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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 29 Research Studies Displayed
Myong C, Hull P, Price M
The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts.
This retrospective study examined the impact of funding for federally qualified health centers (FQHCs) on utilization and emergency department (ED) visits in Massachusetts. The authors theorized that greater funding for FQHCs could increase the local availability of clinic-based care and reduce more costly resource use, such as ED visits. Data from the Massachusetts All Payer Claims Database (APCD) 2010-2013 was used that included enrollees in 559 Massachusetts ZIP codes (2010 numbers 6,173,563). They calculated shift-share predictions of changes in FQHC funding at the ZIP code-level for FQHCs that received Community Health Center funds in any year. They found that a standard deviation increase in prior year FQHC funding (31%) was associated with a 2.3% increase in enrollees with FQHC visits and a 1.3% decrease in enrollees at EDs. However, there were no significant changes in emergent ED visit rates.
Citation: Myong C, Hull P, Price M . The impact of funding for federally qualified health centers on utilization and emergency department visits in Massachusetts. PLoS One 2020 Dec 3;15(12):e0243279. doi: 10.1371/journal.pone.0243279..
Keywords: Community-Based Practice, Healthcare Utilization, Emergency Department, Healthcare Costs, Access to Care, Vulnerable Populations, Policy
Temkin-Greener H, Guo W, Mao Y
COVID-19 pandemic in assisted living communities: results from seven states.
The purpose of this observational study was to describe variations in COVID-19 confirmed cases and deaths among assisted living (AL) residents and examine their associations with key AL characteristics. The investigators concluded that ALs with a higher proportion of minorities had more COVID-19 cases. Many of the previously identified individual risk factors were also present in this vulnerable population.
AHRQ-funded; HS024923; HS026893; HS026893.
Citation: Temkin-Greener H, Guo W, Mao Y . COVID-19 pandemic in assisted living communities: results from seven states. J Am Geriatr Soc 2020 Dec;68(12):2727-34. doi: 10.1111/jgs.16850..
Keywords: Elderly, Public Health, COVID-19, Nursing Homes, Vulnerable Populations, Risk
Joyce NR, Pfeiffer MR, Zullo AR
Individual and geographic variation in driver's license suspensions: evidence of disparities by race, ethnicity and income.
Using data from the New Jersey Safety Health Outcomes data warehouse 2004-2018, the authors compared characteristics of suspended drivers, their residential census tract, as well as access to public transportation and jobs, by reason for the suspension. They found that 91% of license suspensions were for non-driving-related events, with the most common reason for a suspension being failure to pay a fine. Non-driving-related suspended drivers lived in census tracts with a lower household median income, higher proportion of black and Hispanic residents and higher unemployment rates, but also better walkability scores and better access to public transportation and jobs. They recommended additional work to determine what effect this has for the social and economic well-being of suspended drivers.
Citation: Joyce NR, Pfeiffer MR, Zullo AR . Individual and geographic variation in driver's license suspensions: evidence of disparities by race, ethnicity and income. J Transp Health 2020 Dec;19. doi: 10.1016/j.jth.2020.100933..
Keywords: Racial / Ethnic Minorities, Disparities, Low-Income, Vulnerable Populations, Social Determinants of Health
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
Leifheit KM, Schwartz GL, Pollack CE
Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes.
This study measured the association of severe housing insecurity with adverse birth and infant outcomes. Data was analyzed from 3248 mother-infant dyads enrolled in the Fragile Families and Child Wellbeing Study. This prospective cohort study represented births in 20 large U.S. cities from 1998 to 2000. Severe housing insecurity was defined as threatened eviction or homelessness. Adverse outcomes included low birth weight and/or preterm birth, admission to a neonatal intensive care unit (NICU) or stepdown facility, extended hospitalization after delivery, and infant health and temperament. There were statistically significant associations found between severe housing insecurity during pregnancy and low birth weight and/or preterm births. Housing insecurity and infant fair or poor health and poor temperament were not found to have statistically significant associations. Population attributable fraction (PAF) estimates suggested that up to 3% of adverse birth and infant outcomes could be avoided by eliminating severe housing insecurity among low-income, pregnant women.
Citation: Leifheit KM, Schwartz GL, Pollack CE . Severe housing insecurity during pregnancy: association with adverse birth and infant outcomes. Int J Environ Res Public Health 2020 Nov 21;17(22):8659. doi: 10.3390/ijerph17228659..
Keywords: Pregnancy, Labor and Delivery, Vulnerable Populations, Outcomes, Adverse Events, Women, Low-Income, Newborns/Infants
Chambers EC, Heller C, Fiori K
Chronic pediatric health conditions among youth living in public housing and receiving care in a large hospital system in Bronx, NY.
