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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 23 of 23 Research Studies Displayed
Mukamel DB, Haeder SF, Weimer DL
Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.
The authors reviewed the extant literature on regulation and report cards. They found evidence of both functional and dysfunctional effects and identified the areas in which additional research would most likely be valuable.
Citation: Mukamel DB, Haeder SF, Weimer DL . Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards. Annu Rev Public Health 2014;35:477-97. doi: 10.1146/annurev-publhealth-082313-115826.
Keywords: Quality of Care, Policy, Policy, Public Reporting
Gerber DE, Laccetti AL, Xuan L
Impact of prior cancer on eligibility for lung cancer clinical trials.
A prior cancer diagnosis often excludes patients from cancer clinical trials. Lung cancer patients were used to determine estimated impact on trial accrual. This study found that patients previously diagnosed with cancer were excluded in more than two-thirds of lung cancer trials. More research is needed to understand the basis of this policy.
Citation: Gerber DE, Laccetti AL, Xuan L . Impact of prior cancer on eligibility for lung cancer clinical trials. J Natl Cancer Inst. 2014 Nov;106(11). doi: 10.1093/jnci/dju302..
Keywords: Cancer: Lung Cancer, Policy, Cancer, Diagnostic Safety and Quality
Davis AE, Mehrotra S, Ladner DP
Changes in geographic disparity in kidney transplantation since the final rule.
The researchers assessed the significance of changes of geographic disparities for four metrics since the 1998 adoption of HHS Final Rule’s emphasizing objective priority criteria: waiting times, transplant rates, pre-transplant mortality, and organ quality. They found that the ranges of the four metrics have worsened by approximately 30% or more after the Final Rule at both the regional and donor service area levels.
Citation: Davis AE, Mehrotra S, Ladner DP . Changes in geographic disparity in kidney transplantation since the final rule. Transplantation 2014 Nov 15;98(9):931-6. doi: 10.1097/tp.0000000000000446..
Keywords: Transplantation, Disparities, Policy, Outcomes
Lyles CR, Aulakh V, Jameson W
Innovation and transformation in California's safety net health care settings: an inside perspective.
The authors investigated how safety net settings will innovate in order to achieve transformation of care delivery. Through informant interviews, they found that safety net systems have already begun implementing innovative practices supporting their key priority areas, but that more support is needed, specifically to accelerate the change needed to succeed under health reform.
Citation: Lyles CR, Aulakh V, Jameson W . Innovation and transformation in California's safety net health care settings: an inside perspective. Am J Med Qual 2014 Nov-Dec;29(6):538-45. doi: 10.1177/1062860613507474.
Keywords: Healthcare Delivery, Policy, Innovations and Emerging Issues, Organizational Change, Safety Net
Epstein AM, Sommers BD, Kuznetsov Y
Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion.
The authors explored what low-income Americans think about Medicaid. They found that nearly 80 percent of their telephone survey sample favored Medicaid expansion, and approximately two-thirds of uninsured respondents said that they planned to apply for either Medicaid or subsidized private coverage in 2014. Most viewed having Medicaid as better than being uninsured and at least as good as private insurance in overall quality and affordability.
Citation: Epstein AM, Sommers BD, Kuznetsov Y . Low-income residents in three states view Medicaid as equal to or better than private coverage, support expansion. Health Aff 2014 Nov;33(11):2041-7. doi: 10.1377/hlthaff.2014.0747.
Keywords: Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Yeh JS, Austad KE, Franklin JM
Association of medical students' reports of interactions with the pharmaceutical and medical device industries and medical school policies and characteristics: a cross-sectional study.
The study’s goal was to determine which medical school characteristics and which conflict of interest policy dimensions were most predictive of students’ reported behaviors. It found that students at schools with the highest ranked interaction policies based on the American Medical Student Association (AMSA) score were 63 percent less likely to accept gifts as students at the lowest ranked schools.
Citation: Yeh JS, Austad KE, Franklin JM . Association of medical students' reports of interactions with the pharmaceutical and medical device industries and medical school policies and characteristics: a cross-sectional study. PLoS Med 2014 Oct;11(10):e1001743. doi: 10.1371/journal.pmed.1001743..
Keywords: Medical Devices, Medication, Policy, Practice Patterns
Gold R, Bailey SR, O'Malley JP
Estimating demand for care after a Medicaid expansion: lessons from Oregon.
