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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 17 of 17 Research Studies Displayed
McDowell A, Myong C, Tevis D
Sexual orientation and gender identity data reporting among U.S. health centers.
This study examined sexual orientation and gender identity data reporting among community health centers. The study used the 2016-2019 Uniform Data System for 1,381 community health centers to look at trends in reporting. From 2016 to 2016, the percentage of community health centers with sexual orientation and gender identity data for ≥75% of patients increased from 14.9% to 53.0%. In 2019, community health centers were more likely to have this data for ≥75% of patients if they were in nonmetro counties versus metro, were in the South or West (versus Northeast), and had more patients aged between 18 and 39 years, between 40 and 64 years (versus <18 years), or veterans. This was less likely among smaller community health centers serving 10-20,000 patients or >20,000 patients, and centers with more patients of American Indian/Alaskan Native or unknown race (versus White).
Citation: McDowell A, Myong C, Tevis D . Sexual orientation and gender identity data reporting among U.S. health centers. Am J Prev Med 2022 Jun;62(6):e325-e32. doi: 10.1016/j.amepre.2021.12.017..
Keywords: Vulnerable Populations, Community-Based Practice
Adolphe S, Fernandez-Pastrana I, Scott H
EASE-ing the way for pediatric providers and parents: the Engagement and Access to Special Education (EASE) Clinic.
Primary Care Providers (PCPs) are tasked by the American Academy of Pediatrics to identify children who need special education and ensure that those children receive appropriate related services provided by the Individuals with Disabilities Education Act (IDEA). The IDEA entitles children between the ages of 3 and 21 to free education through individualized education programs (IEPs), and other related supports. The extent of PCP knowledge about the IDEA, special education, and available related support services and how to assess them, is largely unknown. Existing research indicates there is a lack of knowledge, training, and confidence in providers about special education. Boston Medical Center’s (BMC) Engagement and Access to Special Education (EASE) clinic was developed to provide support to the parents and PCPs of children with special education needs. The purpose of this article was to introduce and describe the EASE clinical model as a useful method for PCPs to strengthen their ability to provide appropriate and available comprehensive care to their patients requiring special education. The authors reported that of the 14,000 pediatric patients at the Boston Medical Center, 308 children were referred to the EASE clinic between its inception in 2017 and May 2021. The majority of children were Black non-Hispanic, English-speaking, and male, with an average age of 8.3 at first clinic. During that same time 452 total visits were completed, with a waiting list of less than 90 days. The authors conclude that for primary care practices with patients with special education needs, the BMC EASE clinic can serve as a useful model for improving their ability to provide care.
Citation: Adolphe S, Fernandez-Pastrana I, Scott H . EASE-ing the way for pediatric providers and parents: the Engagement and Access to Special Education (EASE) Clinic. Acad Pediatr 2022 May-Jun;24(4):705-07. doi: 10.1016/j.acap.2022.02.011..
Keywords: Children/Adolescents, Caregiving, Patient and Family Engagement, Vulnerable Populations, Disabilities
Cole MB, Nguyen KH, Byhoff E, Byhoff E
Screening for social risk at federally qualified health centers: a national study.
In the United States, millions of low-income patients have unaddressed social risks. Federally Qualified Health Centers (FQHCs) provide services to approximately 29.8 million low-income patients, and data on social risk screening capabilities had never been collected across all FQHCs until 2019. The purpose of this study was to analyze the social risk screening capabilities across the FQHCs, report the national rates, identify screening predictors, and compare rates between states. The researchers collected data from the 2019 Uniform Data System from all 1,384 FQHCs across the U.S., with a primary outcome of determining whether each FQHC collected data on their patients’ social risk factors. The researchers also estimated the relationship between the characteristics of 7 FQHCs (such as their size, and various Medicare features), and their probability of conducting social risk screening. The study reported that 71% of FQHCs collected information on social risks, with variances between states. The researchers concluded that while the majority of FQHCs collect data on social risk factors, there are disparities between different states, and that smaller FQHCs may benefit from having social risk screening resources focused on them and may increase their use of screening tools and practices.
