National Healthcare Quality and Disparities Report
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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 25 of 48 Research Studies DisplayedHeintzman 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
Woodworth L
A leak in the lifeboat: the effect of Medicaid managed care on the vitality of safety-net hospitals.
Woodworth estimated the impact of Medicaid managed care on safety-net hospitals by exploiting a Florida pilot program that required Medicaid recipients in five counties to enroll in managed care. The results suggested that this mandate led to a small reduction in safety-net hospitals' average ratio of payment-to-cost and that the effect on safety-net hospitals was disproportionate.
AHRQ-funded; HS022236.
Citation: Woodworth L .
A leak in the lifeboat: the effect of Medicaid managed care on the vitality of safety-net hospitals.
J Regul Econ 2016 Dec;50(3):251-70. doi: 10.1007/s11149-016-9312-8.
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Keywords: Hospitals, Medicaid, Health Insurance
Nembhard IM, Tucker AL
Applying organizational learning research to Accountable Care Organizations.
In this article, the authors discuss seven lessons from the organizational learning literature that can help Accountable Care Organizations (ACOs) overcome the inherent challenges of learning how to work together in radically new ways. The article concludes by outlining opportunities for future research on organizational learning in ACOs.
AHRQ-funded; HS018987.
Citation: Nembhard IM, Tucker AL .
Applying organizational learning research to Accountable Care Organizations.
Med Care Res Rev 2016 Dec;73(6):673-84. doi: 10.1177/1077558716640415..
Keywords: Quality of Care, Organizational Change, Health Insurance
Chrisinger BW, Grossestreuer AV, Laguna MC
Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk.
The authors investigated how well the likelihood of out-of-hospital cardiac arrest was met by the supply of automated external defibrillators (AED) in a dense urban environment. This article offers one method by which local officials can use spatial data to prioritize attention for AED placement and coverage.
AHRQ-funded; HS018362.
Citation: Chrisinger BW, Grossestreuer AV, Laguna MC .
Characteristics of automated external defibrillator coverage in Philadelphia, PA, based on land use and estimated risk.
Resuscitation 2016 Dec;109:9-15. doi: 10.1016/j.resuscitation.2016.09.021.
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Keywords: Medical Devices, Health Insurance, Urban Health, Cardiovascular Conditions
Furtado KS, Kaphingst KA, Perkins H
Health insurance information-seeking behaviors among the uninsured.
In order to better understand how to reach the uninsured and support their health insurance decision making, this study examined where the uninsured collect information about health insurance and the extent to which they trust those sources and media. Its findings suggest that strategies that pair health care professionals, lay health advisors, or community liaisons with the ubiquity of the Internet may be a strong approach for delivering quality health insurance information to the uninsured.
AHRQ-funded; HS020309.
Citation: Furtado KS, Kaphingst KA, Perkins H .
Health insurance information-seeking behaviors among the uninsured.
J Health Commun 2016;21(2):148-58. doi: 10.1080/10810730.2015.1039678.
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Keywords: Uninsured, Health Insurance, Education: Patient and Caregiver, Web-Based
Abdus S, Selden TM, Keenan P
AHRQ Author: Abdus S, Selden TM, Keenan P
The financial burdens of high-deductible plans.
The increased prevalence of high-deductible health plans raises concerns regarding high financial burdens from health care, particularly for low-income adults.
AHRQ-authored.
Citation: Abdus S, Selden TM, Keenan P .
The financial burdens of high-deductible plans.
Health Aff 2016 Dec;35(12):2297-301. doi: 10.1377/hlthaff.2016.0842.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs, Social Determinants of Health
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Why did the Affordable Care Act raise coverage?
This article discusses NBER Working Paper No. 22213 on Premium Subsidies, the Mandate,and Medicaid Expansion: Coverage Effects of the Affordable Care Act by researchers Molly Frean, Jonathan Gruber, and Benjamin Sommers. The study’s key result is that the ACA’s premium subsidies led to a 0.85 percentage point increase in coverage, while the expansion of Medicaid to newly eligible individuals led to a 0.44 point increase.
