National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (8)
- Behavioral Health (1)
- Brain Injury (1)
- Cancer (2)
- Cancer: Cervical Cancer (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (4)
- Community-Based Practice (2)
- Decision Making (1)
- Disparities (1)
- Education: Patient and Caregiver (1)
- Electronic Health Records (EHRs) (2)
- Family Health and History (1)
- Healthcare Costs (2)
- Healthcare Delivery (1)
- Healthcare Utilization (6)
- Health Insurance (17)
- Health Services Research (HSR) (1)
- Hospitals (1)
- Human Immunodeficiency Virus (HIV) (1)
- Low-Income (5)
- Medicaid (15)
- Medical Expenditure Panel Survey (MEPS) (4)
- Medicare (1)
- Medication (1)
- Outcomes (1)
- Policy (13)
- Prevention (2)
- Primary Care (1)
- Quality of Care (2)
- Racial and Ethnic Minorities (2)
- Sexual Health (1)
- Social Determinants of Health (1)
- Trauma (1)
- Treatments (1)
- (-) Uninsured (27)
- Vulnerable Populations (3)
- Web-Based (1)
- Women (2)
- Young Adults (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 27 Research Studies DisplayedLewis VA, Spivack S, Murray GF
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
Researchers assessed capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients. Data from the National Survey of Healthcare Organizations and Systems was analyzed. They found that federally qualified health centers were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities.
AHRQ-funded; HS024075.
Citation: Lewis VA, Spivack S, Murray GF .
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
J Gen Intern Med 2021 Oct;36(10):2922-28. doi: 10.1007/s11606-021-06746-0..
Keywords: Vulnerable Populations, Primary Care, Access to Care, Uninsured, Medicaid, Quality of Care
Berdahl TA, Moriya AS
AHRQ Author: Berdahl TA, Moriya AS
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
This AHRQ-authored paper estimates insurance disparities across non-standard employment categories and determines how coverage disparities shifted following health reform in 2014. Data on working-age adults was analyzed from the 2010-2012 and 2015-2017 MEPS. Uninsurance decreased after health reform for all groups of nonstandard workers with a 10-14% point decline. Uninsurance remained high for all freelance workers at 30.8%, full-time temporary workers (25.1%) and part-time workers (17.9%) compared to full-time workers (11.9%). Lower uninsurance in a Medicaid expansion state was found for all categories of workers.
AHRQ-authored.
Citation: Berdahl TA, Moriya AS .
Insurance coverage for non-standard workers: experiences of temporary workers, freelancers, and part-time workers in the USA, 2010-2017.
J Gen Intern Med 2021 Jul;36(7):1997-2003. doi: 10.1007/s11606-021-06700-0..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Policy, Uninsured, Medicaid, Low-Income
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization
Hudson JL, Moriya AS
AHRQ Author: Hudson JL
The role of marketplace policy on welcome mat effects for children eligible for Medicaid or the Children's Health Insurance Program.
This study examined the role of marketplace policy on “welcome mat” effects for children eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Data from the American Community Survey from 2013-2018 was used to estimate the relationship between Marketplace policy and increases in Medicaid/CHIP coverage among pre-ACA eligible children after the implementation of the Affordable Care Act (ACA). The sample included non-disabled citizen children ages 0-18 at 139-250% federal poverty level who were Medicaid/CHIP-eligible before and after implementation of the ACA. Marketplace policies and enrollment were compared in expansion states versus non-expansion states. Public coverage did increase more in states that empowered their Marketplace to enroll publicly-eligible applicants directly into Medicaid/CHIP. This was driven by enrollment policy, not by choice of state-based versus federal-based Marketplaces. Welcome mats were largest in expansion states and increases ranged from 9 to 13 percentage points in enrollment.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
The role of marketplace policy on welcome mat effects for children eligible for Medicaid or the Children's Health Insurance Program.
Inquiry 2020 Jan-Dec;57:46958020952920. doi: 10.1177/0046958020952920..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Medicaid, Health Insurance, Policy, Uninsured, Access to Care
Cha P, Brindis CD
Early Affordable Care Act Medicaid: coverage effects for low- and moderate-income young adults.
