National Healthcare Quality and Disparities Report
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- Access to Care (1)
- Ambulatory Care and Surgery (1)
- Burnout (1)
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- Case Study (1)
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- Provider: Health Personnel (1)
- Provider Performance (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 28 Research Studies DisplayedAmu-Nnadi CN, Ross ES, Garcia NH
Health system integration and cancer center access for rural hospitals.
This study’s goal was to assess health system integration and cancer center access for rural hospitals. The authors compared health systems with and without cancer centers based on rural hospital presence. They found that 90% of cancer centers are in a health system, and 72% of health systems (434/607) have a cancer center. Larger health systems with more trainees more often have cancer centers but are no more likely to include rural hospitals (11% vs 6%). The minority of cancer centers not in health systems (N = 95) more often serve low complexity patient populations in non-metropolitan areas.
AHRQ-funded; HS013852.
Citation: Amu-Nnadi CN, Ross ES, Garcia NH .
Health system integration and cancer center access for rural hospitals.
Am Surg 2024 May; 90(5):1023-29. doi: 10.1177/00031348231216497..
Keywords: Health Systems, Cancer, Rural Health, Rural/Inner-City Residents, Access to Care
Friedman CP, Lomotan EA, Richardson JE
AHRQ Author: Lomotan EA
Socio-technical infrastructure for a learning health system.
This partially AHRQ-authored article discusses the third characteristic that contributes to the uniqueness of learning health systems (LHSs) as an approach to health improvement, specifically infrastructure. It examines the role of infrastructure in the overall architecture of an LHS and describes the three linked elements: 1) Improvement cycles directed at critical health problems; 2) Socio-technical infrastructure providing key services supporting co-occurring improvement cycles; and 3) Governance of the system. It then discusses the scope and meaning of socio-technical infrastructure and provides a diagram and brief description of the 10 interconnected socio-technical services.
AHRQ-authored.
Citation: Friedman CP, Lomotan EA, Richardson JE .
Socio-technical infrastructure for a learning health system.
Learn Health Syst 2024 Jan 16; 8(1):e10405. doi: 10.1002/lrh2.10405..
Keywords: Learning Health Systems, Health Systems
Franklin PD, Drane D
Assessment of learning health system science competency in the equity and justice domain.
This paper assessed learning health system (LHS) competency in the newly added knowledge domain of Equity and Justice. This eighth domain was adopted by AHRQ in mid-2022. The authors developed a proficiency assessment for the new equity and justice domain. The assessment criteria were iteratively defined, reviewed, and edited by content experts and trainees. The new items were developed by trainees and experts at one LHS training center with experience conducting research focused on healthcare inequities among marginalized populations. The same proficiency assessment criteria as for the other domains was applied with four levels of mastery: "no exposure," "foundational awareness," "emerging," and "proficient".
AHRQ-funded; HS026385.
Citation: Franklin PD, Drane D .
Assessment of learning health system science competency in the equity and justice domain.
Learn Health Syst 2024 Jan; 8(1):e10381. doi: 10.1002/lrh2.10381..
Keywords: Learning Health Systems, Health Systems
Yilmaz S, LeClaire M, Begnaud A
Developing LHS scholars' competency around reducing burnout and moral injury.
The study addresses the lack of a wellness competency focusing on burnout and moral injury prevention within Learning Health Systems (LHS). Experts collaborated to develop pathways for implementing such programs, emphasizing distinctions between moral injury and burnout, proposing interventions, and integrating expert input. The study found that a competency aimed at equipping scholars with skills for measuring, intervening, and embedding burnout and moral injury prevention into LHS structures, would potentially improve work lives and patient outcomes within LHS.
AHRQ-funded; HS026379.
Citation: Yilmaz S, LeClaire M, Begnaud A .
Developing LHS scholars' competency around reducing burnout and moral injury.
Learn Health Syst 2024 Jan; 8(1):e10378. doi: 10.1002/lrh2.10378..
Keywords: Learning Health Systems, Health Systems, Burnout, Provider: Health Personnel
Chisolm DJ, Dugan JA, Figueroa JF
Improving health equity through health care systems research.
This study’s objective was to describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes. This project was conducted as a component of the AHRQ stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. The stakeholders included experts from academia, health care organizations, industry, and government. Five priority themes were derived iteratively through experts from academia, health care organizations, industry, and government. They identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. They also suggested cross-cutting themes regarding research workforce and research timelines.
AHRQ-funded.
Citation: Chisolm DJ, Dugan JA, Figueroa JF .
Improving health equity through health care systems research.
Health Serv Res 2023 Dec; 58(suppl 3):289-99. doi: 10.1111/1475-6773.14192..
