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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
Berry JG, Hall M, Neff J
Children with medical complexity and Medicaid: spending and cost savings.
The authors described the expenditures for children with medical complexity insured by Medicaid across the care continuum, reported the increasingly large amount of spending on hospital care for these children, and presented a business case that estimates how cost savings might be achieved from potential reductions in hospital and emergency department use and shows how the savings could underwrite investments in outpatient and community care. They concluded by discussing the importance of these findings in the context of Medicaid's quality of care and health care reform.
Citation: Berry JG, Hall M, Neff J . Children with medical complexity and Medicaid: spending and cost savings. Health Aff 2014 Dec;33(12):2199-206. doi: 10.1377/hlthaff.2014.0828.
Keywords: Children/Adolescents, Medicaid, Healthcare Costs, Inpatient Care, Quality of Care
Fowler TT, Schiff J, Applegate MS
Early elective deliveries accounted for nearly 9 percent of births paid for by Medicaid.
The authors reported the results of a perinatal project, led by the state Medicaid medical directors, that sought to coordinate quality improvement efforts related to early elective deliveries for the Medicaid population. Using data from 22 states, they found that 8.9% of Medicaid singleton births were early elective deliveries, and they therefore estimated that there are 160,000 early elective Medicaid deliveries nationwide each year. They concluded that their study offers additional evidence and new tools for policy makers pursuing strategies to further reduce the number of such deliveries.
Citation: Fowler TT, Schiff J, Applegate MS . Early elective deliveries accounted for nearly 9 percent of births paid for by Medicaid. Health Aff 2014 Dec;33(12):2170-8. doi: 10.1377/hlthaff.2014.0534.
Keywords: Labor and Delivery, Maternal Care, Medicaid, Pregnancy
Wheeler SB, Kohler RE, Reeder-Hayes KE
Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors.
The researchers sought to characterize endocrine therapy (ET) use in a low-income Medicaid-insured population in North Carolina. They found that, of 222 women meeting the inclusion criteria, only 50 percent filled a prescription for ET. Results suggest substantial underutilization of ET in this population.
Citation: Wheeler SB, Kohler RE, Reeder-Hayes KE . Endocrine therapy initiation among Medicaid-insured breast cancer survivors with hormone receptor-positive tumors. J Cancer Surviv 2014 Dec;8(4):603-10. doi: 10.1007/s11764-014-0365-3..
Keywords: Cancer: Breast Cancer, Healthcare Utilization, Medicaid, Medication, Patient-Centered Outcomes Research
Raghavan R, Brown DS, Allaire BT
Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States.
The authors aimed to quantify the magnitude of Medicaid expenditures incurred in the purchase of psychotropic drugs for children with histories of abuse or neglect. They concluded that Medicaid agencies should focus their cost containment strategies on antidepressants and antimanic drugs, consider expanding primary care case management arrangements, and expand use of instruments such as the Child Behavior Checklist to identify and treat high-need children.
Citation: Raghavan R, Brown DS, Allaire BT . Medicaid expenditures on psychotropic medications for maltreated children: a study of 36 States. Psychiatr Serv 2014 Dec;65(12):1445-51. doi: 10.1176/appi.ps.201400028.
Keywords: Children/Adolescents, Healthcare Costs, Medicaid, Medication, Behavioral Health
Saloner B, Matone M, Kreider AR
Second-generation antipsychotic use among stimulant-using children, by organization of Medicaid mental health.
The authors compared differences in second-generation antipsychotic utilization among Medicaid-enrolled children across fee-for-service, integrated managed care, and managed behavioral health carve-out organizational structures. They found that carve-outs, versus other arrangements, were associated with lower second-generation antipsychotic use.
AHRQ-funded; HS020269; HS018550.
Citation: Saloner B, Matone M, Kreider AR . Second-generation antipsychotic use among stimulant-using children, by organization of Medicaid mental health. Psychiatr Serv 2014 Dec;65(12):1458-64. doi: 10.1176/appi.ps.201300574.
