. Only 949 of those inmates were being treated. Prices for a twelve-week course of direct-acting antivirals such as sofosbuvir and the combination drug ledipasvir/sofosbuvir varied widely as of September 30, 2015 ($43,418-$84,000 and $44,421-$94,500, respectively).
AHRQ-funded; HS000055.
Citation: Beckman AL, Bilinski A, Boyko R .
New hepatitis C drugs are very costly and unavailable to many state prisoners.
Health Aff 2016 Oct;35(10):1893-901. doi: 10.1377/hlthaff.2016.0296.
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Keywords: Access to Care, Healthcare Costs, Hepatitis, Medication, Vulnerable Populations
Eaton EF, Tamhane A, Saag M
Cost considerations in the current antiretroviral era.
The authors analyzed the relative cost-effectiveness of contemporary antiretroviral therapy in real-world clinical settings. They found that, among the participants studied, raltegravir and efavirenz-based regimens were the most cost-effective options for treatment-naive patients. They suggested that these findings are relevant given changes in recommended regimens for treatment-naive persons. The authors recommended that further data on the comparative effectiveness of efavirenz and rilpivirine are needed.
AHRQ-funded; HS013852.
Citation: Eaton EF, Tamhane A, Saag M .
Cost considerations in the current antiretroviral era.
AIDS 2016 Sep 10;30(14):2115-9. doi: 10.1097/qad.0000000000001120.
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Keywords: Healthcare Costs, Human Immunodeficiency Virus (HIV), Medication
Grundy Q
"Whether something cool is good enough": the role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions.
The author analyzed the ways that committee members constructed and evaluated a case for a product's value, concluding that purchasing committees need unique support that emphasizes local contexts and expertise, while maintaining rigor and minimizing bias. Grundy proposed a guiding framework to support this decision-making.
AHRQ-funded; HS022383.
Citation: Grundy Q .
"Whether something cool is good enough": the role of evidence, sales representatives and nurses' expertise in hospital purchasing decisions.
Soc Sci Med 2016 Sep;165:82-91. doi: 10.1016/j.socscimed.2016.07.042.
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Keywords: Decision Making, Healthcare Costs, Hospitals, Nursing
Breitenstein SM, Schoeny M, Risser H
A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care.
The purpose of this paper is to describe the study protocol evaluating the implementation, efficacy, and cost-effectiveness of implementing the tablet-based ezParent program in pediatric primary care settings. Data on parenting and child behavior outcomes will be obtained at baseline, and at 3, 6, and 12 months post baseline. The authors suggest that the implementation of the ezParent is an innovative opportunity to promote positive parenting with potential for universal access to the preschool population and for low cost by building on existing infrastructure in pediatric primary care settings.
AHRQ-funded; HS024273.
Citation: Breitenstein SM, Schoeny M, Risser H .
A study protocol testing the implementation, efficacy, and cost effectiveness of the ezParent program in pediatric primary care.
Contemp Clin Trials 2016 Sep;50:229-37. doi: 10.1016/j.cct.2016.08.017.
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Keywords: Children/Adolescents, Healthcare Costs, Primary Care, Education: Patient and Caregiver, Caregiving
Shao H, Brown L, Diana ML
Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.
The authors aimed to understand the characteristics of clinics that transformed into patient-centered medical homes and the incremental cost for transformation. The estimated incremental cost for clinics that underwent transformation was $37.61 per visit per 6 months, and overall it cost $24.86 per visit per 6 months in grant funds to support a clinic's transformation.
AHRQ-funded; HS022624.
Citation: Shao H, Brown L, Diana ML .
Estimating the costs of supporting safety-net transformation into patient-centered medical homes in post-Katrina New Orleans.
Medicine 2016 Sep;95(39):e4990. doi: 10.1097/md.0000000000004990.
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Keywords: Patient-Centered Healthcare, Healthcare Costs, Access to Care, Organizational Change
Spector WD, Limcangco R, Owens PL
AHRQ Author: Spector WD, Limcangco R, Owens PL, Steiner CA
Marginal hospital cost of surgery-related hospital-acquired pressure ulcers.
The researchers estimated the hospital marginal cost of a hospital-acquired pressure ulcer (HAPU) for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. They found that 3.5 percent of major surgical patients developed HAPUs and that the HAPUs added approximately $8,200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics.
AHRQ-authored.
Citation: Spector WD, Limcangco R, Owens PL .
Marginal hospital cost of surgery-related hospital-acquired pressure ulcers.
Med Care 2016 Sep;54(9):845-51. doi: 10.1097/mlr.0000000000000558.
