National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Cardiovascular Conditions (3)
- Elderly (6)
- Emergency Medical Services (EMS) (1)
- Healthcare-Associated Infections (HAIs) (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (6)
- Healthcare Delivery (1)
- Health Insurance (1)
- Health Systems (1)
- Heart Disease and Health (3)
- Hospital Discharge (2)
- Hospitalization (3)
- Hospital Readmissions (7)
- (-) Hospitals (24)
- Inpatient Care (1)
- Long-Term Care (1)
- Medicaid (1)
- (-) Medicare (24)
- Medication (1)
- Mortality (4)
- Nursing Homes (1)
- Orthopedics (1)
- Outcomes (1)
- Patient Safety (2)
- Payment (11)
- Pneumonia (1)
- Policy (3)
- Prevention (1)
- Provider: Physician (1)
- Provider Performance (2)
- Quality of Care (2)
- Rural Health (1)
- Surgery (4)
- Uninsured (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 24 of 24 Research Studies DisplayedLiao JM, Chatterjee P, Wang E
The effect of hospital safety net status on the association between bundled payment participation and changes in medical episode outcomes.
This study evaluated whether hospital safety net status affected the association between bundled payment participation and medical outcomes. The hospitals included were participants in Medicare’s Bundled Payments for Care Improvement (BCPI) program from 2011-2016. Data from Medicare fee-for-service beneficiaries hospitalized for acute myocardial infarction, pneumonia, congestive heart failure, and chronic obstructive pulmonary disease were used. Among BCPI hospitals, safety net status was not associated with differential postdischarge spending or quality. However, BPCI safety net hospitals had differentially greater discharge due to institutional post-acute care and lower discharge home with home health than BPCI non-safety net hospitals.
AHRQ-funded; HS027595.
Citation: Liao JM, Chatterjee P, Wang E .
The effect of hospital safety net status on the association between bundled payment participation and changes in medical episode outcomes.
J Hosp Med 2021 Dec;16(12):716-23. doi: 10.12788/jhm.3722..
Keywords: Medicare, Payment, Hospitals
Chhabra KR, Sheetz KH, Regenbogen SE
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Researchers sought to measure the extent of variation in episode spending around total hip replacement for fee-for-service Medicare patients within and across hospital systems identified in the American Hospital Association Annual Survey. They found that average episode payments varied nearly as much within hospital systems as they did between the lowest- and highest-cost quintiles of systems, with variation driven by post-acute care utilization.
AHRQ-funded; HS000053.
Citation: Chhabra KR, Sheetz KH, Regenbogen SE .
Wide variation in surgical spending within hospital systems: a missed opportunity for bundled payment success.
Ann Surg 2021 Dec 1;274(6):e1078-e84. doi: 10.1097/sla.0000000000003741..
Keywords: Surgery, Health Systems, Medicare, Healthcare Costs, Hospitals
Arntson E, Dimick JB, Nuliyalu U
Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program.
This study evaluated changes in Hospital-Acquired Conditions (HACs) and 30-day mortality after the announcement of the Centers for Medicare and Medicare Services’ Hospital-Acquired Condition Reduction Program (HACRP) in August 2013. The authors evaluated models to test for changes in HACs and 30-day mortality before and after the Affordable Care Act (ACA), and after the HACRP. Fee-for-service Medicare claims from 2009 to 2015 were used. The HAC rate declined after the ACA was passed and declined further after the HACRP announcement. However, 30-day mortality rates were unchanged.
AHRQ-funded; HS026244.
Citation: Arntson E, Dimick JB, Nuliyalu U .
Changes in hospital-acquired conditions and mortality associated with the hospital-acquired condition reduction program.
Ann Surg 2021 Oct 1;274(4):e301-e07. doi: 10.1097/sla.0000000000003641..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Mortality, Medicare, Payment, Prevention, Patient Safety
Liao JM, Gupta A, Zhao Y
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
The purpose of this study was to examine and compare 2011-2017 spending for hip and joint replacements between hospitals with voluntary participation, mandatory participation and nonparticipation in the Medicare Bundled Payments for Care Improvement program.
Citation: Liao JM, Gupta A, Zhao Y .
Association between hospital voluntary participation, mandatory participation, or nonparticipation in bundled payments and Medicare episodic spending for hip and knee replacements.