Keywords: Children/Adolescents, Healthcare Utilization, Medicaid, Medication, Behavioral Health
Henke RM, Wier LM, Marder WD
AHRQ Author: Friedman BS, Wong HS
Geographic variation in cesarean delivery in the United States by payer.
This study aimed (1) to determine whether the geographic variation in cesarean delivery rate is consistent for private insurance and Medicaid, and (2) to identify the patient, population, and market factors associated with cesarean rate and determine if these factors vary by payer. It concluded that factors associated with geographic variation in cesarean delivery, a frequent and high-resource inpatient procedure, vary somewhat by payer.
AHRQ-authored; AHRQ-funded; 290200600009C.
Citation: Henke RM, Wier LM, Marder WD . Geographic variation in cesarean delivery in the United States by payer. BMC Pregnancy Childbirth 2014 Nov 19;14:387. doi: 10.1186/s12884-014-0387-x.
Keywords: Healthcare Cost and Utilization Project (HCUP), Health Insurance, Labor and Delivery, Medicaid, Pregnancy
Finnerty M, Neese-Todd S, Bilder S
Best practices: MEDNET: a multistate policy maker-researcher collaboration to improve prescribing practices.
The authors describe the Medicaid/ Mental Health Network for Evidence-Based Treatment (MEDNET), the first multistate Medicaid QI collaborative to focus on improving psychotropic prescribing. In particular, this article includes the development, infrastructure challenges, and early evidence of success of this public-academic partnership.
AHRQ-funded; HSO19937; HS021112.
Citation: Finnerty M, Neese-Todd S, Bilder S . Best practices: MEDNET: a multistate policy maker-researcher collaboration to improve prescribing practices. Psychiatr Serv 2014 Nov 1;65(11):1297-9. doi: 10.1176/appi.ps.201400343..
Keywords: Behavioral Health, Evidence-Based Practice, Medication, Medicaid, Practice Patterns
Fiscella K, Geiger HJ
Caring for the poor in the 21st century: enabling community health centers for a new era.
This article discusses various challenges facing community health centers (CHCs) in the 21st century. These include: potential erosion of the Medicaid prospective payment system, the failure of many States to expand Medicaid, the growth of accountable care organizations, the growth of high deductible health insurance for the privately insured, and increased competition for primary care clinicians.
Citation: Fiscella K, Geiger HJ . Caring for the poor in the 21st century: enabling community health centers for a new era. J Health Care Poor Underserved. 2014 Nov;25(4):2044-52. doi: 10.1353/hpu.2014.0182..
Keywords: Low-Income, Primary Care, Medicaid, Health Insurance
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)
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
Werth SR, Sachdeva N, Roberts AW
North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.
The objectives of this study were (a) evaluate pharmacists’ perceptions of the implementation of the North Carolina (NC) recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success. It concluded that, although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists’ medication gate-keeping role, while minimizing the effort required for successful implementation.
Citation: Werth SR, Sachdeva N, Roberts AW . North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective. J Manag Care Spec Pharm 2014 Nov;20(11):1122-9..
Keywords: Medicaid, Medication, Opioids, Provider: Pharmacist, Substance Abuse
Beil H, Rozier RG, Preisser JS
Effects of early dental office visits on dental caries experience.
This study determined the association between timing of a first dentist office visit before age 5 and dental disease in kindergarten. It found that children with early dental visits (before age 2) had higher rates of tooth decay than those who had later visits (between ages 3 and 5).
Citation: Beil H, Rozier RG, Preisser JS . Effects of early dental office visits on dental caries experience. Am J Public Health. 2014 Oct;104(10):1979-85. doi: 10.2105/AJPH.2013.301325..
Keywords: Dental and Oral Health, Children/Adolescents, Access to Care, Medicaid, Prevention
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
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
Snyder ME, Frail CK, Jaynes H
Predictors of medication-related problems among Medicaid patients participating in a pharmacist-provided telephonic medication therapy management program.
