National Healthcare Quality and Disparities Report
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- Access to Care (1)
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- (-) Asthma (22)
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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
1 to 22 of 22 Research Studies DisplayedAndrews AL, Brinton DL, Simpson AN
A comparison of administrative claims-based risk predictors for pediatric asthma.
This retrospective cohort study used 2013-2014 MarketScan Medicaid data to compare administrative claims-based risk predictors of emergency department (ED) visits for pediatric asthma. The cohort included were children aged 2 to 17 years. Seven risk predictors were compared for 3-month subsequent ED visits/hospitalizations: 3-month rolling asthma medication ratio (AMR), Healthcare Effectiveness Data and Information Set (HEDIS) criteria, revised HEDIS criteria, quarterly short-acting β-agonist (SABA) claims, prior ED visit, prior hospitalization, and prior ED visit or hospitalization. Sensitivity, specificity, positive and negative predictive value (PPV and NPV), and percentage of population identified as high risk were compared for each risk predictor utilization the McNemar test. Cohort total population was 214,452 children with a mean age of 7.8 years. HEDIS and revised HEDIS identified prohibitively large cohorts as high-risk (67% and 48%). For the remaining measures, the NPV range was 97% to 99%, indicating high performance at identifying patients who would not benefit from intervention using AMR and SABA count. Superior sensitivities were found for ED visit and ED/hospitalization measures compared with pharmacy claims-based measures.
AHRQ-funded; HS026783.
Citation: Andrews AL, Brinton DL, Simpson AN .
A comparison of administrative claims-based risk predictors for pediatric asthma.
Am J Manag Care 2021 Dec;27(12):533-37. doi: 10.37765/ajmc.2021.88792..
Keywords: Asthma, Respiratory Conditions, Chronic Conditions, Risk
Parikh K, Hall M, Kaiser SV
Development of a health disparities index: proof of concept with chest radiography in asthma.
The objective of this study was to develop a tool for quantifying health disparity (Health Disparity Index[HDI]) and explore hospital variation measured by this index using chest radiography (CXR) in asthma as the proof of concept. The investigators concluded that the HDI provided a practical measure of disparity. They suggested that to improve equity in healthcare, metrics are needed that are intuitive, accurate, usable, and actionable.
AHRQ-funded; HS016418.
Citation: Parikh K, Hall M, Kaiser SV .
Development of a health disparities index: proof of concept with chest radiography in asthma.
J Pediatr 2021 Nov;238:290-95.e1. doi: 10.1016/j.jpeds.2021.07.022..
Keywords: Asthma, Respiratory Conditions, Disparities
Schechter S, Jaladanki S, Rodean J
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
Community hospitals, which care for most hospitalised children in the USA, may be vulnerable to declines in paediatric care quality when quality improvement (QI) initiatives end. In this study, the investigators aimed to evaluate changes in care quality in community hospitals after the end of the Pathways for Improving Paediatric Asthma Care (PIPA) national QI collaborative. The investigators concluded that the end of the paediatric asthma QI collaborative was associated with concerning declines in guideline adherence in community hospitals.
AHRQ-funded; HS027041.
Citation: Schechter S, Jaladanki S, Rodean J .
Sustainability of paediatric asthma care quality in community hospitals after ending a national quality improvement collaborative.
BMJ Qual Saf 2021 Nov;30(11):876-83. doi: 10.1136/bmjqs-2020-012292..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Hospitals, Quality Improvement, Quality of Care
Nair AA, Farber HJ, Chen H
Utilization of opioid versus non-opioid analgesics in Medicaid and CHIP enrolled children with current asthma.
Opioid analgesics are frequently dispensed in children despite its known risk in children with a compromised airway function. The objectives of the study were to assess the prevalence of opioid analgesic dispensing in children with current asthma and to identify patient and prescriber factors associated with the dispensing of opioid versus non-opioid analgesics. The investigators concluded that opioid analgesics are frequently dispensed to children with asthma. A higher dispensing rate was observed among non-Hispanic White children and among those with a history of uncontrolled asthma.
AHRQ-funded; HS026790.
