National Healthcare Quality and Disparities Report
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Topics
- Access to Care (6)
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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
51 to 75 of 92 Research Studies DisplayedGettel CJ, Canavan ME, D'Onofrio G
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
This study looked at the clinical focus of emergency department (ED) workers using the 2017 Medicare Public Use Files for clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services for Medicare fee-for-service Part B. Clinicians were categorized as EM physicians, non-EM physicians, and advanced practice providers (APPs). Of the 65,710 unique clinicians providing care, 59.4% were classified as EM physicians, 12.4% as non-EM physicians, and 28.5% as APPs. EM physicians have twice as much clinician median focus in comparison to EM physicians providing emergency care (92.8% vs 45.2) and APPs are focused 100%.
AHRQ-funded; HS023614.
Citation: Gettel CJ, Canavan ME, D'Onofrio G .
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
Am J Emerg Med 2021 Apr;42:228-32. doi: 10.1016/j.ajem.2020.11.069..
Keywords: Emergency Department, Workforce, Provider: Physician, Provider: Clinician, Provider, Medicare
Chen G, Lewis VA, Gottlieb D
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
This study looked at the effects of accountable care organizations (ACOs) on lowering health care costs and reducing the rate of hospital readmissions. The authors used Medicare fee-for-service claims data from 2009-2014 to estimate the heterogenous effects of Medicare ACO programs on hospital admissions across hospital referral regions and provider groups. The results suggested that the ACO programs reduced the rate of readmission to hospitals, and that the effect of joining an ACO varied considerably across medical groups.
AHRQ-funded; HS024075.
Citation: Chen G, Lewis VA, Gottlieb D .
Estimating heterogeneous effects of a policy intervention across organizations when organization affiliation is missing for the control group: application to the evaluation of accountable care organizations.
Health Serv Outcomes Res Methodol 2021 Mar;21(1):54-68. doi: 10.1007/s10742-020-00230-8..
Keywords: Medicare, Policy, Healthcare Costs, Hospital Readmissions, Health Insurance
Wang J, Ying M, Temkin-Greener H
Utilization and functional outcomes among Medicare home health recipients varied across living situations.
Home health (HH) is a major type of home-based skilled care available to Medicare beneficiaries. In this study, the investigators examined the association between living situation and utilization and functional outcomes among Medicare HH recipients. The investigators concluded that, in the study population, patients living with others at home had the highest risk of hospitalization and ED visits, whereas assisted living (AL) residents had the lowest risk of hospitalization and patients living alone at home had the lowest risk of ED visits.
AHRQ-funded; HS026893.
Citation: Wang J, Ying M, Temkin-Greener H .
Utilization and functional outcomes among Medicare home health recipients varied across living situations.
J Am Geriatr Soc 2021 Mar;69(3):704-10. doi: 10.1111/jgs.16949..
Keywords: Home Healthcare, Medicare, Outcomes
McCoy RG, Van Houten HK, Deng Y
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
Investigators sought to compare trends in initiation of treatment with GLP-1RA, SGLT2i, and DPP-4i by older adults with type 2 diabetes insured by Medicare Advantage vs commercial health plans. They found that Medicare Advantage beneficiaries may be less likely than commercially insured beneficiaries to be treated with newer medications to lower glucose levels, with greater disparities among lower-income patients. They recommended further investigation of nonclinical factors contributing to treatment decisions and efforts to promote greater equity in diabetes management.
AHRQ-funded; HS025164.
Citation: McCoy RG, Van Houten HK, Deng Y .
Comparison of diabetes medications used by adults with commercial insurance vs Medicare Advantage, 2016 to 2019.
JAMA Netw Open 2021 Feb;4(2):e2035792. doi: 10.1001/jamanetworkopen.2020.35792..
Keywords: Elderly, Diabetes, Chronic Conditions, Medication, Medicare, Health Insurance, Disparities, Low-Income
Meyers DJ, Trivedi AN, Wilson IB, DJ, Trivedi AN, Wilson IB
Higher Medicare Advantage Star Ratings are associated with improvements In patient outcomes.
Researchers examined CMS' five-star rating system for the overall quality of Medicare Advantage (MA) contracts. They found that enrollees experiencing a one-star MA rating increase were 20.8 percent less likely to leave their plan voluntarily to enroll in another plan or traditional Medicare. When hospitalized, enrollees were 3.4 percent more likely to use a higher-quality hospital and 2.6 percent less likely to be readmitted within ninety days. These findings suggest that MA star ratings may capture key domains of an MA plan's quality.
AHRQ-funded; HS027051.
