National Healthcare Quality and Disparities Report
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Topics
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- Opioids (2)
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- Pain (3)
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- Patient-Centered Outcomes Research (8)
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- Primary Care: Models of Care (1)
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- Provider: Pharmacist (3)
- Quality of Care (2)
- Racial and Ethnic Minorities (1)
- Research Methodologies (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 47 Research Studies DisplayedChatterjee P, Liao JM, Wang E
Characteristics, utilization, and concentration of outpatient care for dual-eligible Medicare beneficiaries.
The purpose of this study was to describe the distribution of outpatient care for dual-eligible Medicare beneficiaries ("duals") and characterize the intensity of outpatient care utilization of duals vs non-dual-eligible beneficiaries ("nonduals"). The researchers assessed the distribution of outpatient care across physician practices and compared the use of different outpatient services between duals and nonduals. The study found that nearly 80% of outpatient visits for duals were provided by 35% of practices. Compared with low-dual and no-dual practices, high-dual practices served more patients, with morhe comorbidities. Duals had 2 less outpatient visits per year compared with nonduals with substantially fewer subspecialty care visits despite having more comorbidities.
AHRQ-funded; HS027595.
Citation: Chatterjee P, Liao JM, Wang E .
Characteristics, utilization, and concentration of outpatient care for dual-eligible Medicare beneficiaries.
Am J Manag Care 2022 Oct;28(10):e370-e77. doi: 10.37765/ajmc.2022.89189..
Keywords: Ambulatory Care and Surgery, Medicare, Medicaid, Care Management, Healthcare Utilization
Nguyen JK, Sanghavi P
A national assessment of legacy versus new generation Medicaid data.
The purpose of the study was to review Medicaid legacy, Medicaid new generation, and Medicare claims across multiple states and compare performance on data analytic tasks. The researchers targeted the series of events that begins with a non-hospital-related medical emergency and ends with survival to discharge or death. Six data quality indicators were developed to evaluate the following: ambulance variables; code reporting for external cause of injury; linkage between claims; and death reporting on hospital discharge status codes. For death reporting on hospital discharge status codes the researchers estimated the severity of injuries and developed a model of its correlation with death in the Medicare population. The resulting model was utilized to compare reported versus expected deaths by level of injury severity in the Medicaid population. The study found that new generation Medicare claims had high performance across states and indicators, Medicaid legacy claims underperformed on multiple indicators in most states, and while new generation Medicaid claims outperformed Medicaid legacy claims on several indicators, conducting high-level analysis with that data will require substantial improvements.
AHRQ-funded; HS025720.
Citation: Nguyen JK, Sanghavi P .
A national assessment of legacy versus new generation Medicaid data.
Health Serv Res 2022 Aug;57(4):944-56. doi: 10.1111/1475-6773.13937..
Keywords: Medicaid, Medicare, Care Management
Singh AN, Sanchez V, Kenzie ES
Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: protocol of the ANTECEDENT study.
This study evaluates tailored implementation support to increase screening, brief intervention, referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) in primary care. It will explore how primary care clinics implement SBIRT and MAUD in routine practice and how practice facilitators vary implementation support across diverse clinic settings. It is anticipated that findings will inform how effectively to align implementation support to context, advance understanding of practice facilitator skill development over time, and ultimately improve detection and treatment of unhealthy alcohol use across diverse primary care clinics.
AHRQ-funded; HS027080.
Citation: Singh AN, Sanchez V, Kenzie ES .
Improving screening, treatment, and intervention for unhealthy alcohol use in primary care through clinic, practice-based research network, and health plan partnerships: protocol of the ANTECEDENT study.
PLoS One 2022 Jun 28;17(6):e0269635. doi: 10.1371/journal.pone.0269635..
Keywords: Alcohol Use, Substance Abuse, Behavioral Health, Primary Care, Care Management
Chang E, Ali R, Berkman ND
Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review.
This realist review synthesized data from 48 studies on complex interventions that manage care for high-need, high-cost (HNHC) patients. Intervention care providers and patients require building a trusting relationship to successfully change HNHC patients’ behaviors. The literature emphasized establishing a trusting relationship with the patient, tailoring individualized assistance for medical and non-medical needs, emotional support, and self-management. These practices increased patient participation in managing their own care.
AHRQ-funded; 290201500011I.
Citation: Chang E, Ali R, Berkman ND .
Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review.
