National Healthcare Quality and Disparities Report
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Topics
- Access to Care (1)
- Adverse Drug Events (ADE) (1)
- (-) Cancer (17)
- Cancer: Prostate Cancer (1)
- Cancer: Skin Cancer (1)
- Caregiving (2)
- Care Management (1)
- Children/Adolescents (1)
- Chronic Conditions (2)
- Comparative Effectiveness (1)
- Disparities (2)
- Elderly (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (4)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (1)
- Heart Disease and Health (1)
- Inpatient Care (1)
- Long-Term Care (1)
- Medicare (3)
- Medication (2)
- Men's Health (1)
- Mortality (1)
- Opioids (1)
- Outcomes (2)
- Pain (3)
- (-) Palliative Care (17)
- Patient-Centered Outcomes Research (5)
- Practice Patterns (2)
- Provider: Physician (1)
- Quality Improvement (1)
- Quality Measures (1)
- Quality of Care (1)
- Quality of Life (3)
- Racial and Ethnic Minorities (2)
- Shared Decision Making (1)
- Telehealth (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 17 of 17 Research Studies DisplayedWu A, Ugiliweneza B, Wang D
Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a seer-Medicare retrospective study.
This study investigates differences in palliative care (PC) timing on outcomes for patients with glioblastoma (GBM) using Surveillance, Epidemiology, and End Results (SEER) Medicare data. Findings showed that, despite an overall increase in PC consultations, only a minority of GBM patients receive PC. Patients with late PC had the longest survival times and had greater hospice use in the last month of life compared to other subgroups.
AHRQ-funded; HS028747.
Citation: Wu A, Ugiliweneza B, Wang D .
Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a seer-Medicare retrospective study.
Neurooncol Pract 2022 Aug;9(4):299-309. doi: 10.1093/nop/npac026.
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Keywords: Palliative Care, Cancer, Quality of Life, Healthcare Costs
Jin MC, Hsin G, Ratliff J
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
This study analyzed a cohort of privately insured patients with malignant brain or spinal tumors derived from the Optum Clinformatics Datamart Database to investigate health disparities and access and utilization of palliative care and supportive services. The authors introduced a novel construct, “provider patient racial diversity index” (provider pRDI) which is a measure of the proportion of non-white minority patients a provider encounters to approximate a provider's patient demographics and suggest a provider's cultural sensitivity and exposure to diversity. Their analysis demonstrated low rates of palliative care, home health, and social work services among racial minority patients, with Hispanics having the lowest likelihood of engagement with all three categories of supportive services. Patients who saw providers categorized into high provider pRDI (categories II and III) were increasingly more likely to interface with supportive care services and at an earlier point in their disease courses.
AHRQ-funded; HS028747.
Citation: Jin MC, Hsin G, Ratliff J .
Modifiers of and disparities in palliative and supportive care timing and utilization among neurosurgical patients with malignant central nervous system tumors.
Cancers 2022 May 23;14(10). doi: 10.3390/cancers14102567..
Keywords: Palliative Care, Disparities, Cancer
Dionne-Odom JN, Wells RD, Guastaferro K
An early palliative care telehealth coaching intervention to enhance advanced cancer family caregivers' decision support skills: the CASCADE pilot factorial trial.
The purpose of this study was to evaluate the feasibility, acceptability, and efficacy of the modules of a telehealth palliative care decision support training program (CASCADE training- CAre Supporters Coached to be Adept DEcision Partners) for caregivers of cancer patients. The researchers conducted a pilot trial between October 2019 and October 2020 in which 46 dyads of newly diagnosed cancer patients and their caregivers were randomized and assigned to one of eight experimental conditions. Each experimental condition included a combination of one of three CASCADE modules. Measures of decision support and caregiver and patient distress, training feasibility, and training acceptability were collected. The study found that the individual CASCADE modules were reported to have a possible benefit for decision support and caregiver distress, and that the average caregiver rating for recommending the program was 9.9 on a scale of 1(Not at all likely) to 10 (Extremely likely). The study concluded that the pilot trial was a success and justify and warrant a full-scale trial.
AHRQ-funded; HS013852.
Citation: Dionne-Odom JN, Wells RD, Guastaferro K .
An early palliative care telehealth coaching intervention to enhance advanced cancer family caregivers' decision support skills: the CASCADE pilot factorial trial.
J Pain Symptom Manage 2022 Jan;63(1):11-22. doi: 10.1016/j.jpainsymman.2021.07.023..