JAMA 2021 Aug 3;326(5):438-40. doi: 10.1001/jama.2021.10046..
Keywords: Medicare, Hospitals, Payment, Surgery, Orthopedics, Healthcare Costs
Valdez S
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Within the past decade, the U.S. health care market has undergone massive vertical integration, prompting economists to study the underlying causes and consequences of hospital-physician integration. This paper examined whether or not hospitals strategically chose to vertically integrate with clinical oncologists in order to capture facility fees, a commonly cited reason for increased consolidation in the health care market.
AHRQ-funded; HS000046.
Citation: Valdez S .
Do Medicare's facility fees incentivize hospitals to vertically integrate with oncologists?
Inquiry 2021 Jan-Dec;58:469580211022968. doi: 10.1177/00469580211022968..
Keywords: Medicare, Hospitals, Provider: Physician
Eisenberg MD, Meiselbach MK, Bai G
Large self-insured employers lack power to effectively negotiate hospital prices.
This study examined the ability of self-insured employers to negotiate hospital prices and investigated the relationship between hospital prices and employer market power in the United States. Findings showed that employer market power was low in most metropolitan statistical areas. Recommendations included encouraging self-insured employers to consider building purchase alliances with state and local government employee groups in order to enhance their market power and to lower negotiated prices for hospital services.
AHRQ-funded; HS000029.
Citation: Eisenberg MD, Meiselbach MK, Bai G .
Large self-insured employers lack power to effectively negotiate hospital prices.
Am J Manag Care 2021 Jul;27(7):290-96. doi: 10.37765/ajmc.2021.88702..
Keywords: Health Insurance, Medicare, Medicaid, Healthcare Costs, Hospitals
Post B, Norton EC, Hollenbeck B
Hospital-physician integration and Medicare's site-based outpatient payments.
AHRQ-funded; HS027044.
Citation: Post B, Norton EC, Hollenbeck B .
Hospital-physician integration and Medicare's site-based outpatient payments.
Health Serv Res 2021 Feb;56(1):7-15. doi: 10.1111/1475-6773.13613..
Keywords: Hospitals, Payment, Medicare, Ambulatory Care and Surgery, Healthcare Delivery
Meddings J, Smith SN, Hofer TP
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
This study examined the discrepancy of ratings with hospitals with low readmission grades for heart failure (HF) and acute myocardial infarction (AMI) on the Hospital Compare website, yet received penalties for excessive readmissions under the hospital Readmissions Reduction Program. A retrospective data analysis was conducted of 2956 hospitals that had publicly reported HF grades on Hospital Compare. Of those, 92% were graded as “no different” than the national rate for HD readmissions, yet included 48.6% that were scored as having excessive HF admissions and 87% received an overall readmission penalty. Of the 120 hospitals graded as “better”, none were scored as having excessive HF readmissions and 50% were penalized. There were similar results for AMI.
AHRQ-funded; HS018334; HS019767.
Citation: Meddings J, Smith SN, Hofer TP .
Mixed messages to consumers from Medicare: Hospital Compare grades versus value-based payment penalty.
Am J Manag Care 2018 Dec;24(12):e399-e403..
Keywords: Medicare, Hospital Readmissions, Heart Disease and Health, Hospitals, Quality of Care, Cardiovascular Conditions, Provider Performance, Payment
Agarwal D, Werner RM
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
The purpose of this study was to test for differences in patient outcomes when hospital and post-acute care (PAC) providers participated in accountable care organizations (ACOs). The investigators concluded that hospital and skilled nursing facilities (SNF) participation in an ACO was associated with lower readmission rates, Medicare spending on SNF, and SNF length of stay.
AHRQ-funded; HS024266.
Citation: Agarwal D, Werner RM .
Effect of hospital and post-acute care provider participation in accountable care organizations on patient outcomes and Medicare spending.
Health Serv Res 2018 Dec;53(6):5035-56. doi: 10.1111/1475-6773.13023..
Keywords: Hospital Readmissions, Hospitals, Medicare, Nursing Homes, Outcomes
Huckfeldt P, Escarce J, Wilcock A
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
After announcement and implementation of the Medicare Hospital Readmissions Reduction Program (HRRP), 30-day readmissions declined rapidly among seniors with heart failure (HF) while 30-day mortality rose. This raised questions about whether the policy was responsible, because lower HF readmission rates have historically been associated with higher mortality. In this study, the investigators compared trends in heart failure (HF) mortality at penalized and nonpenalized hospitals nationally.
