National Healthcare Quality and Disparities Report
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Topics
- Cardiovascular Conditions (1)
- COVID-19 (1)
- Disparities (1)
- Elderly (5)
- Emergency Department (2)
- Healthcare Cost and Utilization Project (HCUP) (3)
- Healthcare Costs (2)
- Health Services Research (HSR) (1)
- Heart Disease and Health (2)
- Hospital Discharge (2)
- (-) Hospitalization (14)
- Hospital Readmissions (2)
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- Inpatient Care (3)
- Long-Term Care (2)
- (-) Medicare (14)
- Mortality (4)
- Nursing Homes (2)
- Outcomes (1)
- Payment (3)
- Pneumonia (1)
- Policy (2)
- Practice Patterns (1)
- Provider (2)
- Provider: Physician (1)
- Provider Performance (1)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (1)
- Racial and Ethnic Minorities (1)
- Risk (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 14 of 14 Research Studies DisplayedSong Zhang, Zhang X, Patterson LJ
Racial and ethnic disparities in hospitalization outcomes among Medicare beneficiaries during the COVID-19 pandemic.
This study assessed assess racial and ethnic differences in hospitalization outcomes during the COVID-19 pandemic among Medicare beneficiaries. Medicare claims from the Social Security Administration was used to determine in-hospital mortality and mortality inclusive of discharges to hospice and discharges to postacute care. Over 31 million Medicare recipients in the database were analyzed with over 14 million hospitalizations from January 2019 to February 2021. There was a decline in non-COVID-19 and an emergence of COVID-19 hospitalizations among beneficiaries of different racial and ethnic minority groups through February 2021. In-hospital mortality was not significantly different among Black patients relative to White patients but was 3.5 percentage points higher among Hispanic patients and other racial and ethnic minority groups. There were disparities in discharges to hospice and postacute care as well.
AHRQ-funded; HS024072.
Citation: Song Zhang, Zhang X, Patterson LJ .
Racial and ethnic disparities in hospitalization outcomes among Medicare beneficiaries during the COVID-19 pandemic.
JAMA Health Forum 2021 Dec 23;2(12):e214223. doi: 10.1001/jamahealthforum.2021.4223..
Keywords: COVID-19, Racial and Ethnic Minorities, Disparities, Medicare, Hospitalization, Outcomes, Mortality
Smulowitz PB, O'Malley AJ, McWilliams JM
Variation in rates of hospital admission from the emergency department among Medicare patients at the regional, hospital, and physician levels.
Rates of admission from the emergency department (ED) vary widely across regions of the country, hospitals within regions, and physicians within hospitals. The study objective was to determine the extent to which variation in admission decisions was described by differences in admission rates at these 3 levels. The investigators concluded that within-area variation, both across hospitals within a region and across physicians within a hospital, was a more substantial component of observed variation in admission rates from the ED than regional level variation.
AHRQ-funded; HS025408.
Citation: Smulowitz PB, O'Malley AJ, McWilliams JM .
Variation in rates of hospital admission from the emergency department among Medicare patients at the regional, hospital, and physician levels.
Ann Emerg Med 2021 Oct;78(4):474-83. doi: 10.1016/j.annemergmed.2021.03.020..
Keywords: Medicare, Hospitalization, Emergency Department, Practice Patterns
Smulowitz PB, O'Malley AJ, Zaborski L
Variation in emergency department admission rates among Medicare patients: does the physician matter?
Hospitalizations account for the largest share of health care spending. New payment models increasingly encourage health care providers to reduce hospital admissions. Although emergency department (ED) physicians play a major role in the decision to admit a patient, the extent to which admission rates vary among ED physicians even within the same hospital remains poorly understood. In this study the investigators examined physician-level variation in ED admission rates for Medicare patients.
AHRQ-funded; HS025408.
Citation: Smulowitz PB, O'Malley AJ, Zaborski L .
Variation in emergency department admission rates among Medicare patients: does the physician matter?
Health Aff 2021 Feb;40(2):251-57. doi: 10.1377/hlthaff.2020.00670..
Keywords: Emergency Department, Hospitalization, Medicare, Provider: Physician, Provider
Selden TM, Karaca Z, Decker S
AHRQ Author: Selden TM, Karaca Z, Decker S
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
This study examined whether inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates widened. Using a large discharge dataset covering the period 2001-2011, the investigators tracked changes at age 65 in multiple dimensions of hospital care.
AHRQ-authored.
Citation: Selden TM, Karaca Z, Decker S .
Has inpatient hospital treatment before and after age 65 changed as the difference between private and Medicare payment rates has widened?
Int J Health Econ Manag 2018 Dec;18(4):409-23. doi: 10.1007/s10754-018-9240-5..
Keywords: Payment, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Inpatient Care, Medicare
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
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
Henke RM, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Medicare Advantage and traditional Medicare hospitalization intensity and readmissions.
This study uses 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. The authors found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays.
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB .
Medicare Advantage and traditional Medicare hospitalization intensity and readmissions.
Med Care Res Rev 2018 Aug;75(4):434-53. doi: 10.1177/1077558717692103..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospital Discharge, Hospital Readmissions, Hospitalization, Medicare
Holmgren AJ, Adler-Milstein J, Chen LM
Participation in a voluntary bundled payment program by organizations providing care after an acute hospitalization
This research letter addresses spending on post–acute care (PAC), or care provided after a stay in an acute care hospital. PAC is the largest driver of variation in total per capita Medicare spending. To address this, Medicare has targeted PAC spending in payment reforms including voluntary bundled payment programs. This letter discusses participation in these voluntary payment programs.
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AHRQ-funded; HS024698
Citation: Holmgren AJ, Adler-Milstein J, Chen LM .
Participation in a voluntary bundled payment program by organizations providing care after an acute hospitalization
JAMA 2018 Jul 24;320(4):402-04. doi: 10.1001/jama.2018.8666..
Keywords: Payment, Health Services Research (HSR), Health Services Research (HSR), Hospitalization, Medicare
Henke RM, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
This study investigated the relationship between Medicare Advantage (MA) program growth and inpatient hospital costs and utilization before and after the ACA. Its results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. Researchers did not observe a strong relationship between MA enrollment and inpatient days per enrollee
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB .
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
Med Care 2018 Apr;56(4):321-28. doi: 10.1097/mlr.0000000000000885.
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Keywords: Healthcare Costs, Policy, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Medicare
Goodwin JS, Salameh H, Zhou J
Association of hospitalist years of experience with mortality in the hospitalized Medicare population.
The purpose of the study is to describe the association of hospitalist years of experience with 30-day mortality and hospital mortality of their patients. The authors noted that patients cared for by hospitalists in their first year of practice experienced higher mortality. The authors asserted that early-career hospitalists may require additional support to ensure optimal outcomes for their patients.
AHRQ-funded; HS022134.
Citation: Goodwin JS, Salameh H, Zhou J .
Association of hospitalist years of experience with mortality in the hospitalized Medicare population.
JAMA Intern Med 2018 Feb;178(2):196-203. doi: 10.1001/jamainternmed.2017.7049..
Keywords: Hospitalization, Inpatient Care, Medicare, Mortality, Provider
Middleton A, Li S, Kuo YF
New institutionalization in long-term care after hospital discharge to skilled nursing facility.
Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective of this study was to examine characteristics associated with new institutionalizations of older adults on this care trajectory. Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function.
AHRQ-funded; HS022134.
Citation: Middleton A, Li S, Kuo YF .
New institutionalization in long-term care after hospital discharge to skilled nursing facility.
J Am Geriatr Soc 2018 Jan;66(1):56-63. doi: 10.1111/jgs.15131..
Keywords: Long-Term Care, Nursing Homes, Hospital Discharge, Elderly, Hospitalization, Medicare
Ryskina KL, Konetzka RT, Werner RM
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
The goal of this study was to test whether the improvements in nursing homes’ 5-star ratings were correlated with reductions in rates of hospitalization; the researchers’ hypothesis was that increased attention to ratings motivated nursing homes to make changes to improve ratings but did not affect hospitalization rate, resulting in a weakened association between ratings and hospitalizations. 2007-2010 Medicare hospital claims and nursing home clinical assessment data were used to compare the correlation between nursing homes’ ratings and hospitalization rates. Correlation weakened slightly after the ratings became publicly available. The researchers conclude that improvements in nursing home ratings after the release of Medicare's 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients and, although this dissociation may be due to additional factors, the 5-star ratings became less meaningful as an indicator of nursing home quality for these patients.
AHRQ-funded; HS021861.
Citation: Ryskina KL, Konetzka RT, Werner RM .
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
Inquiry 2018 Jan-Dec;55:46958018787323. doi: 10.1177/0046958018787323..
Keywords: Elderly, Nursing Homes, Medicare, Quality Indicators (QIs), Provider Performance, Quality Measures, Hospitalization, Quality of Care
Chaudhry SI, Khan RF, Chen J
National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010.
The investigators evaluated changes in the incidence of 1-year recurrent acute myocardial infarction (AMI) hospitalization and mortality. In a national sample of Medicare beneficiaries hospitalized for AMI from 1999 to 2010, they found that hospitalization for recurrent AMI decreased, as did subsequent mortality, albeit to a lesser extent. The risk of recurrent AMI hospitalization declined less in black patients than in whites, increasing observed racial disparities by the end of the study period.
AHRQ-funded; HS018781.
Citation: Chaudhry SI, Khan RF, Chen J .
National trends in recurrent AMI hospitalizations 1 year after acute myocardial infarction in Medicare beneficiaries: 1999-2010.
J Am Heart Assoc 2014 Oct;3(5):e001197. doi: 10.1161/jaha.114.001197.
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Keywords: Hospitalization, Medicare, Mortality, Heart Disease and Health, Risk