This study compared the prevalence of chronic pediatric health conditions for youth in public housing with youth not in public housing using clinical electronic health record (EHR) and housing data. Findings showed that disparities in health conditions among youth in public housing were more common in early adolescence: asthma, obesity, depression/anxiety, and behavioral disorders. Chronic pediatric conditions like asthma and obesity that lead to significant morbidity into adulthood are more common among youth living in public housing; however, this pattern is not consistent across all chronic conditions.
Citation: Chambers EC, Heller C, Fiori K . Chronic pediatric health conditions among youth living in public housing and receiving care in a large hospital system in Bronx, NY. Glob Pediatr Health 2020 Nov 11;7:2333794x20971164. doi: 10.1177/2333794x20971164..
Keywords: Children/Adolescents, Vulnerable Populations, Chronic Conditions, Urban Health
Rosenberg J, Rosenthal MS, Cramer LD
Disparities in mental and behavioral health treatment for children and youth in immigrant families.
Children and youth in immigrant families (CIF)-children and youth with at least one foreign-born parent-face unique psychosocial stressors. Yet little is known about access to mental/behavioral health (MBH) services for CIF. Among US CIF and non-CIF with MBH problems, the authors assessed access to MBH treatment using the National Survey of Children's Health-2016, a nationally-representative survey of predominantly English- or Spanish-speaking US parents.
Citation: Rosenberg J, Rosenthal MS, Cramer LD . Disparities in mental and behavioral health treatment for children and youth in immigrant families. Acad Pediatr 2020 Nov-Dec;20(8):1148-56. doi: 10.1016/j.acap.2020.06.013..
Keywords: Children/Adolescents, Behavioral Health, Disparities, Racial / Ethnic Minorities, Vulnerable Populations, Access to Care
Dir AL, Clifton RL
Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth
This study examined court records of drug screens among youth to explore patterns of substance use as well as rates of court-ordered referral to substance use treatment and treatment completion. Of the studied youth with a positive oral drug screen, 96% tested positive for cannabis and 9.8% for opioids at least once; 48.5% were court-ordered to substance use treatment. Of those referred, 67% had history of completing at least one treatment episode. These results underscore the need to utilize objective measures as well as validated self-reports of substance use history in both research and justice system decision-making to aid in identifying youth in need of services.
AHRQ-funded; HS022681; HS023318.
Citation: Dir AL, Clifton RL . Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth J Subst Abuse Treat 2020 Nov;118:108095. doi: 10.1016/j.jsat.2020.108095..
Keywords: Children/Adolescents, Substance Abuse, Screening, Vulnerable Populations
Magee LA, Dir AL, Clifton RL
Patterns of adolescent gun carrying and gun-related crime arrests in Indianapolis, Indiana over an 11-year time period.
This study is a descriptive epidemiology analysis that examines patterns of gun carrying and gun-related crime arrests among justice-involved youth in Marion County, Indiana. Findings indicated that the proportions of juvenile arrests for both gun carrying and gun-related crime have substantially increased compared to ten years ago. The majority of gun-related repeat offenders were first arrested for gun carrying; thus, these gun-carrying arrests may be an opportunity to intervene on an individual level by providing treatment, other needed resources, and discussing safe firearm storage with families and communities.
AHRQ-funded; HS023318; HS022681.
Citation: Magee LA, Dir AL, Clifton RL . Patterns of adolescent gun carrying and gun-related crime arrests in Indianapolis, Indiana over an 11-year time period. Prev Med 2020 Oct;139:106199. doi: 10.1016/j.ypmed.2020.106199..
Keywords: Children/Adolescents, Vulnerable Populations, Prevention
Lara OD, O'Cearbhaill RE, Smith MJ
COVID-19 outcomes of patients with gynecologic cancer in New York City.
Researchers studied clinical characteristics and outcomes of vulnerable populations with gynecologic cancer who developed COVID-19 infections. Among patients from six New York City area hospital systems with known gynecologic cancer and a COVID-19 diagnosis, the researchers found a case fatality rate of 14 percent, with no association between cytotoxic chemotherapy and cancer-directed surgery and COVID-19 severity or death. They recommended that patients be counseled regarding the safety of continued anticancer treatments during the pandemic, as the ability to continue cancer therapies for cancer control and cure is critical.
Citation: Lara OD, O'Cearbhaill RE, Smith MJ . COVID-19 outcomes of patients with gynecologic cancer in New York City. Cancer 2020 Oct 1;126(19):4294-303. doi: 10.1002/cncr.33084..