The objective of this study was to identify predictors of medication-related problems (MRPs) among Medicaid patients participating in a telephonic medication therapy management (MTM) program. The analysis of study results supports the relative importance of number of medications as a predictor of MRPs in the Medicaid population and identifies other predictors.
Citation: Snyder ME, Frail CK, Jaynes H . Predictors of medication-related problems among Medicaid patients participating in a pharmacist-provided telephonic medication therapy management program. Pharmacotherapy 2014 Oct;34(10):1022-32. doi: 10.1002/phar.1462..
Keywords: Adverse Drug Events (ADE), Care Management, Community-Based Practice, Medicaid, Medication, Provider: Pharmacist
Regenstein M, Andres E
Reducing hospital readmissions among Medicaid patients: a review of the literature.
This review aims to identify factors related to readmissions that are unique to Medicaid populations to inform efforts to reduce Medicaid readmissions. It concluded that much of the Medicaid readmissions literature focuses on patients with mental health or substance abuse issues, who are often high utilizers of health care within the Medicaid population.
Citation: Regenstein M, Andres E . Reducing hospital readmissions among Medicaid patients: a review of the literature. Qual Manag Health Care 2014 Oct-Dec;23(4):203-25. doi: 10.1097/qmh.0000000000000043..
Keywords: Hospital Readmissions, Medicaid, Behavioral Health, Substance Abuse, Social Determinants of Health
Reeves S, Garcia E, Kleyn M
Identifying sickle cell disease cases using administrative claims.
The authors developed and tested the accuracy of administrative claims method for identifying children with sickle cell disease (SCD) to enable quality of care assessments among children enrolled in Medicaid. They found that their definition can be used to facilitate a more accurate identification of children with SCD in future studies.
Citation: Reeves S, Garcia E, Kleyn M . Identifying sickle cell disease cases using administrative claims. Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S61-7. doi: 10.1016/j.acap.2014.02.008.
Keywords: Children/Adolescents, Health Insurance, Medicaid, Sickle Cell Disease
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
Gidengil C, Mangione-Smith R, Bailey LC
Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers of excellence in measure development.
The investigators sought to explore the claims data-related issues relevant to quality measure development for Medicaid and the Children's Health Insurance Program (CHIP), illustrating the challenges encountered and solutions developed around 3 distinct performance measure topics: care coordination for children with complex needs, quality of care for high-prevalence conditions, and hospital readmissions. Their three Centers of Excellence in pediatric quality measurement used innovative methods to develop algorithms that use Medicaid claims data to identify children with complex needs; to overcome some shortcomings of existing data for measuring quality of care for common conditions such as otitis media; and to identify readmissions after hospitalizations for lower respiratory infections.
AHRQ-funded; HS020513; HS020506; HS020508.
Citation: Gidengil C, Mangione-Smith R, Bailey LC . Using Medicaid and CHIP claims data to support pediatric quality measurement: lessons from 3 centers of excellence in measure development. Acad Pediatr 2014 Sep-Oct;14(5 Suppl):S76-81. doi: 10.1016/j.acap.2014.06.014.
Keywords: Children's Health Insurance Program (CHIP), Innovations and Emerging Issues, Medicaid, Quality Indicators (QIs), Quality Measures
Trudnak T, Kelley D, Zerzan J
AHRQ Author: Jiang HJ
Medicaid admissions and readmissions: understanding the prevalence, payment, and most common diagnoses.
The authors characterized acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. They found that Medicaid readmissions were both prevalent and costly, and that they represented 12.5 percent of Medicaid payments for all hospitalizations, with the most prevalent diagnostic categories being mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications.
AHRQ-authored; AHRQ-funded; 29020090015C.
Citation: Trudnak T, Kelley D, Zerzan J . Medicaid admissions and readmissions: understanding the prevalence, payment, and most common diagnoses. Health Aff 2014 Aug;33(8):1337-44. doi: 10.1377/hlthaff.2013.0632.
Keywords: Healthcare Costs, Hospitalization, Medicaid, Hospital Readmissions
Schiltz NK, Finkelstein Rosenthal B, Crowley MA
Rehospitalization during the first year of life by insurance status.
