National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Blood Pressure (1)
- Chronic Conditions (2)
- Communication (1)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS) (1)
- Cultural Competence (1)
- Diagnostic Safety and Quality (1)
- Elderly (3)
- Electronic Health Records (EHRs) (3)
- Evidence-Based Practice (1)
- Falls (1)
- Guidelines (1)
- Healthcare Costs (1)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (3)
- (-) Home Healthcare (13)
- Hospitalization (1)
- Hospital Readmissions (1)
- Long-Term Care (1)
- Medicare (2)
- Nursing Homes (1)
- Patient Adherence/Compliance (1)
- Patient Experience (1)
- Patient Safety (1)
- Patient Self-Management (1)
- Provider Performance (2)
- Public Health (1)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (1)
- Respiratory Conditions (1)
- Risk (2)
- Vulnerable Populations (2)
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 13 of 13 Research Studies DisplayedDuan KI, Wong ES, Liao JM
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
The purpose of this study was to explore how respiratory durable medical equipment (DME) supply has changed since Medicare implemented the Competitive Bidding Program (CBP) in 2011and increased the scale of the program nationally in 2013 and 2016. The researchers analyzed all publicly available nationwide Medicare DME data from 2013 to 2019 and analyzed all respiratory DME included in the CBP (excluding accessories such as masks, tubing, and filters). The researchers found that the three highest-volume respiratory DME products were stationary oxygen concentrators, continuous positive airway pressure (CPAP) devices, and gaseous portable oxygen. Decreases in suppliers across all items and increases in claims per supplier for the majority of items suggest greater market concentration of respiratory DME suppliers for Medicare beneficiaries. Even as the Medicare population expanded by 2.6% between 2013 and 2019, the number of patients receiving home oxygen decreased, results that could represent reduced access to home oxygen DME. Finally, in contrast to declines in use for most home oxygen items, the percentage of Medicare beneficiaries using portable oxygen concentrators and CPAP devices increased significantly. The researchers conclude that this analysis addresses a critical knowledge gap and highlights the need for future work evaluating how policies such as the CBP affect respiratory DME access and outcomes.
AHRQ-funded; HS026369.
Citation: Duan KI, Wong ES, Liao JM .
Long-term trends in home respiratory medical equipment among U.S. Medicare patients.
Am J Respir Crit Care Med 2022 Aug 15;206(4):509-11. doi: 10.1164/rccm.202202-0238LE..
Keywords: Home Healthcare, Medicare, Respiratory Conditions
Lee JL, Gustavson AM, Kian L
Reimagining cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations.
This research letter discusses the development process for cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations. These collaborations are proposed between health, social, and academic research systems. The authors collaborated with their local Houston Meals on Wheels (MOW) program, the University of Texas Health Science Center at Houston, and the Harris County Health System. These organizations formed a Healthy Aging Committee with several healthcare professionals from different healthcare systems participating as volunteers. The goal of the Committee was to identify ways to highlight the potential benefits of nutritious meal delivery. The three institutions worked together through all stages of research, from grant writing to recruiting participants, establishing trust in their relationships, and leveraging their connections and expertise in different areas. In their first research project, they investigated the addition of a home-based exercise program with enhanced meal deliveries to improve frailty status in older adults who were frail and homebound. This pilot study had been stopped during the pandemic. The restarted study was revised so that the MOW drivers delivering frozen and shelf-stable meals in person once a week would now also provide exercise handouts for those in the treatment group to minimize face-to-face contact. Their current second research project is evaluating whether the combination of a virtual assistant device such as Amazon Alexa with meal delivery can improve mental health for homebound older adults with cognitive impairment.
AHRQ-funded; HS026379.
Citation: Lee JL, Gustavson AM, Kian L .
Reimagining cross-sector collaborations post-pandemic to optimize care for vulnerable homebound older adult populations.
J Am Geriatr Soc 2022 Jul; 70(7):1939-41. doi: 10.1111/jgs.17813..
Keywords: Elderly, Home Healthcare, Vulnerable Populations, Public Health
Hobensack M, Ojo M, Barrón Y
Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians.
The objectives of this study were to identify risk factors that home healthcare clinicians associate with patient deterioration and to understand clinicians’ response to and documentation of these risk factors. The authors interviewed multidisciplinary home healthcare clinicians and used directed content analysis to identify risk factors for deterioration. A total of 79 risk factors were identified by the clinicians, who responded most often by communicating with the prescribing provider or following up with patients and caregivers. Clinicians also acknowledged that social factors played a role in deterioration risk. The authors noted that, since most risk factors were documented in clinical notes, methods such as natural language processing are needed to extract them. They concluded that by providing a comprehensive list of risk factors grounded in clinician expertise and mapped to standardized terminologies, the results of their study supported the development of an early warning system for patient deterioration.
