National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Access to Care (5)
- Behavioral Health (2)
- Brain Injury (1)
- Children's Health Insurance Program (CHIP) (1)
- (-) Children/Adolescents (14)
- Dental and Oral Health (2)
- Disabilities (1)
- Disparities (1)
- Electronic Health Records (EHRs) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
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- (-) Health Insurance (14)
- Hospital Readmissions (1)
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- Low-Income (3)
- Medicaid (6)
- Medical Expenditure Panel Survey (MEPS) (4)
- Medication (2)
- Newborns/Infants (1)
- Outcomes (1)
- Payment (2)
- Policy (4)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (3)
- Trauma (1)
- Uninsured (3)
- Vaccination (1)
- 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 14 of 14 Research Studies DisplayedHudson JL, Moriya AS
AHRQ Author: Hudson JL
The role of marketplace policy on welcome mat effects for children eligible for Medicaid or the Children's Health Insurance Program.
This study examined the role of marketplace policy on “welcome mat” effects for children eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Data from the American Community Survey from 2013-2018 was used to estimate the relationship between Marketplace policy and increases in Medicaid/CHIP coverage among pre-ACA eligible children after the implementation of the Affordable Care Act (ACA). The sample included non-disabled citizen children ages 0-18 at 139-250% federal poverty level who were Medicaid/CHIP-eligible before and after implementation of the ACA. Marketplace policies and enrollment were compared in expansion states versus non-expansion states. Public coverage did increase more in states that empowered their Marketplace to enroll publicly-eligible applicants directly into Medicaid/CHIP. This was driven by enrollment policy, not by choice of state-based versus federal-based Marketplaces. Welcome mats were largest in expansion states and increases ranged from 9 to 13 percentage points in enrollment.
AHRQ-authored.
Citation: Hudson JL, Moriya AS .
The role of marketplace policy on welcome mat effects for children eligible for Medicaid or the Children's Health Insurance Program.
Inquiry 2020 Jan-Dec;57:46958020952920. doi: 10.1177/0046958020952920..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Medicaid, Health Insurance, Policy, Uninsured, Access to Care
Wisk LE, Peltz A, Galbraith AA
Changes in health care-related financial burden for US families with children associated with the Affordable Care Act.
The Affordable Care Act (ACA) sought to improve access and affordability of health insurance. Although most ACA policies targeted childless adults, the extent to which these policies also impacted families with children remains unclear. The purpose of this study was to examine changes in health care-related financial burden for US families with children before and after the ACA was implemented based on income eligibility for ACA policies.
AHRQ-funded; HS024700.
Citation: Wisk LE, Peltz A, Galbraith AA .
Changes in health care-related financial burden for US families with children associated with the Affordable Care Act.
JAMA Pediatr 2020 Nov;174(11):1032-40. doi: 10.1001/jamapediatrics.2020.3973..
Keywords: Children/Adolescents, Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Health Insurance, Policy, Access to Care
Khouja T, Burgette JM, Donohue JM
Association between Medicaid expansion, dental coverage policies for adults, and children's receipt of preventive dental services.
Researchers examined whether low-income children's use of preventive dental services is linked to variation in state Medicaid policies that affect parents' access to dental care in Medicaid. Using MEPS data along with Area Health Resources File and Medicaid adult dental coverage policies, they found no change in children's receipt of preventive dental care associated with Medicaid expansions in states that covered vs did not cover preventive dental services for adults. They concluded that factors other than parental access to dental benefits through Medicaid may be more salient determinants of preventive dental care use among low-income children.
AHRQ-funded; HS026727.
Citation: Khouja T, Burgette JM, Donohue JM .
Association between Medicaid expansion, dental coverage policies for adults, and children's receipt of preventive dental services.
Health Serv Res 2020 Oct;55(5):642-50. doi: 10.1111/1475-6773.13324..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Dental and Oral Health, Medicaid, Health Insurance, Low-Income, Access to Care, Policy
Bucholz EM,, Schuster MA, Toomey SL
Trends in 30-day readmission for Medicaid and privately insured pediatric patients: 2010-2017.
This study examined trends in 30-day readmission rates for Medicaid and privately insured pediatric patients from 2010 to 2017. The HCUP Nationwide Readmissions Database was used to compare hospital-level risk-adjusted readmission rates. Higher readmission rates were found for Medicaid beneficiaires compared to privately insured pediatric patients during the time period.
AHRQ-funded; HS020513; HS025299.
Citation: Bucholz EM,, Schuster MA, Toomey SL .
Trends in 30-day readmission for Medicaid and privately insured pediatric patients: 2010-2017.
