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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 166 Research Studies DisplayedAnderson KE, Wu RJ, Darden M
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
To discover whether Medicare Advantage enrollees have a lower utilization of elective surgical procedures such as inpatient hip and knee total joint arthroplasty (TJA), which have usually been covered by traditional Medicare without restrictions, researchers conducted a cross-sectional study comparing traditional Medicare claims and Medicare Advantage encounter records for enrollees aged 65-85. Their results showed a lower incidence of TJA in Medicare Advantage enrollees. The interval from initial diagnosis to contact with an orthopedic surgeon and to the surgical procedure were shorter among traditional enrollees.
AHRQ-funded; HS000029.
Citation: Anderson KE, Wu RJ, Darden M .
Medicare Advantage is associated with lower utilization of total joint arthroplasty.
J Bone Joint Surg Am 2024 Feb 7; 106(3):198-205. doi: 10.2106/jbjs.23.00507..
Keywords: Medicare, Orthopedics, Surgery
Post B, Hollenbeck BK, Norton EC
Hospital-physician integration and clinical volume in traditional Medicare.
The purpose of this study was to test the effect of hospital-physician integration on primary care physicians' (PCP) clinical volume in traditional Medicare. The researchers identified 70,000 PCPs, some of whom remained non-integrated and some who became hospital-integrated during this study period. An event study design was utilized to identify the effect of integration on key measures of physicians' clinical volume, including the number of claims, work-relative value units (RVUs), professional revenue generated, number of patients treated, and facility fee revenue generated. The study found that per-physician clinical volume declined by statistically and economically significant margins. Relative to the comparison group who remained non-integrated, work RVUs fell by 7%; the number of patients treated fell by 4%; and claims volume among PCPs who became hospital-integrated fell by over 15%.
AHRQ-funded; HS027044; HS025707.
Citation: Post B, Hollenbeck BK, Norton EC .
Hospital-physician integration and clinical volume in traditional Medicare.
Health Serv Res 2024 Feb; 59(1):e14172. doi: 10.1111/1475-6773.14172..
Keywords: Medicare, Primary Care, Healthcare Delivery, Provider: Physician
Hoffman GJ, Alexander Nb, Ha J
Medicare's hospital readmission reduction program reduced fall-related health care use: an unexpected benefit?
This study’s objective was to assess whether the Medicare Hospital Readmissions Reduction Program (HRRP) was associated with a reduction in severe fall-related injuries (FRIs). The authors looked at secondary data from Medicare to assess changes in 30- and 90-day FRI readmissions before and after HRRP's announcement (April 2010) and implementation (October 2012) for conditions targeted by the HRRP (acute myocardial infarction [AMI], congestive heart failure [CHF], and pneumonia) versus "non-targeted" (gastrointestinal) conditions. They tested for modification by hospitals with "high-risk" before HRRP and accounted for potential upcoding. They also explored changes in 30-day FRI readmissions involving emergency department (ED) or outpatient care, care processes (length of stay, discharge destination, and primary care visit), and patient selection (age and comorbidities). They identified 1.5 million (522,596 pre-HRRP, 514,844 announcement, and 474,029 implementation period) index discharges. After its announcement, HRRP was associated with 12%-20% reductions in 30- and 90-day FRI readmissions for patients with CHF (-0.42 percentage points [ppt]) and AMI (-0.35). Two years after implementation, HRRP was associated with reductions in 90-day FRI readmission for AMI (-1.27 ppt) and CHF (-0.98 ppt) patients. After HRRP's announcement, decreases were observed in home health (AMI: -2.43 ppt; CHF: -8.83 ppt; pneumonia: -1.97 ppt) and skilled nursing facility referrals (AMI: -5.95 ppt; CHF: -3.19 ppt; pneumonia: -10.27 ppt).
AHRQ-funded; HS025838.
Citation: Hoffman GJ, Alexander Nb, Ha J .
Medicare's hospital readmission reduction program reduced fall-related health care use: an unexpected benefit?
Health Serv Res 2024 Feb; 59(1):e14246. doi: 10.1111/1475-6773.14246..