AHRQ-funded; HS027742.
Citation: Hobensack M, Ojo M, Barrón Y .
Documentation of hospitalization risk factors in electronic health records (EHRs): a qualitative study with home healthcare clinicians.
J Am Med Inform Assoc 2022 Apr 13;29(5):805-12. doi: 10.1093/jamia/ocac023..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Home Healthcare, Risk, Hospitalization
Wang J, Ying M, Li Y
Home health agencies with more socially vulnerable patients have poorer experience of care ratings.
The purpose of this study was to evaluate the relationship between Medicare dual eligibility and race/ ethnicity when exploring Medicare-certified Home Health Agencies (CHHAs) and experience of care ratings. The researchers analyzed the 2017 national Consumer Assessment of Healthcare Providers and Systems and matched datasets of 10,906 CHHAs and found that CHHAs with higher concentrations of dual-eligible patients were less likely to have high experience of care ratings. In addition, CHHAs with higher proportions of racial/ ethnic minorities were less likely to have high experience of care ratings in the domains of care delivery, communication, and specific care issues.
AHRQ-funded; HS026893.
Citation: Wang J, Ying M, Li Y .
Home health agencies with more socially vulnerable patients have poorer experience of care ratings.
J Appl Gerontol 2022 Mar;41(3):661-70. doi: 10.1177/07334648211053859..
Keywords: Elderly, Home Healthcare, Vulnerable Populations, Provider Performance
Schwartz ML, Rahman M, Thomas KS
Consumer selection and home health agency quality and patient experience stars.
The objective of this study was to compare the impact of the introduction of two distinct sets of star ratings, quality of care, and patient experience, on home health agency (HHA) selection. The investigators concluded that the introduction of quality of care and patient experience stars were associated with changes in HHA selection; however, the strength of these relationships was weaker than observed in other health care settings where a single star rating was reported.
AHRQ-funded; HS026440.
Citation: Schwartz ML, Rahman M, Thomas KS .
Consumer selection and home health agency quality and patient experience stars.
Health Serv Res 2022 Feb;57(1):113-24. doi: 10.1111/1475-6773.13867..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Home Healthcare, Patient Experience, Quality Measures, Quality of Care, Provider Performance, Quality Indicators (QIs)
Bryant KB, Green MB, Shimbo D
Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go.
This analysis examined how historical use of home blood pressure monitoring (HBPM) aligns with current out-of-office BP monitoring recommendations for hypertensive US adults without a previous hypertension diagnosis and how HBPM use varies by patient characteristics. A cohort of 7185 adults aged 20 years or older without a diagnosis of hypertension or antihypertensive medication use and a high office BP (≥130/80 mm Hg) who participated in the National Health and Nutrition Examination Survey (NHANES) 2009 to 2014 cycle were included. Participants who answered as having self-initiated or physician recommended HBPM were categorized as having used or having been told to use HBPM. The authors estimate that 31.4 million US adults did not have diagnosed hypertension, were not taking antihypertensive medications, and had an office BP ≥130/80 mm Hg. Out of that population, 95.3% would have met criteria to undergo out-of-office BP monitoring by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Only 3.6% (1.1 million) were told to use HBPM, and 15.7% had used HPBM. There were no differences in use by race/ethnicity, sex, health insurance status, or source of routine healthcare. The authors suggest the use of a telemonitoring system to improve ease of HBPM.
AHRQ-funded; HS024262.
Citation: Bryant KB, Green MB, Shimbo D .
Home blood pressure monitoring for hypertension diagnosis by current recommendations: a long way to go.
Hypertension 2022 Feb;79(2):e15-e17. doi: 10.1161/hypertensionaha.121.18463..
Keywords: Blood Pressure, Diagnostic Safety and Quality, Home Healthcare, Guidelines, Evidence-Based Practice
Squires A, Ma C, Miner S
Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis.
In home health care, language barriers are understudied. Language barriers between patients and providers are known to affect a variety of patient outcomes. How a patient's language preference influences hospital readmission risk from home health care has yet to be determined. The objective of this retrospective cross-sectional study was to determine if home care patients' language preference is associated with their risk for hospital readmission from home health care within 30 days of hospital discharge.
AHRQ-funded; HS023593.
Citation: Squires A, Ma C, Miner S .
Assessing the influence of patient language preference on 30 day hospital readmission risk from home health care: a retrospective analysis.
Int J Nurs Stud 2022 Jan;125:104093. doi: 10.1016/j.ijnurstu.2021.104093..