In order to estimate how the Affordable Care Act's Medicaid expansions will affect demand for services, the authors measured ambulatory care utilization among adult patients who gained insurance during Oregon's 2008 Medicaid expansion. They found that, in comparisons of the pre- and postcoverage periods, the mean annual encounters among persons who gained insurance increased 22% to 35%, but declined in the comparison groups.
Citation: Gold R, Bailey SR, O'Malley JP . Estimating demand for care after a Medicaid expansion: lessons from Oregon. J Ambul Care Manage 2014 Oct-Dec;37(4):282-92. doi: 10.1097/jac.0000000000000023.
Keywords: Access to Care, Healthcare Utilization, Policy, Health Services Research (HSR), Medicaid
Kesselheim AS, Tan YT, Darrow JJ
Existing FDA pathways have potential to ensure early access to, and appropriate use of, specialty drugs.
The researchers reviewed the different strategies that the FDA can use to approve and influence the post-approval prescribing of specialty drugs, including expediting the drugs' availability to patients through expanded access programs and expedited approval pathways, limiting the scope of the drugs' indications, and encouraging the development of companion diagnostic tests to indicate which patients should receive the drugs.
Citation: Kesselheim AS, Tan YT, Darrow JJ . Existing FDA pathways have potential to ensure early access to, and appropriate use of, specialty drugs. Health Aff 2014 Oct;33(10):1770-8. doi: 10.1377/hlthaff.2014.0529.
Keywords: Access to Care, Medication, Policy
Hernandez-Boussard T, Burns CS, Wang NE
The Affordable Care Act reduces emergency department use by young adults: evidence from three States.
The authors tested the impact of the Affordable Care Act (ACA) on how young adults used ED services. They found that the largest relative decreases were found in women and blacks. This relative decrease in ED use implies a total reduction of more than 60,000 visits from young adults across three states in 2011.
Citation: Hernandez-Boussard T, Burns CS, Wang NE . The Affordable Care Act reduces emergency department use by young adults: evidence from three States. Health Aff 2014 Sep;33(9):1648-54. doi: 10.1377/hlthaff.2014.0103.
Keywords: Emergency Department, Health Insurance, Policy, Healthcare Cost and Utilization Project (HCUP), Young Adults
Aliu O, Auger KA, Sun GH
The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care.
Using the natural experiment of Medicaid expansion in New York (NY) State in October 2001, the study investigators examined whether Medicaid expansion increased access to common musculoskeletal procedures for Medicaid beneficiaries. They concluded that Medicaid expansion in NY State significantly improved access to common musculoskeletal procedures for Medicaid beneficiaries.
Citation: Aliu O, Auger KA, Sun GH . The effect of pre-Affordable Care Act (ACA) Medicaid eligibility expansion in New York State on access to specialty surgical care. Med Care 2014 Sep;52(9):790-5. doi: 10.1097/mlr.0000000000000175..
Keywords: Access to Care, Policy, Medicaid, Surgery
Davis AE, Mehrotra S, Kilambi V
The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States.
This study examined the effect of Statewide Sharing on geographic allocation disparity over time between donor service areas (DSAs) within Tennessee and Florida and compared them with geographic disparity between the DSAs within a state for all states with more than one DSA (California, New York, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin). Findings suggested that changes which are untested run the risk of unintended consequences, and Statewide Sharing should be further studied and considered.
Citation: Davis AE, Mehrotra S, Kilambi V . The effect of the Statewide Sharing variance on geographic disparity in kidney transplantation in the United States. Clin J Am Soc Nephrol 2014 Aug 7;9(8):1449-60. doi: 10.2215/cjn.05350513.
Keywords: Chronic Conditions, Disparities, Kidney Disease and Health, Policy, Transplantation
Ridgely MS, de Vries D, Bozic KJ
Bundled payment fails to gain a foothold in California: the experience of the IHA bundled payment demonstration.
This article reports on a meeting convened by California's Integrated Healthcare Association to determine whether bundled payment could be an effective payment model for California. An evaluation of the pilot documented a number of barriers, such as administrative burden, state regulatory uncertainty, and disagreements about bundle definition and assumption of risk; however, the evaluation provides lessons for future bundled payment initiatives.
Citation: Ridgely MS, de Vries D, Bozic KJ . Bundled payment fails to gain a foothold in California: the experience of the IHA bundled payment demonstration. Health Aff 2014 Aug;33(8):1345-52. doi: 10.1377/hlthaff.2014.0114.