Keywords: Hospital Readmissions, Medicare, Falls
Danielson EC, Li W, Suleiman L
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
The objective of this study was to determine if county- or patient-level social risk factors are associated with patient-reported outcomes after total knee replacement when added to the comprehensive joint replacement risk-adjustment model. Patient and outcomes data from the Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement cohort were merged with the CDC Social Vulnerability Index. The findings indicated that patient-reported race, education, and income were associated with patient-reported pain or functional scores; pain improvement was negatively associated with Black race and positively associated with higher annual incomes. The authors concluded that these findings suggested that patient-level social factors warrant further investigation to promote health equity in patient-reported outcomes after total knee replacement.
Citation: Danielson EC, Li W, Suleiman L .
Social risk and patient-reported outcomes after total knee replacement: implications for Medicare policy.
Health Serv Res 2024 Feb; 59(1):e14215. doi: 10.1111/1475-6773.14215.
Keywords: Surgery, Orthopedics, Medicare, Outcomes, Patient-Centered Outcomes Research, Social Determinants of Health
French DD, Wang A, Prager AJ
Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare ocular hospitalizations: a cross sectional data analysis.
The purpose of this paper was to determine whether social determinants of health are associated with ocular hospitalizations. Results showed that, compared to an all-condition hospitalized population, ocular hospitalizations tended to have small, yet statistically significant, associations with health behaviors, socioeconomic, and physical environment factors. Further research is recommended on how these variables affect ocular health relative to all-cause hospitalizations.
AHRQ-funded; HS000078; HS000084.
Citation: French DD, Wang A, Prager AJ .
Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare ocular hospitalizations: a cross sectional data analysis.
Ophthalmol Ther 2019 Dec;8(4):611-22. doi: 10.1007/s40123-019-00220-1..
Keywords: Social Determinants of Health, Eye Disease and Health, Hospitalization, Medicare
Buxbaum JD, Lindenauer PK, Cooke CR
Changes in coding of pneumonia and impact on the hospital readmission reduction program.
Researchers evaluated whether changes in diagnosis assignment explain reductions in 30-day readmission for patients with pneumonia following the Hospital Readmission Reduction Program (HRRP). They conducted a retrospective cohort study of Medicare discharges in HRRP-eligible hospitals; outcomes were 30-day readmission rates for pneumonia under both "narrow" and "broad" definitions that included certain diagnoses of sepsis and aspiration pneumonia. They concluded that changes in the coding of inpatient pneumonia admissions do not explain readmission reduction following the HRRP.
AHRQ-funded; HS000055.
Citation: Buxbaum JD, Lindenauer PK, Cooke CR .
Changes in coding of pneumonia and impact on the hospital readmission reduction program.
Health Serv Res 2019 Dec;54(6):1326-34. doi: 10.1111/1475-6773.13207..
Keywords: Pneumonia, Hospital Readmissions, Medicare, Hospitalization
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Roberts ET, Mellor JM, McInerney M
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
The purpose of this study was to examine between-state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. The investigators concluded that characteristics of dual enrollees differed substantially across states, reflecting differences in states' low-income Medicare populations and Medicaid policies.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM, McInerney M .
State variation in the characteristics of Medicare-Medicaid dual enrollees: Implications for risk adjustment.
Health Serv Res 2019 Dec;54(6):1233-45. doi: 10.1111/1475-6773.13205..
Keywords: Medicare, Medicaid, Social Determinants of Health
Keohane LM, Trivedi A, Mor V
States with medically needy pathways: differences in long-term and temporary Medicaid entry for low-income Medicare beneficiaries.
Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs. However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with an increase in the probability of switching to partial Medicaid and an increase in the probability of exiting Medicaid within 12 months. Alternative strategies for protecting low-income Medicare beneficiaries' access to care could provide more stable coverage.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi A, Mor V .
States with medically needy pathways: differences in long-term and temporary Medicaid entry for low-income Medicare beneficiaries.
Med Care Res Rev 2019 Dec;76(6):711-35. doi: 10.1177/1077558717737152..
Keywords: Vulnerable Populations, Low-Income, Medicaid, Medicare, Policy
Hu T, Decker SL, Chou SY
AHRQ Author: Decker SL
The impact of health insurance expansion on physician treatment choice: Medicare Part D and physician prescribing.
Researchers tested the effect of the introduction of Medicare Part D on physician prescribing behavior using data on physician visits from the National Ambulatory Medical Care Survey (NAMCS). Subjects were patients aged 60-69. The researchers found a 32% increase in the number of prescription drugs prescribed or continued per visit and a 46% increase in the number of generic drugs prescribed or continued for the elderly after the introduction of Medicare Part D.
AHRQ-authored.
