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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 30 Research Studies Displayed
Cornelio N, McInerney MP, Mellor JM
Increasing Medicaid's stagnant asset test for people eligible for Medicare and Medicaid will help vulnerable seniors.
Researchers examined states' income and asset tests for full-benefit Medicaid during the period 2006-18 and examined how alternative asset tests would affect eligibility for community-dwelling Medicare beneficiaries ages sixty-five and older. They found that increasing asset limits would lessen restrictions on Medicaid eligibility that arise from stagnant asset tests, broadening eligibility for certain low-income Medicare beneficiaries and allowing them to retain higher, yet still modest, savings.
AHRQ-funded; HS025422; HS026727; HS027698.
Citation: Cornelio N, McInerney MP, Mellor JM . Increasing Medicaid's stagnant asset test for people eligible for Medicare and Medicaid will help vulnerable seniors. Health Affairs 2021 Dec;40(12):1943-52. doi: 10.1377/hlthaff.2021.00841..
Keywords: Elderly, Medicaid, Medicare, Low-Income, Vulnerable Populations
Horner-Johnson W, Klein KA, Campbell J
Experiences of women with disabilities in accessing and receiving contraceptive care.
This study explored the experiences of women with different types of disability when they attempted to obtain contraceptive care. Four semistructured focus groups were created to sample 17 women with different types of disabilities: physical, intellectual and developmental, blind or low vision, and deaf or hard of hearing. Three main themes were identified in challenges to obtaining high-quality contraceptive care: Accessibility and Accommodations, Clinician Attitudes, and Health Insurance. Different challenges occurred with different types of disabilities such as inaccessible clinic rooms and examination tables, and inaccessible clinic forms and information. Processes and infrastructure of contraceptive care are based on an assumption of an able-bodied norm.
Citation: Horner-Johnson W, Klein KA, Campbell J . Experiences of women with disabilities in accessing and receiving contraceptive care. J Obstet Gynecol Neonatal Nurs 2021 Nov;50(6):732-41. doi: 10.1016/j.jogn.2021.07.005..
Keywords: Access to Care, Disabilities, Vulnerable Populations, Women, Sexual Health
Fleming MD, Shim JK, Yen I
Managing the "hot spots": health care, policing, and the governance of poverty in the US.
This research looked at a form of surveillance and intervention by health care systems known as “hot spotting”, which targets high-cost patients who are super-utilizers of emergency departments with intensive health and social services. An ethnographic investigation of hot spotting’s modes of distribution and its workings in the lives of patients and providers found that it targets the same individuals and neighborhoods as the police, who maintain longer-standing practices of hot spotting in zones of racialized urban poverty. The boundaries between them are shifting as a financialized logic of governance has come to dominate both the health and criminal justice systems.
Citation: Fleming MD, Shim JK, Yen I . Managing the "hot spots": health care, policing, and the governance of poverty in the US. Am Ethnol 2021 Nov;48(4):474-88. doi: 10.1111/amet.13032..
Keywords: Low-Income, Social Determinants of Health, Vulnerable Populations
Lewis VA, Spivack S, Murray GF
FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality.
Researchers assessed capabilities around access to and quality of care among primary care practices serving a high share of Medicaid and uninsured patients compared to practices serving a low share of these patients. Data from the National Survey of Healthcare Organizations and Systems was analyzed. They found that federally qualified health centers were more likely than other types of primary care practices (both safety net practices and other practices) to possess capabilities related to access and quality. However, safety net practices were less likely than non-safety net practices to possess health information technology capabilities.
Citation: Lewis VA, Spivack S, Murray GF . FQHC designation and safety net patient revenue associated with primary care practice capabilities for access and quality. J Gen Intern Med 2021 Oct;36(10):2922-28. doi: 10.1007/s11606-021-06746-0..
Keywords: Safety Net, Vulnerable Populations, Primary Care, Access to Care, Uninsured, Medicaid, Quality of Care
Schulson L, Lin MY, Paasche-Orlow MK
Limited English proficient patient visits and emergency department admission rates for ambulatory care sensitive conditions in California: a retrospective cohort study.