AHRQ-funded; HS021291.
Citation: . . .
Why did the Affordable Care Act raise coverage?
Natl Bur Econ Res Bull Aging Health 2016(2):3.
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Keywords: Medicaid, Health Insurance, Policy, Healthcare Costs
Fraze T, Lewis VA, Rodriguez HP
Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients.
The authors examined how accountable care organizations (ACOs) addressed the nonmedical needs of their patients. They found that ACOs most commonly addressed the need for transportation, housing, and food insecurity, which they identified through the primary care visit or care transformation programs. They concluded that their findings offer insights into how health care organizations such as ACOs integrate themselves with nonmedical organizations.
AHRQ-funded; HS024792.
Citation: Fraze T, Lewis VA, Rodriguez HP .
Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients.
Health Aff 2016 Nov;35(11):2109-15. doi: 10.1377/hlthaff.2016.0727.
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Keywords: Social Determinants of Health, Patient-Centered Healthcare, Health Insurance, Healthcare Delivery, Primary Care, Public Health
Politi MC, Kaphingst KA, Liu JE
A randomized trial examining three strategies for supporting health insurance decisions among the uninsured.
This study examined the effectiveness of strategies to support health insurance decisions among the uninsured. Participants were randomized to 1 of 3 conditions: 1) a plain language table; 2) a visual condition where participants chose what information to view and in what order; and 3) a narrative condition. It found that participants across conditions made value-consistent choices, selecting plans that aligned with their preferences for key insurance features.
AHRQ-funded; HS020309.
Citation: Politi MC, Kaphingst KA, Liu JE .
A randomized trial examining three strategies for supporting health insurance decisions among the uninsured.
Med Decis Making. 2016 Oct;36(7):911-22. doi: 10.1177/0272989X15578635.
Keywords: Health Insurance, Uninsured
Kirby JB, Vistnes JP
AHRQ Author: Kirby JB, Vistnes JP
Access to care improved for people who gained Medicaid or marketplace coverage in 2014.
Newly available longitudinal survey data show that people who lacked health insurance in 2013 and gained coverage through Medicaid or the Marketplaces in 2014 were far more likely to obtain a usual source of care and receive preventive care services than their counterparts who remained uninsured in 2014.
AHRQ-authored.
Citation: Kirby JB, Vistnes JP .
Access to care improved for people who gained Medicaid or marketplace coverage in 2014.
Health Aff 2016 Oct 1;35(10):1830-34. doi: 10.1377/hlthaff.2016.0716.
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Keywords: Medical Expenditure Panel Survey (MEPS), Access to Care, Medicaid, Health Insurance
Sommers BD, Blendon RJ, Orav EJ
Changes in utilization and health among low-income adults after Medicaid expansion or expanded private insurance.
The researchers assessed changes in access to care, utilization, and self-reported health among low-income adults in 3 states taking alternative approaches to the ACA. They concluded that in the second year of expansion, Kentucky's Medicaid program and Arkansas's private option were associated with significant increases in outpatient utilization, preventive care, and improved health care quality; reductions in emergency department use; and improved self-reported health.
AHRQ-funded; HS021291.
Citation: Sommers BD, Blendon RJ, Orav EJ .
Changes in utilization and health among low-income adults after Medicaid expansion or expanded private insurance.
JAMA Intern Med 2016 Oct;176(10):1501-09. doi: 10.1001/jamainternmed.2016.4419.
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Keywords: Healthcare Utilization, Low-Income, Health Insurance, Medicaid, Access to Care
Bailey SR, Hoopes MJ, Marino M
Effect of gaining insurance coverage on smoking cessation in community health centers: a cohort study.