Citation: Hu T, Decker SL, Chou SY .
The impact of health insurance expansion on physician treatment choice: Medicare Part D and physician prescribing.
https://www.ncbi.nlm.nih.gov/pubmed/28168448.
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Medicare, Medication, Practice Patterns, Elderly
Werner RM, Konetzka RT, Qi M
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
The objective of this study was to investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. The investigators concluded that Medicare's SNF copayment policy was associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy had unintended and negative effects on patient outcomes.
AHRQ-funded; HS024266.
Citation: Werner RM, Konetzka RT, Qi M .
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
Health Serv Res 2019 Dec;54(6):1184-92. doi: 10.1111/1475-6773.13227..
Keywords: Medicare, Nursing Homes, Payment, Long-Term Care, Healthcare Costs, Elderly, Hospitalization, Hospital Discharge
Jones CD, Falvey J, Hess E
Predicting hospital readmissions from home healthcare in Medicare beneficiaries.
The authors used patient-level clinical variables to develop and validate a parsimonious model to predict hospital readmissions from home healthcare (HHC) in Medicare fee-for-service beneficiaries. They found that variables available to HHC clinicians at the first post-discharge HHC visit can predict readmission risk and inform care plans in HHC. They recommend that future analyses incorporating measures of social determinants of health, such as housing instability or social support, have the potential to enhance prediction of this outcome.
AHRQ-funded; HS024569.
Citation: Jones CD, Falvey J, Hess E .
Predicting hospital readmissions from home healthcare in Medicare beneficiaries.
J Am Geriatr Soc 2019 Dec;67(12):2505-10. doi: 10.1111/jgs.16153..
Keywords: Home Healthcare, Hospital Readmissions, Medicare, Elderly, Transitions of Care
Sharma H, Konetzka RT, Smieliauskas F
The relationship between reported staffing and expenditures in nursing homes.
AHRQ-funded; HS024967.
Citation: Sharma H, Konetzka RT, Smieliauskas F .
The relationship between reported staffing and expenditures in nursing homes.
Med Care Res Rev 2019 Dec 1;76(6):758-83. doi: 10.1177/1077558717739214..
Keywords: Nursing Homes, Long-Term Care, Quality Improvement, Quality of Care, Provider Performance, Medicare
Jacobs PD, Selden TM
AHRQ Author: Jacobs PD, Selden TM
Changes in the equity of US health care financing in the period 2005-16.
This study examined changes in how households pay for health care spending in the United States from 2005 to 2016. At the start of the study period, households in the bottom 20% of income paid 26.8% of their income for health care compared to about half that amount for those with income in the top 1 percent. By 2016 the percentages had become about the same across all income levels. This result reflected increases in coverage through Medicaid and the Affordable Care Act Marketplaces.
AHRQ-authored.
Citation: Jacobs PD, Selden TM .
Changes in the equity of US health care financing in the period 2005-16.
Health Aff 2019 Nov;38(11):1791-800. doi: 10.1377/hlthaff.2019.00625..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Health Insurance, Medicare, Policy
McWilliams JM, Barnett ML, Roberts ET
Did hospital readmissions fall because per capita admission rates fell?
In this study examining the cause of falling hospital readmission rates, the investigators found that the probability of an admission occurring soon after another was lower when there were fewer admissions per patient. The authors indicate that the reduction in admission rates may explain much of the reduction in readmission rates.
AHRQ-funded; HS026727.
Citation: McWilliams JM, Barnett ML, Roberts ET .
Did hospital readmissions fall because per capita admission rates fell?
Health Aff 2019 Nov;38(11):1840-44. doi: 10.1377/hlthaff.2019.00411..
Keywords: Hospital Readmissions, Hospitals, Hospitalization, Quality of Care, Medicare
Briggs ADM, Fraze TK, Glick AL
How do accountable care organizations deliver preventive care services? A mixed-methods study.
The authors sought to understand how Medicare accountable care organizations (ACOs) provide preventive care services to their attributed patients. They found that offering annual wellness visits and having a system-wide approach to closing preventive care gaps are key mechanisms used by high-performing ACOs to address patients' preventive care needs; however, few programs or initiatives were identified that specifically target clinically complex patients. They concluded that understanding the mechanisms and motivations used by high-performing ACOs may help both providers and payers to increase the use of preventive care.
AHRQ-funded; HS024075.
Citation: Briggs ADM, Fraze TK, Glick AL .
