National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (7)
- Ambulatory Care and Surgery (2)
- Antibiotics (1)
- Behavioral Health (2)
- Cancer: Colorectal Cancer (1)
- Cardiovascular Conditions (2)
- Care Management (1)
- Case Study (1)
- Children's Health Insurance Program (CHIP) (1)
- Children/Adolescents (4)
- Chronic Conditions (4)
- Colonoscopy (1)
- Community-Based Practice (2)
- Community Partnerships (1)
- Diabetes (1)
- Disparities (1)
- Elderly (1)
- Emergency Department (2)
- Emergency Medical Services (EMS) (1)
- Healthcare Costs (5)
- Healthcare Utilization (4)
- Health Insurance (9)
- Health Services Research (HSR) (2)
- Heart Disease and Health (1)
- Hospital Readmissions (1)
- Hospitals (2)
- Low-Income (2)
- Maternal Care (1)
- (-) Medicaid (30)
- Medical Expenditure Panel Survey (MEPS) (2)
- Medicare (2)
- Medication (1)
- Mortality (2)
- Opioids (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (3)
- Payment (2)
- Policy (11)
- Pregnancy (1)
- Primary Care (2)
- Quality Measures (1)
- Quality of Care (5)
- Racial and Ethnic Minorities (2)
- Respiratory Conditions (1)
- Risk (1)
- Social Determinants of Health (3)
- Substance Abuse (1)
- Surgery (1)
- Uninsured (6)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 30 Research Studies DisplayedSelden TM, Lipton BJ, Decker SL
AHRQ Author: Selden TM, Lipton BJ, Decker SL
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
The researchers found that as of 2015, adults with incomes of 100-138 percent of the federal poverty level had experienced large declines in uninsurance rates in both expansion and nonexpansion states. Adults in expansion and nonexpansion states also experienced similar increases in having a usual source of care and primary care visits, and similar reductions in delayed receipt of medical care due to cost.
AHRQ-authored.
Citation: Selden TM, Lipton BJ, Decker SL .
Medicaid expansion and marketplace eligibility both increased coverage, with trade-offs in access, affordability.
Health Aff 2017 Dec;36(12):2069-77. doi: 10.1377/hlthaff.2017.0830.
.
.
Keywords: Access to Care, Health Insurance, Policy, Low-Income, Medicaid, Uninsured
Raven MC, Guzman D, Chen AH
Out-of-network emergency department use among managed Medicaid beneficiaries.
The researchers examined factors associated with out-of-network ED use among Medicaid beneficiaries. They concluded that there are a number of factors related to out-of-network ED use, including the proximity and density of out-of-network EDs, race and ethnicity, a prior history of out-of-network ED use, and individuals' connection to primary care.
AHRQ-funded; HS021700.
Citation: Raven MC, Guzman D, Chen AH .
Out-of-network emergency department use among managed Medicaid beneficiaries.
Health Serv Res 2017 Dec;52(6):2156-74. doi: 10.1111/1475-6773.12604.
.
.
Keywords: Emergency Department, Emergency Medical Services (EMS), Medicaid, Primary Care, Social Determinants of Health
Kirby JB, Sharma R
AHRQ Author: Kirby JB
The availability of community health center services and access to medical care.
This study examined the associations between the availability of Community Health Centers (CHCs) services in communities and two key measures of ambulatory care access - having a usual source of care and having any office-based medical visits over a one year period. It found that the availability of CHC services was positively associated with both measures of access among those with no insurance coverage.
AHRQ-authored.
Citation: Kirby JB, Sharma R .
The availability of community health center services and access to medical care.
Healthc 2017 Dec;5(4):174-82. doi: 10.1016/j.hjdsi.2016.12.006.
.
.
Keywords: Access to Care, Community-Based Practice, Medicaid, Medical Expenditure Panel Survey (MEPS), Uninsured
Roman LA, Raffo JE, Dertz K
Understanding perspectives of African American Medicaid-insured women on the process of perinatal care: an opportunity for systems improvement.
The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care across a continuum of clinical and community-based services. It found that many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care.
AHRQ-funded; HS020208.
Citation: Roman LA, Raffo JE, Dertz K .
Understanding perspectives of African American Medicaid-insured women on the process of perinatal care: an opportunity for systems improvement.