BMJ Open 2022 Jun 9;12(6):e058539. doi: 10.1136/bmjopen-2021-058539..
Keywords: Care Management, Communication, Clinician-Patient Communication, Healthcare Delivery
Meiselbach MK, Drake C, Saloner B
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
This study examined variation in access to in-network buprenorphine-prescribing primary care providers that can treat opioid use disorder among Medicaid managed care enrollees. Approximately 32.2% of Medicaid enrollees had fewer than one in-network network buprenorphine-prescribing primary care providers per 100,000 county residents. There was on average a greater number of in-network buprenorphine-prescribing primary care providers in states with higher compared with lower overdose death rates, but most enrollees lived in areas with a shortage of these providers. The authors found that a 25 percent higher network participation rate by prescribers compared with nonprescribers could improve the probability that enrollees see a prescriber by approximately 25 percent.
AHRQ-funded; HS000029.
Citation: Meiselbach MK, Drake C, Saloner B .
Medicaid managed care: access to primary care providers who prescribe buprenorphine.
Health Aff 2022 Jun;41(6):901-10. doi: 10.1377/hlthaff.2021.01719..
Keywords: Medicaid, Primary Care, Access to Care, Medication, Care Management, Opioids, Substance Abuse, Behavioral Health
Hollowell M, Hudmon KS, Perkins SM
Evaluation of a modified and abbreviated scale for assessing chronic illness care for medication therapy management practice.
The purpose of the study was to evaluate the validity and internal consistency of the Assessment of Chronic Illness Care (ACIC) abbreviated, 12-item scale as a novel instrument for measuring Medication Therapy Management (MTM) care delivery. Researchers administered the instrument to pharmacists employed at 27,560 community pharmacies. The study concluded that when applied to the measurement of chronic illness care within the MTM setting, the abbreviated ACIC showed acceptable validity and internal consistency, and could serve as a valuable tool.
AHRQ-funded; HS022119.
Citation: Hollowell M, Hudmon KS, Perkins SM .
Evaluation of a modified and abbreviated scale for assessing chronic illness care for medication therapy management practice.
Res Social Adm Pharm 2022 May;18(5):2804-10. doi: 10.1016/j.sapharm.2021.06.006..
Keywords: Chronic Conditions, Medication, Provider: Pharmacist, Care Management
Rolfson O, Wissig S, van Maasakkers L
Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group.
The researchers defined a minimum Standard Set of outcome measures and case-mix factors for monitoring, comparing, and improving healthcare for patients with clinically diagnosed hip or knee osteoarthritis (OA) with a focus on defining the outcomes that matter most to patients. The Working Group reached consensus on a concise set of outcome measures to evaluate patients' joint pain, physical functioning, health-related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result.
AHRQ-funded; HS018910.
Citation: Rolfson O, Wissig S, van Maasakkers L .
Defining an international standard set of outcome measures for patients with hip or knee osteoarthritis: consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group.
Arthritis Care Res 2016 Nov;68(11):1631-39. doi: 10.1002/acr.22868.
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Keywords: Arthritis, Care Management, Chronic Conditions, Patient-Centered Outcomes Research
Zullo AR, Dore DD, Gutman R
National glucose-lowering treatment complexity is greater in nursing home residents than community-dwelling adults.
This letter describes common glucose-lowering medication usage patterns for a national cross-section of U.S. adults aged 65 and older residing in nursing home (NH) and community settings from 2007 to 2010. The study results suggest that continued efforts are warranted to improve glucose-lowering medication management and simplify treatment regimens in the NH; that the relative importance of CER questions regarding specific glucose-lowering treatments may differ according to the care setting; and that CER studies of glucose-lowering treatments in older adults must address the combination use of medications, especially in NH residents.
AHRQ-funded; HS022998.
Citation: Zullo AR, Dore DD, Gutman R .
National glucose-lowering treatment complexity is greater in nursing home residents than community-dwelling adults.
J Am Geriatr Soc 2016 Nov;64(11):e233-e35. doi: 10.1111/jgs.14485.
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Keywords: Care Management, Chronic Conditions, Diabetes, Elderly, Medication, Nursing Homes
Patil SJ, Ruppar T, Koopman RJ
Peer support interventions for adults with diabetes: a meta-analysis of hemoglobin A1c outcomes.
