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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 32 Research Studies Displayed
Ganguli I, Lupo C, Mainor AJ
Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit.
This observational cohort study looked at the prevalence and cost of care cascades after routine tests considered low value in fee-for-service Medicare patients from January 2013 through March 2015 who had gone for an annual wellness visit (AWV). Among the 75,275 AWV recipients identified, 18.6% received at least 1 low-value test including an ECG, urinalysis, or thyrotropin tests. Patients who were younger, White, and lived in urban, high-income areas were most likely to receive those tests. The cost-cascade was considered notable but of modest cost.
Citation: Ganguli I, Lupo C, Mainor AJ . Assessment of prevalence and cost of care cascades after routine testing during the Medicare annual wellness visit. JAMA Netw Open 2020 Dec;3(12):e2029891. doi: 10.1001/jamanetworkopen.2020.29891..
Keywords: Elderly, Medicare, Healthcare Costs, Value, Diagnostic Safety and Quality
Brewster AL, Fraze TK, Gottlieb LM
The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians.
The authors studied the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. Their results indicated that implementation of social risk screening was not associated with overall exposure to value-based payment for physician practices. They recommended expanding social risk screening in order to reduce the level of innovative capacity required.
Citation: Brewster AL, Fraze TK, Gottlieb LM . The role of value-based payment in promoting innovation to address social risks: a cross-sectional study of social risk screening by US physicians. Milbank Q 2020 Dec;98(4):1114-33. doi: 10.1111/1468-0009.12480..
Keywords: Payment, Social Determinants of Health, Practice Patterns, Innovations and Emerging Issues, Screening, Risk, Value, Nutrition, Vulnerable Populations
Ganguli I, Lupo C, Mainor AJ
Association between specialist compensation and Accountable Care Organization performance.
This study’s objective was to determine whether Medicare Shared Savings Program Accountable Care Organizations (ACOs) using cost reduction measures in specialist compensation demonstrated better performance. National cross-sectional survey data on ACOs from 2013-2015 was linked to public-use data on ACO performance from 2014-2016. Out of 160 ACOs surveys, 26% reported using cost reduction measures to help determine specialist compensation. However, these ACOs did not have savings in the short term.
Citation: Ganguli I, Lupo C, Mainor AJ . Association between specialist compensation and Accountable Care Organization performance. Health Serv Res 2020 Oct;55(5):722-28. doi: 10.1111/1475-6773.13323..
Keywords: Provider Performance, Healthcare Costs, Value, Payment, Medicare
Skaathun B, Pho MT, Pollack HA
Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States.
This analysis compared the effectiveness and cost of three HIV testing strategies in a high HIV burden area in the U.S. in identifying new HIV infections. The investigators performed a cost analysis comparing three HIV testing strategies in Chicago: (1) routine screening (RS) in an inpatient and outpatient setting, (2) modified partner services (MPS) among networks of the recently HIV infected and diagnosed, and (3) a respondent drive sampling (RDS)-based social network (SN) approach targeting young African-American men who have sex with men.
Citation: Skaathun B, Pho MT, Pollack HA . Comparison of effectiveness and cost for different HIV screening strategies implemented at large urban medical centre in the United States. J Int AIDS Soc 2020 Oct;23(10):e25554. doi: 10.1002/jia2.25554..
Keywords: Human Immunodeficiency Virus (HIV), Screening, Healthcare Costs, Prevention, Value, Infectious Diseases
AHRQ Author: Encinosa WE
Is it time for ACOs to start tackling the high costs of surgery?
This article discusses an article appearing in the same issue revisiting the impact of Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) on surgery expenditures. The author suggests that, in order to engage even more surgeons, it is likely that MSSP ACOs will have to work with surgeons in the various Medicare bundled payment programs for surgery. He concludes that the next stage is to examine how these different programs can work together to produce even more savings in surgical care.