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Keywords: Pressure Ulcers, Surgery, Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Patient Safety
Ellimoottil C, Ryan AM, Hou H
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Using Medicare claims for patients in Michigan who underwent lower extremity joint replacement in the period 2011-13, the researchers applied payment methods analogous to those CMS intends to use in determining annual bonuses or penalties (reconciliation payments) to hospitals. Their findings suggest that CMS should include risk adjustment in the Comprehensive Care for Joint Replacement program and in future bundled payment programs.
AHRQ-funded; HS024193; HS018546.
Citation: Ellimoottil C, Ryan AM, Hou H .
Medicare's new bundled payment for joint replacement may penalize hospitals that treat medically complex patients.
Health Aff 2016 Sep;35(9):1651-7. doi: 10.1377/hlthaff.2016.0263.
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Keywords: Medicare, Payment, Healthcare Costs, Orthopedics, Provider Performance
Adrion ER, Ryan AM, Seltzer AC
Out-of-pocket spending for hospitalizations among nonelderly adults.
The researchers evaluated out-of-pocket spending associated with hospitalizations in order to assess how this spending varied over time and by patient characteristics, region, and type of insurance. They found that from 2009 to 2013, total cost sharing per inpatient hospitalization increased by 37 percent, from $738 in 2009 to $1013 in 2013 after adjusting for inflation and case-mix differences.
AHRQ-funded; HS000053.
Citation: Adrion ER, Ryan AM, Seltzer AC .
Out-of-pocket spending for hospitalizations among nonelderly adults.
JAMA Intern Med 2016 Sep;176(9):1325-32. doi: 10.1001/jamainternmed.2016.3663.
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Keywords: Hospitalization, Healthcare Costs, Health Insurance
Ali MM, Chen J, Mutter R
AHRQ Author: Novak P
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
The authors analyzed out-of-pocket spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. They found that the extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group.
AHRQ-authored.
Citation: Ali MM, Chen J, Mutter R .
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
Psychiatr Serv 2016 Sep;67(9):977-82. doi: 10.1176/appi.ps.201500346.
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Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Young Adults
Colla CH, Lewis VA, Kao LS
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
The purpose of this cohort study was to examine the effect of Medicare accountable care organization (ACO) contracts on both spending and high-cost institutional utilization for all Medicare beneficiaries and for clinically vulnerable beneficiaries. The main outcomes and measures for this study were total spending per beneficiary-quarter, spending categories, utilization of hospitals and emergency departments, ambulatory care sensitive admissions, and 30-day readmissions. The study found that total spending decreased by $34 per beneficiary-quarter after implementation of ACO contracts across the overall Medicare population and decreased $114 in clinically vulnerable patients. In the overall Medicare cohort, hospitalizations and emergency department visits decreased by 1.3 and 3.0 events per 1000 beneficiaries per quarter, respectively. Hospitalizations and emergency department visits decreased in the clinically vulnerable cohort by 2.9 and 4.1 events per 1000 beneficiaries per quarter, respectively. Variations in total spending related with ACOs did not differ by clinical condition of beneficiaries.
AHRQ-funded; HS024075.
Citation: Colla CH, Lewis VA, Kao LS .
Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries.
JAMA Intern Med 2016 Aug;176(8):1167-75. doi: 10.1001/jamainternmed.2016.2827.
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Keywords: Medicare, Policy, Healthcare Costs, Payment, Vulnerable Populations
Wang SY, Hall J, Pollack CE
Associations between end-of-life cancer care patterns and Medicare expenditures.
The authors examined the extent to which patterns of intensive end-of-life care explain geographic variation in end-of-life care expenditures among cancer decedents. The mean expenditure per cancer decedent in the last month of life was $10,800, with considerable variation in the percentage of decedents receiving intensive end-of-life care intervention. Regional patterns of late chemotherapy or late hospice use explained only approximately 1% of the expenditure difference, while the proportion of decedents who had ICU admissions within 30 days of death was a major driver of variation, explaining 37.6% of the expenditure difference. They concluded that promoting appropriate end-of-life care has the potential to reduce geographic variation in end-of-life care expenditures.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Associations between end-of-life cancer care patterns and Medicare expenditures.
J Natl Compr Canc Netw 2016 Aug;14(8):1001-8.
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Keywords: Cancer, Elderly, Healthcare Costs, Medicare, Palliative Care
Fleishman JA, Monroe AK, Voss CC
AHRQ Author: Fleishman JA
Expenditures for persons living with HIV enrolled in Medicaid, 2006-2010.