Matern Child Health J 2017 Dec;21(Suppl 1):81-92. doi: 10.1007/s10995-017-2372-2.
.
.
Keywords: Access to Care, Maternal Care, Medicaid, Pregnancy, Racial and Ethnic Minorities
Aalsma MC, Anderson VR, Schwartz K
Preventive care use among justice-involved and non-justice-involved youth.
The objective of this study was to determine how rates of well-child (WC) and emergency department visits, as well as public insurance enrollment continuity, differed between youth involved in the justice system (JIY) and youth who have never been in the system (NJIY). It found that JIY had lower use rates of WC visits and higher use rates of emergency services in comparison with NJIY. JIY had more and longer gaps in Medicaid coverage compared with NJIY.
AHRQ-funded; HS023318.
Citation: Aalsma MC, Anderson VR, Schwartz K .
Preventive care use among justice-involved and non-justice-involved youth.
Pediatrics 2017 Nov;140(5):pii: e20171107. doi: 10.1542/peds.2017-1107.
.
.
Keywords: Children/Adolescents, Emergency Department, Healthcare Utilization, Medicaid
Charles EJ, Johnston LE, Herbert MA
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
The objective of this study was to evaluate the effect of Medicaid expansion on cardiac surgery volume and outcomes comparing one state that expanded to one that did not. It concluded that Medicaid expansion was associated with fewer uninsured cardiac surgery patients and improved predicted risk scores and morbidity rates. In addition to improving health care financing, Medicaid expansion may positively affect patient care and outcomes.
AHRQ-funded; HS022535.
Citation: Charles EJ, Johnston LE, Herbert MA .
Impact of Medicaid expansion on cardiac surgery volume and outcomes.
Ann Thorac Surg 2017 Oct;104(4):1251-58. doi: 10.1016/j.athoracsur.2017.03.079.
.
.
Keywords: Patient-Centered Outcomes Research, Medicaid, Surgery, Cardiovascular Conditions, Policy
Huguet N, Hoopes MJ, Angier H
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
This study assesses changes in insurance status of patients visiting community health centers (CHCs) comparing states that expanded Medicaid to those that did not. Rates of uninsured visits decreased pre- to post- Affordable Care Act with greater drops in expansion (-57 percent) versus nonexpansion (-20 percent) states. Medicaid-insured visits increased 60 percent in expansion states while remaining unchanged in nonexpansion states.
AHRQ-funded; HS024270.
Citation: Huguet N, Hoopes MJ, Angier H .
Medicaid expansion produces long-term impact on insurance coverage rates in community health centers.
J Prim Care Community Health 2017 Oct;8(4):206-12. doi: 10.1177/2150131917709403.
.
.
Keywords: Community Partnerships, Health Insurance, Policy, Medicaid, Uninsured
Gonzales G, Golberstein E, Hill SC
AHRQ Author: Hill, SC; Zuvekas, SH
Psychological distress and enrollment in Medicaid.
Adults with poor mental health may want and need insurance to obtain care, but symptoms may impede enrollment into public health insurance. The enrollment response to Medicaid expansions prior to the Affordable Care Act was stronger for adults symptomatic of psychological distress compared with adults without distress and compared to adults with chronic physical health problems.
AHRQ-authored.
Citation: Gonzales G, Golberstein E, Hill SC .
Psychological distress and enrollment in Medicaid.
J Behav Health Serv Res 2017 Oct;44(4):523-35. doi: 10.1007/s11414-016-9532-9.
.
.
Keywords: Access to Care, Policy, Medicaid, Medical Expenditure Panel Survey (MEPS), Behavioral Health
Keohane LM, Trivedi AN, Mor V
Recent health care use and Medicaid entry of Medicare beneficiaries.
The purpose of this study was to examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries. Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period.
AHRQ-funded; HS023016.
Citation: Keohane LM, Trivedi AN, Mor V .
Recent health care use and Medicaid entry of Medicare beneficiaries.
Gerontologist 2017 Oct 1;57(5):977-86. doi: 10.1093/geront/gnw189..
Keywords: Elderly, Healthcare Utilization, Health Services Research (HSR), Medicaid, Medicare
Chen LM, Epstein AM, Orav EJ
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
The objective of this cross-sectional observational study was to compare performance in the Physician Value-Based Payment Modifier (PVBM) Program by practice characteristics. The investigators found that during the first year of the Medicare Physician Value-Based Payment Modifier Program, physician practices that served more socially high-risk patients had lower quality and lower costs, and practices that served more medically high-risk patients had lower quality and higher costs.