The authors assessed the association of insurance status on infant rehospitalization in a population-based setting. They found that Medicaid coverage and being uninsured were strong predictors of rehospitalizations, with Medicaid bearing a disproportionate share of the economic burden. Normal birth weight infants had the lowest risk. They further found that jaundice and acute bronchiolitis were the leading causes of rehospitalization within 30 days and 1 year, respectively.
Citation: Schiltz NK, Finkelstein Rosenthal B, Crowley MA . Rehospitalization during the first year of life by insurance status. Clin Pediatr 2014 Aug;53(9):845-53. doi: 10.1177/0009922814536924.
Keywords: Health Insurance, Healthcare Cost and Utilization Project (HCUP), Hospital Readmissions, Newborns/Infants, Medicaid, Newborns/Infants
Heintzman J, Bailey SR, Hoopes MJ
Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults.
The researchers sought to compare the agreement of electronic health records (EHR) data versus Medicaid claims data in documenting adult preventive care. For services performed in the primary care setting, EHR data compared favorably to Medicaid claims in documenting the percentage of patients with service receipt; services that were referred out were less frequently observed in the EHR.
Citation: Heintzman J, Bailey SR, Hoopes MJ . Agreement of Medicaid claims and electronic health records for assessing preventive care quality among adults. J Am Med Inform Assoc. 2014 Jul-Aug;21(4):720-4. doi: 10.1136/amiajnl-2013-002333..
Keywords: Electronic Health Records (EHRs), Health Insurance, Medicaid, Prevention, Primary Care
Palmsten K, Huybrechts KF, Kowal MK
Validity of maternal and infant outcomes within nationwide Medicaid data.
The researchers aimed to assess the validity of preeclampsia, congenital cardiac malformations, and persistent pulmonary hypertension of the newborn diagnoses in the U.S. Medicaid Analytic eXtract (MAX), a database that may be useful for perinatal research. The positive predictive values were conservative, particularly when restricting to infants not transferred to another facility shortly after birth because only records from a single hospitalization were reviewed.
Citation: Palmsten K, Huybrechts KF, Kowal MK . Validity of maternal and infant outcomes within nationwide Medicaid data. Pharmacoepidemiol Drug Saf 2014 Jun;23(6):646-55. doi: 10.1002/pds.3627..
Keywords: Newborns/Infants, Maternal Care, Outcomes, Medicaid
Desai RJ, Hernandez-Diaz S, Bateman BT
Increase in prescription opioid use during pregnancy among Medicaid-enrolled women.
The researchers reported the prevalence of prescription opioid use and evaluated the trends in a large cohort of Medicaid-enrolled pregnant women. They observed high and increasing number of filled prescriptions for opioids during pregnancy among Medicaid-enrolled women and recommended further safety evaluations of these drugs and their effects on the developing fetus.
Citation: Desai RJ, Hernandez-Diaz S, Bateman BT . Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstet Gynecol 2014 May;123(5):997-1002. doi: 10.1097/aog.0000000000000208.
Keywords: Healthcare Utilization, Medicaid, Medication, Opioids, Pregnancy
Zhang SM, McGoy SL, Dawes D
The potential for elimination of racial-ethnic disparities in HIV treatment initiation in the Medicaid population among 14 southern states.
This study explored racial/ethnic disparities in the initiation of antiretroviral treatment among HIV-infected Medicaid enrollees in 14 Southern States. It found no significant differences between blacks and non-Hispanic whites but Hispanic/Latino persons were significantly less likely to receive antiretroviral treatment.
AHRQ-funded; HS022444; HS019470
Citation: Zhang SM, McGoy SL, Dawes D . The potential for elimination of racial-ethnic disparities in HIV treatment initiation in the Medicaid population among 14 southern states. PLoS One. 2014 Apr 25;9(4):e96148. doi: 10.1371/journal.pone.0096148..
Keywords: Human Immunodeficiency Virus (HIV), Disparities, Racial / Ethnic Minorities, Medicaid