Keywords: Health Systems, Disparities, Social Determinants of Health, Healthcare Delivery
Bierman AS, Mistry KB
AHRQ Author: Bierman AS, Mistry KB
Commentary: Achieving health equity - the role of learning health systems.
The article discussed learning health systems and their role in achieving health equity. Issues considered were prioritization of health equity, development and implementation of models of care, partnerships with patients and communities, research on the effectiveness of interventions across diverse populations, integration strategies, and multisector collaborations to address social needs. The authors concluded that by considering these issues, learning health systems can play a pivotal role in eliminating health inequities.
AHRQ-authored.
Citation: Bierman AS, Mistry KB .
Commentary: Achieving health equity - the role of learning health systems.
Healthc Policy 2023 Nov; 19(2):21-27. doi: 10.12927/hcpol.2023.27236..
Keywords: Learning Health Systems, Health Systems, Disparities
Ganguli I, Mackwood MB, Yang CW
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
The objective of this retrospective cohort study was to characterize racial differences in receipt of low-value care among older Medicare beneficiaries overall and within U.S. health systems. Medicare fee-for-service administrative data was used for Black and White Medicare patients who were at least 65 as of 2016. Findings showed that, of the 40 low value services examined, Black patients had a higher adjusted receipt of 9 services and lower receipt of 20 services than White patients. Differences were generally small and largely due to differential care within health systems, but the authors concluded that their findings suggested potential factors that researchers, policymakers, and health system leaders might investigate to improve health care quality and equity.
AHRQ-funded; HS024930.
Citation: Ganguli I, Mackwood MB, Yang CW .
Racial differences in low value care among older adult Medicare patients in US health systems: retrospective cohort study.
BMJ 2023 Oct 25; 383:e074908. doi: 10.1136/bmj-2023-074908..
Keywords: Elderly, Racial and Ethnic Minorities, Medicare, Health Systems
Kim B, Cruden G, Crable EL
A structured approach to applying systems analysis methods for examining implementation mechanisms.
This article delineated a structured approach to applying systems analysis methods to examining implementation mechanisms. This approach included steps for selecting, tailoring, and evaluating an implementation strategy. The authors illustrated the approach by using an example case, then discussed the strengths and limitations of this approach, when each step might be appropriate. They suggested work that might extend systems analysis methods to the implementation mechanisms research.
AHRQ-funded; HS025632.
Citation: Kim B, Cruden G, Crable EL .
A structured approach to applying systems analysis methods for examining implementation mechanisms.
Implement Sci Commun 2023 Oct 19; 4(1):127. doi: 10.1186/s43058-023-00504-5..
Keywords: Implementation, Evidence-Based Practice, Health Systems
Simpson SA, Loh R, Elliott L
A mortality surveillance collaboration between a health system and public health department.
The authors described a collaboration between a health system and public health department to create a mortality surveillance system that enabled the health system to identify more than six times the number of deaths identified through local system medical records. They concluded that this epidemiological process that combined nuanced data captured through clinical care in health systems with subsequent data on mortality can be of particular benefit to underserved communities.
AHRQ-funded; HS027389.
Citation: Simpson SA, Loh R, Elliott L .
A mortality surveillance collaboration between a health system and public health department.
Am J Public Health 2023 Sep; 113(9):943-46. doi: 10.2105/ajph.2023.307335..
Keywords: Public Health, Health Systems
Johnson PT, Conway SJ, Berkowitz SA
Transforming health care from volume to value: a health system implementation road map.
The mission of the High Value Practice Academic Alliance is to 1) rapidly disseminate effective value-based performance improvement processes to safely decrease the cost of care for patients, and 2) train the next generation of physicians in principles of high value practice. The organization convened 100 academic medical center partners, and after 5 years of practice, opened membership to any medical center and became the High Value Practice Alliance. In 2021 and 2022, directors of the alliance devoted educational programs of the annual conference to developing a care delivery roadmap identifying the strategies and programs required to maximize resource use, clinical effectiveness, and care coordination. The group is now publishing the “playbook” as a series of focused articles, a comprehensive framework to improve the health care value in a delivery system. This playbook includes 3 performance improvement approaches: 1) resource focused, 2) infrastructure focused, and 3) condition focused. The Transforming Healthcare from Volume to Value: a Health System Implementation RoadMap manuscript series will address each of the strategies and relevant programs.
AHRQ-funded; HS029151; HS026350.
Citation: Johnson PT, Conway SJ, Berkowitz SA .
Transforming health care from volume to value: a health system implementation road map.
Am J Med 2023 Aug; 136(8):763-67. doi: 10.1016/j.amjmed.2023.04.030..