This study aimed to determine if uninsured community health center (CHC) patients who gain Medicaid coverage experience greater primary care utilization, receive more cessation medication orders, and achieve higher quit rates, compared to continuously uninsured smokers. It found that newly insured patients had increased odds of quit smoking status over 24 months of follow-up than those who remained uninsured.
AHRQ-funded; HS021522; HS024270.
Citation: Bailey SR, Hoopes MJ, Marino M .
Effect of gaining insurance coverage on smoking cessation in community health centers: a cohort study.
J Gen Intern Med 2016 Oct;31(10):1198-205. doi: 10.1007/s11606-016-3781-4.
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Keywords: Tobacco Use, Health Insurance, Community-Based Practice, Medicaid, Healthcare Utilization
Vistnes JP, Cohen JW
AHRQ Author: Vistnes JP, Cohen JW
Gaining coverage in 2014: new estimates of marketplace and Medicaid transitions.
The researchers used data from the Medical Expenditure Panel Survey-Household Component to examine coverage transitions for nonelderly US adults. They found that 71.5 percent of Marketplace enrollees in 2014 had some period of uninsurance before enrollment. In Medicaid expansion states, 17.4 percent of adults who were uninsured throughout 2013 gained Medicaid coverage in 2014, compared with only 5.6 percent in those states between 2012 and 2013.
AHRQ-authored.
Citation: Vistnes JP, Cohen JW .
Gaining coverage in 2014: new estimates of marketplace and Medicaid transitions.
Health Aff 2016 Oct 1;35(10):1825-29. doi: 10.1377/hlthaff.2016.0500.
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Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Medicaid, Uninsured, Policy
Sommers BD, Gourevitch R, Maylone B
Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many.
The researchers explored the frequency and implications of changes in insurance coverage over time (i.e., "churning,")through surveying low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a "private option" expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. They found that churning was associated with disruptions in physician care and medication adherence, and increased emergency department use.
AHRQ-funded; HS021291.
Citation: Sommers BD, Gourevitch R, Maylone B .
Insurance churning rates for low-income adults under health reform: lower than expected but still harmful for many.
Health Aff 2016 Oct;35(10):1816-24. doi: 10.1377/hlthaff.2016.0455.
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Keywords: Medicaid, Uninsured, Policy, Health Insurance
Horner-Johnson W, Dobbertin K
Dental insurance and dental care among working-age adults: differences by type and complexity of disability.
The purpose of this study was to examine differences in dental insurance, receipt of dental checkups, and delayed and unmet needs for dental care by type and complexity of disability. It found that all disability types except hearing had significantly higher adjusted odds of being without dental insurance, as did people with complex activity limitations. Further, disparities in care were apparent even when controlling for presence of dental insurance.
AHRQ-funded; HS022981.
Citation: Horner-Johnson W, Dobbertin K .
Dental insurance and dental care among working-age adults: differences by type and complexity of disability.
J Public Health Dent 2016 Sep;76(4):330-39. doi: 10.1111/jphd.12160.
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Keywords: Access to Care, Dental and Oral Health, Disabilities, Health Insurance, Medical Expenditure Panel Survey (MEPS)
Chandrasekar E, Kim KE, Song S
First year open enrollment findings: health insurance coverage for Asian Americans and the role of navigators.
The role of navigators has been shown to increase enrollment rates of public insurance programs. Cambodian, Chinese, Vietnamese, Korean, and Laotian community-based organizations were able to reach individuals for whom the percentage of uninsured is disproportionately high. A community-level intervention was implemented that was associated with increases in first year marketplace enrollment and greater likelihood of obtaining a primary care physician.
AHRQ-funded; HS022063.
Citation: Chandrasekar E, Kim KE, Song S .
First year open enrollment findings: health insurance coverage for Asian Americans and the role of navigators.
J Racial Ethn Health Disparities 2016 Sep;3(3):537-45. doi: 10.1007/s40615-015-0172-1.
