National Healthcare Quality and Disparities Report
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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 45 Research Studies DisplayedScanlon DP, Harvey JB, Wolf LJ
Are health systems redesigning how health care is delivered?
The purpose of this study was to explore why and how health systems are engaging in care delivery redesign (CDR)-defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim. The investigators concluded that the ability to validly and reliably measure CDR activities-particularly across varying organizational contexts and markets-was currently limited but is key to better understanding CDR's impact on intended outcomes, which is important for guiding both health system decision making and policy making.
AHRQ-funded; HS024067.
Citation: Scanlon DP, Harvey JB, Wolf LJ .
Are health systems redesigning how health care is delivered?
Health Serv Res 2020 Dec;55(Suppl 3):1129-43. doi: 10.1111/1475-6773.13585..
Keywords: Health Systems, Healthcare Delivery
Graves JA, Nshuti L, Everson J
Breadth and exclusivity of hospital and physician networks in US insurance markets.
The goal of this study was to quantify network breadth and overlap among primary care physician (PCP), cardiology, and general acute care hospital networks for employer-based (large group and small group), individually purchased (marketplace), Medicare Advantage (MA), and Medicaid managed care (MMC) plans. The main outcomes measured were percentage of in-network physicians and/or hospitals within a 60-minute drive from a hypothetical patient in a given zip code (breadth), and the number of physicians and/or hospitals within each network that overlapped with other insurers' networks, expressed as a percentage of the total possible number of shared connections (exclusivity). Networks were categorized by network breadth size and analyzed by insurance type, state, and insurance, physician, and/or hospital market concentration level, as measured by the Hirschman-Herfindahl index. Markets with concentrated primary care and insurance markets had the broadest and least exclusive primary care networks among large-group commercial plans. Markets with the least concentration had the narrowest and most exclusive networks. Rising levels of insurer and market concentration were associated with broader and less exclusive healthcare networks. The authors suggest that this means that patients could switch to a lower-cost, narrow network plan without losing-in-network coverage to their PCP.
AHRQ-funded; HS025976; HS026395.
Citation: Graves JA, Nshuti L, Everson J .
Breadth and exclusivity of hospital and physician networks in US insurance markets.
JAMA Netw Open 2020 Dec;3(12):e2029419. doi: 10.1001/jamanetworkopen.2020.29419..
Keywords: Health Insurance, Learning Health Systems, Health Systems, Primary Care, Hospitals, Healthcare Delivery
Singer SJ, Sinaiko AD, Tietschert MV
Care integration within and outside health system boundaries.
The purpose of this study was to examine care integration-efforts to unify disparate parts of health care organizations to generate synergy across activities occurring within and between them-to understand whether and at which organizational level health systems impact care quality and staff experience. The investigators concluded that measures of clinical process integration related to higher staff ratings of quality and experience.
AHRQ-funded; HS024067.
Citation: Singer SJ, Sinaiko AD, Tietschert MV .
Care integration within and outside health system boundaries.
Health Serv Res 2020 Dec;55(Suppl 3):1033-48. doi: 10.1111/1475-6773.13578..
Keywords: Health Systems, Healthcare Delivery, Health Services Research (HSR), Research Methodologies
Kranz AM, DeYoreo M, shete-Roesler B
Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.
The goal of this study was to test the hypothesis that health systems provide better care to patients with high needs compared to nonaffiliated physician organizations (POs). The 2015 Medicare Data on Provider Practice and Specialty linked physicians’ database was linked to POs Medicare Provider Enrollment, Chain, and Ownership System (PECOS) and IRS Form 990 data to identify health system affiliations. Among 2,323,301 beneficiaries with high needs, 52.3% received care from system-affiliated practices. The emergency department (ED) visit rate was statistically significantly different in system-affiliated POs and nonaffiliated POs. There were small differences for the remaining five of six quality measures examined: continuity of care, follow-up visits, all-cause readmissions, and ambulatory care-sensitive hospitalizations. Within systems there was substantial variation for rates of continuity of care and follow-up after ED visits.
AHRQ-funded; HS024067.
Citation: Kranz AM, DeYoreo M, shete-Roesler B .
Health system affiliation of physician organizations and quality of care for Medicare beneficiaries who have high needs.
Health Serv Res 2020 Dec;55(Suppl 3):1118-28. doi: 10.1111/1475-6773.13570..
Keywords: Health Systems, Medicare, Quality of Care, Healthcare Delivery
Machta RM, Reschovsky JD, Jones DJ
AHRQ Author: Furukawa MF
Health system integration with physician specialties varies across markets and system types.