This study examined the effects of early Medicaid expansions on low- and moderate-income young adults. They used the American Community Survey 2008-2013 to study three early expansion states: California, Connecticut and Minnesota. Results shows that Medicaid expansion reduced uninsurance in all three states and increased public insurance in California and Minnesota. Young men benefitted more than young women, who historically tend to be uninsured.
AHRQ-funded; HS022241.
Citation: Cha P, Brindis CD .
Early Affordable Care Act Medicaid: coverage effects for low- and moderate-income young adults.
J Adolesc Health 2020 Sep;67(3):425-31. doi: 10.1016/j.jadohealth.2020.05.029..
Keywords: Young Adults, Policy, Medicaid, Uninsured, Access to Care
Zuvekas SH, McClellan CB, Ali MM
AHRQ Author: Zuvekas SH, McClellan CB
Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition.
AHRQ-authored.
Citation: Zuvekas SH, McClellan CB, Ali MM .
Medicaid expansion and health insurance coverage and treatment utilization among individuals with a mental health condition.
J Ment Health Policy Econ 2020 Sep 1;23(3):151-82..
Keywords: Medical Expenditure Panel Survey (MEPS), Behavioral Health, Medicaid, Health Insurance, Access to Care, Healthcare Utilization, Policy, Uninsured
Porter A, Brown CC, Tilford JM
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
This study’s objective was to determine if a health insurance disparity exists among pediatric patients with severe traumatic brain injury using data from the National Trauma Data Bank. The Bank contains data from more than 800 trauma centers in the United States. Isolated traumatic brain injury was defined as patients with a head Abbreviated Injury Scale score of 3+. Procedure codes were used to identify four primary treatment approaches combined into 2 classifications: craniotomy or craniectomy and external or intracranial ventricular draining. Condition at admission was defined including hypotension, Glasgow Coma Scale, mechanism and intent of injury, and Injury Severity Scale. Among the cohort of 12,449 patients, 91% had insurance and 9% were uninsured. Children without insurance had worse condition at admission with higher rates of hypotension and higher Injury Severity Score when compared with publicly and privately insured patients. Having insurance was associated with a 32% increase in the odds of cranial procedures, and 54% increase in the odds of monitor placement. Insurance coverage was associated 25% lower odds of inpatient mortality. Further study is needed to determine what factors lead to worse condition at admission.
Citation: Porter A, Brown CC, Tilford JM .
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
Crit Care Med 2020 Jul;48(7):e584-e91. doi: 10.1097/ccm.0000000000004398..
Keywords: Children/Adolescents, Brain Injury, Trauma, Health Insurance, Access to Care, Uninsured, Outcomes
Darney BG, Biel FM, Rodriguez MI
Payment for contraceptive services in safety net clinics: roles of Affordable Care Act, Title X, and state programs.
This study examined trends in uninsured contraceptive visits before and after Medicaid expansion under the Affordable Care Act (ACA) in a large network of safety-net clinics. Their sample included 237 safety net clinics in 11 states with a common electronic health record. The authors identified 162,666 contraceptive visits in 219 clinics and found a significant decline in uninsured visits. There was a slightly greater decline in expansion states than in non-expansion states.
AHRQ-funded; HS022981; HS025155.
Citation: Darney BG, Biel FM, Rodriguez MI .
Payment for contraceptive services in safety net clinics: roles of Affordable Care Act, Title X, and state programs.
Med Care 2020 May;58(5):453-60. doi: 10.1097/mlr.0000000000001309..
Keywords: Sexual Health, Policy, Uninsured, Women
Tilhou AS, Huguet N, DeVoe J
The Affordable Care Act Medicaid Expansion positively impacted community health centers and their patients.
In this paper, the investigators summarized their results to-date as experts in investigating the impact of the Patient Protection and Affordable Care Act (ACA) Medicaid expansion on Community Health Centers (CHCs) and the patients they serve. They found the ACA Medicaid expansion increased access to care and preventive services, primarily in Medicaid expansion states. Rates of physical and mental health conditions rose substantially from pre- to post-ACA in expansion states, suggesting underdiagnosis pre-ACA.
AHRQ-funded; HS024270.
Citation: Tilhou AS, Huguet N, DeVoe J .
The Affordable Care Act Medicaid Expansion positively impacted community health centers and their patients.