AHRQ-funded; HS024698.
Citation: Chen LM, Epstein AM, Orav EJ .
Association of practice-level social and medical risk with performance in the Medicare physician value-based payment modifier program.
JAMA 2017 Aug 1;318(5):453-61. doi: 10.1001/jama.2017.9643..
Keywords: Healthcare Costs, Medicaid, Medicare, Payment, Quality of Care
Olesiuk WJ, Farley JF, Domino ME
Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia?
The purpose of this study was to determine whether Medicaid recipients with co-occurring diabetes and schizophrenia that are medical-home-enrolled are more likely to receive guideline-concordant diabetes care than those who are not medical-home-enrolled, controlling for confounders. The study concluded that medical-home enrollment is generally associated with greater likelihood of receiving guideline-concordant diabetes care for Medicaid enrollees with diabetes and schizophrenia.
AHRQ-funded; HS023099; HS019659; HS000032.
Citation: Olesiuk WJ, Farley JF, Domino ME .
Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia?
J Health Care Poor Underserved 2017;28(3):1030-41. doi: 10.1353/hpu.2017.0094..
Keywords: Care Management, Diabetes, Medicaid, Behavioral Health, Patient-Centered Healthcare
Davis MM, Renfro S, Pham R
Geographic and population-level disparities in colorectal cancer testing: a multilevel analysis of Medicaid and commercial claims data.
This study used Medicaid and commercial claims data to examine individual and geographic factors associated with colorectal cancer testing rates in Oregon. CRC testing in newly age-eligible Medicaid and commercial members remains markedly low. Disparities exist by gender, geographic residence, insurance coverage, and access to primary care.
AHRQ-funded; HS022981.
Citation: Davis MM, Renfro S, Pham R .
Geographic and population-level disparities in colorectal cancer testing: a multilevel analysis of Medicaid and commercial claims data.
Prev Med 2017 Aug;101:44-52. doi: 10.1016/j.ypmed.2017.05.001.
.
.
Keywords: Cancer: Colorectal Cancer, Colonoscopy, Disparities, Medicaid, Social Determinants of Health
Hatch B, Marino M, Killerby M
Medicaid's impact on chronic disease biomarkers: a cohort study of community health center patients.
This study assessed changes in biomarkers of chronic disease among community health center (CHC) patients who gained Medicaid coverage with the Oregon Medicaid expansion (2008-2011). It found that patients with uncontrolled chronic conditions experienced objective health improvements over time. In two of three chronic disease cohorts, those who gained Medicaid coverage were more likely to achieve a controlled measurement than those who remained uninsured.
AHRQ-funded; HS024270.
Citation: Hatch B, Marino M, Killerby M .
Medicaid's impact on chronic disease biomarkers: a cohort study of community health center patients.
J Gen Intern Med 2017 Aug;32(8):940-47. doi: 10.1007/s11606-017-4051-9.
.
.
Keywords: Medicaid, Chronic Conditions, Access to Care, Policy
Simon TD, Cawthon ML, Popalisky J
Development and validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0.
The Pediatric Medical Complexity Algorithm (PMCA) was developed to stratify children by level of medical complexity. The researchers sought to refine PMCA and evaluate its performance based on the duration of eligibility and completeness of Medicaid data. They concluded that PMCA version 2.0 identifies children with C-CD with good sensitivity and very good specificity when applied to Medicaid data.
AHRQ-funded; HS020506.
Citation: Simon TD, Cawthon ML, Popalisky J .
Development and validation of the Pediatric Medical Complexity Algorithm (PMCA) Version 2.0.
Hosp Pediatr 2017 Jul;7(7):373-77. doi: 10.1542/hpeds.2016-0173.
.
.
Keywords: Chronic Conditions, Hospitals, Medicaid, Ambulatory Care and Surgery, Children/Adolescents
Gao YN, Nocon RS, Sharma R
What factors are associated with Medicaid patients' use of health centers?.
This study identified patient and neighborhood factors associated with health center (HC) use. Dually eligible patients and those with high chronic disease burden had lower odds of HC use. Temporary Assistance for Needy Families participants and Hispanic beneficiaries had higher odds. Local HC presence predicted higher HC use.