Data from the AHRQ Compendium of US Health Systems and the IQVIA OneKey database was used to examine the change from 2016 to 2018 in the percentage of physicians in systems, focusing on primary care and the 10 most numerous non-hospital based specialties across 382 metropolitan statistical areas (MSAs) in the US. The authors also categorized systems by ownership, mission, and payment program participation and examined how these characteristics were related to their patterns of physician integration in 2018. Findings were that specialists with lucrative hospital services were the most commonly integrated with systems, including hematology-oncology, cardiology, and general surgery. High market concentration by insurers and hospital-systems was associated with lower rates of physician integration. In addition, systems with academic medical centers (AMCs) and publicly owned systems unrelated to the physicians’ potential contribution to hospital revenue, and investor-owned systems demonstrated more limited physician integration.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky JD, Jones DJ .
Health system integration with physician specialties varies across markets and system types.
Health Serv Res 2020 Dec;55(Suppl 3):1062-72. doi: 10.1111/1475-6773.13584..
Keywords: Health Systems, Healthcare Delivery, Primary Care
Colla C, Yang W, Mainor AJ
Organizational integration, practice capabilities, and outcomes in clinically complex Medicare beneficiaries.
This study examines the association between clinical integration and financial integration, quality-focused care delivery processes, and beneficiary utilization and outcomes. Data was used from multiphysician practices in the 2017-2018 National Survey of Healthcare Organizations and Systems and 2017 Medicare claims data. Out of 1.6M fee-for-service Medicare beneficiaries aged 66 or older attributed to 2113 practices, 414,209 were considered clinically complex (frailty or 2 or more chronic conditions). Financial and clinical integration were weakly correlated. Clinical integration was significantly associated with greater adoption of quality-focused care delivery processes, while financial integration was associated with the opposite. Integration was not associated with reduced utilization or better beneficiary-level health-related outcomes, but both integration types were associated with lower spending.
AHRQ-funded; HS024075.
Citation: Colla C, Yang W, Mainor AJ .
Organizational integration, practice capabilities, and outcomes in clinically complex Medicare beneficiaries.
Health Serv Res 2020 Dec;55(Suppl 3):1085-97. doi: 10.1111/1475-6773.13580..
Keywords: Medicare, Health Systems, Healthcare Delivery
Timbie JW, Kranz AM, DeYoreo M
Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations.
The purpose of this study was to assess racial and ethnic disparities in care for Medicare fee-for-service (FFS) beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs. The investigators found no evidence that system-affiliated POs had smaller racial and ethnic disparities than nonaffiliated POs. Where differences existed, disparities were slightly larger in affiliated POs.
AHRQ-funded; HS024067.
Citation: Timbie JW, Kranz AM, DeYoreo M .
Racial and ethnic disparities in care for health system-affiliated physician organizations and non-affiliated physician organizations.
Health Serv Res 2020 Dec;55(Suppl 3):1107-17. doi: 10.1111/1475-6773.13581..
Keywords: Racial and Ethnic Minorities, Disparities, Medicare, Health Systems
Ridgely MS, Buttorff C, Wolf L
The importance of understanding and measuring health system structural, functional, and clinical integration.
In this study, the authors explored if there were ways to characterize health systems-not already revealed by secondary data-that could provide new insights into differences in health system performance. The investigators sought to collect rich qualitative data to reveal whether and to what extent health systems varied in important ways across dimensions of structural, functional, and clinical integration.
AHRQ-funded; HS024067.
Citation: Ridgely MS, Buttorff C, Wolf L .
The importance of understanding and measuring health system structural, functional, and clinical integration.
Health Serv Res 2020 Dec;55(Suppl 3):1049-61. doi: 10.1111/1475-6773.13582..
Keywords: Health Systems, Healthcare Delivery
Harvey JB, Vanderbrink J, Mahmud Y
Understanding how health systems facilitate primary care redesign.
The objectives of this study were to understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work. A sample of 24 health systems in 4 states was used to identify how system leaders define and implement initiatives to redesign primary care delivery and identify challenges. Codes based on the theoretical PCR literature was used and researchers also created new codes. Semi-structured telephone interviews with 162 system executives and physician organization leaders from 24 systems were conducted. Initiatives to redesign the delivery of primary care were described by leaders, but many were still in the early stages. Motivating factors for team-based care included improvement efficiency and enhancing clinician job satisfaction. Changes in payment and risk assumption as well as community needs were commonly cited as motivators for population health management and care coordination. Challenges health systems face in redesigning primary included return on investment and slower than anticipated rate in moving from fee-for-service to value-based payment.