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Keywords: Health Insurance, Policy, Patient-Centered Healthcare, Racial and Ethnic Minorities
Adrion ER, Ryan AM, Seltzer AC
Out-of-pocket spending for hospitalizations among nonelderly adults.
The researchers evaluated out-of-pocket spending associated with hospitalizations in order to assess how this spending varied over time and by patient characteristics, region, and type of insurance. They found that from 2009 to 2013, total cost sharing per inpatient hospitalization increased by 37 percent, from $738 in 2009 to $1013 in 2013 after adjusting for inflation and case-mix differences.
AHRQ-funded; HS000053.
Citation: Adrion ER, Ryan AM, Seltzer AC .
Out-of-pocket spending for hospitalizations among nonelderly adults.
JAMA Intern Med 2016 Sep;176(9):1325-32. doi: 10.1001/jamainternmed.2016.3663.
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Keywords: Hospitalization, Healthcare Costs, Health Insurance
Ali MM, Chen J, Mutter R
AHRQ Author: Novak P
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
The authors analyzed out-of-pocket spending as a share of total health care expenditures for young adults with behavioral health conditions before and after the implementation of the ACA dependent care provision. They found that the extension of health insurance coverage to young adults with behavioral health disorders has provided them with additional financial protection, which can be important given the low incomes and high debt burden that characterize the age group.
AHRQ-authored.
Citation: Ali MM, Chen J, Mutter R .
The ACA's dependent coverage expansion and out-of-pocket spending by young adults with behavioral health conditions.
Psychiatr Serv 2016 Sep;67(9):977-82. doi: 10.1176/appi.ps.201500346.
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Keywords: Behavioral Health, Healthcare Costs, Health Insurance, Medical Expenditure Panel Survey (MEPS), Young Adults
Colla CH, Lewis VA, Bergquist SL
Accountability across the continuum: the participation of postacute care providers in accountable care organizations.
The authors examined the extent to which accountable care organizations (ACOs) formally incorporate postacute care providers. They found that ACOs with a relationship with a postacute care provider are more likely to have advanced transition management, end of life planning, readmission prevention, and care management capabilities. However, many ACOs have not formally engaged postacute care.
AHRQ-funded; HS024075.
Citation: Colla CH, Lewis VA, Bergquist SL .
Accountability across the continuum: the participation of postacute care providers in accountable care organizations.
Health Serv Res 2016 Aug;51(4):1595-611. doi: 10.1111/1475-6773.12442.
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Keywords: Policy, Healthcare Delivery, Health Insurance
McManus KA, Rhodes A, Bailey S
Affordable Care Act qualified health plan coverage: association with improved HIV viral suppression for AIDS drug assistance program clients in a Medicaid nonexpansion state.
The objective of this study was to characterize the demographic and healthcare delivery factors associated with Virginia AIDS Drug Assistance Programs (ADAPs) clients' qualified health plan (QHP) enrollment and to assess the relationship between qualified health coverage and human immunodeficiency virus (HIV) viral suppression. It concluded that QHP coverage was associated with viral suppression, an essential outcome for individuals and for public health.
AHRQ-funded; HS024196.
Citation: McManus KA, Rhodes A, Bailey S .
Affordable Care Act qualified health plan coverage: association with improved HIV viral suppression for AIDS drug assistance program clients in a Medicaid nonexpansion state.
Clin Infect Dis 2016 Aug;63(3):396-403. doi: 10.1093/cid/ciw277.
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Keywords: Health Insurance, Human Immunodeficiency Virus (HIV), Medicaid, Medication, Outcomes
Berry SA, Fleishman JA, Yehia BR
AHRQ Author: Fleishman JA
Healthcare coverage for HIV provider visits before and after implementation of the Affordable Care Act.