AHRQ-funded; HS000084.
Citation: Gao YN, Nocon RS, Sharma R .
What factors are associated with Medicaid patients' use of health centers?.
J Prim Care Community Health 2017 Jul;8(3):141-46. doi: 10.1177/2150131916687919.
.
.
Keywords: Community-Based Practice, Healthcare Utilization, Medicaid, Primary Care, Social Determinants of Health
Ndumele CD, Schpero WL, Schlesinger MJ
Association between health plan exit from Medicaid managed care and quality of care, 2006-2014.
This study aimed to determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. It found that between 2006 and 2014, health plan exit from the US Medicaid program was frequent; however the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market.
AHRQ-funded; HS017589; HS016978.
Citation: Ndumele CD, Schpero WL, Schlesinger MJ .
Association between health plan exit from Medicaid managed care and quality of care, 2006-2014.
JAMA 2017 Jun 27;317(24):2524-31. doi: 10.1001/jama.2017.7118.
.
.
Keywords: Medicaid, Healthcare Costs, Health Insurance, Quality of Care
Barnett ML, Linder JA, Clark CR
Low-value medical services in the safety-net population.
The objective of this study was to measure rates of low-value care and high-value care received by patients without insurance or with Medicaid, compared with privately insured patients, and provided by safety-net physicians vs non-safety-net physicians. The study concluded that rates of low-value and high-value care were similar among physicians serving vulnerable patients and other physicians. Overuse of low-value care is a potentially important focus for state Medicaid programs and safety-net institutions to pursue cost savings and improved quality of health care delivery.
AHRQ-funded; HS021291.
Citation: Barnett ML, Linder JA, Clark CR .
Low-value medical services in the safety-net population.
JAMA Intern Med 2017 Jun;177(6):829-37. doi: 10.1001/jamainternmed.2017.0401..
Keywords: Access to Care, Uninsured, Medicaid, Quality of Care
Olfson M, Wall M, Wang S
Service use preceding opioid-related fatality.
The authors analyzed health service patterns before opioid-related death among nonelderly individuals in the Medicaid program, focusing on decedents with and without past-year diagnoses of non-cancer chronic pain. They found that persons dying of opioid-related causes, particularly those who were diagnosed with chronic pain conditions, commonly received services related to drug use disorders and mental disorders in the last year of life, though opioid use disorder diagnoses near the time of death were rare.
AHRQ-funded; HS021112.
Citation: Olfson M, Wall M, Wang S .
Service use preceding opioid-related fatality.
Am J Psychiatry 2017 Jun;175(6):538-44. doi: 10.1176/appi.ajp.2017.17070808.
.
.
Keywords: Chronic Conditions, Opioids, Medicaid, Mortality, Substance Abuse
Adedinsewo D, Xu J, Agasthi P
Effect of digoxin use among Medicaid enrollees with atrial fibrillation.
The study’s goal was to examine risk factors for hospitalizations and mortality with digoxin use in a diverse real-world atrial fibrillation patient population and evaluate racial differences. It found an overall increased risk of hospitalizations and mortality with digoxin use. No racial/ethnic differences in outcomes were observed.
AHRQ-funded; HS022444.
Citation: Adedinsewo D, Xu J, Agasthi P .
Effect of digoxin use among Medicaid enrollees with atrial fibrillation.
Circ Arrhythm Electrophysiol 2017 May;10(5):e004573. doi: 10.1161/circep.116.004573.
.
.
Keywords: Heart Disease and Health, Medication, Medicaid, Cardiovascular Conditions, Patient-Centered Outcomes Research
Horwitz LI, Bernheim SM, Ross JS
Hospital characteristics associated with risk-standardized readmission rates.
This national study using Medicare data examined the independent association of 8 hospital characteristics with hospital-wide 30-day risk-standardized readmission rate (RSRR). Overall, larger, urban, academic facilities had modestly higher RSRRs than smaller, suburban, community hospitals, although there was a wide range of performance. The strong regional effect suggests that local practice patterns are an important influence.
AHRQ-funded; HS022882.
Citation: Horwitz LI, Bernheim SM, Ross JS .
Hospital characteristics associated with risk-standardized readmission rates.
Med Care 2017 May;55(5):528-34. doi: 10.1097/mlr.0000000000000713.
.
.