Citation: Nair AA, Farber HJ, Chen H .
Utilization of opioid versus non-opioid analgesics in Medicaid and CHIP enrolled children with current asthma.
Pharmacoepidemiol Drug Saf 2021 Nov;30(11):1520-31. doi: 10.1002/pds.5336..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Opioids, Medication, Asthma, Respiratory Conditions
Rudin RA, Perez S, Rodriguez JA
User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care.
The objective of this study was to determine user and electronic health records (EHR) integration requirements for a scalable remote symptom monitoring intervention for asthma patients and their providers. Using the NASSS framework to guide their user-centered design process, the investigators identified patient and provider requirements for scaling an EHR-integrated remote symptom monitoring intervention in primary care.
AHRQ-funded; HS026432.
Citation: Rudin RA, Perez S, Rodriguez JA .
User-centered design of a scalable, electronic health record-integrated remote symptom monitoring intervention for patients with asthma and providers in primary care.
J Am Med Inform Assoc 2021 Oct 12;28(11):2433-44. doi: 10.1093/jamia/ocab157..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Asthma, Respiratory Conditions, Primary Care
Parikh K, Richmond M, Lee M
Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
The purpose of this study was to evaluate a multi-component hospital-to-home (H2H) transition program for children hospitalized with an asthma exacerbation. A pilot prospective randomized clinical trial of guideline-based asthma care with and without a patient-centered multi-component H2H program was conducted among children enrolled in K-8(th) grade on Medicaid hospitalized for an asthma exacerbation. The investigators concluded that the pilot data suggested that comprehensive care coordination initiated during the inpatient stay was feasible and acceptable.
AHRQ-funded; HS024554.
Citation: Parikh K, Richmond M, Lee M .
Outcomes from a pilot patient-centered hospital-to-home transition program for children hospitalized with asthma.
J Asthma 2021 Oct;58(10):1384-94. doi: 10.1080/02770903.2020.1795877..
Keywords: Children/Adolescents, Patient-Centered Healthcare, Transitions of Care, Asthma, Hospital Discharge, Care Coordination, Chronic Conditions
Hirayama A, Goto T, Faridi MK
Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013.
The authors sought to investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for asthma exacerbation using data from State Inpatient Databases from seven U.S. states. They found that, overall, OSA was associated with a significantly higher incident rate of all-cause readmission. Additionally, OSA was associated with higher incident rates of readmissions for five major diseases: asthma, COPD, respiratory failure, pneumonia, and congestive heart failure, compared to non-OSA.
AHRQ-funded; HS023305.
Citation: Hirayama A, Goto T, Faridi MK .
Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18-54 years: a population-based study, 2010-2013.
J Asthma 2021 Sep;58(9):1176-85. doi: 10.1080/02770903.2020.1781887..
Keywords: Healthcare Cost and Utilization Project (HCUP), Sleep Problems, Hospital Readmissions, Asthma, Respiratory Conditions, Chronic Conditions
Curry CW, Felt D, Kan K
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
Researchers sought to examine adjusted odds of non-remitting asthma by sexual identity, race/ethnicity, and their intersections, along with their relationship with traditional non-remitting asthma risk factors and victimization. Using data from the Youth Risk Behavior Survey, they found that, at the intersections, 8 sexual minority and racial/ethnic minority subpopulations were significantly more likely to have non-remitting asthma compared with White heterosexual sex-matched peers. They concluded that the evidence suggests that traditional non-remitting asthma risk factors and victimization may partly explain disparities in non-remitting asthma.
AHRQ-funded; HS026385.
Citation: Curry CW, Felt D, Kan K .
Asthma remission disparities among us youth by sexual identity and race/ethnicity, 2009-2017.
J Allergy Clin Immunol Pract 2021 Sep;9(9):3396-406. doi: 10.1016/j.jaip.2021.04.046..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Chronic Conditions, Disparities
Joseph CLM, Alexander GL, Lu M
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
The authors piloted an electronic medical record-based tailored discussion guide (TDG) and a brief provider training to address weight management in overweight teens with asthma. They observed modest improvements in patient-reported asthma outcomes and health behaviors. They found strong evidence that the TDG supports provider discussion of weight and asthma to create a more patient-centered conversation from the perspective of participating teens. They recommended addressing challenges to recruitment and clinic adaptation prior to advancing to a full-scale trial.