Citation: Meyers DJ, Trivedi AN, Wilson IB, DJ, Trivedi AN, Wilson IB .
Higher Medicare Advantage Star Ratings are associated with improvements In patient outcomes.
Health Aff 2021 Feb;40(2):243-50. doi: 10.1377/hlthaff.2020.00845..
Keywords: Patient Experience, Provider Performance, Medicare, Quality Improvement, Quality of Care, Outcomes
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
Kuo YF, Lin YL, D Jupiter, et al.
How to identify team-based primary care in the United States using Medicare data.
The authors assessed whether analyses using different sets of Medicare data can produce results similar to those from analyses using 100% data from an entire state in identifying primary care teams through social network analysis. They found that, depending on specific study purposes, researchers could use either 100% data from Medicare beneficiaries in randomly selected primary care services areas or data from a 20% national sample of Medicare beneficiaries to study team-based primary care in the United States.
AHRQ-funded; HS020642.
Citation: Kuo YF, Lin YL, D Jupiter, et al..
How to identify team-based primary care in the United States using Medicare data.
Med Care 2021 Feb;59(2):118-22. doi: 10.1097/mlr.0000000000001478.
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Keywords: Teams, Primary Care: Models of Care, Primary Care, Medicare, Health Services Research (HSR), Healthcare Delivery
Sanchez JI, Shankaran V, Unger JM
Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.
After colorectal cancer (CRC) surgery, surveillance with colonoscopy is an important step for the early detection of local recurrence. Unfortunately, surveillance colonoscopy is underused, especially among racial/ethnic minorities. This study assessed the association between patient and neighborhood factors and receipt of surveillance colonoscopy. The investigators concluded that receipt of initial surveillance colonoscopy remained low, and that there were acute disparities between Black and NHW patients.
AHRQ-funded; HS013853.
Citation: Sanchez JI, Shankaran V, Unger JM .
Inequitable access to surveillance colonoscopy among Medicare beneficiaries with surgically resected colorectal cancer.
Cancer 2021 Feb;127(3):412-21. doi: 10.1002/cncr.33262..
Keywords: Colonoscopy, Cancer: Colorectal Cancer, Cancer, Access to Care, Screening, Prevention, Disparities, Medicare
Modi PK, Kaufman SR, Caram ME
Medicare Accountable Care Organizations and the adoption of new surgical technology.
Dissemination of new surgical technology is a major contributor to healthcare spending growth. Accountable care organization (ACO) policy aims to control spending while maintaining quality. As a result, ACOs provide incentive for hospitals to selectively adopt newer procedures with high value. In this retrospective cohort study the investigators concluded that despite ACO policy incentives to selectively adopt newer surgical technology, ACO participation was not associated with differences in rate of surgery or use of newer surgical technology for 6 major surgical procedures.
AHRQ-funded; HS025707.
Citation: Modi PK, Kaufman SR, Caram ME .
Medicare Accountable Care Organizations and the adoption of new surgical technology.
J Am Coll Surg 2021 Feb;232(2):138-45.e2. doi: 10.1016/j.jamcollsurg.2020.10.016..
Keywords: Medicare, Surgery, Policy, Healthcare Costs
Feder SL, Canavan ME, Wang S
Patterns of opioid prescribing among Medicare Advantage beneficiaries with pain and cardiopulmonary conditions.
This study’s objective was to compare patterns of opioid prescribing among older adults reporting pain with cardiopulmonary conditions, cancer, or both. Data from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey resource linked to Medicare Part D prescription claims was used to identify patients who self-reported moderate- to-severe pain interference with daily activities. Patients included were stratified by 1) self-reported history of cardiopulmonary conditions; 2) were within five years of cancer diagnosis; 3) had both conditions; or 4) neither. Of 10,516 patients identified, 1758 had cardiopulmonary conditions, 3383 cancer, 2861 both, and 2514 neither: with 46% aged 75 or more, 65% non-Hispanic white, and 10% non-Hispanic black. At the time of the survey, 1627 (15.5%) received opioids. Adjusted proportions of opioid use were similar for all conditions, with 14% for cardiopulmonary conditions only, 17% with cancer only, and 17% for both conditions. Patients with neither condition had a 13.1% opioid use rate.
AHRQ-funded; HS022882; HS025164.
Citation: Feder SL, Canavan ME, Wang S .
Patterns of opioid prescribing among Medicare Advantage beneficiaries with pain and cardiopulmonary conditions.
J Palliat Med 2021 Feb;24(2):195-204. doi: 10.1089/jpm.2020.0193..