AHRQ-funded; HS024284.
Citation: Huckfeldt P, Escarce J, Wilcock A .
HF mortality trends under Medicare readmissions reduction program at penalized and nonpenalized hospitals.
J Am Coll Cardiol 2018 Nov 13;72(20):2539-40. doi: 10.1016/j.jacc.2018.08.2174..
Keywords: Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Readmissions, Medicare, Hospitals, Provider Performance, Payment
Makam AN, Nguyen OK, Kirby B
Effect of site-neutral payment policy on long-term acute care hospital use.
The purpose of this study was to assess the projected effect of the Centers for Medicare and Medicaid Services new site-neutral payment policy, which aims to decrease unnecessary long-term acute care hospital (LTACH) admissions by reducing reimbursements for less-ill individuals by 2020. The investigators concluded that the site-neutral payment policy may limit LTACH access in existing LTAC-scarce markets, with potential adverse implications for recovery of hospitalized older adults.
AHRQ-funded; HS022418.
Citation: Makam AN, Nguyen OK, Kirby B .
Effect of site-neutral payment policy on long-term acute care hospital use.
J Am Geriatr Soc 2018 Nov;66(11):2104-11. doi: 10.1111/jgs.15539..
Keywords: Policy, Hospitalization, Payment, Long-Term Care, Healthcare Costs, Medicare, Elderly, Hospitals
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Middleton A, Kuo YF, Graham JE
Readmission patterns over 90-day episodes of care among Medicare fee-for-service beneficiaries discharged to post-acute care.
This retrospective cohort study’s objective was to examine readmission patterns over 90-day episodes of care in patients discharged from hospitals to skilled nursing facilities (SNFs). Data was used from a national cohort of Medicare fee-for-service beneficiaries discharged from SNF care from July 2013 to July 2014. The cohort studied were adults 65 years and older who were hospitalized for stroke, joint replacement, or hip fracture, and had survived 90 days post-discharge. Patients with hemorrhagic stroke were more likely than those with ischemic stroke to be rehospitalized over the first 30 days after discharge. For patients receiving nonelective joint replacements, readmissions increased from the 30 to 90-day period post-acute discharge.
AHRQ-funded; HS022134.
Citation: Middleton A, Kuo YF, Graham JE .
Readmission patterns over 90-day episodes of care among Medicare fee-for-service beneficiaries discharged to post-acute care.
J Am Med Dir Assoc 2018 Oct;19(10):896-901. doi: 10.1016/j.jamda.2018.03.006..
Keywords: Hospital Readmissions, Hospital Discharge, Medicare, Hospitals, Elderly
Bazzoli GJ, Thompson MP, Waters TM
Medicare payment penalties and safety net hospital profitability: minimal impact on these vulnerable hospitals.
The purpose of this study was to examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. The investigators conducted bivariate and multivariate analysis of pooled cross-sectional data and found that safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. They assert that while reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time.
AHRQ-funded; HS023783.
Citation: Bazzoli GJ, Thompson MP, Waters TM .
Medicare payment penalties and safety net hospital profitability: minimal impact on these vulnerable hospitals.
Health Serv Res 2018 Oct;53(5):3495-506. doi: 10.1111/1475-6773.12833.
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Keywords: Payment, Hospitals, Medicare
Blecker S, Herrin J, Kwon JY
Effect of hospital readmission reduction on patients at low, medium, and high risk of readmission in the Medicare population.
This study examined the effect of hospital readmission reduction on patients at low, medium, and high risk of readmission in Medicare beneficiaries. The researchers theorized that the hospitals could be filled with more high-risk patients. National data from January 2009 to June 2015 was used to examine 5 specialty cohorts. The readmission rate was 16.2% for unplanned readmission within 30 days. There was a higher risk of readmission for surgery/gynecology and neurology cohorts but no significant increase in predicted risk for hospitalizations in medicine, cardiovascular, or cardiorespiratory cohorts.
AHRQ-funded; HS023683; HS022882.