The researchers used Medicaid claims data to comprehensively assess payments for care for persons living with HIV between 2006 and 2010. They found that estimated Medicaid payment amounts are higher than some prior estimates. More complete capture of expensive inpatient hospitalizations in Medicaid data may partially explain this finding.
AHRQ-authored.
Citation: Fleishman JA, Monroe AK, Voss CC .
Expenditures for persons living with HIV enrolled in Medicaid, 2006-2010.
J Acquir Immune Defic Syndr 2016 Aug 1;72(4):408-15. doi: 10.1097/qai.0000000000000985.
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Keywords: Human Immunodeficiency Virus (HIV), Medicaid, Healthcare Costs
Hsu DY, Gordon K, Silverberg JI
Serious infections in hospitalized patients with psoriasis in the United States.
The researchers sought to determine rates and predictors of serious infections in hospitalized psoriasis patients and quantify costs of care, length of stay, and mortality. Among patients with psoriasis, rates of serious infections increased over all time intervals analyzed and were significantly higher compared with those without psoriasis across all time intervals.
AHRQ-funded; HS023011.
Citation: Hsu DY, Gordon K, Silverberg JI .
Serious infections in hospitalized patients with psoriasis in the United States.
J Am Acad Dermatol 2016 Aug;75(2):287-96. doi: 10.1016/j.jaad.2016.04.005..
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Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Healthcare Costs, Inpatient Care
McGarry BE, Temkin-Greener H, Chapman BP
The impact of consumer numeracy on the purchase of long-term care insurance.
The researchers sought to determine the effect of consumers' numeric abilities on the likelihood of owning private long-term care insurance (LTCI). Using the 2010 wave of the Health and Retirement Study, they found that each additional correct answer on a numeracy scale was associated with a 13% increase in the likelihood of holding LTCI. They recommended that policy efforts aimed at increasing consumer decision support or restructuring the marketplace for long-term care insurance may be needed to increase older adults' ability to prepare for future long-term care expenses.
AHRQ-funded; HS023714.
Citation: McGarry BE, Temkin-Greener H, Chapman BP .
The impact of consumer numeracy on the purchase of long-term care insurance.
Health Serv Res 2016 Aug;51(4):1612-31. doi: 10.1111/1475-6773.12439.
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Keywords: Education: Patient and Caregiver, Healthcare Costs, Health Insurance, Long-Term Care
Haidari LA, Brown ST, Constenla D
The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique.
The researchers assessed how well tetanus toxoid (TT) immunization locations meet population demand in Mozambique. They found that TT immunization locations are not geographically accessible by a significant proportion of pregnant women, resulting in substantial healthcare and productivity costs that could potentially be averted by adding or reconfiguring TT immunization locations.
AHRQ-funded; HS023317.
Citation: Haidari LA, Brown ST, Constenla D .
The economic value of increasing geospatial access to tetanus toxoid immunization in Mozambique.
Vaccine 2016 Jul 29;34(35):4161-65. doi: 10.1016/j.vaccine.2016.06.065.
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Keywords: Access to Care, Healthcare Costs, Health Services Research (HSR), Pregnancy, Vaccination
Haidari LA, Brown ST, Ferguson M
The economic and operational value of using drones to transport vaccines.
Using a simulation model, the researchers performed sensitivity analyses to assess the impact of using an unmanned aerial system (UAS) for routine vaccine distribution under a range of circumstances . They found that implementing a UAS could increase vaccine availability and decrease costs in a wide range of settings and circumstances if the drones are used frequently enough to overcome the capital costs of installing and maintaining the system.
AHRQ-funded; HS023317.
Citation: Haidari LA, Brown ST, Ferguson M .
The economic and operational value of using drones to transport vaccines.
Vaccine 2016 Jul 25;34(34):4062-7. doi: 10.1016/j.vaccine.2016.06.022.
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Keywords: Health Information Technology (HIT), Healthcare Costs, Vaccination
Jacobs PD, Duchovny N, Lipton BJ
AHRQ Author: Jacobs PD
Changes in health status and care use after ACA expansions among the insured and uninsured.
The authors investigated average health status and use of health care following the Affordable Care Act's insurance expansion provisions in 2014, finding that Medicaid enrollees and the uninsured were both healthier in 2014 than those respective groups were in 2013, but that those with individual private insurance coverage appeared less healthy as a group.
AHRQ-authored.
Citation: Jacobs PD, Duchovny N, Lipton BJ .
Changes in health status and care use after ACA expansions among the insured and uninsured.
Health Aff 2016 Jul;35(7):1184-8. doi: 10.1377/hlthaff.2015.1539.
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Keywords: Healthcare Costs, Health Insurance, Policy, Health Status, Medicaid