Keywords: Elderly, Opioids, Medication, Practice Patterns, Medicare
Mafi JN, Reid RO, Baseman LH
Trends in low-value health service use and spending in the US Medicare fee-for-service program, 2014-2018.
Researchers sought to assess national trends in low-value care use and spending. In this cross-sectional study, they found that among individuals with fee-for-service Medicare receiving any of 32 measured services, low-value care use and spending decreased marginally from 2014 to 2018, despite a national education campaign in collaboration with clinician specialty societies and increased attention on low-value care. While most use of low-value care came from three services, one of these was opioid prescriptions, which increased over time despite the harms associated with their use. They concluded that their findings may represent several opportunities to prevent patient harm and lower spending.
AHRQ-funded; HS024067.
Citation: Mafi JN, Reid RO, Baseman LH .
Trends in low-value health service use and spending in the US Medicare fee-for-service program, 2014-2018.
JAMA Netw Open 2021 Feb;4(2):e2037328. doi: 10.1001/jamanetworkopen.2020.37328..
Keywords: Medicare, Healthcare Costs
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
Fung V, Price M, Hull P
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
The purpose of this study was to examine the association between the Affordable Care Act (ACA) fee bump and primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Medicare claims data from 2012 to 2016 was used. Findings showed that the ACA fee bump was not associated with increases in primary care visits for dual-eligible Medicare and Medicaid beneficiaries. Additionally, visits for dual-eligible beneficiaries with primary care physicians decreased after the ACA, a decrease that was partially offset by increases in visits with nonphysician clinicians.
AHRQ-funded; HS024725; HS025378.
Citation: Fung V, Price M, Hull P .
Assessment of the Patient Protection and Affordable Care Act's increase in fees for primary care and access to care for dual-eligible beneficiaries.
JAMA Netw Open 2021 Jan;4(1):e2033424. doi: 10.1001/jamanetworkopen.2020.33424..
Keywords: Access to Care, Medicaid, Medicare, Health Insurance, Healthcare Costs, Policy
Fraze TK, Beidler LB, Briggs ADM
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
Researchers sought to understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs. After conducting semi-structured interviews with Medicare ACOs, they found that ACOs were using care plans for patients with complex needs, but their use of care plans did not always meet the best practices; ACOs were adapting use of care plans to better fit the needs of patients and providers.
AHRQ-funded; HS024075.
Citation: Fraze TK, Beidler LB, Briggs ADM .
Translating evidence into practice: ACOs' use of care plans for patients with complex health needs.
J Gen Intern Med 2021 Jan;36(1):147-53. doi: 10.1007/s11606-020-06122-4..
Keywords: Implementation, Evidence-Based Practice, Medicare, Health Insurance, Healthcare Delivery
Schmittdiel J, Raebel M, Dyer W
Medicare Star excludes diabetes patients with poor CVD risk factor control.
This study is designed to improve understanding of novel CMS quality measures (adherence to antihypertensives, antihyperlipidemics, and oral antihyperglycemics) by assessing the proportion of Medicare patients with diabetes who are excluded from the Medicare Star medication adherence metrics due to early nonadherence and insulin use. Medicare’s STAR measures are used to evaluate the performance of Medicare Advantage plans.
AHRQ-funded; HS019859
Citation: Schmittdiel J, Raebel M, Dyer W .
Medicare Star excludes diabetes patients with poor CVD risk factor control.
Am J Manag Care. 2014 Dec; 20(12):e573-81..
Keywords: Medicare, Diabetes, Quality Measures, Patient Adherence/Compliance
Bilchick KC, Stukenborg GJ
Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration.
The researchers examined the long-term outcomes among Medicare patients with cardiac resynchronization therapy defibrillators (CRT-D) compared with those receiving standard implantable cardioverter defibrillators. They found that the greatest benefit of CRT-D was in patients with guideline-based class I recommendations for CRT-D. For these patients, there was a 17 percent reduction in risk of death.
AHRQ-funded; HS017693
Citation: Bilchick KC, Stukenborg GJ .
Comparative effectiveness of cardiac resynchronization therapy in combination with implantable defibrillator in patients with heart failure and wide QRS duration.
Am J Cardiol. 2014 Nov 15;114(10):1537-42. doi: 10.1016/j.amjcard.2014.08.017..
Keywords: Comparative Effectiveness, Medicare, Outcomes, Cardiovascular Conditions, Medical Devices
Du DT, McKean SJ, Kelman JA, et al.
AHRQ Author: Encinosa W
Early mortality after aortic valve replacement with mechanical prosthetic vs bioprosthetic valves among Medicare beneficiaries: a population-based cohort study.