Citation: Blecker S, Herrin J, Kwon JY .
Effect of hospital readmission reduction on patients at low, medium, and high risk of readmission in the Medicare population.
J Hosp Med 2018 Aug;13(8):537-43. doi: 10.12788/jhm.2936..
Keywords: Hospital Readmissions, Medicare, Hospitals, Elderly, Hospitalization
Navathe AS, Bain AM, Werner RM
Do changes in post-acute care use at hospitals participating in an accountable care organization spillover to all Medicare beneficiaries?
The objective of this study was to evaluate whether changes in post-acute care (PAC) use and Medicare spending spill over to all beneficiaries admitted to hospitals participating in the Medicare Shared Savings Program (MSSP). The investigators found that hospital participation in an accountable care organization (ACO) did not result in spillovers in PAC utilization or payments to all beneficiaries, even when considering high PAC-use conditions and ACO hospitals that also have an ACO-participating PAC.
AHRQ-funded; HS024266.
Citation: Navathe AS, Bain AM, Werner RM .
Do changes in post-acute care use at hospitals participating in an accountable care organization spillover to all Medicare beneficiaries?
J Gen Intern Med 2018 Jun;33(6):831-38. doi: 10.1007/s11606-018-4368-z..
Keywords: Hospitals, Medicare, Policy
Nathan H, Thumma JR, Norton EC
Strategies for reducing population surgical costs in Medicare: local referrals to low-cost hospitals.
An analysis was done of hospital cost variations for elective inpatient surgery in a small geographic area. Medicare payment data was used to calculate 30-day surgical episode costs for elderly patients undergoing 1 of 7 elective surgeries during 2010-2012. The highest and lowest cost hospitals were identified in their metropolitan statistical area. It was found that high-cost hospitals had higher complication and readmission rates than their lower-cost peers. Medicare expenditures at the high-cost hospitals were $4424 to $10,417 higher than the lowest-cost hospitals.
AHRQ-funded; HS024763.
Citation: Nathan H, Thumma JR, Norton EC .
Strategies for reducing population surgical costs in Medicare: local referrals to low-cost hospitals.
Ann Surg 2018 May;267(5):878-85. doi: 10.1097/sla.0000000000002340..
Keywords: Elderly, Healthcare Costs, Hospitals, Medicare, Surgery
Middleton A, Downer B, Haas A
Functional status is associated with 30-day potentially preventable readmissions following skilled nursing facility discharge among Medicare beneficiaries.
This retrospective cohort study’s objective was to determine the association between patients’ functional status at discharge from skilled nursing facility (SNF) care and 30-day potentially preventable readmissions. Data was used from a national cohort of Medicare fee-for-service beneficiaries discharged from SNF care from July 2013 to July 2014. The average age was 81.4 years, 67% were women, and 86.3% non-Hispanic white. Functional data used from the Minimum Data Set was self-care, mobility, and cognition domains. The overall rate of 30-day potentially preventable readmissions was 5.7%. The 5 most common conditions for readmissions were congestive heart failure, septicemia, urinary tract infection, bacterial pneumonia, and renal failure. Mobility was the most dependent category followed by self-care and cognition.
AHRQ-funded; HS022134.
Citation: Middleton A, Downer B, Haas A .
Functional status is associated with 30-day potentially preventable readmissions following skilled nursing facility discharge among Medicare beneficiaries.
J Am Med Dir Assoc 2018 Apr;19(4):348-54.e4. doi: 10.1016/j.jamda.2017.12.003..
Keywords: Hospital Readmissions, Hospital Discharge, Hospitals, Medicare, Elderly
Gowrisankaran G, Lucarelli C, Schmidt-Dengler P
Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare.
This paper sought to understand the impact of the Medicare Rural Hospital Flexibility (Flex) Program on hospital choice and consumer welfare for rural residents. The Flex Program created a new class of hospital, the Critical Access Hospital (CAH), which received more generous Medicare reimbursements in return for limits on capacity and length of stay. The investigators found that conversion to CAH status resulted in a 4.7 percent drop in inpatient admissions to participating hospitals, almost all of which was driven by factors other than capacity constraints.
AHRQ-funded; HS018424.
Citation: Gowrisankaran G, Lucarelli C, Schmidt-Dengler P .
Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare.