J Gen Intern Med 2020 Apr;35(4):1292-95. doi: 10.1007/s11606-019-05571-w..
Keywords: Policy, Medicaid, Access to Care, Uninsured, Health Insurance
Ellis RJ, Schlick CJR, Feinglass J
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
This study examined hospital variation in cancer patients who did not receive recommended chemotherapy. Patients with breast, colon, and lung cancers who did not receive chemotherapy from 2000 to 2015 were identified from the National Cancer Database. A total of 183,148 patients at 1281 hospitals were included. For breast cancer, 3.5% of patients failed to receive recommended chemotherapy, and 6.6% with colon, and 10.7% with lung cancer. Sociodemographic factors showed that patients were less likely to receive chemotherapy if they were uninsured or on Medicaid, as were non-Hispanic black patients with both breast and colon cancer. There was also significant hospital variation with failure to administer as high as 21.8% for breast, 40.2% for colon, and 40.0% for lung cancer.
AHRQ-funded; HS000078; HS026385.
Citation: Ellis RJ, Schlick CJR, Feinglass J .
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
BMJ Qual Saf 2020 Feb;29(2):103-12. doi: 10.1136/bmjqs-2019-009742..
Keywords: Treatments, Cancer, Healthcare Delivery, Access to Care, Healthcare Utilization, Social Determinants of Health, Vulnerable Populations, Uninsured, Hospitals, Quality of Care
DeLia D, Yedidia MJ
The policy and practice legacy of the New Jersey Medicaid ACO Demonstration Project.
This paper examined the New Jersey Medicaid Accountable Care Organization (ACO) Demonstration and what was learned from the Demonstration. The Demonstration did not lead to a sustainable accountable care financing model as hoped for. Instead, the ACOs evolved into community health coalitions focused on a wide range of activities in partnership with state government, private health systems, community leaders, and MCOs. Policy parameters are currently being developed by the state to reposition the ACOs as regional partners to implement state-directed population health initiatives.
AHRQ-funded; HS023493.
Citation: DeLia D, Yedidia MJ .
The policy and practice legacy of the New Jersey Medicaid ACO Demonstration Project.
J Ambul Care Manage 2020 Jan/Mar;43(1):2-10. doi: 10.1097/jac.0000000000000308..
Keywords: Medicaid, Policy, Health Insurance, Uninsured
Furtado KS, Kaphingst KA, Perkins H
Health insurance information-seeking behaviors among the uninsured.
In order to better understand how to reach the uninsured and support their health insurance decision making, this study examined where the uninsured collect information about health insurance and the extent to which they trust those sources and media. Its findings suggest that strategies that pair health care professionals, lay health advisors, or community liaisons with the ubiquity of the Internet may be a strong approach for delivering quality health insurance information to the uninsured.
AHRQ-funded; HS020309.
Citation: Furtado KS, Kaphingst KA, Perkins H .
Health insurance information-seeking behaviors among the uninsured.
J Health Commun 2016;21(2):148-58. doi: 10.1080/10810730.2015.1039678.
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Keywords: Uninsured, Health Insurance, Education: Patient and Caregiver, Web-Based
Harrison KL, Taylor HA
Healthcare resource allocation decisions affecting uninsured services.
The authors described resource allocation and policy decisions related to providing health services for the uninsured. They recommend that how healthcare decisions are actually made can be matched with literature that describes how healthcare resource decisions ought to be made, in order to provide a normative grounding for future decisions.
AHRQ-funded; HS000029.
Citation: Harrison KL, Taylor HA .
Healthcare resource allocation decisions affecting uninsured services.
J Health Organ Manag 2016 Nov 21;30(8):1162-82. doi: 10.1108/jhom-01-2016-0003.
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Keywords: Decision Making, Health Services Research (HSR), Policy, Uninsured
Politi MC, Kaphingst KA, Liu JE
A randomized trial examining three strategies for supporting health insurance decisions among the uninsured.
This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. Participants were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. It found that participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features.
AHRQ-funded; HS020309.
Citation: Politi MC, Kaphingst KA, Liu JE .
A randomized trial examining three strategies for supporting health insurance decisions among the uninsured.
Med Decis Making. 2016 Oct;36(7):911-22. doi: 10.1177/0272989X15578635.
