National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (1)
- Cardiovascular Conditions (1)
- Community-Based Practice (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (3)
- Diabetes (1)
- Diagnostic Safety and Quality (1)
- Elderly (2)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (1)
- Health Status (1)
- Heart Disease and Health (1)
- Hospital Discharge (1)
- Hospitalization (1)
- Hospital Readmissions (2)
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- Low-Income (1)
- Medical Devices (1)
- Medical Errors (1)
- (-) Medicare (12)
- Mortality (1)
- Nursing Homes (1)
- Outcomes (1)
- Patient-Centered Healthcare (1)
- Patient Experience (2)
- Patient Safety (1)
- Payment (2)
- Provider Performance (4)
- Quality Improvement (1)
- Quality Indicators (QIs) (2)
- Quality Measures (2)
- (-) Quality of Care (12)
- Registries (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 12 of 12 Research Studies DisplayedMeddings 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
Berenson R, Singh H
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Researchers examined ways that payment innovations could be used to improve diagnostic accuracy and reduce diagnostic error among Medicare patients. They recommended three different approaches: 1) coding changes in the Medicare Physician Fee schedule; new Alternative Payment Models (APMs) that could improve accuracy in challenging cases and even provide second or third opinions; and 3) have a method that accurate diagnoses would trigger APM payments and establish payment amounts.
AHRQ-funded; HS022087; HS017820.
Citation: Berenson R, Singh H .
Payment innovations to improve diagnostic accuracy and reduce diagnostic error.
Health Aff 2018 Nov;37(11):1828-35. doi: 10.1377/hlthaff.2018.0714..
Keywords: Diagnostic Safety and Quality, Payment, Medical Errors, Medicare, Patient Safety, Quality of Care
Fraze TK, Lewis VA, Tierney E
Quality of care improves for patients with diabetes in Medicare shared savings accountable care organizations: organizational characteristics associated with performance.
This study analyzed secondary data retrospectively to examine Medicare Shared Savings Program (MSSP) Accountable Care Organizations’ performance on diabetes metrics in the first 2 years of ACO contracts in order to determine how ACO organizational characteristics - such as composition, staffing, care management, and experiences with health reform - were associated with quality of care delivered to patients with diabetes.
AHRQ-funded; HS024075.
Citation: Fraze TK, Lewis VA, Tierney E .
Quality of care improves for patients with diabetes in Medicare shared savings accountable care organizations: organizational characteristics associated with performance.
Popul Health Manag 2018 Oct;21(5):401-08. doi: 10.1089/pop.2017.0102..
Keywords: Diabetes, Quality of Care, Medicare, Provider Performance, Quality Improvement
Hays RD, Mallett JS, Haas A
Associations of CAHPS composites with global ratings of the doctor vary by Medicare beneficiaries' health status.
This study examines whether the association of care coordination with global ratings of one's personal doctor varies by number of chronic conditions and self-rated health. Results were consistent with the hypothesis that patients in worse health weigh care coordination more heavily in global physician assessments than patients in better health. Emphasis on improving care coordination, especially for patients in poorer health, may improve patients' overall assessments of their providers.
AHRQ-funded; HS016980; HS025920.
Citation: Hays RD, Mallett JS, Haas A .
Associations of CAHPS composites with global ratings of the doctor vary by Medicare beneficiaries' health status.
Med Care 2018 Aug;56(8):736-39. doi: 10.1097/mlr.0000000000000942..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Health Status, Medicare, Provider Performance
Comfort LN, Shortell SM, Rodriguez HP
Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance.
The purpose of this study was to examine whether an empirically derived taxonomy of Accountable Care Organizations (ACOs) was associated with quality and spending performance among patients of ACOs in the Medicare Shared Savings Program (MSSP). The investigators found that there was greater heterogeneity within ACO types than between ACO types; there were no consistent differences in quality by ACO type, nor were there differences in likelihood of achieving savings or overall spending per-person-year; and was evidence for higher spending on physician services for physician-led ACOs.
AHRQ-funded; HS024075.
Citation: Comfort LN, Shortell SM, Rodriguez HP .
Medicare accountable care organizations of diverse structures achieve comparable quality and cost performance.
Health Serv Res 2018 Aug;53(4):2303-23. doi: 10.1111/1475-6773.12829..