AHRQ-funded; HS024067.
Citation: Harvey JB, Vanderbrink J, Mahmud Y .
Understanding how health systems facilitate primary care redesign.
Health Serv Res 2020 Dec;55(Suppl 3):1144-54. doi: 10.1111/1475-6773.13576..
Keywords: Health Systems, Primary Care: Models of Care, Primary Care, Healthcare Delivery
Short MN, Ho V
Weighing the effects of vertical integration versus market concentration on hospital quality.
Provider organizations are increasing in complexity, as hospitals acquire physician practices and physician organizations grow in size. At the same time, hospitals are merging with each other to improve bargaining power with insurers. In this study, the investigators analyzed 29 quality measures reported to the Center for Medicare and Medicaid Services' Hospital Compare database for 2008 to 2015 to test whether vertical integration between hospitals and physicians or increases in hospital market concentration influenced patient outcomes.
AHRQ-funded; HS024727.
Citation: Short MN, Ho V .
Weighing the effects of vertical integration versus market concentration on hospital quality.
Med Care Res Rev 2020 Dec;77(6):538-48. doi: 10.1177/1077558719828938.
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Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Patient Experience, Hospitals, Medicare, Provider Performance, Health Systems
Agniel D, Haviland A, Shekelle P
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
The purpose of this study was to develop and evaluate a measure that ranks health care systems by ambulatory care quality. The authors concluded that their measure, using publicly reported data to produce valid, reliable, and stable ranks of ambulatory care quality for health care systems in Minnesota and California, could also be used in other applications.
AHRQ-funded; HS024067.
Citation: Agniel D, Haviland A, Shekelle P .
Distinguishing high-performing health systems using a composite of publicly reported measures of ambulatory care.
Ann Intern Med 2020 Nov 17;173(10):791-98. doi: 10.7326/m20-0718..
Keywords: Health Systems, Ambulatory Care and Surgery, Quality Indicators (QIs), Quality Measures, Quality of Care, Provider Performance, Healthcare Delivery
Hernandez AV, Roman YM, White CM
Developing criteria and associated instructions for consistent and useful quality improvement study data extraction for health systems.
This paper describes AHRQ’s efforts to collate and assess quality improvement studies to support learning health systems (LHS). The authors identified quality improvement studies and evaluated the consistency of data extraction from two experienced independent reviewers at three time points: baseline, first revision, and final revision. Six investigators looked at the data extracted by the independent reviewers and determined the extent of similarity on a scale of 0 to 10. Two LHS participants were then asked to assess the relative value of their criteria. The consistency of extraction improved from a mean 1.17 score at baseline to 6.07 at first revision, and 6.81 at the final revision. There was not a significant improvement from the first to final revision. However, the LHS participants rated the value of these ratings a 9 and a 6, demonstrating that there is value in developing criteria.
AHRQ-funded; 290201500012I.
Citation: Hernandez AV, Roman YM, White CM .
Developing criteria and associated instructions for consistent and useful quality improvement study data extraction for health systems.
J Gen Intern Med 2020 Nov;35(Suppl 2):802-07. doi: 10.1007/s11606-020-06098-1..
Keywords: Quality Improvement, Quality of Care, Learning Health Systems, Health Systems, Health Services Research (HSR), Research Methodologies
Fischer SH, Rudin RS, Shi Y
Trends in the use of computerized physician order entry by health-system affiliated ambulatory clinics in the United States, 2014-2016.
This study examined trends in the use of computerized physical order entry (CPOE) by health-system affiliated ambulatory clinics from 2014-2016 in the United States. A total of 19,109 ambulatory clinics that participated in all 3 years of the Healthcare Information and Management Systems Society Analytics survey was analyzed. They calculated descriptive statistics to examine overall trends in use, location of order entry, and system-level use of CPOE. The use of CPOE increased from than 9 percentage points from 2015 to 2016, from 58% to 67%. Larger clinics and those affiliated with multi-health hospital systems were more likely to use CPOE.
AHRQ-funded; HS024067.
Citation: Fischer SH, Rudin RS, Shi Y .
Trends in the use of computerized physician order entry by health-system affiliated ambulatory clinics in the United States, 2014-2016.
BMC Health Serv Res 2020 Sep 7;20(1):836. doi: 10.1186/s12913-020-05679-4..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Ambulatory Care and Surgery, Health Systems
Machta RM, Reschovsky J, Jones DJ
AHRQ Author: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ .
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Health Systems, Hospitals, Orthopedics, Healthcare Costs, Payment, Quality of Care
Furukawa MF, Kimmey L, Jones DJ
AHRQ Author: Furukawa MF, Guo J
Consolidation of providers into health systems increased substantially, 2016-18.
This article reports that provider consolidation into vertically-integrated health systems increased from 2016 to 2018. More than half of US physicians and 72 percent of hospitals were affiliated with one of 637 health systems in 2018. For-profit and church-operated systems had the largest increases in system size, driven in part by a large number of system mergers and acquisitions.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Furukawa MF, Kimmey L, Jones DJ .
Consolidation of providers into health systems increased substantially, 2016-18.
Health Aff 2020 Aug;39(8):1321-25. doi: 10.1377/hlthaff.2020.00017..
Keywords: Health Systems, Provider
Fisher ES, Shortell SM, O'Malley AJ
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
This study looked at whether financial integration of hospitals and physician practices was associated with greater quality. A total of 739 hospitals and 2,189 physician practices were included in the nationally representative survey. They were stratified by whether they were independent or owned by complex systems, simple systems, or medical groups. Nine scales were used to measure the level of adoption of diverse, quality-focused care delivery and payment reforms. While quality scores favored financially integrated systems for 4 of 9 hospital measures and one of 9 practice measures, none of them favored complex systems. Better quality was generally not associated with greater financial integration.
AHRQ-funded; U19 HS024075.
Citation: Fisher ES, Shortell SM, O'Malley AJ .
Financial integration's impact on care delivery and payment reforms: a survey of hospitals and physician practices. Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813.
Health Aff 2020 Aug;39(8):1302-11. doi: 10.1377/hlthaff.2019.01813..
Keywords: Healthcare Delivery, Payment, Hospitals, Health Systems, Quality of Care
Furukawa MF, Machta RM, Barrett KA
AHRQ Author: Furukawa MF
Landscape of health systems in the United States.
This paper describes AHRQ’s development of the Compendium of U.S. Health Systems to help identify and describe health systems. This data resource supports research on comparative health system performance. The authors describe the methods used to create the compendium and create a picture of vertical integration. They identified 626 health systems in 2016, which accounted for 70% of nonfederal general acute care hospitals. The systems varied by key structural attributes, including size, ownership, and geographic prevalence.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Furukawa MF, Machta RM, Barrett KA .
Landscape of health systems in the United States.
Med Care Res Rev 2020 Aug;77(4):357-66. doi: 10.1177/1077558718823130..
Keywords: Health Systems, Healthcare Delivery, Hospitals
Nguyen AM, Johnson CE, Wood SJ
The contribution of physician-system integrating structure to select health system outcomes.
Physician groups are increasingly being vertically integrated with hospitals and health systems; yet, the evidence on the impact of physician-system integration on health system outcomes is mixed. The objective of this mixed-methods study was to examine the impact of increased physician-system integration on select health system outcomes.
AHRQ-funded; HS024895.
Citation: Nguyen AM, Johnson CE, Wood SJ .
The contribution of physician-system integrating structure to select health system outcomes.
J Ambul Care Manage 2020 Jul/Sep;43(3):237-56. doi: 10.1097/jac.0000000000000331..
Keywords: Health Systems, Healthcare Delivery, Outcomes
Sutherland BL, Pecanac K, Bartels CM
Expect delays: poor connections between rural and urban health systems challenge
Rural Americans with diabetic foot ulcers (DFUs) face a 50% increased risk of major amputation compared to their urban counterparts. In this study, the investigators sought to identify health system barriers contributing to this disparity. The investigators concluded that poor connections across rural and urban healthcare systems were described as the primary health system barrier driving the rural disparity in major amputations.
AHRQ-funded; HS026279.
Citation: Sutherland BL, Pecanac K, Bartels CM .
Expect delays: poor connections between rural and urban health systems challenge
J Foot Ankle Res 2020 Jun 16;13(1):32. doi: 10.1186/s13047-020-00395-y..
Keywords: Rural Health, Health Systems, Disparities, Diabetes, Chronic Conditions, Healthcare Delivery
Lin JS, Murad MH, Leas B
A narrative review and proposed framework for using health system data with systematic reviews to support decision-making.
This paper addresses when and how the use of health system data might make systematic reviews more useful to decisionmakers. The authors have developed a framework to guide the use of health system data alongside systematic reviews based on a narrative review of the literature and empirical experience. They recommend future methodological work on how best to handle internal and external validity concerns of health system data in the context of systematically reviewed data and work on developing infrastructure to do this type of work.
AHRQ-funded; 290201500007I; 29032001T05; 290201500005I; 290201500009I.