Keywords: Health Insurance, Uninsured
Vistnes JP, Cohen JW
AHRQ Author: Vistnes JP, Cohen JW
Gaining coverage in 2014: new estimates of marketplace and Medicaid transitions.
The researchers used data from the Medical Expenditure Panel Survey-Household Component to examine coverage transitions for nonelderly US adults. They found that 71.5 percent of Marketplace enrollees in 2014 had some period of uninsurance before enrollment. In Medicaid expansion states, 17.4 percent of adults who were uninsured throughout 2013 gained Medicaid coverage in 2014, compared with only 5.6 percent in those states between 2012 and 2013.
AHRQ-authored.
Citation: Vistnes JP, Cohen JW .
Gaining coverage in 2014: new estimates of marketplace and Medicaid transitions.
Health Aff 2016 Oct 1;35(10):1825-29. doi: 10.1377/hlthaff.2016.0500.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Medicaid, Uninsured, Policy
Sommers BD, Gourevitch R, Maylone B
Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many.
The researchers explored the frequency and implications of changes in insurance coverage over time (i.e., "churning,")through surveying low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a "private option" expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. They found that churning was associated with disruptions in physician care and medication adherence, and increased emergency department use.
AHRQ-funded; HS021291.
Citation: Sommers BD, Gourevitch R, Maylone B .
Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many.
Health Aff 2016 Oct;35(10):1816-24. doi: 10.1377/hlthaff.2016.0455.
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Keywords: Medicaid, Uninsured, Policy, Health Insurance
Sommers BD, Chua KP, Kenney GM
California's early coverage expansion under the Affordable Care Act: a county-level analysis.
The researchers assessed the coverage effects of California's 2011 Low-Income Health Program (LIHP), enacted as an "early expansion" under the Affordable Care Act (ACA), and to demonstrate the feasibility of using Census data to measure county-level coverage changes. They concluded that California's 2011 expansion produced significant increases in public coverage for low-income individuals, particularly Latinos.
AHRQ-funded; HS021291.
Citation: Sommers BD, Chua KP, Kenney GM .
California's early coverage expansion under the Affordable Care Act: a county-level analysis.
Health Serv Res 2016 Jun;51(3):825-45. doi: 10.1111/1475-6773.12397.
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Keywords: Medicaid, Uninsured, Policy, Health Insurance, Racial and Ethnic Minorities
Raghavan R, Allaire BT, Brown DS
Medicaid disenrollment patterns among children coming into contact with child welfare agencies.
The authors examined retention of Medicaid coverage over time for children in the child welfare system. Using Medicaid claims files from 36 states, they found that half retained Medicaid coverage across 4 years of follow up, with most disenrollments happening in year 4. They recommend finding ways to promote entry of child welfare-involved children into health insurance coverage in order to assure services.
AHRQ-funded; HS020269.
Citation: Raghavan R, Allaire BT, Brown DS .
Medicaid disenrollment patterns among children coming into contact with child welfare agencies.
Matern Child Health J 2016 Jun;20(6):1280-7. doi: 10.1007/s10995-016-1929-9.
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Keywords: Children/Adolescents, Family Health and History, Medicaid, Uninsured, Vulnerable Populations
DeVoe JE, Tillotson CJ, Marino M
Trends in type of health insurance coverage for US children and their parents, 1998-2011.
The objective of this paper is to examine trends in health insurance type among US children and their parents. Using Medical Expenditure Panel Survey data (1998-2011), the authors found that low- and middle-income US families experienced a decrease in the percentage of child-parent pairs with private health insurance and pairs without insurance. At the same time, they found a rise in discordant coverage patterns - mainly publicly insured children with uninsured parents.
AHRQ-funded; HS018569.
Citation: DeVoe JE, Tillotson CJ, Marino M .
Trends in type of health insurance coverage for US children and their parents, 1998-2011.
Acad Pediatr 2016 Mar;16(2):192-9. doi: 10.1016/j.acap.2015.06.009.
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Keywords: Children/Adolescents, Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS), Uninsured
Hoopes MJ, Angier H, Gold R
Utilization of community health centers in Medicaid expansion and nonexpansion states, 2013-2014.