Keywords: Palliative Care, Cancer, Telehealth, Health Information Technology (HIT), Caregiving
Kaufmann TL, Getz KD, Hsu JY
Identification of patient-reported outcome phenotypes among oncology patients with palliative care needs.
This retrospective study used patient-reported outcome (PRO) data to characterize oncology patients with palliative care needs. The objective was to determine if PRO data can identify latent phenotypes that characterize indications for specialty palliative care referral. Self-reported symptoms were collected on the Edmonton Symptom Assessment Symptom from solid tumor oncology patients (n = 745) referred to outpatient palliative care at eight community and academic sites from October 2012 to October 2018. The authors identified four PRO phenotypes: low symptoms (39.6%); moderate pain/fatigue + mood (24.2%); moderate pain/fatigue + appetite + dypsnea (27%); and high symptoms (9.3%). A secondary analysis of 421 patients found that two brief items assessing social and existential needs aligned with higher severity symptoms and psychological distress phenotypes.
AHRQ-funded; HS023681.
Citation: Kaufmann TL, Getz KD, Hsu JY .
Identification of patient-reported outcome phenotypes among oncology patients with palliative care needs.
JCO Oncol Pract 2021 Oct;17(10):e1473-e88. doi: 10.1200/op.20.00849..
Keywords: Cancer, Palliative Care, Patient-Centered Outcomes Research, Outcomes
Enzinger AC, Ghosh K, Keating NL
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
This study looked at trends in opioid prescriptions for cancer patients near the end-of-life (EOL) defined as the 30 days before death or hospice enrollment. The authors looked at Medicare part D data from 2007 to 2017 for 270,632 Medicare fee-for-service decedents with poor prognosis cancers. During that time, the proportion of decedents with poor prognosis cancers receiving 1 or greater opioid prescriptions near EOL declined 15.5% and the proportion receiving 1 or greater long-acting opioid prescriptions declined 36.5% to 18.1%. The mean daily dose fell from 24.5%, from 85.6 morphine milligram equivalents per day (MMED) to 64.6. The total amount of opioids prescribed fell from 1,075 morphine milligram equivalents per decedent to 666 morphine milligram equivalents per decedents. At the same time, the proportion of patients with pain-related ED visits increase 50.8% from 13.2% to 19.9%.
AHRQ-funded; HS024072.
Citation: Enzinger AC, Ghosh K, Keating NL .
US trends in opioid access among patients with poor prognosis cancer near the end-of-life.
J Clin Oncol 2021 Sep 10;39(26):2948-58. doi: 10.1200/jco.21.00476..
Keywords: Cancer, Opioids, Palliative Care, Pain, Access to Care, Medication, Practice Patterns
Lee K, Gani F, Canner JK
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
The primary objective of this study was to describe racial differences in the use of inpatient palliative care consultations (IPCC) for patients with advanced cancer who are admitted to a hospital in the United States. Hospital admissions of patients with advanced cancers were identified through the National Inpatient Dataset. Findings showed that death during hospitalization was a significant modifier of the relationship between race and receipt of palliative care consultation. There were significant racial disparities in the utilization of IPCC for patients with advanced cancer.
AHRQ-funded; HS024736.
Citation: Lee K, Gani F, Canner JK .
Racial disparities in utilization of palliative care among patients admitted with advanced solid organ malignancies.
Am J Hosp Palliat Care 2021 Jun;38(6):539-46. doi: 10.1177/1049909120922779..
Keywords: Healthcare Cost and Utilization Project (HCUP), Palliative Care, Cancer, Disparities, Racial and Ethnic Minorities, Healthcare Utilization, Inpatient Care, Chronic Conditions
LeBlanc TW, Ritchie CS, Friedman F
Adherence to measuring what matters items when caring for patients with hematologic malignancies versus solid tumors.
The authors sought to assess adherence to Measuring What Matters (MWM) measures by palliative care clinicians caring for patients with hematologic malignancies, compared to those with solid tumors. They found that MWM adherence regarding symptom assessment and meeting emotional needs was lower for patients with hematologic malignancies compared to those with solid tumors. They concluded that this finding suggests two key areas for quality improvement initiatives in palliative care for patients with hematologic malignancies.
AHRQ-funded; HS023681; HS022763.
Citation: LeBlanc TW, Ritchie CS, Friedman F .
Adherence to measuring what matters items when caring for patients with hematologic malignancies versus solid tumors.