AHRQ-funded; HS022417.
Citation: Joseph CLM, Alexander GL, Lu M .
Pilot study of a brief provider and EMR-based intervention for overweight teens with asthma.
Pilot Feasibility Stud 2021 Aug 30;7(1):167. doi: 10.1186/s40814-021-00848-6..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Asthma, Chronic Conditions, Respiratory Conditions, Electronic Health Records (EHRs), Health Information Technology (HIT)
Piwnica-Worms K, Staiger B, Ross JS
Effects of forced disruption in Medicaid managed care on children with asthma.
The objective of this study was to evaluate the effect of a forced disruption to Medicaid managed care plans and provider networks on health utilization and outcomes for children with persistent asthma. The investigators concluded that while there was a decrease in the number of outpatient visits associated with forced disruption of Medicaid managed care plans for children with persistent asthma, there were no consistent associations with worse asthma quality performance or higher emergent health care utilization.
AHRQ-funded; HS022882; HS025164.
Citation: Piwnica-Worms K, Staiger B, Ross JS .
Effects of forced disruption in Medicaid managed care on children with asthma.
Health Serv Res 2021 Aug;56(4):668-76. doi: 10.1111/1475-6773.13643..
Keywords: Children/Adolescents, Medicaid, Asthma, Respiratory Conditions, Chronic Conditions, Quality of Care
Schechter SB, Pantell MS, Parikh K
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
The objective of this study was to assess whether disparities in asthma care and outcomes based on insurance type existed before a national quality improvement (QI) collaborative, and to determine the effects of the collaborative on these disparities. The investigators concluded that at baseline, children with public insurance had higher asthma health care utilization than those with private insurance, despite receiving more evidence-based care.
AHRQ-funded; HS026383; HS024554; HS024592.
Citation: Schechter SB, Pantell MS, Parikh K .
Impact of a national quality collaborative on pediatric asthma care quality by insurance status.
Acad Pediatr 2021 Aug;21(6):1018-24. doi: 10.1016/j.acap.2021.02.009..
Keywords: Children/Adolescents, Asthma, Chronic Conditions, Disparities, Quality Improvement, Quality of Care, Health Insurance
Doshi H, Hsia B, Shahani J
Impact of technology-based interventions on patient-reported outcomes in asthma: a systematic review.
This systematic review’s goal was to identify which technology-based interventions (TBIs) for asthma management have been formally evaluated using patient-reported outcomes (PROs). The authors aimed to: 1) identify the TBIs that have been evaluated in clinical trials using PROs; 2) identify the most commonly used PROs in these trials; and 3) determine the impact of TBIs on PROs in the management of chronic asthma. PubMed and Clinicaltrials.gov databases were searched for English-language studies published between January 2000 and February 2020. The final analysis included 14 clinical trials with 1 to 3 arms. Five different TBI types were identified, most commonly involving multimedia education. Four different categories of PROs were identified. At least 1 PRO domain with positive outcomes were reported by patients in 12 of 14 studies.
AHRQ-funded; R18 HS025645.
Citation: Doshi H, Hsia B, Shahani J .
Impact of technology-based interventions on patient-reported outcomes in asthma: a systematic review.
J Allergy Clin Immunol Pract 2021 Jun;9(6):2336-41. doi: 10.1016/j.jaip.2021.01.027..
Keywords: Asthma, Respiratory Conditions, Chronic Conditions, Telehealth, Health Information Technology (HIT)
Turi KN, Gebretsadik T, Ding T
Dose, timing, and spectrum of prenatal antibiotic exposure and risk of childhood asthma.
The potential for prenatal antibiotic exposure to influence asthma risk is not clear. The investigators aimed to determine the effect of timing, dose, and spectrum of prenatal antibiotic exposure on the risk of childhood asthma. The investigators concluded that increased cumulative dose, early pregnancy first course, and broad-spectrum antibiotic exposure were associated with childhood asthma risk.