Keywords: COVID-19, Respiratory Conditions, Cancer, Women, Vulnerable Populations, Outcomes, Urban Health
Vasan A, Morgan JW, Mitra N
Effects of a standardized community health worker intervention on hospitalization among disadvantaged patients with multiple chronic conditions: a pooled analysis of three clinical trials.
The purpose of this study was to analyze the effects of a standardized community health worker (CHW) intervention on hospitalization. The investigators concluded that data from three randomized clinical trials across multiple settings showed that a standardized CHW intervention reduced total hospital days and hospitalizations outside the primary health system. They indicated that this study was the largest analysis of randomized trials to demonstrate reductions in hospitalization with a health system-based social intervention.
Citation: Vasan A, Morgan JW, Mitra N . Effects of a standardized community health worker intervention on hospitalization among disadvantaged patients with multiple chronic conditions: a pooled analysis of three clinical trials. Health Serv Res 2020 Oct;55(Suppl 2):894-901. doi: 10.1111/1475-6773.13321..
Keywords: Hospitalization, Chronic Conditions, Vulnerable Populations, Social Determinants of Health, Community-Based Practice
Chaiyachati BH, Wood JN, Mitra N
All-cause mortality among children in the US foster care system, 2003-2016.
This letter provides data from a cross-sectional analysis of the Adoption and Foster Care Analysis and Reporting System on mortality rates among children in the US foster care system compared to the general population. The rate was found to be significantly higher for children in foster care (35.4 deaths per 100,000 person-years vs 25.0 for the general population). The highest mortality rates were among African-American children at 43.8 deaths per 100,000 person-years. Older children ages 15-18 had the highest mortality rate per years. Two major limitations of the analysis are that children in foster care are unable to be excluded from the Centers for Disease Control and Prevention data file, and more deaths in foster care were excluded relative to person-years in foster care because of incomplete demographic data.
Citation: Chaiyachati BH, Wood JN, Mitra N . All-cause mortality among children in the US foster care system, 2003-2016. JAMA Pediatr 2020 Sep;174(9):896-98. doi: 10.1001/jamapediatrics.2020.0715..
Keywords: Children/Adolescents, Vulnerable Populations, Mortality
Rael CT, Giguere R, Lopez-Rios J
Transgender women's experiences using a home HIV-testing kit for partner-testing.
HIV partner-testing (PT) may represent a unique and empowering HIV prevention strategy for groups that face structural and institutional barriers to HIV testing and care, including transgender women. In this study, the investigators reported on in-depth interviews (IDIs) with transgender women who used HIV self-test kits for three months to screen potential sexual partners in a randomized controlled trial that took place in New York City and San Juan, Puerto Rico.
Citation: Rael CT, Giguere R, Lopez-Rios J . Transgender women's experiences using a home HIV-testing kit for partner-testing. AIDS Behav 2020 Sep;24(9):2732-41. doi: 10.1007/s10461-020-02829-x..
Keywords: Human Immunodeficiency Virus (HIV), Prevention, Vulnerable Populations, Women, Patient Experience, Screening
Luk JW, Parker EO, Richardson LP
Sexual attraction and experiences in the primary care setting: examining disparities in satisfaction with provider and health self-efficacy.
This study examines whether sexual minority adolescents report lower satisfaction with primary care providers and lower health self-efficacy compared to heterosexual males and females. Data from 535 adolescents who participated in one of two randomized clinical trials were analyzed. Both sets of adolescents reported high satisfaction with providers. Relative to heterosexual males, sexual minority males reported lower self-efficacy in reaching health goals. Sexual minority females reported lower confidence in positively impacting their own health and lower self-efficacy in setting health goals compared to heterosexual females.
Citation: Luk JW, Parker EO, Richardson LP . Sexual attraction and experiences in the primary care setting: examining disparities in satisfaction with provider and health self-efficacy. J Adolesc 2020 Jun;81:96-100. doi: 10.1016/j.adolescence.2020.04.009..
Keywords: Children/Adolescents, Patient Experience, Primary Care, Clinician-Patient Communication, Vulnerable Populations, Disparities
Ruggeri K, Folke T, Benzerga A
Nudging New York: adaptive models and the limits of behavioral interventions to reduce no-shows and health inequalities.
Missed healthcare appointments (no-shows) are costly and operationally inefficient for health systems. No-show rates are particularly high for vulnerable populations, even though these populations often require additional care. The purpose of this study was to identify predictors of no-show behavior and to analyze the effects of a reminder intervention in urban FQHCs in order to design effective policy solutions to a protracted issue in healthcare.