Little is known about the risk of admission for emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) by limited English proficient (LEP) patients. The objective of this study was to estimate admission rates from ED for ACSCs comparing LEP and English proficient (EP) patients and examine how these rates varied at hospitals with a high versus low proportion of LEP patients.
Citation: Schulson L, Lin MY, Paasche-Orlow MK . Limited English proficient patient visits and emergency department admission rates for ambulatory care sensitive conditions in California: a retrospective cohort study. J Gen Intern Med 2021 Sep;36(9):2683-91. doi: 10.1007/s11606-020-06523-5..
Keywords: Emergency Department, Vulnerable Populations, Communication
Kuhn J, Levinson Udhnani, MD
What happens after a positive primary care autism screen among historically underserved families? Predictors of evaluation and autism diagnosis.
This study examined predictors of receiving a recommended diagnostic evaluation after a recommended primary care-administered autism screen, and of those who screen positive, who is most likely to be diagnosed with autism. Participants were 309 predominantly low-income, racial/ethnic minority parents and their child aged 15-27 months who screened positive with the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Significant predictors of diagnostic evaluation included older parental age, being non-Hispanic and the child having private insurance, lower child communication functioning, or receiving Early Intervention services. Significant predictors of an autism diagnosis included being male, having lower child communication functioning, screening directly in the parent’s preferred language, White/non-Hispanic parent, and no parent history of mood disorder.
Citation: Kuhn J, Levinson Udhnani, MD . What happens after a positive primary care autism screen among historically underserved families? Predictors of evaluation and autism diagnosis. J Dev Behav Pediatr 2021 Sep;42(7):515-23. doi: 10.1097/dbp.0000000000000928..
Keywords: Children/Adolescents, Autism, Screening, Vulnerable Populations, Diagnostic Safety and Quality
Khorasani SB, Koutoujian PJ, Zubiago J
COVID-19 vaccine interest among corrections officers and people who are incarcerated at Middlesex County jail, Massachusetts.
The Middlesex [Massachusetts] Sheriff’s Office developed and distributed two self-response surveys to assess COVID-19 vaccine willingness among people incarcerated in the jail and among people who work at the jail. The goal of this study was to characterize vaccine willingness in these two populations at the Middlesex House of Correction and Jail. Findings showed that 59% of people incarcerated in jail did not want the COVID-19 vaccine, while 82% of jail staff were interested in receiving the vaccine. Among people who were incarcerated, those who identified as Black had significantly decreased odds of wanting the vaccine compared to those who identified as white. Race was not significantly associated with vaccine willingness among jail employees when adjusting for role and gender.
Citation: Khorasani SB, Koutoujian PJ, Zubiago J . COVID-19 vaccine interest among corrections officers and people who are incarcerated at Middlesex County jail, Massachusetts. J Urban Health 2021 Aug;98(4):459-63. doi: 10.1007/s11524-021-00545-y..
Keywords: COVID-19, Vaccination, Vulnerable Populations
Abdul-Chani MM, Moreno CP, Reeder JA
Perceived community disability stigma in multicultural, low-income populations: measure development and validation.
Investigators sought to develop and validate a brief bilingual (English/Spanish) perceived disability stigma measure, to compare perceived disability and autism stigma, and to examine perceived disability stigma by parent sociodemographic characteristics and disability familiarity. They found that perceived autism stigma was greater than perceived disability stigma, with Latino parents reporting less perceived disability stigma than white parents. They concluded that their perceived disability stigma scale demonstrated sound psychometric properties, with results suggesting differences in how stigma is perceived across sociodemographic characteristics and disability familiarity.
Citation: Abdul-Chani MM, Moreno CP, Reeder JA . Perceived community disability stigma in multicultural, low-income populations: measure development and validation. Res Dev Disabil 2021 Aug;115:103997. doi: 10.1016/j.ridd.2021.103997..
