National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (3)
- (-) Children's Health Insurance Program (CHIP) (16)
- Children/Adolescents (13)
- Disparities (1)
- Electronic Health Records (EHRs) (2)
- Healthcare Costs (1)
- Healthcare Utilization (1)
- Health Insurance (3)
- Health Services Research (HSR) (3)
- Low-Income (3)
- Medicaid (5)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medicare (2)
- Payment (1)
- Policy (1)
- Primary Care (1)
- Quality Improvement (1)
- Quality Indicators (QIs) (3)
- Quality Measures (7)
- Quality of Care (7)
- Uninsured (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedHudson 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
Soylu TG, Goldberg DG, Cuellar AE
Medicare access and CHIP reauthorization act in small to medium-sized primary care practices.
Despite major efforts to transition to a new physician payment system under the Medicare Access and CHIP Reauthorization Act (MACRA), little is known about how well practices are prepared. This study aimed to understand how small and medium-sized primary care practices in the Heart of Virginia Healthcare (https://www.vahealthinnovation.org/hvh/) perceived their quality incentives under MACRA.
AHRQ-funded; HS023913.
Citation: Soylu TG, Goldberg DG, Cuellar AE .
Medicare access and CHIP reauthorization act in small to medium-sized primary care practices.
J Am Board Fam Med 2020 Nov-Dec;33(6):942-52. doi: 10.3122/jabfm.2020.06.200142..
Keywords: Children's Health Insurance Program (CHIP), Medicare, Primary Care, Health Insurance
Apathy NC, Everson J
High rates of partial participation in the first year of the merit-based incentive payment system.
This article discusses concerns over the implementation of the Merit-based Incentive Payment System (MIPS) for clinicians, which was authorized with the Medicare Access and CHIP Reauthorization Act of 2015. Data was analyzed from 2017, the first implementation year of MIPS. The authors found that although 90% of participating clinicians reported performance equal to or better than the lower performance threshold of 3 out of 100, almost half of clinicians did not participate in at least one of the three program categories. Even with the low participation rate, 74% of clinicians who only partially participated in the program received positive payment adjustments. The findings underline concerns that the design may have been too flexible to effectively incentivize clinicians to make incremental progress across all targeted aspects of the program (quality, advancing care information, and improvement activities).
AHRQ-funded; K12 HS026395.
Citation: Apathy NC, Everson J .
High rates of partial participation in the first year of the merit-based incentive payment system.
Health Aff 2020 Sep;39(9):1513-21. doi: 10.1377/hlthaff.2019.01648..
Keywords: Payment, Medicare, Medicaid, Children's Health Insurance Program (CHIP), Health Insurance
Shah AY, LLanos K, Dougherty D
AHRQ Author: Dougherty D
State challenges to child health quality measure reporting and recommendations for improvement.
The authors sought to assess reporting barriers of the Children's Health Insurance Program (CHIP) and to identify potential opportunities for improvement. They found that low reporting states believed they had inadequate staffing and that data collection and extraction was too time-consuming. They concluded that possible solutions to improve reporting would include funding and staff support, refining the technical assistance provided, and creating venues for state-to-state interaction.
AHRQ-authored.
Citation: Shah AY, LLanos K, Dougherty D .
State challenges to child health quality measure reporting and recommendations for improvement.
Healthc 2016 Sep;4(3):217-24. doi: 10.1016/j.hjdsi.2016.03.001.
.
.
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Quality of Care, Medicaid, Quality Indicators (QIs)
Bailey SR, Marino M, Hoopes M
Healthcare utilization after a children's health insurance program expansion in Oregon.
This study used electornic health record data from 154 Oregon community health centers to evaluate children's healthcare utilization after the Children's Health Insurance Program (CHIP) expansion. The authors found that utilization among the newly-insured remained higher than the uninsured group. This finding confirms that Children's Health Insurance Program expansions are associated with increased utilization of essential pediatric primary and preventive care.
AHRQ-funded; HS021522; HS018569.
Citation: Bailey SR, Marino M, Hoopes M .
Healthcare utilization after a children's health insurance program expansion in Oregon.
Matern Child Health J 2016 May;20(5):946-54. doi: 10.1007/s10995-016-1971-7.
.
.
Keywords: Children's Health Insurance Program (CHIP), Electronic Health Records (EHRs), Healthcare Utilization, Children/Adolescents, Access to Care
Wherry LR, Kenney GM, Sommers BD
The role of public health insurance in reducing child poverty.