How do accountable care organizations deliver preventive care services? A mixed-methods study.
J Gen Intern Med 2019 Nov;34(11):2451-59. doi: 10.1007/s11606-019-05271-5..
Keywords: Prevention, Healthcare Delivery, Medicare
Mueller S, Zheng J, Orav EJ
Inter-hospital transfer and patient outcomes: a retrospective cohort study.
Inter-hospital transfer (IHT, the transfer of patients between hospitals) occurs regularly and exposes patients to risks of discontinuity of care, though outcomes of transferred patients remains largely understudied. The purpose of this retrospective cohort study was to evaluate the association between IHT and healthcare utilisation and clinical outcomes. The investigators concluded that IHT was associated with higher costs, longer LOS and lower odds of discharge home, but was differentially associated with odds of early death and 30 -day mortality depending on patients' disease category.
AHRQ-funded; HS023331.
Citation: Mueller S, Zheng J, Orav EJ .
Inter-hospital transfer and patient outcomes: a retrospective cohort study.
BMJ Qual Saf 2019 Nov;28(11):e1. doi: 10.1136/bmjqs-2018-008087..
Keywords: Transitions of Care, Hospitals, Patient Safety, Elderly, Outcomes, Chronic Conditions, Mortality, Medicare
Solotke MT, Ross JS, Shah ND
Medicare prescription drug plan formulary restrictions after postmarket FDA black box warnings.
This study investigated whether Medicare prescription drug plan formulary restrictions were enacted after the FDA issued black box warnings for drugs that are now considered problematic. Investigators looked at drugs that were issued new or updated black box warnings from 2008 to 2015 and found there was only a 3% decrease in drug formularies providing unrestricted prescriptions.
AHRQ-funded; HS025164.
Citation: Solotke MT, Ross JS, Shah ND .
Medicare prescription drug plan formulary restrictions after postmarket FDA black box warnings.
J Manag Care Spec Pharm 2019 Nov;25(11):1201-17. doi: 10.18553/jmcp.2019.25.11.1201..
Keywords: Medication, Medicare, Policy
Makam AN, Tran T, Miller ME
The clinical course after long-term acute care hospital admission among older Medicare beneficiaries.
Investigators sought to examine the clinical course after long-term acute care (LTAC) admission. They found that hospitalized older adults transferred to LTAC hospitals had poor survival, spent most of their remaining life as an inpatient, and frequently underwent life-prolonging procedures. This prognostic understanding is essential to inform goals of care discussions and to prioritize healthcare needs for these adults. Given the exceedingly low rates of palliative care consultations, they recommend future research to examine unmet palliative care needs in this population.
AHRQ-funded; HS022418.
Citation: Makam AN, Tran T, Miller ME .
The clinical course after long-term acute care hospital admission among older Medicare beneficiaries.
J Am Geriatr Soc 2019 Nov;67(11):2282-88. doi: 10.1111/jgs.16106..
Keywords: Elderly, Medicare, Palliative Care, Patient-Centered Outcomes Research, Outcomes, Care Management, Healthcare Delivery
Kuo YF, Raji MA, Lin YL
Use of Medicare data to identify team-based primary care: is it possible?
This study’s goal was to determine if Medicare data can be used to identify type and degree of collaboration between primary care providers (PCPs), nurse practitioners, and physician assistants in a team care model. Researchers surveyed 63 primary care practices in Texas and linked the survey results to 2015 100% Medicare data. They measured sensitivity, specificity and positive predictive value (PPV) of dyad teams in Medicare data. They found a higher PPV between MD-nurse practitioner/physician assistant pairs than for MD-MD pairs. There was low sensitivity over all (27.8%), but specificity was 91.7% and PPV 72.2%.
AHRQ-funded; HS020642.
Citation: Kuo YF, Raji MA, Lin YL .
Use of Medicare data to identify team-based primary care: is it possible?
Med Care 2019 Nov;57(11):905-12. doi: 10.1097/mlr.0000000000001201..
Keywords: Medicare, Primary Care, Teams, Primary Care: Models of Care, Healthcare Delivery
Chhabra KR, Nuliyalu U, Dimick JB
Who will be the costliest patients? Using recent claims to predict expensive surgical episodes.
Researchers studied the effects of surgeon and hospital characteristics on surgical expenditures using Medicare claims data. They found that a significant proportion of surgical spending can be predicted using patient factors on the basis of readily available claims data and recommended adjusting for patient factors to facilitate future research on unwarranted variation in episode payments driven by surgeons, hospitals, or other market forces.