Keywords: Disabilities, Low-Income, Vulnerable Populations, Social Stigma
Klawetter S, Glaze K, Sward A
Warm Connections: integration of infant mental health services into WIC.
Warm Connections is an innovative integrated behavioral health program delivered in the Special Supplemental Nutrition Program for Women, Infants, and Children and rooted in an infant and early childhood mental health framework. This exploratory study describes Warm Connections and provides evaluation results from its pilot implementation. Findings suggest Warm Connections may reduce distress and increase parenting efficacy among low-income mothers and support further research of this program's feasibility.
Citation: Klawetter S, Glaze K, Sward A . Warm Connections: integration of infant mental health services into WIC. Community Ment Health J 2021 Aug;57(6):1130-41. doi: 10.1007/s10597-020-00744-y..
Keywords: Newborns/Infants, Maternal Care, Behavioral Health, Patient-Centered Healthcare, Low-Income, Vulnerable Populations
Lillie KM, Shaw J, Jansen KJ
Buprenorphine/naloxone for opioid use disorder among Alaska Native and American Indian people.
Opioid-related disparities are magnified among Alaska Native and American Indian (ANAI) people. Yet, no outcome studies on medication for addiction treatment, an effective treatment in other populations, among ANAI people exist. The objective of this study was to identify variables associated with buprenorphine/naloxone retention among ANAI people with opioid use disorder (OUD). The investigators concluded that younger patients and those with co-occurring substance use remained at higher risk of discontinuing buprenorphine/naloxone treatment for OUD in this population of ANAI people.
Citation: Lillie KM, Shaw J, Jansen KJ . Buprenorphine/naloxone for opioid use disorder among Alaska Native and American Indian people. J Addict Med 2021 Jul-Aug 01;15(4):297-302. doi: 10.1097/adm.0000000000000757..
Keywords: Opioids, Substance Abuse, Behavioral Health, Medication, Racial / Ethnic Minorities, Vulnerable Populations
Tabaac AR, Charlton BM, Tan ASL
Differences in tobacco product use by sexual orientation and violence factors among United States youth.
The goal of this study was to assess differences in the relationship between violence factor exposure and tobacco product pattern use (exclusive and poly). The investigators hypothesized that compared with heterosexuals, sexual minority youth would be more likely to report exclusive-tobacco and poly-tobacco use patterns and controlling for violence factors would attenuate these associations. The investigators concluded that sexual minority girls have greater exclusive- and poly-tobacco use compared with heterosexual girls.
Citation: Tabaac AR, Charlton BM, Tan ASL . Differences in tobacco product use by sexual orientation and violence factors among United States youth. J Pediatr 2021 Jun;233:241-48. doi: 10.1016/j.jpeds.2021.02.011..
Keywords: Children/Adolescents, Tobacco Use, Domestic Violence, Vulnerable Populations
Walter LA, Schoenfeld EM, Smith CH
Emergency department-based interventions affecting social determinants of health in the United States: a scoping review.
Emergency departments (EDs) function as the safety nets of the American health care system, caring for many vulnerable populations. ED-based interventions to assess social risk and mitigate social needs have been reported in the literature. However, the breadth and scope of these interventions have not been evaluated. As the field of social emergency medicine (SEM) expands, a mapping and categorization of previous interventions may help shape future research. In this study, the investigators sought to identify, summarize, and characterize ED-based interventions aimed at mitigating negative social determinants of health.
AHRQ-funded; HS025701; HS013852.
Citation: Walter LA, Schoenfeld EM, Smith CH . Emergency department-based interventions affecting social determinants of health in the United States: a scoping review. Acad Emerg Med 2021 Jun;28(6):666-74. doi: 10.1111/acem.14201..
Keywords: Emergency Department, Social Determinants of Health, Vulnerable Populations, Low-Income
Wurcel AG, Reyes J, Zubiago J
"I'm not gonna be able to do anything about it, then what's the point?": A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail.