Citation: Cole MB, Nguyen KH, Byhoff E, Byhoff E . Screening for social risk at federally qualified health centers: a national study. Am J Prev Med 2022 May;62(5):670-78. doi: 10.1016/j.amepre.2021.11.008..
Keywords: Social Determinants of Health, Vulnerable Populations, Screening
Kenney MK, Chanlongbutra A, Fanflick PL
AHRQ Author: Chanlongbutra A
Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017.
The purpose of the study was to compare Children and Youth with Special Health Care Needs (CYSHCN) with non-CYSHCN in the likelihood of experiencing Adverse Childhood Events (ACEs), and then document the differences in receiving recommended and needed health care services among CYSHCS with and without ACEs. The researchers studied a sample of 16,304 CYSHCN from the 2016 and 2017 National Survey of Children’s Health (N=71,181). The study found that CYHSCN had a greater likelihood of having each of the measured Adverse Childhood Events, and greater likelihood of experiencing aggregated levels of ACE’s than non-CYSHCN. In addition, an increase in ACEs was related to a decrease in the likelihood of a CYSHCN having a medical home with family-centered and coordinated care. Having one or greater ACEs increased the likelihood of having unmet mental health care needs. The study concluded that the researcher’s findings extend the current understanding of the relationship between CYSHCN and ACEs, and that the need for additional work to establish care systems for this vulnerable population continues.
Citation: Kenney MK, Chanlongbutra A, Fanflick PL . Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016-2017. Disabil Health J 2022 Apr;15(2):101226. doi: 10.1016/j.dhjo.2021.101226..
Keywords: Children/Adolescents, Disabilities, Healthcare Delivery, Vulnerable Populations
Behr CL, Hull P, Hsu J
Geographic access to federally qualified health centers before and after the Affordable Care Act.
Funding for Federally Qualified Health Centers (FQHCs) increased with the advent of the Affordable Care Act (ACA). The purpose of this study was to define FQHC service areas based on patient use and examine the characteristics of areas that gained FQHC access post-ACA. The researchers first defined FQHC service areas using total patient counts by ZIP code from the Uniform Data System (UDS) and then compared that approach with other methods. The authors then compared the characteristics of ZIP codes from Medically Underserved Areas/ Populations (MUA/Ps) that gained access to FQHCs between 2011-2015, with MUA/P ZIP codes that did not gain access to FQHCs during that same time period. The study found that FQHC service areas based on the UDS data included a larger percentage of FQHC patients and a higher use of FQHCs among low-income residents, on average, than Primary Care Service Areas or counties. The researchers also discovered that MUA/Ps that gained access to an FQHC between 2011 and 2015 included more poor, publicly insured, uninsured, and foreign born residents than underserved areas that did not gain access. The study concluded that measures of actual patient use are a useful method of assessing FQHC service areas and access.
Citation: Behr CL, Hull P, Hsu J . Geographic access to federally qualified health centers before and after the Affordable Care Act. BMC Health Serv Res 2022 Mar 23;22(1):385. doi: 10.1186/s12913-022-07685-0..
Keywords: Access to Care, Uninsured, Safety Net, Vulnerable Populations
Riviello ED, Dechen T, O'Donoghue AL
Assessment of a crisis standards of care scoring system for resource prioritization and estimated excess mortality by race, ethnicity, and socially vulnerable area during a regional surge in COVID-19.
Researchers analyzed the association of a crisis standards of care (CSOC) scoring system with resource prioritization and estimated excess mortality by race, ethnicity, and residence in a socially vulnerable area during the COVID-19 pandemic. Using data from 6 hospitals in greater Boston, Massachusetts, they found that a CSOC priority score resulted in lower prioritization of Black patients to receive scarce resources. Also, a model using a random lottery resulted in more estimated excess deaths overall without improving equity by race.
Citation: Riviello ED, Dechen T, O'Donoghue AL . Assessment of a crisis standards of care scoring system for resource prioritization and estimated excess mortality by race, ethnicity, and socially vulnerable area during a regional surge in COVID-19. JAMA Netw Open 2022 Mar;5(3):e221744. doi: 10.1001/jamanetworkopen.2022.1744..