Keywords: Hospitals, Hospital Readmissions, Medicaid, Risk, Quality of Care
Decker SL, Lipton BJ, Sommers BD
AHRQ Author: Decker SL, Lipton BJ
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
The researchers used detailed federal survey data through 2015 to analyze recent changes in coverage for low-income adults after the expansion associated with the Affordable Care Act's (ACA's) Medicaid expansion in 2014. They found that the uninsurance rate fell in both expansion and nonexpansion states but that it fell significantly more in expansion states.
AHRQ-authored; AHRQ-funded; HS021291.
Citation: Decker SL, Lipton BJ, Sommers BD .
Medicaid expansion coverage effects grew in 2015 with continued improvements in coverage quality.
Health Aff 2017 May;36(5):819-25. doi: 10.1377/hlthaff.2016.1462.
.
.
Keywords: Medicaid, Low-Income, Health Insurance, Uninsured, Policy
Frean M, Gruber J, Sommers BD
Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.
Using premium subsidies for private coverage, an individual mandate, and Medicaid expansion, the Affordable Care Act (ACA) has increased insurance coverage. Win this study, the investigators provide the first comprehensive assessment of these provisions' effects, using the 2012-2015 American Community Survey and a triple-difference estimation strategy that exploits variation by income, geography, and time.
AHRQ-funded; HS021291.
Citation: Frean M, Gruber J, Sommers BD .
Premium subsidies, the mandate, and Medicaid expansion: coverage effects of the Affordable Care Act.
J Health Econ 2017 May;53:72-86. doi: 10.1016/j.jhealeco.2017.02.004..
Keywords: Healthcare Costs, Health Insurance, Policy, Medicaid
Westney G, Foreman MG, Xu J
Impact of comorbidities among Medicaid enrollees with chronic obstructive pulmonary disease, United States, 2009.
Researchers quantified the cost of Medicaid-insured patients with chronic obstructive pulmonary disease (COPD) co-diagnosed with other chronic disorders. They concluded that comorbidities markedly increased health services use among people with COPD insured with Medicaid, although ED visits in this study were predominantly unrelated to COPD. Acute care, hospital bed days, and total Medicaid-reimbursed costs increased as the number of comorbidities increased.
AHRQ-funded; HS022444.
Citation: Westney G, Foreman MG, Xu J .
Impact of comorbidities among Medicaid enrollees with chronic obstructive pulmonary disease, United States, 2009.
Prev Chronic Dis 2017 Apr 13;14:E31. doi: 10.5888/pcd14.160333.
.
.
Keywords: Chronic Conditions, Respiratory Conditions, Healthcare Utilization, Medicaid
Sohn H
Medicaid's lasting impressions: population health and insurance at birth.
This article examines lasting mortality improvements associated with availability of Medicaid at time and place of birth. Being born after Medicaid was associated with between 2.03 and 3.64 fewer deaths per 100,000 person-years in childhood and between 1.35 and 3.86 fewer deaths per 100,000 person-years in the thirties. The association between Medicaid at birth and mortality was the strongest in the oldest age group (36-40) in this study.
AHRQ-funded; HS000046.
Citation: Sohn H .
Medicaid's lasting impressions: population health and insurance at birth.
Soc Sci Med 2017 Mar;177:205-12. doi: 10.1016/j.socscimed.2017.01.043.
.
.
Keywords: Access to Care, Health Insurance, Health Services Research (HSR), Medicaid, Mortality
Goldman JL, Richardson T, Newland JG
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
The study’s objective was to characterize outpatient parenteral antimicrobial therapy (OPAT) use and clinical outcomes for a large population of pediatric Medicaid enrollees treated with OPAT. It found that ceftriaxone and vancomycin were the most commonly prescribed antimicrobials. An emergency department visit or hospital admission occurred during 38 percent of OPAT episodes, among which 61 percent were OPAT-related.
AHRQ-funded; HS023320.
Citation: Goldman JL, Richardson T, Newland JG .
Outpatient parenteral antimicrobial therapy in pediatric Medicaid enrollees.
J Pediatric Infect Dis Soc 2017 Mar 1;6(1):65-71. doi: 10.1093/jpids/piv106.
.
.
Keywords: Antibiotics, Children/Adolescents, Medicaid, Ambulatory Care and Surgery, Patient-Centered Outcomes Research