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
51 to 71 of 71 Research Studies DisplayedMullen MT, Pajerowski W, Messe SR
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
The purpose of this study was to evaluate the impact of a primary stroke center (PSC) destination policy in a major metropolitan city and to use geographic modeling in order to evaluate expected changes for a comprehensive stroke center policy. Suspected stroke emergency medical services encounters in Philadelphia, PA, were identified, and transport times before and after the initiation of a PSC destination policy in October 2011 were compared. Geographic modeling was used to estimate the impact of bypassing the closest hospital for the closest PSC or comprehensive stroke centers, which was common before the official policy and increased steadily over time. The researchers conclude that the time taken to route patients to PSCs or comprehensive stroke centers is low.
AHRQ-funded; HS018362.
Citation: Mullen MT, Pajerowski W, Messe SR .
Geographic modeling to quantify the impact of primary and comprehensive stroke center destination policies.
Stroke 2018 Apr;49(4):1021-23. doi: 10.1161/strokeaha.118.020691.
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Keywords: Emergency Department, Emergency Medical Services (EMS), Hospitals, Policy, Stroke
Kafali N, Progovac A, Hou SS
Long-run trends in antidepressant use among youths after the FDA black box warning.
This study analyzed long-run trends in antidepressant use among children before and after the black box warning for those with and without severe psychological impairment. It concluded that in the long run (2008-2011), however, there was no statistically significant difference. This return to the rates before the black box warning raises concern that the impact of the warning may have dissipated over time.
AHRQ-funded; HS021486.
Citation: Kafali N, Progovac A, Hou SS .
Long-run trends in antidepressant use among youths after the FDA black box warning.
Psychiatr Serv 2018 Apr;69(4):389-95. doi: 10.1176/appi.ps.201700089.
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Keywords: Medication, Children/Adolescents, Healthcare Utilization, Medical Expenditure Panel Survey (MEPS), Policy
Henke RM, Karaca Z, Gibson TB
AHRQ Author: Karaca Z, Wong HS
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
This study investigated the relationship between Medicare Advantage (MA) program growth and inpatient hospital costs and utilization before and after the ACA. Its results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. Researchers did not observe a strong relationship between MA enrollment and inpatient days per enrollee
AHRQ-authored; AHRQ-funded; 290201300002C.
Citation: Henke RM, Karaca Z, Gibson TB .
Medicare Advantage penetration and hospital costs before and after the Affordable Care Act.
Med Care 2018 Apr;56(4):321-28. doi: 10.1097/mlr.0000000000000885.
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Keywords: Healthcare Costs, Policy, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Medicare
Wey A, Pyke J, Schladt DP
Offer acceptance practices and geographic variability in allocation model for end-stage liver disease at transplant.
Offer acceptance practices may cause geographic variability in allocation Model for End-Stage Liver Disease (aMELD) score at transplant and could magnify the effect of donor supply and demand on aMELD variability. To evaluate these issues, offer acceptance practices of liver transplant programs and donation service areas (DSAs) were estimated using offers of livers from donors recovered between January 1, 2016, and December 31, 2016.
AHRQ-funded; HS024527.
Citation: Wey A, Pyke J, Schladt DP .
Offer acceptance practices and geographic variability in allocation model for end-stage liver disease at transplant.
Liver Transpl 2018 Apr;24(4):478-87. doi: 10.1002/lt.25010..
Keywords: Health Services Research (HSR), Policy, Transplantation
Jahn JL, Cohen JFW, Gorski-Findling MT
Product reformulation and nutritional improvements after new competitive food standards in schools.
In 2012, Massachusetts enacted school competitive food and beverage standards similar to national Smart Snacks. These standards aim to improve the nutritional quality of competitive snacks. This study assessed whether products were reformulated after standards were implemented; the availability of reformulated products outside schools; and whether compliance with the standards improved the nutrient composition of competitive snacks. The investigators concluded that Massachusetts' law was effective in improving the nutritional content of snacks and product reformulation helped schools adhere to the law.
AHRQ-funded; HS000055.
Citation: Jahn JL, Cohen JFW, Gorski-Findling MT .
Product reformulation and nutritional improvements after new competitive food standards in schools.
Public Health Nutr 2018 Apr;21(5):1011-18. doi: 10.1017/s1368980017003445..
Keywords: Children/Adolescents, Nutrition, Policy
Alderwick H, Shortell SM, Briggs ADM
Can accountable care organisations really improve the English NHS? Lessons from the United States.