Keywords: COVID-19, Racial / Ethnic Minorities, Mortality, Public Health, Vulnerable Populations
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.
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
Porteny T, Ponce N, Sommers BD
Immigrants and the Affordable Care Act: changes in coverage and access to care by documentation status.
This study used data from the California Health Interview Survey (2003-2016) to compare changes in health coverage and access to care among immigrants in California before and after the Affordable Care Act (ACA). The authors found that the ACA has led to major gains in coverage for lawful permanent residents in California, but unauthorized immigrants experienced only modest increases in coverage. This result widened the disparity in uninsured rates for unauthorized immigrants relative to citizens considerably since 2014.
Citation: Porteny T, Ponce N, Sommers BD . Immigrants and the Affordable Care Act: changes in coverage and access to care by documentation status. J Immigr Minor Health 2022 Feb;24(1):86-94. doi: 10.1007/s10903-020-01124-0..
Keywords: Access to Care, Health Insurance, Uninsured, Vulnerable Populations
Kronk CA, Everhart AR, Ashley F
Transgender data collection in the electronic health record: current concepts and issues.
The authors present recommendations and common pitfalls involving sex- and gender-related data collection in electronic health records (EHRs) regarding the over 1 million transgender people living in the United States. They also briefly discuss adequate additions to the EHR considering name and pronoun usage. They conclude that collaborations between local transgender and gender-diverse persons and medication providers as well as open inclusion of transgender and gender-diverse individuals on terminology and standards boards is crucial to shifting the paradigm in transgender and gender-diverse health.
AHRQ-funded; HS026385; HS000029.
Citation: Kronk CA, Everhart AR, Ashley F . Transgender data collection in the electronic health record: current concepts and issues. J Am Med Inform Assoc 2022 Jan 12;29(2):271-84. doi: 10.1093/jamia/ocab136..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Vulnerable Populations
Mojica CM, Gunn R, Pham R
An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees.
This study was conducted to describe clinical workflows for fecal immunochemical tests/fecal occult blood tests (FIT/FOBT) in Oregon primary care practices and to identify specific workflow processes that might be associated with higher colorectal cancer (CRC) screening rates. Findings showed that primary care practices with higher CRC screening rates among newly age-eligible Medicaid enrollees had more established visit-based and population outreach workflows to support identifying patients due for screening, FIT/FOBT distribution, reminders, and follow up. Higher CRC screening was associated with having medical assistants discuss and review FIT/FOBT screening and instructions with patients.
Citation: Mojica CM, Gunn R, Pham R . An observational study of workflows to support fecal testing for colorectal cancer screening in primary care practices serving Medicaid enrollees. BMC Cancer 2022 Jan 25;22(1):106. doi: 10.1186/s12885-021-09106-7..
Keywords: Workflow, Screening, Cancer: Colorectal Cancer, Cancer, Primary Care, Vulnerable Populations
Sequeira GM, Boyer T, Coulter RWS
Healthcare experiences of gender diverse youth across clinical settings.
The objectives of this study were to describe the current experiences of gender diverse youth in healthcare settings outside of multidisciplinary gender clinics and determine how healthcare experiences differ by gender identity and across settings, with the goal of informing interventions that can create more gender-affirming health systems.
Citation: Sequeira GM, Boyer T, Coulter RWS . Healthcare experiences of gender diverse youth across clinical settings. J Pediatr 2022 Jan;240:251-55. doi: 10.1016/j.jpeds.2021.08.089..
Keywords: Children/Adolescents, Patient Experience, Case Study, Vulnerable Populations
Davidson L, Haynes SC, Favila-Meza A
Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities.
This study investigated patient and therapist experience and cost savings from the payer perspective associated with a novel tele-physiatry program for children living in rural and underserved communities. Study setting was four school-based clinics in Northern California with a total of 268 encounters (124 telemedicine and 144 in-person). Parent and therapists reported no difference in experience and perceived quality of care between telemedicine and in-person encounters. For parents whose children received a telemedicine encounter, 54.8% reported no preference for their child’s subsequent encounter, 28.8% preferred a physiatrist telemedicine visit, and 12 preferred a physiatrist in-person visit. There was also an average cost savings of $100 per clinic owing to physician milage for in-person visits.