AHRQ-funded; HS024763; HS000053.
Citation: Chhabra KR, Nuliyalu U, Dimick JB .
Who will be the costliest patients? Using recent claims to predict expensive surgical episodes.
Med Care 2019 Nov;57(11):869-74. doi: 10.1097/mlr.0000000000001204..
Keywords: Healthcare Costs, Surgery, Medicare
Goldstone AB, Chiu P, Baiocchi M
Interfacility transfer of Medicare beneficiaries with acute type a aortic dissection and regionalization of care in the United States.
Researchers investigated the hypothesis that regionalizing care at high-volume hospitals for acute type A aortic dissections will lower mortality. Operative mortality and long-term survival were compared for Medicare beneficiaries diagnosed with an acute type A aortic dissection who were transferred versus not transferred, underwent surgery at high-volume versus low-volume hospitals, and were rerouted versus not rerouted to a high-volume hospital for treatment. The researchers found that, despite delaying surgery, a regionalization policy that transfers patients to high-volume hospitals was associated with a 7.2% absolute risk reduction in operative mortality. They recommended that policymakers evaluate the feasibility and benefits of regionalizing the surgical treatment of acute type A aortic dissection in the United States.
AHRQ-funded; HS022192.
Citation: Goldstone AB, Chiu P, Baiocchi M .
Interfacility transfer of Medicare beneficiaries with acute type a aortic dissection and regionalization of care in the United States.
Circulation 2019 Oct 8;140(15):1239-50. doi: 10.1161/circulationaha.118.038867..
Keywords: Transitions of Care, Medicare, Heart Disease and Health, Cardiovascular Conditions, Patient-Centered Outcomes Research, Risk, Evidence-Based Practice, Mortality, Hospitals
Everson J, Richards MR, Buntin MB
Horizontal and vertical integration's role in meaningful use attestation over time.
This study examined rates of attestation and attrition from the meaningful use (MU) program by independent, horizontally integrated, and vertically integrated physicians. The goal was to determine if MU created pressure for independent physicians to join integrated organizations. They compared attestation rates using secondary data from SK&A and Medicare MU Files from 2011-2016 with office-based physicians. The sample size was 291,234 physicians. Forty-nine percent of physicians that remained independent during the period attested to MU at least once during the program, compared with 70% that remained horizontally or vertically integrated. There was also significantly more attrition among independent physicians than those physicians who were integrated.
AHRQ-funded; HS026395.
Citation: Everson J, Richards MR, Buntin MB .
Horizontal and vertical integration's role in meaningful use attestation over time.
Health Serv Res 2019 Oct;54(5):1075-83. doi: 10.1111/1475-6773.13193..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workforce, Provider: Physician, Provider, Medicare
Schwarzkopf R, Behery OA, Yu H
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
Unplanned readmissions following elective total hip (THA) and knee (TKA) arthroplasty as a result of surgical complications likely have different quality improvement targets and cost implications than those for nonsurgical readmissions. In this study, the investigators compared payments, timing, and location of unplanned readmissions with Center for Medicare and Medicaid Services (CMS)-defined surgical complications to readmissions without such complications.
AHRQ-funded; HS022882.
Citation: Schwarzkopf R, Behery OA, Yu H .
Patterns and costs of 90-day readmission for surgical and medical complications following total hip and knee arthroplasty.
J Arthroplasty 2019 Oct;34(10):2304-07. doi: 10.1016/j.arth.2019.05.046..
Keywords: Orthopedics, Surgery, Hospital Readmissions, Adverse Events, Quality Improvement, Quality of Care, Medicare, Hospitals
Beckett MK, Elliott MN, Burkhart Q
The effects of survey version on patient experience scores and plan rankings.
Researchers assessed the effect of changing survey questions on plan-level patient experience measures and ratings. Using CAHPS data, they concluded that their analyses illustrated how to assess the impact of seemingly minor survey modifications for other national surveys considering changes and highlighted the importance of screeners in instrument design.
AHRQ-funded; HS016978.
Citation: Beckett MK, Elliott MN, Burkhart Q .
The effects of survey version on patient experience scores and plan rankings.
Health Serv Res 2019 Oct;54(5):1016-22. doi: 10.1111/1475-6773.13172..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Patient Experience, Medicare, Quality of Care