Keywords: Payment, Policy
Larkin I, Ang D, Avorn J
Restrictions on pharmaceutical detailing reduced off-label prescribing of antidepressants and antipsychotics in children.
The researchers estimated the effect of anti-detailing policies on off-label prescribing of antidepressants and antipsychotics by pediatricians and by child and adolescent psychiatrists in the period January 2006-June 2009. They found that prescriptions for off-label use of promoted drugs fell by 11 percent and that prescriptions for on-label use of promoted drugs fell by 34 percent. Conversely, prescriptions for on-label use of nonpromoted drugs rose by 14 percent, and those for off-label use of nonpromoted drugs rose by 35 percent. They concluded that these results suggest that pharmaceutical sales representatives promoted drugs not approved for pediatric use and that policies that restrict detailing by those representatives reduced such off-label prescribing.
Citation: Larkin I, Ang D, Avorn J . Restrictions on pharmaceutical detailing reduced off-label prescribing of antidepressants and antipsychotics in children. Health Aff 2014 Jun;33(6):1014-23. doi: 10.1377/hlthaff.2013.0939.
Keywords: Medication, Children/Adolescents, Communication, Policy, Practice Patterns
Ryan AM, Mushlin AI
The Affordable Care Act's payment reforms and the future of hospitals.
The author places likely hospital responses to the Affordable Care Act’s payment reforms in the historical context of their previous responses to such reforms as price controls, certificate-of-need laws, and prospective payment systems. He then discusses possible hospital responses to counter readmission penalties, revenue reductions, bundled payment strategies, and accountable care organizations.
Citation: Ryan AM, Mushlin AI . The Affordable Care Act's payment reforms and the future of hospitals. Ann Intern Med. 2014 May 20;160(10):729-30. doi: 10.7326/M13-2033..
Keywords: Healthcare Costs, Payment, Value, Hospitals, Policy
Greer SL, Lillvis DF
Beyond leadership: political strategies for coordination in health policies.
The objective of this article is to utilize the political science and public administration literatures to document the problems that serve as obstacles to intersectoral governance– and therefore, the implementation of a Health in All Policies (HiAP) approach–as well as solutions to overcome these obstacles.
Citation: Greer SL, Lillvis DF . Beyond leadership: political strategies for coordination in health policies. Health Policy 2014 May;116(1):12-7. doi: 10.1016/j.healthpol.2014.01.019..
Keywords: Policy, Public Health, Policy
Hill SC, Abdus S, Hudson JL
AHRQ Author: Hill SC, Hudson JL, Selden TM
Adults in the income range for the Affordable Care Act's Medicaid expansion are healthier than pre-ACA enrollees.
The investigators used MEPS data to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACA's Medicaid expansion and thus newly eligible for coverage. They found that both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees. They concluded that by expanding Medicaid eligibility, states could provide coverage to millions of healthier adults as well as to millions who have chronic conditions and who need care.
Citation: Hill SC, Abdus S, Hudson JL . Adults in the income range for the Affordable Care Act's Medicaid expansion are healthier than pre-ACA enrollees. Health Aff 2014 Apr;33(4):691-9. doi: 10.1377/hlthaff.2013.0743.
Keywords: Health Insurance, Policy, Health Status, Low-Income, Medicaid, Medical Expenditure Panel Survey (MEPS)
Lyon SM, Wunsch H, Asch DA
Use of intensive care services and associated hospital mortality after Massachusetts healthcare reform.
This study examined the impact of increased insurance coverage on intensive care unit (ICU) usage and mortality in Massachusetts where health insurance reform had expanded coverage. It found that reform was not associated with either significant changes in ICU use or changed hospital mortality for ICU patients.
Citation: Lyon SM, Wunsch H, Asch DA . Use of intensive care services and associated hospital mortality after Massachusetts healthcare reform. Crit Care Med. 2014 Apr;42(4):763-70. doi: 10.1097/CCM.0000000000000044..
Keywords: Intensive Care Unit (ICU), Health Insurance, Healthcare Utilization, Mortality, Policy
Hwang TJ, Avorn J, Carpenter D
Quantifying the Food And Drug Administration's rulemaking delays highlights the need for transparency.