Keywords: Health Systems, Implementation, Healthcare Delivery
Ong T, Albon D, Amin RS
Establishing a Cystic Fibrosis Learning Network: interventions to promote collaboration and data-driven improvement at scale.
This paper describes the Cystic Fibrosis Learning Network (CFLN), which was designed to improve medical outcomes and quality of life through an intentional focus on achieving reliable evidence-based chronic care delivery and creating a system for data-driven collaborative learning. The authors described the development and growth of the CFLN considering six domains of a Network Maturity Grid: system leadership; governance and policy management; quality improvement (QI); engagement and community building; data and analytics; and research. The CFLN represents 36 accredited care centers in the CF Foundation Care Center Network caring for over 6300 patients, with 77% of 6779 patient clinical care visits/quarter entering into the Registry within 30 days. Almost all CFLN teams (94%) have a patient/family partner (PFP), and 74% of PFPs indicate they are actively participating, taking ownership of, or leading QI initiatives with the interdisciplinary care team. In 2022, most (97%) centers reported completing 1-13 improvement cycles per month, and 82% contributed to monthly QI progress reports to share learning.
AHRQ-funded; HS02639.
Citation: Ong T, Albon D, Amin RS .
Establishing a Cystic Fibrosis Learning Network: interventions to promote collaboration and data-driven improvement at scale.
Learn Health Syst 2023 Jul; 7(3):e10354. doi: 10.1002/lrh2.10354..
Keywords: Learning Health Systems, Health Systems
Harrison MI, Borsky AE
AHRQ Author: Harrison MI
How alignment between health systems and their embedded research units contributes to system learning.
This AHRQ-authored paper examined the organization of learning health system (LHS) research units and conditions affecting their contributions to system improvement and learning. The authors conducted 12 key-informant and 44 semi-structured interviews in six delivery systems engaged in LHS research. Using rapid qualitative analysis, they identified themes and compared successful versus challenging projects; LHS units and other research units in the same system; and LHS units in different systems. They found that LHS units operate both independently and as subunits within larger research centers. Key alignment factors identified were availability of internal (system) funding directing researchers' work toward system priorities; researchers' skills and experiences that fit a system's operational needs; LHS unit subculture supporting system improvement and collaboration with clinicians and other internal stakeholders; applications of external funding to system priorities; and executive leadership for system-wide learning. Direct consultation between LHS unit leaders and system executives and engagement of researchers in clinical and operational activities fostered mutual understanding and collaboration between researchers, clinicians, and leaders.
AHRQ-authored.
Citation: Harrison MI, Borsky AE .
How alignment between health systems and their embedded research units contributes to system learning.
Healthc 2023 Jun; 11(2):100688. doi: 10.1016/j.hjdsi.2023.100688..
Keywords: Health Systems, Learning Health Systems
Beaulieu ND, Chernew ME, McWilliams JM
Organization and performance of US health systems.
The objectives of this evidence review were to identify and describe health systems in the US, to assess differences between physicians and hospitals in and outside of health systems, and to compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. A total of 580 health systems in a great variety of sizes were identified; prices for physician, hospital services, and total spending were assessed in 2018 commercial claims data. Health system physicians and hospitals were shown to deliver a large portion of medical services. Clinical quality performance and patient experience measures were slightly better in systems; however, spending and prices were significantly higher, especially in small practices. The authors concluded that slight quality differentials in combination with large price differentials suggested that health systems have not realized their potential for better care at equal or lower cost.
AHRQ-funded; HS024072.
Citation: Beaulieu ND, Chernew ME, McWilliams JM .
Organization and performance of US health systems.
JAMA 2023 Jan 24; 329(4):325-35. doi: 10.1001/jama.2022.24032..
Keywords: Health Systems, Healthcare Delivery, Provider Performance, Quality Measures, Quality of Care, Hospitals
Sirkin JT, Flanagan E, Tong ST
AHRQ Author: Tong ST, McNellis RJ, Bierman AS
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
The purpose of this paper was to review the Agency for Healthcare Research and Quality’s (AHRQ) learning community organized to engage and support primary care in responding to COVID-19 and provide an opportunity for participants to communicate learning and peer support, improve understanding of the stressors and challenges faced by practices, determine needs, and identify possible solutions to challenges of the pandemic. The researchers identified challenges, responses, and innovations that occurred through the engagement and information sharing of the learning community and categorized them across 5 domains, including: patient-centeredness, clinician and practice, systems and infrastructure, community and public health; and health equity which cut across each of the other domains. The authors concluded that the learning community provided valuable insights for future research and policy, primary care delivery improvement, and ensuring greater preparedness for future challenges.