Keywords: Medicare, Healthcare Costs, Quality Indicators (QIs), Quality of Care
Middleton A, Graham JE, Ottenbacher KJ
Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among aged Medicare fee-for-service beneficiaries.
This study has two purposes: Determine the association between functional status of patients at discharge following inpatient rehabilitation and their potentially preventable readmission; Examine conditions that result in potentially preventable readmissions. The study examined inpatient rehabilitation facilities that submitted claims to Medicare, and concluded that functional status is associated with readmission and this may help to identify at-risk patients.
AHRQ-funded; HS022134.
Citation: Middleton A, Graham JE, Ottenbacher KJ .
Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among aged Medicare fee-for-service beneficiaries.
Arch Phys Med Rehabil 2018 Jun;99(6):1067-76. doi: 10.1016/j.apmr.2017.05.001..
Keywords: Elderly, Quality of Care, Hospital Discharge, Hospital Readmissions, Medicare
Hatfield LA, Zaslavsky AM
Separable covariance models for health care quality measures across years and topics.
Public quality reports for Medicare Advantage health plans include 11 measures of patient experiences reported in the annual Consumer Assessment of Healthcare Providers and Systems surveys. To summarize associations among measures and years, the authors model the variance-covariance matrix governing the plan-level vectors of yearly quality measures as a Kronecker product of an across-measure matrix and an across-year matrix, or a sum of such Kronecker products.
AHRQ-funded; HS016978.
Citation: Hatfield LA, Zaslavsky AM .
Separable covariance models for health care quality measures across years and topics.
Stat Med 2018 May 30;37(12):2053-66. doi: 10.1002/sim.7656..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality Measures, Quality of Care, Patient Experience, 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
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
Sharma R, Lebrun-Harris LA, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q
Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.
The authors determined the association between access to primary care by the underserved and Medicare spending and clinical quality across hospital referral regions (HRRs). They found that, compared with elderly fee-for-service beneficiaries residing in areas with low-penetration of health center patients among low-income residents, those residing in high-penetration areas may accrue Medicare cost savings.
AHRQ-authored.
Citation: Sharma R, Lebrun-Harris LA, Ngo-Metzger Q .
Costs and clinical quality among Medicare beneficiaries: associations with health center penetration of low-income residents.
Medicare Medicaid Res Rev 2014 Sep 8;4(3). doi: 10.5600/mmrr.004.03.a05.
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Keywords: Access to Care, Community-Based Practice, Quality of Care, Low-Income, Medicare
Borne RT, Peterson PN, Greenlee R
Temporal trends in patient characteristics and outcomes among Medicare beneficiaries undergoing primary prevention implantable cardioverter-defibrillator placement in the United States, 2006-2010.
Results from the National Cardiovascular Data Registry's Implantable Cardioverter-Defibrillator Registry. This study characterizing trends in clinical profiles and outcomes among Medicare patients undergoing primary implantable cardioverter-defibrillator implantation found only modest changes in clinical characteristics between 2006 and 2010. However, 6-month mortality and rehospitalization improved significantly over time, suggesting that there were meaningful improvements.
AHRQ-funded; HS019814
Citation: Borne RT, Peterson PN, Greenlee R .
Temporal trends in patient characteristics and outcomes among Medicare beneficiaries undergoing primary prevention implantable cardioverter-defibrillator placement in the United States, 2006-2010.
Circulation. 2014 Sep 2;130(10):845-53. doi: 10.1161/CIRCULATIONAHA.114.008653..
Keywords: Medical Devices, Outcomes, Medicare, Registries, Quality of Care
Hays RD, Berman LJ, Kanter MH
Evaluating the psychometric properties of the CAHPS Patient-Centered Medical Home survey.
This study surveyed Medicare beneficiaries to evaluate the reliability and validity of a new five-item care coordination measure. The composite score had a strong unique association with the CAHPS global rating of health care, after controlling for the CAHPS core composite scores.
AHRQ-funded; HS016980
Citation: Hays RD, Berman LJ, Kanter MH .
Evaluating the psychometric properties of the CAHPS Patient-Centered Medical Home survey.
Clin Ther. 2014 May;36(5):689-696.e1. doi: 10.1016/j.clinthera.2014.04.004..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Medicare, Patient Experience, Patient-Centered Healthcare