J Health Econ 2018 Mar;58:110-22. doi: 10.1016/j.jhealeco.2018.01.004..
Keywords: Rural Health, Access to Care, Hospitals, Medicare, Payment
Desai S, McWilliams JM
Consequences of the 340B drug pricing program.
Researchers used Medicare claims and a regression-discontinuity design, taking advantage of the threshold for program eligibility among general acute care hospitals to isolate the effects of the 340B Drug Pricing Program on hospital-physician consolidation and on the outpatient administration of parenteral drugs. They concluded that the Program has been associated with hospital-physician consolidation in hematology-oncology and with more hospital-based administration of parenteral drugs in hematology-oncology and ophthalmology.
AHRQ-funded; HS024072.
Citation: Desai S, McWilliams JM .
Consequences of the 340B drug pricing program.
N Engl J Med 2018 Feb 8;378(6):539-48. doi: 10.1056/NEJMsa1706475.
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Keywords: Healthcare Costs, Payment, Hospitals, Medicare, Medication
Ibrahim AM, Dimick JB, Sinha SS
Association of coded severity with readmission reduction after the hospital readmissions reduction program.
This research letter describes a study which examined coding by hospitals used to determine rates of readmission under the Hospital Readmission Reduction Program (HRRP). Hospitals who go above a certain rate are subject to financial penalties for 3 targed medical conditions. It was determined that hospitals have begun to change their coding to show increased severity of illness in many of those readmissions. Data came from discharges from the Medicare Provider Analysis and review file between 2008 and 2014. Researchers compared coding severity levels from before HRRP was implemented and post April 1, 2010 when it began.
AHRQ-funded; HS024525; HS024728.
Citation: Ibrahim AM, Dimick JB, Sinha SS .
Association of coded severity with readmission reduction after the hospital readmissions reduction program.
JAMA Intern Med 2018 Feb;178(2):290-92. doi: 10.1001/jamainternmed.2017.6148..
Keywords: Hospital Readmissions, Hospitals, Medicare, Policy
Hsuan C, Horwitz JR, Ponce NA
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
EMTALA, which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. Respondents identified 5 main causes of noncompliance as well as suggesting methods to improve compliance.
AHRQ-funded; HS024247.
Citation: Hsuan C, Horwitz JR, Ponce NA .
Complying with the Emergency Medical Treatment and Labor Act (EMTALA): challenges and solutions.
J Healthc Risk Manag 2018 Jan;37(3):31-41. doi: 10.1002/jhrm.21288.
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Keywords: Emergency Medical Services (EMS), Payment, Hospitals, Medicare, Uninsured
Cutler E, Karaca Z, Henke R
AHRQ Author: Karaca Z, Wong HS
The effects of Medicare accountable organizations on inpatient mortality rates.
This study examined whether Medicare Accountable Care Organizations (ACOs) have improved hospital quality of care, specifically focusing on preventable inpatient mortality. The investigators concluded that, on average, Medicare ACO hospitals are not associated with improved mortality rates for the studied inpatient quality indicator conditions. They suggest that stakeholders may potentially consider providing ACOs with incentives or designing new programs for ACOs to target inpatient mortality reductions.
AHRQ-authored.
Citation: Cutler E, Karaca Z, Henke R .
The effects of Medicare accountable organizations on inpatient mortality rates.
Inquiry 2018 Jan-Dec;55:46958018800092. doi: 10.1177/0046958018800092..
Keywords: Quality of Care, Healthcare Cost and Utilization Project (HCUP), Hospitals, Medicare, Mortality
Calderwood MS, Kleinman K, Bratzler DW
Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
This study found that among Medicare patients who underwent vascular surgery at 2,512 U.S. hospitals, a patient undergoing surgery in a hospital ranked in the worst-performing decile based on claims had a 2.5 times greater likelihood of developing a chart-confirmed surgical site infection relative to a patient characteristics in a hospital in the best-performing decile.
AHRQ-funded; HS018878
Citation: Calderwood MS, Kleinman K, Bratzler DW .
Medicare claims can be used to identify US hospitals with higher rates of surgical site infection following vascular surgery.
Med Care. 2014 Oct;52(10):918-25. doi: 10.1097/MLR.0000000000000212..
Keywords: Medicare, Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Hospitals, Adverse Events