Using electronic health record data, the researchers examined longitudinal changes in community health center (CHC) visit rates from 2013 through 2014 in Medicaid expansion versus nonexpansion states. Rates increased in expansion state CHCs for new patient, preventive, and limited-service visits (14 percent, 41percent, and 23 percent, respectively), whereas these rates remained unchanged in nonexpansion states.
AHRQ-funded; HS024270.
Citation: Hoopes MJ, Angier H, Gold R .
Utilization of community health centers in Medicaid expansion and nonexpansion states, 2013-2014.
J Ambul Care Manage 2016 Jan 13;39(4):290-8. doi: 10.1097/jac.0000000000000123.
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Keywords: Electronic Health Records (EHRs), Community-Based Practice, Healthcare Utilization, Medicaid, Uninsured
Vargas Bustamante A, Chen J
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
This study of the association between the timing of the Great Recession (GR) and health spending among uninsured U.S. immigrants found that the probability of any spending diminished for recent immigrants compared to citizens during the GR. For those with any spending, recent immigrants reported 27 percent higher spending during the GR.
AHRQ-funded; HS022634
Citation: Vargas Bustamante A, Chen J .
The great recession and health spending among uninsured U.S. immigrants: implications for the Affordable Care Act implementation.
Health Serv Res. 2014 Dec;49(6):1900-24. doi: 10.1111/1475-6773.12193..
Keywords: Healthcare Costs, Uninsured, Disparities
Epstein AM, Sommers BD, Kuznetsov Y
Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.
The authors explored what low-income Americans think about Medicaid. They found that nearly 80 percent of their telephone survey sample favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability.
AHRQ-funded; HS021291.
Citation: Epstein AM, Sommers BD, Kuznetsov Y .
Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.
Health Aff 2014 Nov;33(11):2041-7. doi: 10.1377/hlthaff.2014.0747.
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Keywords: Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Heintzman J, Marino M, Hoopes M
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
This study used EHR data to compare the preventive service utilization of uninsured patients receiving care at Oregon community health centers (CHCs) in 2008 through 2011 with that of continuously insured patients at the same CHCs in the same period. The results showed that CHCs provided many preventive services to uninsured patients, but that uninsured patients were less likely than continuously insured patients to receive 5 of 11 preventive services. The authors concluded that lack of insurance is a barrier to preventive service utilization, even in patients who can access care at a CHC.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Hoopes M .
Using electronic health record data to evaluate preventive service utilization among uninsured safety net patients.
Prev Med 2014 Oct;67:306-10. doi: 10.1016/j.ypmed.2014.08.006.
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Keywords: Community-Based Practice, Electronic Health Records (EHRs), Healthcare Utilization, Prevention, Uninsured
Yehia BR, Fleishman JA, Agwu AL
AHRQ Author: Fleishman JA
Health insurance coverage for persons in HIV care, 2006-2012.
The authors examined trends in health insurance coverage at 11 US HIV clinics between 2006 and 2012. They found that Medicaid coverage was more prevalent among women than men; blacks and Hispanics than whites; and individuals with injection drug use risk compared with other transmission risk factors, with Hispanics and younger age groups more likely to be uninsured than other racial/ethnic and older age groups, respectively.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Yehia BR, Fleishman JA, Agwu AL .
Health insurance coverage for persons in HIV care, 2006-2012.
J Acquir Immune Defic Syndr 2014 Sep 1;67(1):102-6. doi: 10.1097/qai.0000000000000251.
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Keywords: Health Insurance, Human Immunodeficiency Virus (HIV), Medicare, Racial and Ethnic Minorities, Uninsured
Crisp GD, Roberts AW, Esserman DA
The University of North Carolina's Health Care Pharmacy Assistance Program.
This study examined a program providing financial assistance to uninsured residents of North Carolina who need prescription medications. It found that from 2009 to 2011, the program served 7,180 patients in 81 counties. These patients received a mean of 23 prescriptions at an average cost of $754 per recipient per year.
AHRQ-funded; HS000032
Citation: Crisp GD, Roberts AW, Esserman DA .
The University of North Carolina's Health Care Pharmacy Assistance Program.
N C Med J. 2014 Sep-Oct;75(5):303-9..
Keywords: Healthcare Costs, Uninsured, Medication, Healthcare Utilization