J Pain Symptom Manage 2016 Dec;52(6):775-82. doi: 10.1016/j.jpainsymman.2016.09.004.
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Keywords: Cancer, Quality of Care, Palliative Care, Patient-Centered Outcomes Research, Quality Measures
Perone JA, Riall TS, Olino K
Palliative care for pancreatic and periampullary cancer.
This article summarizes surgical, endoscopic, and other palliative techniques for relief of obstructive jaundice, relief of duodenal or gastric outlet obstruction, and relief of pain due to invasion of the celiac plexus. It also introduces the utility of the palliative care triangle in clarifying a patient's and family's goals to guide decision making.
AHRQ-funded; HS022134.
Citation: Perone JA, Riall TS, Olino K .
Palliative care for pancreatic and periampullary cancer.
Surg Clin North Am 2016 Dec;96(6):1415-30. doi: 10.1016/j.suc.2016.07.012.
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Keywords: Cancer, Palliative Care, Pain, Shared Decision Making
Hochman MJ, Kamal AH, Wolf SP
Anticholinergic drug burden in noncancer versus cancer patients near the end of life.
This article's objective is to determine anticholinergic load (ACL) and its impact in noncancer versus cancer palliative care patients. The authors concluded that ACL is associated with worse fatigue and quality of life and may not differ significantly between cancer and noncancer patients nearing end of life. Symptom management drugs are more responsible for ACL in cancer and noncancer patients, although disease management drugs contribute significantly to ACL in the latter group. They recommend more attention to reducing anticholinergic use in all patients with life-limiting illness.
AHRQ-funded; HS023681.
Citation: Hochman MJ, Kamal AH, Wolf SP .
Anticholinergic drug burden in noncancer versus cancer patients near the end of life.
J Pain Symptom Manage 2016 Nov;52(5):737-43.e3. doi: 10.1016/j.jpainsymman.2016.03.020.
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Keywords: Adverse Drug Events (ADE), Cancer, Medication, Palliative Care, Quality of Life
Wang SY, Hall J, Pollack CE
Associations between end-of-life cancer care patterns and Medicare expenditures.
The authors examined the extent to which patterns of intensive end-of-life care explain geographic variation in end-of-life care expenditures among cancer decedents. The mean expenditure per cancer decedent in the last month of life was $10,800, with considerable variation in the percentage of decedents receiving intensive end-of-life care intervention. Regional patterns of late chemotherapy or late hospice use explained only approximately 1% of the expenditure difference, while the proportion of decedents who had ICU admissions within 30 days of death was a major driver of variation, explaining 37.6% of the expenditure difference. They concluded that promoting appropriate end-of-life care has the potential to reduce geographic variation in end-of-life care expenditures.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Associations between end-of-life cancer care patterns and Medicare expenditures.
J Natl Compr Canc Netw 2016 Aug;14(8):1001-8.
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Keywords: Cancer, Elderly, Healthcare Costs, Medicare, Palliative Care
Wang SY, Hall J, Pollack CE
Trends in end-of-life cancer care in the Medicare program.
The researchers sought to examine contemporary trends in end-of-life cancer care and geographic variation of end-of-life care aggressiveness among Medicare beneficiaries. They found that the proportion of beneficiaries receiving at least one potentially aggressive end-of-life intervention increased in repeated hospitalization, repeated ED visits, ICU admissions, and late hospice enrollment but declined in in-hospital death. End-of-life chemotherapy use did not change significantly over time. They concluded that despite growing focus on providing appropriate end-of-life care, there has not been an improvement in aggressive end-of-life cancer care in the Medicare program.
AHRQ-funded; HS023900.
Citation: Wang SY, Hall J, Pollack CE .
Trends in end-of-life cancer care in the Medicare program.
J Geriatr Oncol 2016 Mar;7(2):116-25. doi: 10.1016/j.jgo.2015.11.007.
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Keywords: Cancer, Care Management, Elderly, Medicare, Palliative Care, Outcomes, Patient-Centered Outcomes Research, Practice Patterns
Dinan MA, Li Y, Zhang Y
Resource use in the last year of life among patients who died with versus of prostate cancer.
The researchers conducted a retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data of men with prostate cancer. Patients who died of prostate cancer rather than from other causes had more hospice and outpatient use, less inpatient and ICU use, and lower overall costs. Efforts to shift care toward outpatient settings might provide more efficient and judicious care for patients during the end of life.
AHRQ-funded; HS022189.