AHRQ-funded; HS026395; HS018454.
Citation: Turi KN, Gebretsadik T, Ding T .
Dose, timing, and spectrum of prenatal antibiotic exposure and risk of childhood asthma.
Clin Infect Dis 2021 Feb 1;72(3):455-62. doi: 10.1093/cid/ciaa085.
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Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Antibiotics, Medication, Risk
Fleischer DM, Chan ES, Venter C
A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical
This paper provides a consensus approach to the primary prevention of pediatric food allergy through nutrition using data from a number of high-impact randomized controlled trials. Recommendations from the American Academy of Allergy, Asthma, and Immunology, American College of Allergy, Asthma, and Immunology, and the Canadian Society for Allergy and Clinical Immunology are to introduce peanut and egg around age 6 months, but not before 4 months as well as introducing other allergens. Maternal exclusion of allergens during pregnancy and/or breastfeeding to prevent food allergy is not recommended. No association was found between exclusive breast-feeding and the primary prevention of any specific food allergy.
AHRQ-funded; HS024599.
Citation: Fleischer DM, Chan ES, Venter C .
A consensus approach to the primary prevention of food allergy through nutrition: guidance from the American Academy of Allergy, Asthma, and Immunology; American College of Allergy, Asthma, and Immunology; and the Canadian Society for Allergy and Clinical
J Allergy Clin Immunol Pract 2021 Jan;9(1):22-43.e4. doi: 10.1016/j.jaip.2020.11.002..
Keywords: Asthma, Respiratory Conditions, Prevention, Guidelines, Evidence-Based Practice
Malhotra K, Baltrus P P, Zhang S
Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states.
Using 2007 Medicaid claims data from 556 counties in 14 southern states, the researchers described the local area variation in 1-year asthma prevalence rates, emergency department visit rates, and racial disparity rate ratios. They found much local area variation in asthma prevalence and asthma ED visit rates among Medicaid-enrolled children. Between black and white children, more counties had higher prevalence of asthma and higher ED visit rates among blacks.
AHRQ-funded; HS022444; HS019470
Citation: Malhotra K, Baltrus P P, Zhang S .
Geographic and racial variation in asthma prevalence and emergency department use among Medicaid-enrolled children in 14 southern states.
J Asthma. 2014 Nov;51(9):913-21. doi: 10.3109/02770903.2014.930479..
Keywords: Asthma, Medicaid, Social Determinants of Health, Emergency Department, Emergency Medical Services (EMS)
Mohanan S, Tapp H, McWilliams A
Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care.
This review summarizes existing data that support the pathophysiologic mechanisms underlying the association between obesity and asthma, as well as the current and future state of treatment for the obese patient with asthma. It suggests that evidence of chronic inflammatory response linking obesity and asthma indicates a need to address obesity during asthma management, possibly by using patient-centered approaches such as shared decisionmaking.
AHRQ-funded; HS019946
Citation: Mohanan S, Tapp H, McWilliams A .
Obesity and asthma: pathophysiology and implications for diagnosis and management in primary care.
Exp Biol Med. 2014 Nov;239(11):1531-40. doi: 10.1177/1535370214525302..
Keywords: Obesity, Asthma, Diagnostic Safety and Quality, Primary Care, Chronic Conditions
Wu AC, Li L, Fung V
Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.
The researchers compared the effectiveness of different controller medication regimens under real-life conditions. They found that the risk of emergency department visits, hospitalizations, and oral corticosteroids did not differ between children who initiated leukotriene antagonist and those who initiated inhaled corticosteroid. These findings may be explainable by leukotriene antagonist having similar effectiveness as inhaled corticosteroid in real-life usage.
AHRQ-funded; HS019669.
Citation: Wu AC, Li L, Fung V .
Use of leukotriene receptor antagonists are associated with a similar risk of asthma exacerbations as inhaled corticosteroids.
J Allergy Clin Immunol Pract 2014 Sep-Oct;2(5):607-13. doi: 10.1016/j.jaip.2014.05.009..