This study aimed to estimate the effect of peer support interventions delivered by people affected by diabetes (those with the disease or a caregiver) on hemoglobin A1c (HbA1c) levels in adults. It found that peer support interventions for diabetes overall achieved a statistically significant but minor improvement in HbA1c levels.
AHRQ-funded; HS022140.
Citation: Patil SJ, Ruppar T, Koopman RJ .
Peer support interventions for adults with diabetes: a meta-analysis of hemoglobin A1c outcomes.
Ann Fam Med 2016 Nov;14(6):540-51. doi: 10.1370/afm.1982.
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Keywords: Care Management, Diabetes, Patient-Centered Outcomes Research
Gaither JR, Goulet JL, Becker WC
The effect of substance use disorders on the association between guideline-concordant long-term opioid therapy and all-cause mortality.
The objective of this study was to determine whether the presence of a substance use disorder (SUD) modifies the association between guideline-concordant care and 1-year all-cause mortality among patients receiving long-term opioid therapy (LtOT) for pain. It found that for clinicians prescribing LtOT to patients with untreated SUDs, engaging patients with psychotherapeutic and SUD treatment services may reduce mortality.
AHRQ-funded; U19 HS021112.
Citation: Gaither JR, Goulet JL, Becker WC .
The effect of substance use disorders on the association between guideline-concordant long-term opioid therapy and all-cause mortality.
J Addict Med 2016 Nov/Dec;10(6):418-28. doi: 10.1097/adm.0000000000000255.
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Keywords: Care Management, Medication, Mortality, Substance Abuse, Opioids, Patient-Centered Outcomes Research
Reid MC, Eccleston C, Pillemer K
Management of chronic pain in older adults.
This review summarized recent evidence on the assessment and management of pain in older patients. Evidence is taken from systematic reviews, meta-analyses, individual trials, and clinical guidelines. Based on their review, the authors argue that all older adults with chronic pain should undergo a comprehensive geriatric pain assessment and that a comprehensive assessment can guide selection of treatments most likely to benefit the patient and identify targets for intervention besides pain relief.
AHRQ-funded; HS020648.
Citation: Reid MC, Eccleston C, Pillemer K .
Management of chronic pain in older adults.
BMJ 2015;350:h532. doi: 10.1136/bmj.h532..
Keywords: Care Management, Chronic Conditions, Elderly, Comparative Effectiveness, Evidence-Based Practice, Pain
Berridge C
Breathing room in monitored space: the impact of passive monitoring technology on privacy in independent living.
The author examines articulations of the relationship between privacy and passive monitoring by users and former users of a sensor-based remote monitoring system. This research identifies where boundary intrusion can occur in the use of passive monitoring and how changes to technology design and practice could create opportunities for residents to manage their own boundaries according to their privacy needs.
AHRQ-funded; HS000011.
Citation: Berridge C .
Breathing room in monitored space: the impact of passive monitoring technology on privacy in independent living.
Gerontologist 2016 Oct;56(5):807-16. doi: 10.1093/geront/gnv034.
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Keywords: Care Management, Elderly, Health Information Technology (HIT)
Gernant SA, Snyder ME, Jaynes H
The effectiveness of pharmacist-provided telephonic medication therapy management on emergency department utilization in home health patients.
This article's objective is to evaluate the effectiveness of a telephonic medication therapy management (MTM) service on reducing emergency department utilization within a Medicare-insured home health population. The authors found that this pharmacist-delivered telephonic medication therapy management program did not decrease emergency department utilization overall but may further reduce the such risk among patients who are at lower risk of utilization.
AHRQ-funded; HS022119.
Citation: Gernant SA, Snyder ME, Jaynes H .
The effectiveness of pharmacist-provided telephonic medication therapy management on emergency department utilization in home health patients.
J Pharm Technol 2016 Oct 1;32(5):179-84. doi: 10.1177/8755122516660376.
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Keywords: Care Management, Emergency Department, Medication, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Prevention, Provider: Pharmacist, Provider
Carney RM, Freedland KE, Steinmeyer BC
Collaborative care for depression symptoms in an outpatient cardiology setting: a randomized clinical trial.
The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC). Tthis trial did not show that CC produces better depression outcomes than UC.
AHRQ-funded; HS018335.
Citation: Carney RM, Freedland KE, Steinmeyer BC .
Collaborative care for depression symptoms in an outpatient cardiology setting: a randomized clinical trial.