The researchers reviewed a growing body of evidence that public health insurance provides important financial benefits to low-income families and also reviewed the potential poverty-reducing effects of public health insurance coverage. They found that Medicaid plays a significant role in decreasing poverty for many children and families. They also reviewed emerging evidence that access to public health insurance in childhood has long-term effects for health and economic outcomes in adulthood. They concluded that the nation's public health insurance programs have many important short- and long-term poverty-reducing benefits for low-income families with children.
AHRQ-funded; HS021291.
Citation: Wherry LR, Kenney GM, Sommers BD .
The role of public health insurance in reducing child poverty.
Acad Pediatr 2016 Apr;16(3 Suppl):S98-s104. doi: 10.1016/j.acap.2015.12.011.
.
.
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Low-Income, Medicaid
Kreider AR, French B, Aysola J
Quality of health insurance coverage and access to care for children in low-income families.
This study compared health care access, quality, and cost outcomes by insurance type (Medicaid, CHIP, private, and uninsured) for children in households with low to moderate incomes. It found that children with all insurance types experienced challenges in access to specialty care, with caregivers of children insured by the Children’s Health Insurance Program reporting the highest rates of difficulty accessing specialty care, problems obtaining a referral, and frustration obtaining health care services.
AHRQ-funded; HS021706.
Citation: Kreider AR, French B, Aysola J .
Quality of health insurance coverage and access to care for children in low-income families.
JAMA Pediatr 2016 Jan;170(1):43-51. doi: 10.1001/jamapediatrics.2015.3028..
Keywords: Children's Health Insurance Program (CHIP), Children/Adolescents, Access to Care, Low-Income
Bailey LC, Mistry KB, Tinoco A
AHRQ Author: Mistry KB
Addressing electronic clinical information in the construction of quality measures.
The authors draw on the experience of Centers of Excellence to review both structural and pragmatic considerations in e-measurement. They suggest that addressing these challenges will require investment by vendors, researchers, and clinicians alike in developing better pediatric content for standard terminologies and data models, encouraging wider adoption of technical standards that support reliable quality measurement, better harmonizing data collection with clinical work flow in EHRs, and better understanding the behavior and potential of e-measures.
AHRQ-authored.
Citation: Bailey LC, Mistry KB, Tinoco A .
Addressing electronic clinical information in the construction of quality measures.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S82-9. doi: 10.1016/j.acap.2014.06.006.
.
.
Keywords: Children's Health Insurance Program (CHIP), Electronic Health Records (EHRs), Quality Improvement, Quality Indicators (QIs), Quality Measures
Mistry KB, Chesley F, Llanos K
AHRQ Author: Mistry KB, Chesley F, Dougherty D.
Advancing children's health care and outcomes through the pediatric quality measures program.
This article focuses on the Pediatric Quality Measures Program and provides an overview of the program's goals and related activities, lessons learned, and future opportunities.
AHRQ-authored.
Citation: Mistry KB, Chesley F, Llanos K .
Advancing children's health care and outcomes through the pediatric quality measures program.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S19-26. doi: 10.1016/j.acap.2014.06.025.
.
.
Keywords: Children's Health Insurance Program (CHIP), Quality of Care, Health Services Research (HSR), Children/Adolescents, Quality Measures
Kuhlthau KA, Mistry KB, Forrest CB
AHRQ Author: Mistry KB, Dougherty D
Advancing the science of measurement in pediatric quality of care.
This overview describes the articles in this supplement as falling into 3 broad themes: the value of pediatric quality measures to stakeholders; the scope of the CHIPRA Pediatric Quality Measures Program measurement initiative; and challenges in developing and testing pediatric quality measures. It concludes that the articles illustrate the considerations necessary for creating good measure sets and provide strategies for overcoming challenges encountered in the measurement development process.
AHRQ-authored; AHRQ-funded; HS020408.
Citation: Kuhlthau KA, Mistry KB, Forrest CB .
Advancing the science of measurement in pediatric quality of care.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S1-3. doi: 10.1016/j.acap.2014.06.016..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Children/Adolescents, Quality Measures, Quality Measures
Dougherty D, Mistry KB, Llanos K
AHRQ Author: Dougherty D, Mistry KB, Chesley F
An AHRQ and CMS perspective on the pediatric quality measures program.
This article describes the Pediatric Quality Measures Program (PQMP). The PQMP has worked to close gaps in children’s health care quality by increasing the portfolio of new measures and methods as envisioned by the CHIPRA legislation. It is the adoption and use of these measures that can lead to improvements in the quality of care and elimination of disparities in health care for children over time.
AHRQ-authored.
Citation: Dougherty D, Mistry KB, Llanos K .