Citation: Davidson L, Haynes SC, Favila-Meza A . Parent experience and cost savings associated with a novel tele-physiatry program for children living in rural and underserved communities. Arch Phys Med Rehabil 2022 Jan;103(1):8-13. doi: 10.1016/j.apmr.2021.07.807..
Keywords: Children/Adolescents, Telehealth, Health Information Technology (HIT), Healthcare Costs, Rural Health, Vulnerable Populations, Disabilities, Rehabilitation
Gilmer TP, Stefancic A, Katz ML
Fidelity to the housing first model and effectiveness of permanent supported housing programs in California.
This paper examined the relationship between fidelity to the Housing First model and residential outcomes among clients of full service partnerships (FSPs) in California. They concluded that programs with greater fidelity to the Housing First model enrolled clients with longer histories of homelessness and placed most of them in apartments.
Citation: Gilmer TP, Stefancic A, Katz ML . Fidelity to the housing first model and effectiveness of permanent supported housing programs in California. Psychiatr Serv 2014 Nov;65(11):1311-7. doi: 10.1176/appi.ps.201300447.
Keywords: Value, Vulnerable Populations
Vanderwerker L, Akincigil A, Olfson M
Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.
The researchers investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths. They found that foster care youths had higher rates of externalizing disorders than the comparison group and greater antipsychotic use. Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates.
AHRQ-funded; HS017918; HS019937; HS021112.
Citation: Vanderwerker L, Akincigil A, Olfson M . Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths. Psychiatr Serv 2014 Oct;65(10):1281-4. doi: 10.1176/appi.ps.201300455.
Keywords: Children/Adolescents, Medication, Medicaid, Vulnerable Populations, Behavioral Health
Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q
AHRQ Author: Ngo-Metzger Q
Substance use, risk of dependence, counseling and treatment among adult health center patients.
The authors examined the prevalence of substance use and risk of dependence among health center patients, and identified factors associated with desire for counseling/treatment and discussions about substance use with a clinician. They found that 84% of patients who desired substance use counseling or treatment reported receiving it, and those patients most likely to desire substance use counseling or treatment were male, unmarried, insured, current smokers, and indicated mental health problems.
Citation: Lebrun-Harris LA, Tomoyasu N, Ngo-Metzger Q . Substance use, risk of dependence, counseling and treatment among adult health center patients. J Health Care Poor Underserved 2014 Aug;25(3):1217-30. doi: 10.1353/hpu.2014.0130.
Keywords: Behavioral Health, Community-Based Practice, Substance Abuse, Vulnerable Populations
Allgood KL, Rauscher GH, Whitman S
Validating self-reported mammography use in vulnerable communities: findings and recommendations.
The researchers examined the potential extent of overreporting of mammography use in low-income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. They found that although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all ethnic groups studied.
Citation: Allgood KL, Rauscher GH, Whitman S . Validating self-reported mammography use in vulnerable communities: findings and recommendations. Cancer Epidemiol Biomarkers Prev 2014 Aug;23(8):1649-58. doi: 10.1158/1055-9965.epi-13-1253.
Keywords: Healthcare Utilization, Mammogram, Racial / Ethnic Minorities, Vulnerable Populations, Low-Income, Urban Health, Women
Moy E, Freeman W
AHRQ Author: Moy E, Freeman W
Federal investments to eliminate racial/ethnic health-care disparities.
The authors presented a model that describes the relationships among social disadvantage, health-care disparities, and health disparities. They proposed that increasing the diversity of the public health and health-care workforces is an efficient strategy for reducing disparities because it impacts both access to care and patient-provider communication.
Citation: Moy E, Freeman W . Federal investments to eliminate racial/ethnic health-care disparities. Public Health Rep 2014 Jan-Feb;129 Suppl 2:62-70. doi: 10.1177/00333549141291s212.
Keywords: Access to Care, Disparities, Racial / Ethnic Minorities, Social Determinants of Health, Vulnerable Populations