Citation: Lin JS, Murad MH, Leas B .
A narrative review and proposed framework for using health system data with systematic reviews to support decision-making.
J Gen Intern Med 2020 Jun;35(6):1830-35. doi: 10.1007/s11606-020-05783-5..
Keywords: Learning Health Systems, Health Systems, Evidence-Based Practice, Data, Decision Making
Sheetz KH, Chhabra K, Nathan H
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
The objective of this study was to assess whether the quality of surgical care changes as hospitals form networks with established, high-quality medical centers. The investigators concluded that network formation was not associated with a significant improvement in quality or reduction in Medicare expenditures across all procedures studied for hospitals joining the networks of America’s highest rated medical centers.
AHRQ-funded; HS023597.
Citation: Sheetz KH, Chhabra K, Nathan H .
The quality of surgical care at hospitals associated with America's highest-rated medical centers.
Ann Surg 2020 May;271(5):862-67. doi: 10.1097/sla.0000000000003195..
Keywords: Surgery, Hospitals, Quality of Care, Medicare, Health Systems
Niedzwiecki MJ, Machta RM, Reschovsky JD
Characteristics of academic-affiliated health systems.
Changing market forces increasingly are leading academic medical centers (AMCs) to form or join health systems. But it is unclear how this shift is affecting the tripartite academic mission of education, research, and high-quality patient care. To explore this topic, the authors identified and characterized the types of health systems that owned or managed AMCs in the United States in 2016.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Niedzwiecki MJ, Machta RM, Reschovsky JD .
Characteristics of academic-affiliated health systems.
AHRQ-authored; AHRQ-funded; 290201600001C..
Keywords: Health Systems, Hospitals
Dukhanin V, Feeser S, Berkowitz SA
Who represents me? A patient-derived model of patient engagement via patient and family advisory councils (PFACs).
This study examined what expectations would be from patients who are not patient and family advisory council (PFAC) members of PFACs. Patients and caregivers from the Johns Hopkins Medical Alliance for Patients, LLC were recruited in 2014. This Medicare accountable care organization has an established PFAC, the Beneficiary Advisory Council. Five focus groups with 42 patients and caregivers participated. Most participants were not aware of PFACs and wanted to know more about representation, what they could do and expected that patients could communicate with PFACs if desired.
AHRQ-funded; HS023684.
Citation: Dukhanin V, Feeser S, Berkowitz SA .
Who represents me? A patient-derived model of patient engagement via patient and family advisory councils (PFACs).
Health Expect 2020 Feb;23(1):148-58. doi: 10.1111/hex.12983..
Keywords: Patient and Family Engagement, Patient-Centered Outcomes Research, Patient-Centered Healthcare, Healthcare Delivery, Health Systems
Heeringa J, Mutti A, Furukawa MF
AHRQ Author: Furukawa MF
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
The authors conducted a narrative review of 10 years of literature to identify definitional components of key organizational structures in the United States. They found that U.S. policymakers seek to promote provider integration and coordination. They conclude that emerging evidence suggested that organizational structures, composition, and other characteristics influence cost and quality performance. They recommend future research to examine systematically the role of organizational structure in cost and quality outcomes.
AHRQ-authored; AHRQ-funded.
Citation: Heeringa J, Mutti A, Furukawa MF .
Horizontal and vertical integration of health care providers: a framework for understanding various provider organizational structures.
Int J Integr Care 2020 Jan 20;20(1):2. doi: 10.5334/ijic.4635.
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Keywords: Health Systems, Healthcare Delivery, Patient-Centered Healthcare, Care Coordination, Organizational Change, Policy
Guise JM, Reid E, Fiordalisi CV
AHRQ Author: Borsky A, Chang S
AHRQ series on improving translation of evidence: progress and promise in supporting learning health systems.
The authors discuss the articles in the AHRQ EPC series published in this journal over the past six months. They state that satisfaction, care, and costs would all improve if health care delivery were as efficient and effective as possible given current knowledge. They conclude that millions of health decisions must be made by clinicians, patients, and health care systems, and they believe better decisions will be made with evidence.
AHRQ-authored; AHRQ-funded; 290201700003C.
Citation: Guise JM, Reid E, Fiordalisi CV .
AHRQ series on improving translation of evidence: progress and promise in supporting learning health systems.
Jt Comm J Qual Patient Saf 2020 Jan;46(1):51-52. doi: 10.1016/j.jcjq.2019.10.008..
Keywords: Implementation, Evidence-Based Practice, Learning Health Systems, Health Systems, Healthcare Delivery, Decision Making