Keywords: Comparative Effectiveness, Medication, Children/Adolescents, Asthma, Risk
Gillette C, Blalock SJ, Rao JK
Provider-caregiver-child discussions about risks associated with asthma control medications: content and prevalence.
The objectives of the study were to: (1) describe the extent to which primary care pediatric providers discuss risks associated with asthma control medications with families and (2) examine the relationship between child, caregiver, provider, and clinic visit characteristics and discussions about risks associated with asthma control medications. It found that providers discussed asthma control medication risks during 23% of visits.
AHRQ-funded; HS020534.
Citation: Gillette C, Blalock SJ, Rao JK .
Provider-caregiver-child discussions about risks associated with asthma control medications: content and prevalence.
Pediatr Pulmonol 2014 Aug;49(8):727-33. doi: 10.1002/ppul.22892..
Keywords: Medication, Asthma, Children/Adolescents, Clinician-Patient Communication, Primary Care
Sarpong EM
AHRQ Author: Sarpong EM
The impact of obesity on medication use and expenditures among nonelderly adults with asthma.
The author examined the impact of obesity on medication use and expenditures among nonelderly adults with asthma using the Medical Expenditure Panel Survey. He found that obese classes II/III individuals were more likely to have current asthma, seek treatment for asthma, use more medications, and have higher medication and health care expenditures compared with normal weight individuals. His results suggested that reduction in body weight may help reduce health resource use and expenditures for nonelderly adults with asthma.
AHRQ-authored.
Citation: Sarpong EM .
The impact of obesity on medication use and expenditures among nonelderly adults with asthma.
J Health Care Poor Underserved 2014 Aug;25(3):1245-61. doi: 10.1353/hpu.2014.0142.
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Keywords: Asthma, Healthcare Costs, Medical Expenditure Panel Survey (MEPS), Medication, Obesity
Fung V, Graetz I, Galbraith A
Financial barriers to care among low-income children with asthma: health care reform implications.
This study examined the associations between cost-sharing, income, and care seeking and financial stress among children with asthma. It found that cost-related barriers to care among children with asthma were concentrated among low-income families with higher cost-sharing levels.
AHRQ-funded; HS019669
Citation: Fung V, Graetz I, Galbraith A .
Financial barriers to care among low-income children with asthma: health care reform implications.
JAMA Pediatr. 2014 Jul;168(7):649-56. doi: 10.1001/jamapediatrics.2014.79..
Keywords: Children/Adolescents, Asthma, Low-Income, Access to Care, Healthcare Costs
Jackson DJ, Hartert TV, Martinez FD
Asthma: NHLBI workshop on the primary prevention of chronic lung diseases.
This article reports on the state of primary prevention research in asthma, with emphasis on specific recommendations for research priorities and interventions that could be undertaken now. The emphasis of this work was on prevention of disease onset, and because the majority of asthma begins during preschool years, this document focuses on childhood asthma.
AHRQ-funded; HS018454, HS022093
Citation: Jackson DJ, Hartert TV, Martinez FD .
Asthma: NHLBI workshop on the primary prevention of chronic lung diseases.
Ann Am Thorac Soc. 2014 Apr;11 Suppl 3:S139-45. doi: 10.1513/AnnalsATS.201312-448LD..
Keywords: Asthma, Prevention, Children/Adolescents, Chronic Conditions
Li L, Vollmer WM, Butler MG
A comparison of confounding adjustment methods for assessment of asthma controller medication effectiveness.
Using three confounding adjustment procedures—covariate-adjusted regression, propensity score regression, and high-dimemsional propensity score regression—on a population of 24,680 children with asthma, researchers found that patients treated with leukotriene antagonists were no more likely than those treated with inhaled corticosteroids to experience adverse outcomes.
AHRQ-funded; HS019669
Citation: Li L, Vollmer WM, Butler MG .
A comparison of confounding adjustment methods for assessment of asthma controller medication effectiveness.
Am J Epidemiol. 2014 Mar 1;179(5):648-59. doi: 10.1093/aje/kwt323..
Keywords: Comparative Effectiveness, Outcomes, Children/Adolescents, Asthma, Medication