Citation: Encinosa WE . Is it time for ACOs to start tackling the high costs of surgery? Am J Accountable Care 2020 Sep 15;8(3):26-27..
Keywords: Surgery, Healthcare Costs, Medicaid, Health Insurance, Payment, Value
Iglesia EGA, Greenhawt M, Shaker MS
Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system.
Researchers sought to define the concept of value-based care in allergy, and to review challenges and opportunities in value-based health care delivery for allergists and immunologists. A review of articles describing practice variation, health care financing and reimbursement, shared decision-making, cost-effective health care delivery, patient-reported outcome measures, social determinants of health, and screening was conducted. The researchers concluded that, as health care systems continue to evolve, allergists and immunologists will play a key role in optimizing value by translating emerging evidence into practice and communicating novel approaches to prevent and treat allergic diseases.
Citation: Iglesia EGA, Greenhawt M, Shaker MS . Achieving the Quadruple Aim to deliver value-based allergy care in an ever-evolving health care system. Ann Allergy Asthma Immunol 2020 Aug;125(2):126-36. doi: 10.1016/j.anai.2020.04.007..
Keywords: Value, Healthcare Delivery, Healthcare Costs
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, Value, Healthcare Costs, Payment, Quality of Care
Kennedy G, Lewis VA, Kundu S
Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks.
This study examined the relationship between accountable care organizations (ACOs) and skilled nursing facilities (SNFs) for patients who are discharged from a hospital into a SNF. A mixed-method design was used and survey data was examined from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs who performed well on cost and quality measures. Over half of ACOs had no formal relationship with SNFs; however the majority of ACO interviewees had preferred SNF networks. These preferred networks are beginning to transform the ACO post-acute care landscape.
Citation: Kennedy G, Lewis VA, Kundu S . Kennedy G, Lewis VA, Kundu S, Mousqués J, Colla CH. Accountable care organizations and post-acute care: a focus on preferred SNF networks. Med Care Res Rev 2020 Aug;77(4):312-23. doi: 10.1177/1077558718781117..
Keywords: Nursing Homes, Healthcare Costs, Payment, Value
Berlin NL, Skolarus TA, Kerr EA
Too much surgery: overcoming barriers to deimplementation of low-value surgery.
The objectives of this surgical perspective are to discuss the unique aspects of surgical care delivery acting as barriers to de-implementation and to suggest potential strategies to reduce low-value surgery in the United States. Successful de-implementation of low-value surgery will depend on understanding why low-value procedures persist, leveraging quality collaboratives to monitor appropriateness, implementing clinical decision support systems, and developing incentives for de-implementation.
Citation: Berlin NL, Skolarus TA, Kerr EA . Too much surgery: overcoming barriers to deimplementation of low-value surgery. Ann Surg 2020 Jun;271(6):1020-22. doi: 10.1097/sla.0000000000003792..
Keywords: Surgery, Value, Decision Making
Friedman Peahl A, Heisler M, Essenmacher LK
A comparison of international prenatal care guidelines for low-risk women to inform high-value care.
The authors compared U.S. to international prenatal care consensus guidelines for low-risk women to inform care delivery reforms. They found that U.S. and peer-country guidelines recommended similar prenatal education and psychosocial services for low-risk women; however, peer countries generally recommended fewer visits, longer intervals between visits, and less reliance on obstetrician-gynecologists for routine, low-risk prenatal care. They recommended that further investigation evaluate associations between recommended care and actual practice, as well as the effects of different components of prenatal care and delivery models on maternal-infant outcomes, patient-centeredness, and health care expenditures in the U.S.
Citation: Friedman Peahl A, Heisler M, Essenmacher LK . A comparison of international prenatal care guidelines for low-risk women to inform high-value care. Am J Obstet Gynecol 2020 May;222(5):505-07. doi: 10.1016/j.ajog.2020.01.021..