Citation: Ruggeri K, Folke T, Benzerga A . Nudging New York: adaptive models and the limits of behavioral interventions to reduce no-shows and health inequalities. BMC Health Serv Res 2020 Apr 26;20(1):363. doi: 10.1186/s12913-020-05097-6..
Keywords: Patient Adherence/Compliance, Disparities, Vulnerable Populations
Kang JX, Levanon Seligson A, Dragan KL
Identifying New York City neighborhoods at risk of being overlooked for interventions.
Public health agencies are often faced with difficult decisions about where and how to allocate funding and resources. In this study, the investigators walked readers through a process of identifying needs across different neighborhoods in New York City (NYC) by examining community district-level health outcomes using data from published Community Health Profile reports released by the NYC Department of Health and Mental Hygiene (DOHMH) in 2015.
Citation: Kang JX, Levanon Seligson A, Dragan KL . Identifying New York City neighborhoods at risk of being overlooked for interventions. Prev Chronic Dis 2020 Apr 23;17:E32. doi: 10.5888/pcd17.190325..
Keywords: Public Health, Disparities, Urban Health, Vulnerable Populations
Ornelas IJ, Yamanis TJ, Ruiz RA
The health of undocumented Latinx immigrants: what we know and future directions.
This review article summarizes the limited but growing literature on the health of undocumented Latinx immigrations and how exposure to trauma, immigration enforcement, changes to social networks, and discrimination negatively affect their mental and physical health. The authors discuss how policies and social ties can promote their health. They focus on areas of concern and recommend how future research should be conducted.
Citation: Ornelas IJ, Yamanis TJ, Ruiz RA . The health of undocumented Latinx immigrants: what we know and future directions. Annu Rev Public Health 2020 Apr 2;41:289-308. doi: 10.1146/annurev-publhealth-040119-094211..
Keywords: Racial / Ethnic Minorities, Vulnerable Populations, Social Determinants of Health, Policy
Desai AD, Zhou C, Haaland W
Social disadvantage, access to care, and disparities in physical functioning among children hospitalized with respiratory illness.
This study examined associations between social disadvantage, access to care, and disparities in physical functioning among children hospitalized with acute respiratory illness. The study cohort included children ages 8-16 years and/or caregivers of children 2 weeks to 16 years admitted to five tertiary care children’s hospitals for three common respiratory illnesses from July 2014 through June 2016. Surveys were completed within 2 to 8 weeks after discharge. The survey assessed social disadvantage, difficulty/delays accessing care, and baseline and follow-up health-related quality of life (HRQoL), and physical functioning using the Pediatric Quality of Life Inventory (PedsQL). A total of 1,325 patients and/or their caregivers completed both PedsQL surveys. Adjusted mean baseline PedsQL scores were significantly lower for patients with social disadvantage (minority race/ethnicity, limited English proficiency, low education, and low income), than for patients with none. There were also disadvantage markers or difficulty/delays accessing care which were associated with lower physical functioning. However, these differences were reduced after hospital discharge.
Citation: Desai AD, Zhou C, Haaland W . Social disadvantage, access to care, and disparities in physical functioning among children hospitalized with respiratory illness. J Hosp Med 2020 Apr;15(4):211-18. doi: 10.12788/jhm.3359..
Keywords: Children/Adolescents, Respiratory Conditions, Hospitalization, Access to Care, Disparities, Vulnerable Populations, Quality of Life
Heller CG, Parsons AS, Chambers EC
Social risks among primary care patients in a large urban health system.
The objective of this study was to understand the variability in the number and types of social risks overall and in population subgroups among primary care patients routinely screened in a large urban health system. Participants across nineteen ambulatory sites in the Bronx, New York, completed a 10-item screener. Findings showed that there were important differences in the prevalence of overall and individual social risks by subgroup. These findings should be considered to inform clinical care and social risk screening and interventions.
Citation: Heller CG, Parsons AS, Chambers EC . Social risks among primary care patients in a large urban health system. Am J Prev Med 2020 Apr;58(4):514-25. doi: 10.1016/j.amepre.2019.11.011..
Keywords: Social Determinants of Health, Primary Care, Urban Health, Risk, Vulnerable Populations
Ellis RJ, Schlick CJR, Feinglass J
Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot?
This study examined hospital variation in cancer patients who did not receive recommended chemotherapy. Patients with breast, colon, and lung cancers who did not receive chemotherapy from 2000 to 2015 were identified from the National Cancer Database. A total of 183,148 patients at 1281 hospitals were included. For breast cancer, 3.5% of patients failed to receive recommended chemotherapy, and 6.6% with colon, and 10.7% with lung cancer. Sociodemographic factors showed that patients were less likely to receive chemotherapy if they were uninsured or on Medicaid, as were non-Hispanic black patients with both breast and colon cancer. There was also significant hospital variation with failure to administer as high as 21.8% for breast, 40.2% for colon, and 40.0% for lung cancer.