The authors summarize evidence on accountable care organizations in the US - including what they look like, their effect on the quality and cost of healthcare, and how they are redesigning care. Recognizing major differences in context, they offer lessons from the US experience for National Health Service policy makers as they consider the future of similar ventures in England.
AHRQ-funded; HS022241; HS024075.
Citation: Alderwick H, Shortell SM, Briggs ADM .
Can accountable care organisations really improve the English NHS? Lessons from the United States.
BMJ 2018 Mar 2;360:k921. doi: 10.1136/bmj.k921.
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Keywords: Healthcare Costs, Quality of Care, Health Services Research (HSR), Policy
Wisk LE, Gray SH, Gooding HC
I thought you said this was confidential?-Challenges to protecting privacy for teens and young adults.
In this opinion paper, the authors discuss challenges to protecting privacy for teens and young adults. They specifically examine the implications of the dependent coverage expansion provision of the Affordable Care Act.
AHRQ-funded; HS022986.
Citation: Wisk LE, Gray SH, Gooding HC .
I thought you said this was confidential?-Challenges to protecting privacy for teens and young adults.
JAMA Pediatr 2018 Mar;172(3):209-10. doi: 10.1001/jamapediatrics.2017.3927..
Keywords: Caregiving, Children/Adolescents, Clinician-Patient Communication, Communication, Policy, Young Adults
Cohen MS, Schpero WL
Household immigration status had differential impact on Medicaid enrollment in expansion and nonexpansion states.
This study identified households that likely included undocumented immigrants and then examined whether gains in health care coverage due to the expansion of Medicaid eligibility under the Affordable Care Act (ACA) were dampened for eligible people living in households with mixed immigration status. It found that coverage gains were significantly lower for people in mixed-status households relative to those in non-mixed-status households in nonexpansion states.
AHRQ-funded; HS017589.
Citation: Cohen MS, Schpero WL .
Household immigration status had differential impact on Medicaid enrollment in expansion and nonexpansion states.
Health Aff 2018 Mar;37(3):394-402. doi: 10.1377/hlthaff.2017.0978.
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Keywords: Health Insurance, Policy, Medicaid, Racial and Ethnic Minorities, Vulnerable Populations
Agimi Y, Albert SM, Youk AO
AHRQ Author: Steiner CA
Dementia and motor vehicle crash hospitalizations: role of physician reporting laws.
This study sought to determine the effect of physician reporting laws and state licensing requirements on crash hospitalizations among drivers with dementia. It concluded that physician reporting laws, mandated or legally protected, were not associated with a lower likelihood of dementia among crash hospitalized drivers. Vision testing at in-person renewal and in-person renewal requirements were significantly related with a lower prevalence of dementia in hospitalized older drivers.
AHRQ-authored.
Citation: Agimi Y, Albert SM, Youk AO .
Dementia and motor vehicle crash hospitalizations: role of physician reporting laws.
Neurology 2018 Feb 27;90(9):e808-e13. doi: 10.1212/wnl.0000000000005022.
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Keywords: Dementia, Elderly, Healthcare Cost and Utilization Project (HCUP), Hospitalization, Policy
Berridge C
Medicaid becomes the first third-party payer to cover passive remote monitoring for home care: policy analysis.
This study examined passive remote monitoring technologies in state Medicaid programs. Its goals were to identify which states allowed location tracking, sensor systems, and cameras, what policies were in place to track usage, what implementation processes and program monitoring mechanisms were in place, and what related insights Medicaid program stakeholders would like to learn. Interviews were conducted with state, federal, and managed care organization (MCO) Medicaid program stakeholders about the use of these technologies in state waivers that served community-dwelling older adults in 15 states. While two-thirds of the states covered location tracking and activity-monitoring sensors and one-third covered cameras, only 3 states had specific service categories that allowed tracking of when they pay for these technologies. The authors conclude that technologies that have great potential to alter the way older adults receive supportive services are often used without research on their use, social or ethical implications, or outcomes. New service categories are needed to enable oversight, and more interaction between policymakers and researchers in this field would aid in the prioritization of research aims to inform practice.
AHRQ-funded; HS000011.
Citation: Berridge C .
Medicaid becomes the first third-party payer to cover passive remote monitoring for home care: policy analysis.
J Med Internet Res 2018 Feb 21;20(2):e66. doi: 10.2196/jmir.9650..