An AHRQ and CMS perspective on the pediatric quality measures program.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S17-8. doi: 10.1016/j.acap.2014.06.017.
.
.
Keywords: Children's Health Insurance Program (CHIP), Quality of Care, Health Services Research (HSR), Children/Adolescents, Quality Measures
Byron SC, Gardner W, Kleinman LC
Developing measures for pediatric quality: methods and experiences of the CHIPRA pediatric quality measures program grantees.
The authors described the processes used by the Pediatric Quality Measures Program (PQMP) grantees to develop measures to assess the health care of children and adolescents in Medicaid and the Children's Health Insurance Program. They found that PQMP grantees faced common challenges, including the limited evidence base, data systems difficult or unsuited for measures reporting, and conflicting stakeholder priorities. Grantees were able to explore innovative methods to overcome measurement challenges, resulting in new quality measures for pediatric care.
AHRQ-funded; HS020513; HS020498; HS020516; HS020506; HS020518; HS020508; HS020503.
Citation: Byron SC, Gardner W, Kleinman LC .
Developing measures for pediatric quality: methods and experiences of the CHIPRA pediatric quality measures program grantees.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S27-32. doi: 10.1016/j.acap.2014.06.013.
.
.
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Quality of Care, Children/Adolescents, Quality Measures
Dougherty D, Mistry KB, Lindly O
AHRQ Author: Dougherty D, Mistry KB, Desoto M, Chesley F
Systematic evidence-based quality measurement life-cycle approach to measure retirement in CHIPRA.
The authors assessed selected child core set (CCS) measures for potential retirement. The Subcommittee of the National Advisory Council on Healthcare Research and Quality recommended 3 measures for retirement: access to primary care; testing for strep before recommending antibiotics for pharyngitis; and annual HbA1c testing of children with diabetes. CMS recommended that state Medicaid and CHIP programs retire 2 of the recommended measures from the CCS, but retained the access to primary care measure.
AHRQ-authored.
Citation: Dougherty D, Mistry KB, Lindly O .
Systematic evidence-based quality measurement life-cycle approach to measure retirement in CHIPRA.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S97-s103. doi: 10.1016/j.acap.2014.06.015.
.
.
Keywords: Children's Health Insurance Program (CHIP), Quality of Care, Health Services Research (HSR), Children/Adolescents, Quality Measures
Gidengil C, Mangione-Smith R, Bailey LC
Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers of excellence in measure development.
The investigators sought to explore the claims data-related issues relevant to quality measure development for Medicaid and the Children's Health Insurance Program (CHIP), illustrating the challenges encountered and solutions developed around 3 distinct performance measure topics: care coordination for children with complex needs, quality of care for high-prevalence conditions, and hospital readmissions. Their three Centers of Excellence in pediatric quality measurement used innovative methods to develop algorithms that use Medicaid claims data to identify children with complex needs; to overcome some shortcomings of existing data for measuring quality of care for common conditions such as otitis media; and to identify readmissions after hospitalizations for lower respiratory infections.
AHRQ-funded; HS020513; HS020506; HS020508.
Citation: Gidengil C, Mangione-Smith R, Bailey LC .
Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers of excellence in measure development.
Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S76-81. doi: 10.1016/j.acap.2014.06.014.
.
.
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Medicaid, Quality Indicators (QIs), Quality Measures, Quality of Care
Abdus S, Hudson J, Hill SC
AHRQ Author: Abdus S, Hudson J, Hill SC, Selden TM
Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.
Using MEPS data, the authors showed that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. They found that the increase in uninsurance is largest among children whose parents lack offers of employer coverage.
AHRQ-authored.
Citation: Abdus S, Hudson J, Hill SC .
Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.
Health Aff 2014 Aug;33(8):1353-60. doi: 10.1377/hlthaff.2014.0182.
.
.
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Low-Income
Dougherty D, Chen X, Gray DT
AHRQ Author: Dougherty D, Gray DT
Child and adolescent health care quality and disparities: are we making progress?
The authors sought to examine trends over time in health care quality and disparities by race, Hispanic ethnicity, income, insurance, gender, rurality, and special health care needs. Using data from the 2011 National Healthcare Quality Report and Naitonal Healthcare Disparities Reprot, they found that there was some progress in health care quality and reducing disparities in children's health care quality from 2000 to 2009, but opportunities for targeting improvement strategies remain.
AHRQ-authored.
Citation: Dougherty D, Chen X, Gray DT .
Child and adolescent health care quality and disparities: are we making progress?
Acad Pediatr 2014 Mar-Apr;14(2):137-48. doi: 10.1016/j.acap.2013.11.008.
.
.
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Disparities, Quality of Care