Despite national guidelines promoting hepatitis C virus (HCV) testing in prisons, there is substantial heterogeneity on the implementation of HCV testing in jails. IN this study, the investigators sought to better understand barriers and opportunities for HCV testing by interviewing a broad group of stakeholders involved in HCV testing and treatment policies and procedures in Massachusetts jails.
Citation: Wurcel AG, Reyes J, Zubiago J . "I'm not gonna be able to do anything about it, then what's the point?": A broad group of stakeholders identify barriers and facilitators to HCV testing in a Massachusetts jail. PLoS One 2021 May 26;16(5):e0250901. doi: 10.1371/journal.pone.0250901..
Keywords: Hepatitis, Vulnerable Populations, Screening, Prevention, Public Health, Social Stigma
Simmel C, Bowden CF, Neese-Todd S
Antipsychotic treatment for youth in foster care: Perspectives on improving youths' experiences in providing informed consent.
Citation: Simmel C, Bowden CF, Neese-Todd S . Antipsychotic treatment for youth in foster care: Perspectives on improving youths' experiences in providing informed consent. Am J Orthopsychiatry 2021;91(2):258-70. doi: 10.1037/ort0000532..
Keywords: Children/Adolescents, Vulnerable Populations, Behavioral Health, Medication, Patient Experience
Langston DM, Oslock WM, Paredes AZ
Hospital location and socioeconomic disadvantage of emergency general surgery patients.
This study’s purpose was to test the hypothesis that a hospital’s neighborhood disadvantage is associated with vulnerability of its emergency general surgery (EGS) patients. An area deprivation index (ADI), which is a neighborhood-level measure of disadvantage, and key characteristics of 724 hospitals in 14 states were linked to patient-level data in State Inpatient Databases. Hospitals in more disadvantaged areas disproportionately serve underserved EGS patient populations but are less likely to have robust resources for EGS care or train future EGS surgeons.
Citation: Langston DM, Oslock WM, Paredes AZ . Hospital location and socioeconomic disadvantage of emergency general surgery patients. J Surg Res 2021 May;261:376-84. doi: 10.1016/j.jss.2020.12.028..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Social Determinants of Health, Vulnerable Populations, Critical Care, Safety Net
Alcántara C, Giorgio Cosenzo L, McCullough E
Cultural adaptations of psychological interventions for prevalent sleep disorders and sleep disturbances: a systematic review of randomized controlled trials in the United States.
This systematic review examined behavioral randomized controlled trials (RCTs) on prevalent sleep-wake disorders and sleep disturbances to determine if these studies targeted underserved populations or addressed contextual and cultural factors. The authors examined sociodemographic characteristics of behavioral RCTs that targeted underserved adults, identified types of cultural adaptations (surface-level or deep-level), and described intervention effectiveness on primary sleep outcomes. Overall out of 56 studies, 6.97% targeted underserved groups (veterans, women, racial/ethnic minorities, low socioeconomic status, disability status); and 64.9% made surface-level or deep-level cultural adaptations. Most cultural adaptions were made to behavioral therapies, and cognitive behavioral therapy for insomnia (CBT-I). Surface-level cultural adaptions made were mostly to the delivery modality and setting. Deep-level cultural adaptations to the content and core intervention components were the most typical. Intervention effectiveness varied by type of adapted intervention and the participant population. RCTs including adapted CBT-I interventions among participants showed consistent significant reductions in adverse sleep outcomes versus control.
Citation: Alcántara C, Giorgio Cosenzo L, McCullough E . Cultural adaptations of psychological interventions for prevalent sleep disorders and sleep disturbances: a systematic review of randomized controlled trials in the United States. Sleep Med Rev 2021 Apr;56:101455. doi: 10.1016/j.smrv.2021.101455..
Keywords: Sleep Problems, Cultural Competence, Behavioral Health, Racial / Ethnic Minorities, Vulnerable Populations
Sutter ME, Simmons VN, Sutton SK
Oncologists' experiences caring for LGBTQ patients with cancer: qualitative analysis of items on a national survey.