Keywords: Elderly, Health Information Technology (HIT), Health Insurance, Healthcare Delivery, Home Healthcare, Medicaid, Policy
Mehrotra S, Kilambi V, Bui K
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Policymakers are deliberating policy reforms to reduce geographic disparity in liver allocation. This study conducted simulations comparing current allocation with the neighborhoods and sharing policies. The study concluded that the current 11 districts can be adapted systematically by adding neighboring donor service areas (DSAs) to improve geographic disparity, mortality, and airplane travel distance. Modifications to Share 35 and Share 15 policies result in further improvements.
AHRQ-funded; HS024840.
Citation: Mehrotra S, Kilambi V, Bui K .
A concentric neighborhood solution to disparity in liver access that contains current UNOS districts.
Transplantation 2018 Feb;102(2):255-78. doi: 10.1097/tp.0000000000001934..
Keywords: Access to Care, Disparities, Policy, Transplantation
Ibrahim AM, Dimick JB, Sinha SS
Association of coded severity with readmission reduction after the hospital readmissions reduction program.
This research letter describes a study which examined coding by hospitals used to determine rates of readmission under the Hospital Readmission Reduction Program (HRRP). Hospitals who go above a certain rate are subject to financial penalties for 3 targed medical conditions. It was determined that hospitals have begun to change their coding to show increased severity of illness in many of those readmissions. Data came from discharges from the Medicare Provider Analysis and review file between 2008 and 2014. Researchers compared coding severity levels from before HRRP was implemented and post April 1, 2010 when it began.
AHRQ-funded; HS024525; HS024728.
Citation: Ibrahim AM, Dimick JB, Sinha SS .
Association of coded severity with readmission reduction after the hospital readmissions reduction program.
JAMA Intern Med 2018 Feb;178(2):290-92. doi: 10.1001/jamainternmed.2017.6148..
Keywords: Hospital Readmissions, Hospitals, Medicare, Policy
Kilambi V, Bui K, Mehrotra S
LivSim: An open-source simulation software platform for community research and development for liver allocation policies.
This brief discusses LivSim, an open-source software alternative to the Liver Simulated Allocation Model (LSAM) created by the Scientific Registry of Transplant Recipients. LivSim is an open-source simulation software platform for community research and development for liver allocation policies.
AHRQ-funded; HS024840.
Citation: Kilambi V, Bui K, Mehrotra S .
LivSim: An open-source simulation software platform for community research and development for liver allocation policies.
Transplantation 2018 Feb;102(2):e47-e48. doi: 10.1097/tp.0000000000002000..
Keywords: Health Services Research (HSR), Policy, Transplantation
Jou J, Kozhimannil KB, Abraham JM
Paid maternity leave in the United States: associations with maternal and infant health.
Using data from Listening to Mothers III, a national survey of women ages 18-45 who gave birth in 2011-2012, the investigators conducted multivariate logistic regression to predict the likelihood of outcomes related to infant health, maternal physical and mental health, and maternal health behaviors by the use and duration of paid maternity leave. They concluded that Practice Paid maternity leave significantly predicted lower odds of maternal and infant re-hospitalization and higher odds of doing well with exercise and stress management.
AHRQ-funded; HS023950.
Citation: Jou J, Kozhimannil KB, Abraham JM .
Paid maternity leave in the United States: associations with maternal and infant health.
Matern Child Health J 2018 Feb;22(2):216-25. doi: 10.1007/s10995-017-2393-x..
Keywords: Maternal Care, Newborns/Infants, Policy, Pregnancy, Women
Lee BY, Ferguson MC, Hertenstein DL
Simulating the impact of sugar-sweetened beverage warning labels in three cities.
A number of locations have been considering sugar-sweetened beverage point-of-purchase warning label policies to help address rising adolescent overweight and obesity prevalence. This study exploring the impact of such policies concluded that agent-based simulations showed how warning labels may decrease overweight and obesity prevalence in a variety of circumstances with label efficacy and literacy rate identified as potential drivers.
AHRQ-funded; HS023317.
Citation: Lee BY, Ferguson MC, Hertenstein DL .
Simulating the impact of sugar-sweetened beverage warning labels in three cities.
Am J Prev Med 2018 Feb;54(2):197-204. doi: 10.1016/j.amepre.2017.11.003.
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Keywords: Policy, Nutrition, Obesity, Policy
Lewis VA, D'Aunno T, Murray GF
The hidden roles that management partners play in accountable care organizations.
This study sought to understand the prevalence of nonprovider management partners' involvement in accountable care organizations (ACOs), the services these partners provide, and the structure of ACOs that have such partners. It found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards..
AHRQ-funded; HS024075.