Citation: Dinan MA, Li Y, Zhang Y .
Resource use in the last year of life among patients who died with versus of prostate cancer.
Clin Genitourin Cancer 2016 Feb;14(1):28-37.e2. doi: 10.1016/j.clgc.2015.07.006.
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Keywords: Cancer, Cancer: Prostate Cancer, Healthcare Costs, Healthcare Utilization, Men's Health, Mortality, Palliative Care, Patient-Centered Outcomes Research
Thienprayoon R, Marks E, Funes M
Perceptions of the pediatric hospice experience among English- and Spanish-speaking families.
The objective of this study was to explore parental perspectives of the hospice experience in children with cancer, and to explore how race/ethnicity impacts this experience. Both English and Spanish speakers described the importance of honest, direct communication by medical providers, and anxieties surrounding the expectation of the moment of death. English-speaking families were more likely to return to the hospital because of unsatisfactory symptom management.
AHRQ-funded; HS022418.
Citation: Thienprayoon R, Marks E, Funes M .
Perceptions of the pediatric hospice experience among English- and Spanish-speaking families.
J Palliat Med 2016 Jan;19(1):30-41. doi: 10.1089/jpm.2015.0137.
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Keywords: Children/Adolescents, Palliative Care, Long-Term Care, Racial and Ethnic Minorities, Cancer
Rocke DJ, Beumer HW, Taylor DH, Jr.
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
The investigators sought to determine how baseline attitudes toward quality vs quantity of life affect end-of-life resource allocation. They found that, compared with patients and caregivers, otolaryngology-head and neck surgery (OHNS) physician allocations differed significantly in all 15 benefit categories except home care. They concluded that understanding the effect of baseline attitudes is important for effective end-of-life discussions.
AHRQ-funded; HS018360.
Citation: Rocke DJ, Beumer HW, Taylor DH, Jr. .
Physician and patient and caregiver health attitudes and their effect on Medicare resource allocation for patients with advanced cancer.
JAMA Otolaryngol Head Neck Surg 2014 Jun;140(6):497-503. doi: 10.1001/jamaoto.2014.494.
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Keywords: Cancer, Caregiving, Medicare, Palliative Care, Provider: Physician, Quality of Life
Huo J, Lairson DR, Du XL
Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
The authors analyzed the association of hospice use with survival and health care costs among patients diagnosed with metastatic melanoma. They found that the median survival time was 6.1 months for patients with no hospice care, 6.5 months for patients enrolled in hospice for 1 to 3 days, and 10.2 months for patients enrolled for 4 or more days. Patients with 4 or more days of hospice care incurred lower end-of-life costs than the comparison groups.
AHRQ-funded; HS018956.
Citation: Huo J, Lairson DR, Du XL .
Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
Am J Manag Care 2014 May;20(5):366-73.
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Keywords: Cancer, Cancer: Skin Cancer, Healthcare Costs, Palliative Care, Patient-Centered Outcomes Research
Kavalieratos D, Kamal AH, Abernethy AP
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
This study characterized the unresolved symptom and treatment needs which patients with heart failure and those with cancer present to palliative care. It found that patients with HF presented with fewer unresolved symptoms; however, they were more likely to report dyspnea and more commonly experienced dyspnea-related treatment gaps.
AHRQ-funded; HS000032; HS017587
Citation: Kavalieratos D, Kamal AH, Abernethy AP .
Comparing unmet needs between community-based palliative care patients with heart failure and patients with cancer.
J Palliat Med. 2014 Apr;17(4):475-81. doi: 10.1089/jpm.2013.0526..
Keywords: Palliative Care, Cancer, Heart Disease and Health, Chronic Conditions
Martinez KA, Aslakson RA, Wilson RF
A systematic review of health care interventions for pain in patients with advanced cancer.
The authors sought to synthesize the evidence on the effectiveness of pain-focused interventions in patients with advanced cancer. In nineteen studies, they found moderate strength of evidence that pain management in advanced cancer can be improved using health care interventions, particularly nurse-led patient-centered interventions.
AHRQ-funded; 290200710061.
Citation: Martinez KA, Aslakson RA, Wilson RF .
A systematic review of health care interventions for pain in patients with advanced cancer.
Am J Hosp Palliat Care 2014 Feb;31(1):79-86. doi: 10.1177/1049909113476129.
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Keywords: Cancer, Comparative Effectiveness, Pain, Palliative Care, Quality Improvement