Int J Cardiol 2016 Sep 15;219:164-71. doi: 10.1016/j.ijcard.2016.06.045.
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Keywords: Care Management, Cardiovascular Conditions, Depression, Healthcare Delivery, Behavioral Health, Outcomes, Ambulatory Care and Surgery, Teams
Haggerty CL, Totten PA, Tang G
Identification of novel microbes associated with pelvic inflammatory disease and infertility.
The authors examined the relationship between select novel bacteria, pelvic inflammatory disease (PID), and long-term sequelae. They demonstrated that S. sanguinegens, S. amnionii, BVAB1 and A. vaginae are associated with PID and suggested that optimal antibiotic regimens for PID may require coverage of novel bacterial vaginosis-associated microbes.
AHRQ-funded; HS008358.
Citation: Haggerty CL, Totten PA, Tang G .
Identification of novel microbes associated with pelvic inflammatory disease and infertility.
Sex Transm Infect 2016 Sep;92(6):441-6. doi: 10.1136/sextrans-2015-052285.
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Keywords: Antibiotics, Care Management, Medication, Women
Holtrop JS, Potworowski G, Fitzpatrick L
Effect of care management program structure on implementation: a normalization process theory analysis.
This study used normalization process theory (NPT) to understand how care management structure affected how well care management became routine in practice. It concluded that, although care management can introduce many new changes into delivery of clinical practice, implementing it successfully as a new complex intervention is possible. NPT can be helpful in explaining differences in implementing a new care management program.
AHRQ-funded; HS020108.
Citation: Holtrop JS, Potworowski G, Fitzpatrick L .
Effect of care management program structure on implementation: a normalization process theory analysis.
BMC Health Serv Res 2016 Aug 15;16(a):386. doi: 10.1186/s12913-016-1613-1.
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Keywords: Care Management, Chronic Conditions, Primary Care, Healthcare Delivery
Mukherjee JT, Beshansky JR, Ruthazer R
In-hospital measurement of left ventricular ejection fraction and one-year outcomes in acute coronary syndromes: results from the IMMEDIATE Trial.
The relationships between reduced left ventricular ejection fraction (LVEF) measured during index acute coronary syndrome (ACS) hospitalization and mortality and heart failure (HF) within 1 year are not well-defined. The researchers performed a retrospective analysis of 445 patients who had LVEF measured by left ventriculography or echocardiogram during hospitalization. They found that among patients with ACS, lower in-hospital LVEF is associated with increased 1-year mortality or hospitalization for HF.
AHRQ-funded; HS000060.
Citation: Mukherjee JT, Beshansky JR, Ruthazer R .
In-hospital measurement of left ventricular ejection fraction and one-year outcomes in acute coronary syndromes: results from the IMMEDIATE Trial.
Cardiovasc Ultrasound 2016 Aug 3;14(1):29. doi: 10.1186/s12947-016-0068-1.
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Keywords: Cardiovascular Conditions, Care Management, Heart Disease and Health, Mortality, Outcomes
Lima FO, Silva GS, Furie KL
Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes.
The authors aimed to develop a simple field scale to identify large vessel occlusion strokes (LVOS). They found that Field Assessment Stroke Triage for Emergency Destination (FAST-ED) is a simple scale that, if successfully validated in the field, may be used by medical emergency professionals to identify LVOS in the prehospital setting enabling rapid triage of patients.
AHRQ-funded; HS011392.
Citation: Lima FO, Silva GS, Furie KL .
Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes.
Stroke 2016 Aug;47(8):1997-2002. doi: 10.1161/strokeaha.116.013301.
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Keywords: Care Management, Elderly, Emergency Department, Stroke
Senders A, Sando K, Wahbeh H
Managing psychological stress in the multiple sclerosis medical visit: patient perspectives and unmet needs.
Psychological stress can negatively impact multiple sclerosis. To further understand how stress is addressed in the multiple sclerosis medical visit, 34 people with multiple sclerosis participated in focus groups. Transcripts were analyzed by inductive thematic analysis. The majority of participants did not discuss stress with their provider, citing barriers to communication such as lack of time, poor coordination between specialties, physician reliance on pharmaceutical prescription, and patient lack of self-advocacy. Participants recommended several ways to better manage psychological well-being in the clinical setting. These findings provide a foundation for future studies aimed at minimizing the detrimental effect of stress in multiple sclerosis.
AHRQ-funded; HS017582.