Keywords: Maternal Care, Pregnancy, Women, Value, Guidelines, Evidence-Based Practice, Healthcare Delivery
Socal MP, Anderson KE, Sen A
Biosimilar uptake in Medicare Part B varied across hospital outpatient departments and physician practices: the case of filgrastim.
The purpose of this study was to examine the uptake of filgrastim-sndz (Zarxio), the first biosimilar to launch in the United States, in the Medicare Part B fee-for-service program from its launch in September 2015 to December 2017 and compare characteristics of patients and facilities that used filgrastim-sndz or originator filgrastim (Neupogen). The investigators concluded that uptake of biosimilar filgrastim in the Medicare Part B program occurred despite multiple challenges to the adoption of biosimilars in the US market, suggesting that substantial potential savings could be generated by improving biosimilar uptake.
Citation: Socal MP, Anderson KE, Sen A . Biosimilar uptake in Medicare Part B varied across hospital outpatient departments and physician practices: the case of filgrastim. Value Health 2020 Apr;23(4):481-86. doi: 10.1016/j.jval.2019.12.007..
Keywords: Medicare, Practice Patterns, Medication, Healthcare Costs, Value
Bartsch SM, Asti L, Stokes-Cawley OJ
The potential economic value of a Zika vaccine for a woman of childbearing age.
The authors mapped the Zika vaccine and vaccination characteristic thresholds at which vaccination becomes cost effective, highly cost effective, and cost saving. They developed a Markov model to simulate a woman of childbearing age to follow the potential risk and clinical course of a Zika infection. They found that, in some cases, the vaccine was cost effective when the risk was as low as 0.015%, the cost was as high as $7,500, the efficacy was as low as 25%, and the duration of protection was 1 year. They concluded that the thresholds at which vaccination becomes cost effective and cost saving can provide targets for Zika vaccine development and implementation.
Citation: Bartsch SM, Asti L, Stokes-Cawley OJ . The potential economic value of a Zika vaccine for a woman of childbearing age. Am J Prev Med 2020 Mar;58(3):370-77. doi: 10.1016/j.amepre.2019.10.023..
Keywords: Vaccination, Women, Infectious Diseases, Public Health, Healthcare Costs, Value, Prevention
Weerahandi H, Bao H, Herrin J
Home health care after skilled nursing facility discharge following heart failure hospitalization.
Heart failure (HF) readmission rates have plateaued despite scrutiny of hospital discharge practices. Many HF patients are discharged to skilled nursing facility (SNF) after hospitalization before returning home. Home healthcare (HHC) services received during the additional transition from SNF to home may affect readmission risk. In this study, the investigators examined whether receipt of HHC affects readmission risk during the transition from SNF to home following HF hospitalization.
Citation: Weerahandi H, Bao H, Herrin J . Home health care after skilled nursing facility discharge following heart failure hospitalization. J Am Geriatr Soc 2020 Jan;68(1):96-102. doi: 10.1111/jgs.16179..
Keywords: Home Healthcare, Nursing Homes, Heart Disease and Health, Cardiovascular Conditions, Hospitalization, Hospital Readmissions, Transitions of Care, Rehabilitation, Value
Markovitz AA, Rozier MD, Ryan AM
Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians.
The purpose of this study was to assess Accountable Care Organization (ACO) engagement of clinicians and whether engagement was associated with clinicians' reported difficulty implementing recommendations against low-value care. Participants included 1289 clinicians in the Physician Organization of Michigan ACO. Results showed that clinicians participating in a large Medicare ACO were broadly unaware of and unengaged with ACO objectives and activities. Whether low clinician engagement limits ACO efforts to reduce low-value care warrants further longitudinal study.
AHRQ-funded; HS024525; HS024728; HS025615.
Citation: Markovitz AA, Rozier MD, Ryan AM . Low-value care and clinician engagement in a large Medicare shared savings program ACO: a survey of frontline clinicians. J Gen Intern Med 2020 Jan;35(1):133-41. doi: 10.1007/s11606-019-05511-8..