Pediatrics 2020 Aug;146(2). doi: 10.1542/peds.2020-0270..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Health Insurance, Medicaid, Hospitals
Porter A, Brown CC, Tilford JM
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
This study’s objective was to determine if a health insurance disparity exists among pediatric patients with severe traumatic brain injury using data from the National Trauma Data Bank. The Bank contains data from more than 800 trauma centers in the United States. Isolated traumatic brain injury was defined as patients with a head Abbreviated Injury Scale score of 3+. Procedure codes were used to identify four primary treatment approaches combined into 2 classifications: craniotomy or craniectomy and external or intracranial ventricular draining. Condition at admission was defined including hypotension, Glasgow Coma Scale, mechanism and intent of injury, and Injury Severity Scale. Among the cohort of 12,449 patients, 91% had insurance and 9% were uninsured. Children without insurance had worse condition at admission with higher rates of hypotension and higher Injury Severity Score when compared with publicly and privately insured patients. Having insurance was associated with a 32% increase in the odds of cranial procedures, and 54% increase in the odds of monitor placement. Insurance coverage was associated 25% lower odds of inpatient mortality. Further study is needed to determine what factors lead to worse condition at admission.
Citation: Porter A, Brown CC, Tilford JM .
Association of insurance status with treatment and outcomes in pediatric patients with severe traumatic brain injury.
Crit Care Med 2020 Jul;48(7):e584-e91. doi: 10.1097/ccm.0000000000004398..
Keywords: Children/Adolescents, Brain Injury, Trauma, Health Insurance, Access to Care, Uninsured, Outcomes
Mackie TI, Cook S, Crystal S
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
This study examined a multimodal antipsychotic intervention implemented by a specialized Medicaid managed care organization (MMCO) for youths in foster care with routine mental health screening, health passports, elective psychiatric consultation line, and retrospective drug utilization reviews to determine whether this multimodal intervention significantly reduced antipsychotic dispensing for youths with conditions without US Food and Drug Administration (FDA)-approved indications. Findings showed that MMCO implementation significantly reduced antipsychotic medications without FDA-indicated conditions prescribed to youths, while not significantly affecting antipsychotic medications prescribed to youths with FDA-indicated conditions.
AHRQ-funded; HS026001.
Citation: Mackie TI, Cook S, Crystal S .
Antipsychotic use among youth in foster care enrolled in a specialized managed care organization intervention.
J Am Acad Child Adolesc Psychiatry 2020 Jan;59(1):166-76.e3. doi: 10.1016/j.jaac.2019.04.022..
Keywords: Children/Adolescents, Behavioral Health, Medication, Vulnerable Populations, Medicaid, Health Insurance
Olin S, Storfer-Isser A, Morden E
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
This study examined the performance of health plans on two Healthcare Effectiveness Data and Information Set (HEDIS) measures: metabolic monitoring of children and adolescents prescribed an antipsychotic and use of first-line psychosocial care for children and adolescents prescribed an antipsychotic for a nonindicated use. This study then identified key plan characteristics and other contextual factors associated with health plan performance on quality measures related to pediatric antipsychotic prescribing. Findings suggested that quality measures, in conjunction with policies such as prior authorization, can encourage better care delivery to vulnerable populations.
ARHQ-funded; HS020503; HS025296.
Citation: Olin S, Storfer-Isser A, Morden E .
Quality measures for managing prescription of antipsychotic medication among youths: factors associated with health plan performance.
Psychiatr Serv 2019 Nov;70(11):1020-26. doi: 10.1176/appi.ps.201900089..
Keywords: Children/Adolescents, Medication, Behavioral Health, Quality Measures, Quality of Care, Health Insurance
Kemmick Pintor J, Call KT
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Investigators sought to measure differences in insurance by mother's documentation status among a nationally representative sample of US-born children in immigrant families and to examine the role of state-level immigrant access to prenatal coverage. They found that, in states with nonrestrictive prenatal coverage for immigrants, there were no differences in children's insurance by mother's documentation status, while large inequities were observed within states with restrictive policies.
AHRQ-funded; HS021973.
Citation: Kemmick Pintor J, Call KT .
State-level immigrant prenatal health care policy and inequities in health insurance among children in mixed-status families.
Glob Pediatr Health 2019 Sep 26;6:2333794x19873535. doi: 10.1177/2333794x19873535..
Keywords: Policy, Health Insurance, Children/Adolescents, Access to Care, Vulnerable Populations, Disparities
Chien AT, Toomey SL, Kuo DZ
Care quality and spending among commercially insured children with disabilities.
Researchers examined the prevalence of children with disabilities (CWD) within a commercially insured population and compared outpatient care quality and annual health plan spending levels for CWD relative to children with complex medical conditions without disabilities; children with chronic conditions that are not complex; and children without disabling, complex, or chronic conditions. The cross-sectional study comprised over 1M person-years of Blue Cross Blue Shield Massachusetts data for beneficiaries aged from 1 to 19 years. The researchers found that CWD were prevalent in the commercially insured population, with these children experiencing suboptimal levels of care which were comparable to non-CWD groups. They concluded that improving the care value for CWD involves a deeper understanding of what higher spending delivers and additional aspects of care quality.