Sexual and gender minority (SGM) individuals experience cancer-related health disparities and reduced quality of cancer care compared to the general population in part due to a lack of knowledgeable providers. This study explored oncologists' experiences and perspectives in providing patient-centered care for SGM individuals with cancer. The investigators concluded that oncologists recognized their knowledge deficits and need strategies to overcome communication barriers and microaggressions among the cancer care team to provide SGM-affirming care.
Citation: Sutter ME, Simmons VN, Sutton SK . Oncologists' experiences caring for LGBTQ patients with cancer: qualitative analysis of items on a national survey. Patient Educ Couns 2021 Apr;104(4):871-76. doi: 10.1016/j.pec.2020.09.022..
Keywords: Cancer, Provider: Physician, Vulnerable Populations
Teixeira da Silva D, Biello K, Lin WY
COVID-19 vaccine acceptance among an online sample of sexual and gender minority men and transgender women.
Sexual and gender minority (SGM) populations are particularly vulnerable to poor COVID-19 outcomes and are more likely to experience stigma and medical mistrust that may impact COVID-19 vaccine acceptance. This study examined the prevalence of COVID testing and diagnosis and assessed COVID-19 vaccine acceptance among a large sample of SGM. The investigators found that black participants were significantly less likely to accept a COVID-19 vaccine, and Asian participants were significantly more likely to accept a vaccine, compared to White peers.
Citation: Teixeira da Silva D, Biello K, Lin WY . COVID-19 vaccine acceptance among an online sample of sexual and gender minority men and transgender women. Vaccines 2021 Mar;9(3). doi: 10.3390/vaccines9030204..
Keywords: Vaccination, COVID-19, Public Health, Racial / Ethnic Minorities, Vulnerable Populations
Nguyen KH, Trivedi AN, Cole MB
Receipt of social needs assistance and health center patient experience of care.
The goal of this study was to examine the degree to which community health center patients report receiving social needs assistance and compares measures of access and quality. A nationally representative sample of 4,699 nonelderly adults receiving care at community health centers out of 12.6 million patients was studied from the 2014-2015 HRSA Health Center Patient Survey. Social needs assistance was defined as a patient receiving community health center assistance accessing social programs such as applying for government benefits or obtaining basic needs such as transportation, housing, or food. From the sample, 36% reported receiving social needs assistance. Patients receiving assistance were more likely to report their usual source of care as a community health center and to report perceived quality of care as “the best”. They were also significantly less likely to use emergency departments as their usual source of care.
Citation: Nguyen KH, Trivedi AN, Cole MB . Receipt of social needs assistance and health center patient experience of care. Am J Prev Med 2021 Mar;60(3):e139-e47. doi: 10.1016/j.amepre.2020.08.030..
Keywords: Social Determinants of Health, Vulnerable Populations, Patient Experience, Quality of Care
Olmos-Ochoa TT, Miake-Lye IM, Glenn BA
Sustaining successful clinical-community partnerships in medically underserved urban areas: a qualitative case study.
This qualitative case study examines the Faith Community Health Partnership, which is a collaboration between faith-community nurses and community organizations sustained over 25 years. Factors supporting partnership sustainability were identified through semi-structured interviews with 18 FHCP partners. Factors include maintaining partners’ commitment over time; strategic resource-sharing; facilitating engagement; and preserving partnership flexibility.
Citation: Olmos-Ochoa TT, Miake-Lye IM, Glenn BA . Sustaining successful clinical-community partnerships in medically underserved urban areas: a qualitative case study. J Community Health Nurs 2021 Jan-Mar;38(1):1-12. doi: 10.1080/07370016.2021.1869423.
Keywords: Community Partnerships, Vulnerable Populations, Urban Health, Case Study, Access to Care, Healthcare Delivery
Malloy GSP, Puglisi L, Brandeau ML
Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis.
The authors sought to estimate the impact of various mitigation strategies on COVID-19 transmission in a US jail beyond those offered in national guidelines. They found that depopulation, single celling, and asymptomatic testing within jails can be effective strategies to mitigate COVID-19 transmission in addition to standard public health measures. They recommended that decision makers prioritize reductions in the jail population, single celling, and testing asymptomatic populations as additional measures to manage COVID-19 within correctional settings.