Keywords: Medicare, Policy, Value, Provider
Geynisman DM, Chien CR, Smieliauskas F
Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review.
The researchers performed a comprehensive literature review of cost and cost-effectiveness research on therapeutic cancer vaccines and monoclonal antibodies, to better understand the economic impacts of these treatments. They discussed the implications surrounding the economic factors involved in cancer immunotherapies and suggested that further research on cost and cost-effectiveness of newer cancer vaccines and immunotherapies were warranted as this is a rapidly growing field with many new drugs on the horizon.
Citation: Geynisman DM, Chien CR, Smieliauskas F . Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review. Hum Vaccin Immunother 2014;10(11):3415-24. doi: 10.4161/hv.29407.
Keywords: Cancer, Healthcare Costs, Vaccination, Value
Gilmer TP, Stefancic A, Katz ML
Fidelity to the housing first model and effectiveness of permanent supported housing programs in California.
This paper examined the relationship between fidelity to the Housing First model and residential outcomes among clients of full service partnerships (FSPs) in California. They concluded that programs with greater fidelity to the Housing First model enrolled clients with longer histories of homelessness and placed most of them in apartments.
Citation: Gilmer TP, Stefancic A, Katz ML . Fidelity to the housing first model and effectiveness of permanent supported housing programs in California. Psychiatr Serv 2014 Nov;65(11):1311-7. doi: 10.1176/appi.ps.201300447.
Keywords: Value, Vulnerable Populations
Ostrowsky B, Ruiz R, Brown S
Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions.
The researchers sought to determine whether controlling the prescription of targeted antibiotics would translate to a measurable reduction in hospital-onset Clostridium difficile infection (CDI) rates. They found that decreases in target antibiotic consumption did not translate into reductions of hospital-onset CDI in this study, but many valuable lessons were learned.
Citation: Ostrowsky B, Ruiz R, Brown S . Lessons learned from implementing Clostridium difficile-focused antibiotic stewardship interventions. Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S86-95. doi: 10.1086/677828.
Keywords: Antibiotics, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Patient Safety, Value
Starner CI, Alexander GC, Bowen K
Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums.
The investigators examined insurers' role in maintaining the affordability and accessibility of specialty drugs while maximizing their value. They found that drug coupons accounted for $21.2 million of patients' $35.3 million annual out-of-pocket costs. In the vast majority of cases, coupons reduced monthly cost sharing to less than $250, a point at which patients were far less likely to abandon therapy with biologic anti-inflammatory drugs or with drugs for multiple sclerosis. They highlighted that, by reducing cost sharing, coupons may also circumvent efforts to encourage patients to use the most cost-effective drugs.
Citation: Starner CI, Alexander GC, Bowen K . Specialty drug coupons lower out-of-pocket costs and may improve adherence at the risk of increasing premiums. Health Aff 2014 Oct;33(10):1761-9. doi: 10.1377/hlthaff.2014.0497.
Keywords: Healthcare Costs, Health Insurance, Medication, Patient Adherence/Compliance, Value
Arling PA, Abrahamson K, Miech EJ
Communication and effectiveness in a US nursing home quality-improvement collaborative.
The investigators explored the relationship between changes in resident health outcomes, practitioner communication patterns, and practitioner perceptions of group effectiveness within a quality-improvement collaborative of nursing home clinicians. They found that reductions in fall rates were highest in facilities where respondents experienced the highest levels of communication with collaborative members outside of scheduled meetings. Clinician and practitioner observations were discussed.
Citation: Arling PA, Abrahamson K, Miech EJ . Communication and effectiveness in a US nursing home quality-improvement collaborative. Nurs Health Sci 2014 Sep;16(3):291-7. doi: 10.1111/nhs.12098.
Keywords: Communication, Falls, Nursing Homes, Quality of Care, Prevention, Quality Improvement, Value
Holzer J, Canavan M, Bradley E
County-level correlation between adult obesity rates and prevalence of dentists.