Citation: Lewis VA, D'Aunno T, Murray GF .
The hidden roles that management partners play in accountable care organizations.
Health Aff 2018 Feb;37(2):292-98. doi: 10.1377/hlthaff.2017.1025.
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Keywords: Medicare, Policy, Health Insurance, Healthcare Costs
Ho V
Refinement of the Affordable Care Act.
This article begins by listing some of the major reasons critics dislike the Affordable Care Act (ACA), then discusses the validity of these concerns from an economics perspective. Suggestions for refining the ACA and its market-based insurance system are then offered, with the goals of lowering insurance premiums, improving coverage rates, and/or addressing the concerns of ACA critics.
AHRQ-funded; HS024727.
Citation: Ho V .
Refinement of the Affordable Care Act.
Annu Rev Med 2018 Jan 29;69:19-28. doi: 10.1146/annurev-med-052616-044854..
Keywords: Policy, Health Insurance, Healthcare Costs
Tran Smith B, Seaton K, Andrews C
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
This study assessed the extent to which state insurance departments regulate the types of substance use disorder (SUD) treatment that services and medications plans must provide, and also their use of utilization controls. Data were obtained from state insurance departments via an internet-based survey, as part of the National Drug Abuse Treatment System Survey. The results indicate that states vary widely in regulations on qualified health plans’ (QHPs) administration of SUD treatment benefits; some required plans to cover all the SUD treatment services and medications assessed in this study, while others did not require plans to cover any at all. Nearly all states allowed the plans to employ utilization controls, but reported little guidance on their usage. The authors conclude that by not requiring coverage for the entire SUD continuum of care, some states hinder client access to the appropriate types of care needed for recovery.
AHRQ-funded; HS000084.
Citation: Tran Smith B, Seaton K, Andrews C .
Benefit requirements for substance use disorder treatment in state health insurance exchanges.
Am J Drug Alcohol Abuse 2018;44(4):426-30. doi: 10.1080/00952990.2017.111934..
Keywords: Access to Care, Health Insurance, Medication, Policy, Substance Abuse
Soni A, Sabik LM, Simon K
Changes in insurance coverage among cancer patients under the Affordable Care Act.
Uninsurance among patients with newly diagnosed cancer fell by one-third in the ACA’s first year. Coverage gains were significant across numerous common cancers, multiple demographic groups, and early-stage and late-stage disease. Large gains among Hispanic individuals were consistent with findings of other ACA studies and may indicate narrowing disparities.
AHRQ-funded; HS021291.
Citation: Soni A, Sabik LM, Simon K .
Changes in insurance coverage among cancer patients under the Affordable Care Act.
JAMA Oncol 2018 Jan;4(1):122-24. doi: 10.1001/jamaoncol.2017.3176.
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Keywords: Cancer, Health Insurance, Policy, Uninsured
Ngo-Metzger Q, Moyer V, Grossman D
AHRQ Author: Ngo-Metzger Q, Chowdhury J, Kato E
Conflicts of interest in clinical guidelines: update of U.S. Preventive Services Task Force policies and procedures.
The conflicts of interest policy is described, as is the formal process by which best practices were incorporated to update the policy. The USPSTF conflicts of interest policy includes disclosures for immediate family members, a clear non-financial conflicts of interest definition, long look-back period and application of the policy to prospective members. The conflicts of interest policy is publicly available as part of the USPSTF Procedure Manual.
AHRQ-authored.
Citation: Ngo-Metzger Q, Moyer V, Grossman D .
Conflicts of interest in clinical guidelines: update of U.S. Preventive Services Task Force policies and procedures.
Am J Prev Med 2018 Jan;54(1s1):S70-s80. doi: 10.1016/j.amepre.2017.06.034.
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Keywords: Evidence-Based Practice, Guidelines, Policy, U.S. Preventive Services Task Force (USPSTF)
Lindrooth RC, Perraillon MC, Hardy RY
Understanding the relationship between Medicaid expansions and hospital closures.
The investigators hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals' financial position. They tested this hypothesis using data for the period 2008-16 on hospital closures and financial performance and discuss their findings in this paper.
AHRQ-funded; HS024959; HS025208.
Citation: Lindrooth RC, Perraillon MC, Hardy RY .
Understanding the relationship between Medicaid expansions and hospital closures.
Health Aff 2018 Jan;37(1):111-20. doi: 10.1377/hlthaff.2017.0976..
Keywords: Healthcare Costs, Policy, Hospitals, Medicaid, Rural Health