Citation: Senders A, Sando K, Wahbeh H .
Managing psychological stress in the multiple sclerosis medical visit: patient perspectives and unmet needs.
J Health Psychol 2016 Aug;21(8):1676-87. doi: 10.1177/1359105314562084.
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Keywords: Care Management, Neurological Disorders, Ambulatory Care and Surgery, Stress
Luo Z, Chen Q, Annis AM
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
Two contrasting strategies of chronic care management include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). The researchers aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. They found that in a commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year.
AHRQ-funded; HS020108.
Citation: Luo Z, Chen Q, Annis AM .
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
J Gen Intern Med 2016 Jul;31(7):762-70. doi: 10.1007/s11606-016-3617-2.
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Keywords: Chronic Conditions, Care Management, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Comparative Effectiveness, Patient-Centered Outcomes Research, Health Insurance
Silverberg JI
Practice gaps in pruritus.
There are several practice gaps in the evaluation and management of itch. These gaps include a dearth of objective measures of itch, infrequent use of validated patient-reported outcomes for itch, non-evidence-based treatment, and lack of consensus about the ideal workup for generalized itch. The present article reviews these gaps and presents potential solutions.
AHRQ-funded; HS023011.
Citation: Silverberg JI .
Practice gaps in pruritus.
Dermatol Clin 2016 Jul;34(3):257-61. doi: 10.1016/j.det.2016.02.008.
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Keywords: Care Management, Evidence-Based Practice, Patient-Centered Outcomes Research
Raval AD, Madhavan S, Mattes MD
Types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer.
The authors sought to examine the association between types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer. They found that a significant proportion of elderly men with chronic conditions have received aggressive initial cancer treatment, and they suggested a conservative approach for the initial prostate cancer treatment among elderly men with significant chronic conditions and localised prostate cancer.
AHRQ-funded; HS018622.
Citation: Raval AD, Madhavan S, Mattes MD .
Types of chronic conditions combinations and initial cancer treatment among elderly Medicare beneficiaries with localised prostate cancer.
Int J Clin Pract 2016 Jul;70(7):606-18. doi: 10.1111/ijcp.12838.
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Keywords: Cancer, Cancer: Prostate Cancer, Care Management, Chronic Conditions, Elderly, Men's Health
Dugas AF, Kirsch TD, Toerper M
An electronic emergency triage system to improve patient distribution by critical outcomes.
This study derives and validates a computer-based electronic triage system (ETS) to improve patient acuity distribution based on serious patient outcomes. The authors found improved differentiation of patients compared to the current standard Emergency Severity Index.
AHRQ-funded; HS023641.
Citation: Dugas AF, Kirsch TD, Toerper M .
An electronic emergency triage system to improve patient distribution by critical outcomes.
J Emerg Med 2016 Jun;50(6):910-8. doi: 10.1016/j.jemermed.2016.02.026.
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Keywords: Care Management, Electronic Health Records (EHRs), Emergency Department, Health Information Technology (HIT), Healthcare Delivery
Chung S, Zhao B, Lauderdale D
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
The researchers examined patterns and predictors of initiation of treatment for incident diabetes in an ambulatory care setting in the US. They found that only half of patients were treated during the first year following diabetes incidence, and only 20% of patients received both medication prescription and lifestyle modification interventions.
AHRQ-funded; HS019815.
Citation: Chung S, Zhao B, Lauderdale D .
Initiation of treatment for incident diabetes: evidence from the electronic health records in an ambulatory care setting.
Prim Care Diabetes 2015 Feb;9(1):23-30. doi: 10.1016/j.pcd.2014.04.005..
Keywords: Ambulatory Care and Surgery, Care Management, Diabetes, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Practice Patterns
Jindai K, Sterkel AK, Reed KD
Limb embolism in a 52-year-old woman.
In response to a photo quiz, the authors make the following diagnosis: arterial thrombus caused by Histoplasma capsulatum deriving from native valve endocarditis caused by the same organism. Various aspects of the case are discussed.
AHRQ-funded; HS022465; HS023779.
Citation: Jindai K, Sterkel AK, Reed KD .
Limb embolism in a 52-year-old woman.
Clin Infect Dis 2016 May 15;62(10):1320-1. doi: 10.1093/cid/ciw081.
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Keywords: Blood Clots, Care Management, Case Study, Diagnostic Safety and Quality, Patient Safety