AHRQ-authored.
Citation: Sirkin JT, Flanagan E, Tong ST .
Primary care's challenges and responses in the face of the COVID-19 pandemic: insights from AHRQ's learning community.
Ann Fam Med 2023 Jan-Feb; 21(1):76-82. doi: 10.1370/afm.2904..
Keywords: COVID-19, Primary Care, Learning Health Systems, Health Systems, Evidence-Based Practice, Public Health
Misra-Hebert AD, Perzynski A, Rothberg MB
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
This mixed-methods comparative case study examined the implementation of team-based primary care models in a large integrated health system. Field observations of 9 practices were conducted along with 75 interviews and provider and staff surveys. The 9 practices were categorized into 3 groups: high, partial, and low update of the new models. Ability of the practices to implement the new team-based model depended on their ability to adapt to change and to adapt team roles in workflow.
AHRQ-funded; HS024128.
Citation: Misra-Hebert AD, Perzynski A, Rothberg MB .
Implementing team-based primary care models: a mixed-methods comparative case study in a large, integrated health care system.
J Gen Intern Med 2018 Nov;33(11):1928-36. doi: 10.1007/s11606-018-4611-7..
Keywords: Case Study, Health Systems, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Teams
Harrison MI, Grantham S
AHRQ Author: Harrison MI
Learning from implementation setbacks: identifying and responding to contextual challenges.
The authors addressed organizational learning about implementation context during setbacks to primary care redesign in an ambulatory system. They found that redesigned teams were not implemented as widely or rapidly as anticipated and did not deliver hoped-for gains in operational metrics; however, team redesign was leading to improvements in chronic care and prevention and eased provider burden. Redesign and system leaders engaged in more thorough organizational learning. Their responses to challenges helped to strengthen the redesign's prospects, improved the delivery system's position in its labor market, and helped the system prepare to meet emerging requirements for value-based care and population health.
AHRQ-authored; AHRQ-funded; 2902010000341.
Citation: Harrison MI, Grantham S .
Learning from implementation setbacks: identifying and responding to contextual challenges.
Learn Health Syst 2018 Oct;2(4):e10068. doi: 10.1002/lrh2.10068..
Keywords: Organizational Change, Learning Health Systems, Health Systems, Primary Care: Models of Care, Primary Care, Ambulatory Care and Surgery, Implementation
Vest JR, Simon K
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
This study examined hospitals’ adoption of interoperability of health information technology (HIT). The relationship between hospitals’ intra- (within the same organization) and inter-system information exchange capabilities was explored using data from the 2010-2014 American Hospital Association’s Annual Health Information Technology Survey. As expected, there was more intra-system information exchange than inter-system but as time went on inter-system information exchange has increased. During the study period, hospitals were sharing 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange.
AHRQ-funded; HS024717.
Citation: Vest JR, Simon K .
Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange.
J Am Med Inform Assoc 2018 Sep;25(9):1189-96. doi: 10.1093/jamia/ocy058..
Keywords: Health Information Exchange (HIE), Health Systems, Health Information Technology (HIT), Hospitals
Poon BY, Shortell S, Rodriguez HP
Physician practice transitions to system ownership do not result in diminished practice responsiveness to patients.
The purpose of this study was to examine the extent to which physician-to-system ownership transitions were associated with declines in practice-reported patient responsiveness (PRPR). Data were collected from three nationally representative surveys of physician organizations - the National Survey of Large Physician Organizations/National Survey of Small- and Medium-Sized Physician Organizations and the National Survey of All-Size Physician Organizations - consisting of 40-minute interviews with medical directors, presidents, or chief executive officers. Multivariable regression estimated the effect of ownership on changes in PRPR, controlled for practice size, specialty composition, and market characteristics. The study results showed that practices that switched to system ownership did not have significantly lower PRPR at baseline, when compared to practices that were continuously physician-owned, but continuously system-owned practices did. Transitions to system ownership were associated with increased PRPR when compared to continuously physician ownership. Increased practice size and changes in specialty composition were associated with diminished PRPR.
AHRQ-funded; HS024075.
Citation: Poon BY, Shortell S, Rodriguez HP .
Physician practice transitions to system ownership do not result in diminished practice responsiveness to patients.
Health Serv Res 2018 Aug;53(4):2268-84. doi: 10.1111/1475-6773.12804.
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Keywords: Healthcare Delivery, Health Systems, Patient Experience
Funk RJ, Owen-Smith J, Kaufman SA
Association of informal clinical integration of physicians with cardiac surgery payments.