The researchers compared early mortality after aortic valve replacement (AVR) between the recipients of mechanical and bioprosthetic aortic valves. Among 66,453 Medicare beneficiaries who received AVRs, use of mechanical valves was associated with a higher risk for death on the date of surgery and within 30 days compared with the bioprosthetic aortic valves. However, this applied only to those who underwent concurrent AVR and coronary artery bypass graft but not isolated AVR.
AHRQ-authored
Citation: Du DT, McKean SJ, Kelman JA, et al..
Early mortality after aortic valve replacement with mechanical prosthetic vs bioprosthetic valves among Medicare beneficiaries: a population-based cohort study.
JAMA Intern Med. 2014 Nov;174(11):1788-95. doi: 10.1001/jamainternmed.2014.4300..
Keywords: Cardiovascular Conditions, Medicare, Mortality, Patient-Centered Outcomes Research, Surgery
Trish E, Joyce G, Goldman DP
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
The authors analyzed trends in specialty drug spending among Medicare beneficiaries ages sixty-five and older using 2007-11 pharmacy claims data. They found that annual specialty drug spending per beneficiary who used specialty drugs increased considerably during the study period, but specialty drugs accounted for less than ten percent of total drug spending per beneficiary. Additionally, in 2011, cost-sharing reductions under the Affordable Care Act significantly reduced specialty drug users' out-of-pocket burden, which decreased 26 percent from 2010.
AHRQ-funded; HS000046.
Citation: Trish E, Joyce G, Goldman DP .
Specialty drug spending trends among Medicare and Medicare Advantage enrollees, 2007-11.
Health Aff 2014 Nov;33(11):2018-24. doi: 10.1377/hlthaff.2014.0538.
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Keywords: Healthcare Costs, Health Insurance, Medicare, Medication
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
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
Eckenrode S, Bakullari A, Metersky ML
The association between age, sex, and hospital-acquired infection rates: results from the 2009-2011 National Medicare Patient Safety Monitoring System.
The researchers, using six different measures of hospital-acquired infections (HAIs), analyzed data from a large national sample of patients admitted to the hospital with acute cardiovascular disease, pneumonia, and major surgery to determine to determine age- and sex-related differences in HAI rates. They found that there are no simple ways to focus HAI-prevention efforts based solely on age or sex.
AHRQ-funded; 290201200003C
Citation: Eckenrode S, Bakullari A, Metersky ML .
The association between age, sex, and hospital-acquired infection rates: results from the 2009-2011 National Medicare Patient Safety Monitoring System.
Infect Control Hosp Epidemiol. 2014 Oct;35 Suppl 3:S3-9. doi: 10.1086/677831..
Keywords: Healthcare-Associated Infections (HAIs), Patient Safety, Medicare, Critical Care
Cook EA, Schneider KM, Robinson J
Field methods in medical record abstraction: assessing the properties of comparative effectiveness estimates.
Comparative effectiveness studies using Medicare claims data are vulnerable to treatment selection biases and supplemental data from a sample of patients has been recommended for examining the magnitude of this bias. The investigators collected medical record data from a subsample of patients to assess the validity of assumptions and to aid in the interpretation of our estimates. In this paper, they sought to describe and document the process used to collect and validate this supplemental information.
AHRQ-funded; HS018381.
Citation: Cook EA, Schneider KM, Robinson J .
Field methods in medical record abstraction: assessing the properties of comparative effectiveness estimates.
BMC Health Serv Res 2014 Sep 15;14:391. doi: 10.1186/1472-6963-14-391..
Keywords: Comparative Effectiveness, Medicare, Evidence-Based Practice, Research Methodologies
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
Yehia BR, Fleishman JA, Agwu AL
AHRQ Author: Fleishman JA
Health insurance coverage for persons in HIV care, 2006-2012.
The authors examined trends in health insurance coverage at 11 US HIV clinics between 2006 and 2012. They found that Medicaid coverage was more prevalent among women than men; blacks and Hispanics than whites; and individuals with injection drug use risk compared with other transmission risk factors, with Hispanics and younger age groups more likely to be uninsured than other racial/ethnic and older age groups, respectively.
AHRQ-authored; AHRQ-funded; 290201100007C.
Citation: Yehia BR, Fleishman JA, Agwu AL .
Health insurance coverage for persons in HIV care, 2006-2012.
J Acquir Immune Defic Syndr 2014 Sep 1;67(1):102-6. doi: 10.1097/qai.0000000000000251.
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Keywords: Health Insurance, Human Immunodeficiency Virus (HIV), Medicare, Racial and Ethnic Minorities, Uninsured