The researchers compared HIV provider coverage pre (2011-2013) versus post (first half of 2014) ACA among a total of 28,374 persons living with HIV (PLWH) followed in 4 sites in Medicaid expansion states (CA, OR, MD), 4 in a state (NY) that expanded Medicaid in 2001, and 2 in non-expansion states (TX, FL). In expansion state sites, half of PLWH relying on Ryan White HIVAIDS Program(RWHAP)/Uncomp shifted to Medicaid, while in NY and non-expansion state sites, reliance on RWHAP/Uncomp remained constant.
AHRQ-authored.
Citation: Berry SA, Fleishman JA, Yehia BR .
Healthcare coverage for HIV provider visits before and after implementation of the Affordable Care Act.
Clin Infect Dis 2016 Aug 1;63(3):387-95. doi: 10.1093/cid/ciw278.
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Keywords: Human Immunodeficiency Virus (HIV), Medicaid, Medicare, Health Insurance
McGarry BE, Temkin-Greener H, Chapman BP
The impact of consumer numeracy on the purchase of long-term care insurance.
The researchers sought to determine the effect of consumers' numeric abilities on the likelihood of owning private long-term care insurance (LTCI). Using the 2010 wave of the Health and Retirement Study, they found that each additional correct answer on a numeracy scale was associated with a 13% increase in the likelihood of holding LTCI. They recommended that policy efforts aimed at increasing consumer decision support or restructuring the marketplace for long-term care insurance may be needed to increase older adults' ability to prepare for future long-term care expenses.
AHRQ-funded; HS023714.
Citation: McGarry BE, Temkin-Greener H, Chapman BP .
The impact of consumer numeracy on the purchase of long-term care insurance.
Health Serv Res 2016 Aug;51(4):1612-31. doi: 10.1111/1475-6773.12439.
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Keywords: Education: Patient and Caregiver, Healthcare Costs, Health Insurance, Long-Term Care
Rivera-Hernandez M, Rahman M, Mor V
The Impact of social health insurance on diabetes and hypertension process indicators among older adults in Mexico.
The researchers examined the impact of Seguro Popular (Mexican social health insurance for the poor) on diabetes and hypertension care, They concluded that social health insurance for the poor improved some but not all health care process indicators among diabetic and hypertensive older people in Mexico.
AHRQ-funded; HS000011.
Citation: Rivera-Hernandez M, Rahman M, Mor V .
The Impact of social health insurance on diabetes and hypertension process indicators among older adults in Mexico.
Health Serv Res 2016 Aug;51(4):1323-46. doi: 10.1111/1475-6773.12404.
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Keywords: Health Insurance, Diabetes, Blood Pressure, Elderly, Access to Care
Luo Z, Chen Q, Annis AM
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
Two contrasting strategies of chronic care management include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). The researchers aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. They found that in a commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year.
AHRQ-funded; HS020108.
Citation: Luo Z, Chen Q, Annis AM .
A comparison of health plan- and provider-delivered chronic care management models on patient clinical outcomes.
J Gen Intern Med 2016 Jul;31(7):762-70. doi: 10.1007/s11606-016-3617-2.
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Keywords: Chronic Conditions, Care Management, Primary Care: Models of Care, Primary Care, Healthcare Delivery, Comparative Effectiveness, Patient-Centered Outcomes Research, Health Insurance
Jacobs PD, Duchovny N, Lipton BJ
AHRQ Author: Jacobs PD
Changes in health status and care use after ACA expansions among the insured and uninsured.
The authors investigated average health status and use of health care following the Affordable Care Act's insurance expansion provisions in 2014, finding that Medicaid enrollees and the uninsured were both healthier in 2014 than those respective groups were in 2013, but that those with individual private insurance coverage appeared less healthy as a group.
AHRQ-authored.
Citation: Jacobs PD, Duchovny N, Lipton BJ .
Changes in health status and care use after ACA expansions among the insured and uninsured.
Health Aff 2016 Jul;35(7):1184-8. doi: 10.1377/hlthaff.2015.1539.
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Keywords: Healthcare Costs, Health Insurance, Policy, Health Status, Medicaid