This study examined how physician interaction patterns vary between health systems and to assess whether variation in informal integration is associated with care delivery payments. It found that when beneficiaries were treated in health systems with higher informal integration, the greatest savings of lower estimated payments were from hospital readmissions (13.0 percent) and postacute care services (5.8 percent).
AHRQ-funded; HS024728.
Citation: Funk RJ, Owen-Smith J, Kaufman SA .
Association of informal clinical integration of physicians with cardiac surgery payments.
JAMA Surg 2018 May;153(5):446-53. doi: 10.1001/jamasurg.2017.5150.
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Keywords: Healthcare Costs, Payment, Health Systems, Surgery
Henke RM, Karaca Z, Moore B
AHRQ Author: Karaca Z, Wong HS
Impact of health system affiliation on hospital resource use intensity and quality of care.
This study assessed the impact of hospital affiliation, centralization, and managed care plan ownership on inpatient cost and quality. It found that hospitals affiliated with health systems had a higher cost per discharge and better quality of care compared with independent hospitals. Centralized systems in particular had the highest cost per discharge and longest stays. Independent hospitals with managed care plans had a higher cost per discharge.
AHRQ-authored.
Citation: Henke RM, Karaca Z, Moore B .
Impact of health system affiliation on hospital resource use intensity and quality of care.
Health Serv Res 2018 Feb;53(1):63-86. doi: 10.1111/1475-6773.12631..
Keywords: Healthcare Costs, Quality of Care, Health Systems, Healthcare Cost and Utilization Project (HCUP), Hospitals
Rangachari P
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in health care organizations (HCOs). It summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.
AHRQ-funded; HS024335.
Citation: Rangachari P .
Innovation implementation in the context of hospital QI: lessons learned and strategies for success.
Innov Entrep Health 2018;5:1-14. doi: 10.2147/ieh.s151040.
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Keywords: Evidence-Based Practice, Health Systems, Health Information Technology (HIT), Implementation, Quality Improvement, Hospitals, Quality of Care
Nix M, McNamara P, Genevro J
AHRQ Author: Nix M, McNamara P, Genevro J, Vargas N, Mistry K, Fournier A, Shofer M, Lomotan E, Miller T, Ricciardi R, Bierman AS
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
The authors examined AHRQ's experience with learning collaboratives to characterize their attributes, identify factors that might contribute to their success or failure, and assess the challenges they encountered. Building on the literature and insights from AHRQ's experience, they propose a taxonomy that can offer guidance to decision makers and funders about the factors they should consider in developing collaboratives.
AHRQ-authored.
Citation: Nix M, McNamara P, Genevro J .
Learning collaboratives: Insights and a new taxonomy from AHRQ's two decades of experience.
Health Aff 2018 Feb;37(2):205-12. doi: 10.1377/hlthaff.2017.1144.
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Keywords: Learning Health Systems, Health Systems, Quality Improvement, Quality of Care, Healthcare Delivery
Bishai D, Sherry M, Pereira CC
Development and usefulness of a district health systems tool for performance improvement in essential public health functions in Botswana and Mozambique.
This study describes the development of a self-audit tool for public health and the associated methodology for implementing a district health system self-audit tool that can provide quantitative data on how district governments perceive their performance of the essential public health functions. It found that instant feedback from the audit was a feature that 100 percent of pilot respondents found most useful.
AHRQ-funded; HS000029.
Citation: Bishai D, Sherry M, Pereira CC .
Development and usefulness of a district health systems tool for performance improvement in essential public health functions in Botswana and Mozambique.
J Public Health Manag Pract 2016 Nov-Dec;22(6):586-96. doi: 10.1097/phh.0000000000000407.
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Keywords: Health Systems, Public Health, Quality Improvement
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
Simianu VV, Fichera A, Bastawrous AL
Number of diverticulitis episodes before resection and factors associated with earlier interventions.
The authors described patterns of episodes of diverticulitis before surgery and factors associated with earlier interventions using inpatient, outpatient, and antibiotic prescription claims. They found that 56.3% of elective resections for uncomplicated diverticulitis occurred after fewer than 3 episodes. Further, they determined that earlier surgery was not explained by younger age, laparoscopy, time between the last 2 episodes preceding surgery, or financial risk-bearing for patients.
AHRQ-funded; HS020025.
Citation: Simianu VV, Fichera A, Bastawrous AL .
Number of diverticulitis episodes before resection and factors associated with earlier interventions.
JAMA Surg 2016 Jul;151(7):604-10. doi: 10.1001/jamasurg.2015.5478.
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Keywords: Shared Decision Making, Digestive Disease and Health, Health Systems, Healthcare Utilization, Surgery