Keywords: Cultural Competence, Home Healthcare, Hospital Readmissions, Risk, Communication
Kendall L, Eschler J, Lozano P
Engineering for reliability in at-home chronic disease management.
The researchers examined how individuals responsible for managing their own or others’ chronic conditions integrate reminders and notification systems into their daily routines. Based on the participants’ experiences, they contend that many self-management failures should be viewed as systems failures, rather than individual failures and non-compliance.
AHRQ-funded; HS021590.
Citation: Kendall L, Eschler J, Lozano P .
Engineering for reliability in at-home chronic disease management.
AMIA Annu Symp Proc 2014 Nov 14;2014:777-86..
Keywords: Chronic Conditions, Patient Self-Management, Home Healthcare, Patient Adherence/Compliance
Smucker DR, Regan S, Elder NC
Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members.
The study objective was to explore the types and characteristics of patient safety incidents in home hospice care from the experiences of hospice interdisciplinary team members. Based on interviews of 19 experienced hospice leaders, the most commonly described categories of patient harm were injuries from falls and inadequate symptom control.
AHRQ-funded; HS018245
Citation: Smucker DR, Regan S, Elder NC .
Patient safety incidents in home hospice care: the experiences of hospice interdisciplinary team members.
J Palliat Med. 2014 May;17(5):540-4. doi: 10.1089/jpm.2013.0111..
Keywords: Patient Safety, Home Healthcare, Falls, Chronic Conditions
Huckfeldt PJ, Sood N, Escarce JJ
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
The researchers contrasted the effects of two Medicare payment reforms for home health agencies: the interim payment system (IPS) and the prospective payment system (PPS). The 1997 IPS reform lowered payments for both fee-for-service and episode-based care, as predicted by their conceptual model. The PPS in 2000 raised average but lowered marginal payment.
AHRQ-funded; HS018541
Citation: Huckfeldt PJ, Sood N, Escarce JJ .
Effects of Medicare payment reform: evidence from the home health interim and prospective payment systems.
J Health Econ. 2014 Mar;34:1-18. doi: 10.1016/j.jhealeco.2013.11.005..
Keywords: Medicare, Healthcare Costs, Home Healthcare
Thomas KS
The relationship between Older Americans Act in-home services and low-care residents in nursing homes.
This study examining the relationship between the proportion of older adults in a State who receive in-home services funded by the Older Americans Act and the proportion of residents in nursing homes finds that for every additional 1 percent of the 65+ population that receives personal care services, there is a 0.8% decrease in the proportion of low-care residents in nursing homes.
AHRQ-funded; HS00011
Citation: Thomas KS .
The relationship between Older Americans Act in-home services and low-care residents in nursing homes.
J Aging Health. 2014 Mar;26(2):250-60. doi: 10.1177/0898264313513611..
Keywords: Elderly, Long-Term Care, Home Healthcare, Nursing Homes, Healthcare Delivery
Sockolow PS, Bowles KH, Adelsberger MC
Challenges and facilitators to adoption of a point-of-care electronic health record in home care.
In order to identify challenges to the adoption of electronic health records (EHR) in the home care setting, the researchers assessed clinician satisfaction, informed by workflow and patient outcomes. Using a combination of surveys, observations, and interviews in an agency with 137 clinicians, the researchers found that adoption challenges included: (a) hardware problems coupled with lack of field support; (b) inadequate training; and (c) mismatch of EHR usability/functionality and workflow.
AHRQ-funded; HS021008.
Citation: Sockolow PS, Bowles KH, Adelsberger MC .
Challenges and facilitators to adoption of a point-of-care electronic health record in home care.
Home Health Care Serv Q 2014;33(1):14-35. doi: 10.1080/01621424.2013.870098..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Home Healthcare
Sockolow PS, Bowles KH, Adelsberger MC
Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes.
The study objective was to assess the impact of attaining efficiency and health goals of a point-of-care EHR in home care. To realize this objective, the researchers compared clinical documentation workflow, financial time-to-billing and patient physiological and behavioral outcomes to evaluate its impact. The findings indicate that EHR use significantly improved the timeliness of clinical documentation and billing for reimbursement but had limited impact on improving patient outcomes.
AHRQ-funded; HS021008.
Citation: Sockolow PS, Bowles KH, Adelsberger MC .
Impact of homecare electronic health record on timeliness of clinical documentation, reimbursement, and patient outcomes.
Appl Clin Inform 2014;5(2):445-62. doi: 10.4338/aci-2013-12-ra-0106..
Keywords: Health Information Technology (HIT), Electronic Health Records (EHRs), Home Healthcare