AHRQ-funded; HS025299.
Citation: Chien AT, Toomey SL, Kuo DZ .
Care quality and spending among commercially insured children with disabilities.
Acad Pediatr 2019 Apr;19(3):291-99. doi: 10.1016/j.acap.2018.06.004..
Keywords: Quality of Care, Children/Adolescents, Disabilities, Healthcare Costs, Health Insurance
Heintzman J, Marino M, Hoopes M
Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?
The researchers sought to validate electronic health record (EHR) insurance information for low-income pediatric patients at Oregon community health centers (CHCs), compared to reimbursement data and Medicaid coverage data. They concluded that EHR coverage data for children had a high overall correspondence with Medicaid data and reimbursement data, suggesting that in some systems EHR data could be utilized to promote insurance stability in their patients.
AHRQ-funded; HS021522.
Citation: Heintzman J, Marino M, Hoopes M .
Supporting health insurance expansion: do electronic health records have valid insurance verification and enrollment data?
J Am Med Inform Assoc 2015 Jul;22(4):909-13. doi: 10.1093/jamia/ocv033..
Keywords: Electronic Health Records (EHRs), Health Insurance, Medicaid, Low-Income, Children/Adolescents
Berdahl T, Hudson J, Simpson L
AHRQ Author: Berdahl T, Hudson J
Annual report on children's health care: dental and orthodontic utilization and expenditures for children, 2010-2012.
The researchers examined general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. Overall, 41.9 percent of US children reported an annual dental office-based visit for general (nonorthodontic) dental care.
AHRQ-authored.
Citation: Berdahl T, Hudson J, Simpson L .
Annual report on children's health care: dental and orthodontic utilization and expenditures for children, 2010-2012.
Acad Pediatr 2016 May-Jun;16(4):314-26. doi: 10.1016/j.acap.2016.02.013.
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Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Dental and Oral Health, Healthcare Costs, Health Insurance
Hu T, Decker SL, Chou SY
AHRQ Author: Decker SL
Medicaid pay for performance programs and childhood immunization status.
This national study examined the effects of pay for performance (P4P) programs on childhood immunization rates. It found no overall effect of Medicaid P4P on the chance that children aged 19-35 months had completed the 4:3:1:3:3:1 vaccination series. However, there was a 4 percentage point increase in the chance that a child 19-23 months had completed the series.
AHRQ-authored.
Citation: Hu T, Decker SL, Chou SY .
Medicaid pay for performance programs and childhood immunization status.
Am J Prev Med 2016 May;50(5 Suppl 1):S51-7. doi: 10.1016/j.amepre.2016.01.012.
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Keywords: Newborns/Infants, Children/Adolescents, Medicaid, Vaccination, Payment, Health Insurance
Chien AT, Schiavoni KH, Sprecher E
How accountable care organizations responded to pediatric incentives in the alternative quality contract.
The authors characterized the pediatric infrastructure of adult-oriented accountable care organizations (ACOs) and obtained leaders' perspectives on their ACOs' response to pediatric incentives. They found that most ACOs augmented their pediatric quality improvement and spending reduction efforts when faced with pediatric incentives.
AHRQ-funded; HS017146.
Citation: Chien AT, Schiavoni KH, Sprecher E .
How accountable care organizations responded to pediatric incentives in the alternative quality contract.
Acad Pediatr 2016 Mar;16(2):200-7. doi: 10.1016/j.acap.2015.10.008.
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Keywords: Children/Adolescents, Health Insurance, Quality of Care, Payment, Quality Indicators (QIs)
DeVoe JE, Tillotson CJ, Marino M
Trends in type of health insurance coverage for US children and their parents, 1998-2011.
The objective of this paper is to examine trends in health insurance type among US children and their parents. Using Medical Expenditure Panel Survey data (1998-2011), the authors found that low- and middle-income US families experienced a decrease in the percentage of child-parent pairs with private health insurance and pairs without insurance. At the same time, they found a rise in discordant coverage patterns - mainly publicly insured children with uninsured parents.
AHRQ-funded; HS018569.
Citation: DeVoe JE, Tillotson CJ, Marino M .
Trends in type of health insurance coverage for US children and their parents, 1998-2011.
Acad Pediatr 2016 Mar;16(2):192-9. doi: 10.1016/j.acap.2015.06.009.
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Keywords: Children/Adolescents, Health Insurance, Low-Income, Medical Expenditure Panel Survey (MEPS), Uninsured