The researchers conducted a study to examine the association between the prevalence of dentists and the rates of adult obesity. They found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity. This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population.
Citation: Holzer J, Canavan M, Bradley E . County-level correlation between adult obesity rates and prevalence of dentists. J Am Dent Assoc 2014 Sep;145(9):932-9. doi: 10.14219/jada.2014.48.
Keywords: Dental and Oral Health, Obesity, Risk, Social Determinants of Health, Value
David G, Lindrooth RC, Helmchen LA
Do hospitals cross-subsidize?
The authors used repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. They studied how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. They estimated that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose.
Citation: David G, Lindrooth RC, Helmchen LA . Do hospitals cross-subsidize? J Health Econ 2014 Sep;37:198-218. doi: 10.1016/j.jhealeco.2014.06.007.
Keywords: Healthcare Costs, Quality of Care, Hospitals, Value
Hockenberry JM, Helmchen LA
The nature of surgeon human capital depreciation.
The authors estimated how temporal breaks affect surgeons' performance of coronary artery bypass grafting (CABG). They found that a surgeon's additional day away from the operating room raised patients' inpatient mortality by up to 0.067 percentage points but reduced total hospitalization costs by up to 0.59 percentage points, and among emergent patients treated by high-volume providers, an additional day away raised mortality risk by 0.398 percentage points but reduced cost by up to 1.4 percentage points. They concluded that their results are consistent with the hypothesis that as temporal distance increases, surgeons are less likely to recognize and address life-threatening complications.
Citation: Hockenberry JM, Helmchen LA . The nature of surgeon human capital depreciation. J Health Econ 2014 Sep;37:70-80. doi: 10.1016/j.jhealeco.2014.06.001.
Keywords: Healthcare Costs, Mortality, Provider Performance, Surgery, Value
de Souza JA, Santana IA, de Castro Jr G
Economic analyses in squamous cell carcinoma of the head and neck: a review of the literature from a clinical perspective.
This review aims to evaluate the current literature related to economic analyses of treatment modalities for squamous cell cancer of the head and neck. The variation in findings among the studies reviewed demonstrates the challenges of performing economic analyses in a disease that requires an evolving and complex multidisciplinary approach.
Citation: de Souza JA, Santana IA, de Castro Jr G . Economic analyses in squamous cell carcinoma of the head and neck: a review of the literature from a clinical perspective. Int J Radiat Oncol Biol Phys. 2014 Aug 1;89(5):989-96. doi: 10.1016/j.ijrobp.2014.03.040..
Keywords: Cancer, Healthcare Costs, Value
Henrikson NB, Anderson ML, Hubbard RA
Employee knowledge of value-based insurance design benefits.
The authors assessed knowledge of features of a value-based insurance design (VBD). They concluded that incomplete knowledge of benefits is prevalent in an employee population soon after VBD rollout.
Citation: Henrikson NB, Anderson ML, Hubbard RA . Employee knowledge of value-based insurance design benefits. Am J Prev Med 2014 Aug;47(2):115-22. doi: 10.1016/j.amepre.2014.03.005.
Keywords: Evidence-Based Practice, Healthcare Delivery, Health Insurance, Value
Smieliauskas F, Chien CR, Shen C
Cost-effectiveness analyses of targeted oral anti-cancer drugs: a systematic review.
The researchers’ objective was to perform the first comprehensive review of cost-effectiveness analyses of targeted oral anti-cancer medications (OAMs). They concluded that in over half of the treatment settings in which a targeted OAM was compared with treatment that was not a targeted OAM, targeted OAMs were considered cost-effective.
Citation: Smieliauskas F, Chien CR, Shen C . Cost-effectiveness analyses of targeted oral anti-cancer drugs: a systematic review. Pharmacoeconomics 2014 Jul;32(7):651-80. doi: 10.1007/s40273-014-0160-z..
Keywords: Value, Healthcare Costs, Medication, Cancer