AHRQ-funded; HS000078; HS026385.
Citation: Ellis RJ, Schlick CJR, Feinglass J . Failure to administer recommended chemotherapy: acceptable variation or cancer care quality blind spot? BMJ Qual Saf 2020 Feb;29(2):103-12. doi: 10.1136/bmjqs-2019-009742..
Keywords: Treatments, Cancer, Healthcare Delivery, Access to Care, Healthcare Utilization, Social Determinants of Health, Vulnerable Populations, Uninsured, Hospitals, Quality of Care
Acree ME, McNulty M, Blocker O
Shared decision-making around anal cancer screening among black bisexual and gay men in the USA.
This study focused on shared decision-making on anal cancer screening among black gay and bisexual men in the US. The researchers conducted 30 semi-structured one-on-one interviews and two focus groups in 2016-2017. Out of forty-five participants, all were black and male, with 13 identified as bisexual and 32 as gay. Barriers to screening include internalized racism, biphobia/homophobia, provider bias lead to reduced healthcare engagement and discomfort discussing sexual practices which hindered shared decision-making.
Citation: Acree ME, McNulty M, Blocker O . Shared decision-making around anal cancer screening among black bisexual and gay men in the USA. Cult Health Sex 2020 Feb;22(2):201-16. doi: 10.1080/13691058.2019.1581897..
Keywords: Decision Making, Cancer, Screening, Prevention, Racial / Ethnic Minorities, Vulnerable Populations
Giguere R, Lopez-Rios J, Frasca T
Use of HIV self-testing kits to screen clients among transgender female sex workers in New York and Puerto Rico.
This research focused on the use of HIV self-testing (HIVST) kits given to transgender female sex workers (TFSW) to screen sexual partners. Ten TFSWs were given ten HIVST kits each and they complete an online questionnaire 3 months later or underwent an interview. Eight of them reported using the test kit with potential clients or partners. The majority who were asked to test were clients (84%). Out of those 50 potential partners or clients, 34 out of 50 accepted and 16 refused. Participants felt empowered but the market cost of these kits is prohibitive and could only be implemented if the costs were lowered or subsidized.
Citation: Giguere R, Lopez-Rios J, Frasca T . Use of HIV self-testing kits to screen clients among transgender female sex workers in New York and Puerto Rico. AIDS Behav 2020 Feb;24(2):506-15. doi: 10.1007/s10461-019-02730-2..
Keywords: Human Immunodeficiency Virus (HIV), Vulnerable Populations, Diagnostic Safety and Quality, Sexual Health, Patient Self-Management, Women
Mackie TI, Cook S, Crystal S
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
This study examined a multimodal antipsychotic intervention implemented by a specialized Medicaid managed care organization (MMCO) for youths in foster care with routine mental health screening, health passports, elective psychiatric consultation line, and retrospective drug utilization reviews to determine whether this multimodal intervention significantly reduced antipsychotic dispensing for youths with conditions without US Food and Drug Administration (FDA)-approved indications. Findings showed that MMCO implementation significantly reduced antipsychotic medications without FDA-indicated conditions prescribed to youths, while not significantly affecting antipsychotic medications prescribed to youths with FDA-indicated conditions.
Citation: Mackie TI, Cook S, Crystal S . Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention. J Am Acad Child Adolesc Psychiatry 2020 Jan;59(1):166-76.e3. doi: 10.1016/j.jaac.2019.04.022..
Keywords: Children/Adolescents, Behavioral Health, Medication, Vulnerable Populations, Medicaid, Health Insurance
Perrin PB, Sutter ME, Trujillo MA
The minority strengths model: development and initial path analytic validation in racially/ethnically diverse LGBTQ individuals.
This study created and initially validated the minority strengths model, which outlines how personal and collective strengths in minority populations create resilience and positive mental and physical health. A national online survey was answered by a study sample of lesbian, gay, bisexual, transgender, and queer individuals from diverse racial/ethnic backgrounds. Findings showed that the minority strengths model holds promise to stimulate research on the personal and collective strengths of minority populations and the ways in which strengths generate resilience and positive mental and physical health.
Citation: Perrin PB, Sutter ME, Trujillo MA . The minority strengths model: development and initial path analytic validation in racially/ethnically diverse LGBTQ individuals. J Clin Psychol 2020 Jan;76(1):118-36. doi: 10.1002/jclp.22850..
Keywords: Racial / Ethnic Minorities, Vulnerable Populations
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