In order to better understand the FDA’s rulemaking process, the authors examined the evolution of significant rules that the agency published during 2000–12 for drugs, devices, and other medical products. They found that the rules’ median time to finalization was 7.3 years. Longer review times were significantly associated with a reduction in the stringency of final rules, compared to the originally proposed versions.
Citation: Hwang TJ, Avorn J, Carpenter D . Quantifying the Food And Drug Administration's rulemaking delays highlights the need for transparency. Health Aff 2014 Feb;33(2):309-15. doi: 10.1377/hlthaff.2013.0564..
Keywords: Patient Safety, Policy, Decision Making, Medication
Kronick R, McKinney M
AHRQ Author: Kronick R
Ready to provide evidence for ‘making adjustments’ in Obamacare.
In this interview with Modern Healthcare, Richard Kronick, director of the Agency for Healthcare Research and Quality (AHRQ), states that his main objective for AHRQ is to produce evidence to improve the quality, safety, accessibility, and affordability of health care. He discusses several AHRQ programs and places them in the context of changes in the healthcare system triggered by Affordable Care Act.
Citation: Kronick R, McKinney M . Ready to provide evidence for ‘making adjustments’ in Obamacare. Mod Healthc. 2014 Jan 6;44(1):28-9..
Keywords: Healthcare Costs, Quality of Care, Policy, Patient Safety
Hendrich A, McCoy CK, Gale J
Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise.
This article presents a case study concerning challenges, including physician resistance, to the establishment of a common full disclosure protocol at five labor and delivery demonstration sites. Twenty-seven months after implementation, the rate of full disclosure had increased by 221 percent. Practitioners saw a number of factors as key catalysts for change including consistent and ongoing leadership by local practitioners and hospitals.
Citation: Hendrich A, McCoy CK, Gale J . Ascension health's demonstration of full disclosure protocol for unexpected events during labor and delivery shows promise. Health Aff 2014 Jan;33(1):39-45. doi: 10.1377/hlthaff.2013.1009..
Keywords: Adverse Events, Clinician-Patient Communication, Communication, Labor and Delivery, Medical Errors, Medical Liability, Policy, Pregnancy, Women
AHRQ Author: Lawrence WF
Comparative effectiveness research in practice and policy for radiation oncology.
In radiation oncology, the line between comparative effectiveness research (CER) and traditional research may be blurred, but an increased emphasis on CER can help to bridge the research enterprise and clinical practice, helping to inform decision making at the patient, clinician, and policy levels.
Citation: Lawrence WF . Comparative effectiveness research in practice and policy for radiation oncology. Semin Radiat Oncol 2014 Jan;24(1):54-60. doi: 10.1016/j.semradonc.2013.09.001.
Keywords: Comparative Effectiveness, Evidence-Based Practice, Guidelines, Policy, Research Methodologies
Kachalia A, Little A, Isavoran M
Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by physicians.
The Oregon Health Authority analyzed the potential for safe harbors to improve patient safety and the performance of the medical liability system, as well as legal challenges and stakeholder concerns that might arise with legislation enacting safe harbors. They found that such legislation would have changed the liability outcome in favor of the physician defendant in only 1 percent of 266 claims from the period 2002–09 that were reviewed.
Citation: Kachalia A, Little A, Isavoran M . Greatest impact of safe harbor rule may be to improve patient safety, not reduce liability claims paid by physicians. Health Aff 2014 Jan;33(1):59-66. doi: 10.1377/hlthaff.2013.0834..
Keywords: Patient Safety, Medical Liability, Medical Errors, Quality of Care, Policy
Sage WM, Gallagher TH, Armstrong S
How policy makers can smooth the way for communication-and- resolution programs.
The authors argue that State and federal policy makers should try to allay potential defendants’ fears of litigation (e.g., by protecting apologies from use in court), facilitate patient participation (e.g., by ensuring access to legal representation), and address the reputational and economic concerns of health care providers (e.g., by clarifying practices governing National Practitioner Data Bank reporting and payers’ financial recourse following medical error).
AHRQ-funded; HS019505; HS019531; HS019561; HS019565; HSO19608; HS19537.
Citation: Sage WM, Gallagher TH, Armstrong S . How policy makers can smooth the way for communication-and- resolution programs. Health Aff 2014 Jan;33(1):11-9. doi: 10.1377/hlthaff.2013.0930..
Keywords: Communication, Policy, Medical Liability, Policy