Citation: Malloy GSP, Puglisi L, Brandeau ML . Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis. BMJ Open 2021 Feb 17;11(2):e042898. doi: 10.1136/bmjopen-2020-042898..
Keywords: COVID-19, Public Health, Vulnerable Populations, Prevention, Infectious Diseases
Stakeholder experiences with gender identity data capture in electronic health records: implementation effectiveness and a visibility paradox.
Advocates have endorsed transgender visibility via gender identity (GI) data capture with the advent of the Affordable Care Act and electronic health record (EHR) requirements. Visibility in data in order to enumerate a population contrasts with ways in which other LGBT and public health scholars have deployed these concepts. This article aims to assess the effectiveness of GI data capture in EHRs and implications for trans health care quality improvements and research.
Citation: Thompson HM . Stakeholder experiences with gender identity data capture in electronic health records: implementation effectiveness and a visibility paradox. Health Educ Behav 2021 Feb;48(1):93-101. doi: 10.1177/1090198120963102.
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Health Services Research (HSR), Vulnerable Populations, Sex Factors
Magee LA, Fortenberry JD, Rosenman M
Two-year prevalence rates of mental health and substance use disorder diagnoses among repeat arrestees.
Investigators examined the prevalence of mental health and substance use diagnoses among arrestees and repeat arrestees to identify opportunities for intervention. Their retrospective cohort study linked police arrest and clinical care data at the individual level for persons arrested in Indianapolis, Indiana, in 2016. They found that linked clinical and criminal justice data systems identified individuals at risk of repeat arrest and informed opportunities for interventions aimed at low-level offenders with behavioral health needs.
Citation: Magee LA, Fortenberry JD, Rosenman M . Two-year prevalence rates of mental health and substance use disorder diagnoses among repeat arrestees. Health Justice 2021 Jan 7;9(1):2. doi: 10.1186/s40352-020-00126-2..
Keywords: Behavioral Health, Substance Abuse, Vulnerable Populations
Puglisi LB, Malloy GSP, Harvey TD
Estimation of COVID-19 basic reproduction ratio in a large urban jail in the United States.
The purpose of this study was to estimate the basic reproduction ratio () of SARS-CoV-2 inside a correctional facility early in the COVID-19 pandemic. The investigators concluded that the high of SARS-CoV-2 in a large urban jail highlighted the importance of including correctional facilities in public health strategies for COVID-19. The investigators suggested that in the absence of more aggressive mitigation strategies, correctional facilities will continue to contribute to community infections.
Citation: Puglisi LB, Malloy GSP, Harvey TD . Estimation of COVID-19 basic reproduction ratio in a large urban jail in the United States. Ann Epidemiol 2021 Jan;53:103-05. doi: 10.1016/j.annepidem.2020.09.002..
Keywords: COVID-19, Public Health, Vulnerable Populations, Prevention, Infectious Diseases
Chambers EC, McAuliff KE, Heller CG
Toward understanding social needs among primary care patients with uncontrolled diabetes.
This study examined the relationship between unmet social needs and diabetes among a predominantly Black and Hispanic patient population in a large urban hospital system in Bronx, New York. A total of 5846 patients with diabetes seen at a primary care visit between April 2018 and December 2019 were included and completed a social needs screener. Twenty-two percent of the patient sample had at least 1 unmet social need, with the most prevalent unmet needs being housing issues, food insecurity, and lack of healthcare transportation. Patients with more unmet needs had a greater likelihood of uncontrolled diabetes, with lack of healthcare transportation and food insecurity having the greatest likelihood.
Citation: Chambers EC, McAuliff KE, Heller CG . Toward understanding social needs among primary care patients with uncontrolled diabetes. J Prim Care Community Health 2021 Jan-Dec;12:2150132720985044. doi: 10.1177/2150132720985044..
Keywords: Diabetes, Chronic Conditions, Primary Care, Vulnerable Populations, Social Determinants of Health