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
26 to 50 of 67 Research Studies DisplayedAndrews CM, Grogan CM, Smith BT
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
This study looked at the effects the Affordable Care Act (ACA) had on Medicaid benefits for addiction treatment. The ACA established a minimum standard of benefits and required state Medicaid programs to make changes to their treatment benefits. Researchers surveyed all 50 states and the District of Columbia in 2014 and 2017 when the ACA requirements came into effect. There was a substantial increase in benefits with a decrease in annual service limits of over 50 percent. There was a large reduction in preauthorization requirements for medications to treat opioid use disorder as well as other reductions in preauthorizations.
AHRQ-funded; HS000084.
Citation: Andrews CM, Grogan CM, Smith BT .
Medicaid benefits for addiction treatment expanded after implementation of the Affordable Care Act.
Health Aff 2018 Aug;37(8):1216-22. doi: 10.1377/hlthaff.2018.0272..
Keywords: Access to Care, Behavioral Health, Health Insurance, Medicaid, Policy, Substance Abuse
Myerson R, Lu T, Tonnu-Mihara I
Medicaid eligibility expansions may address gaps in access to diabetes medications.
The purpose of this study was to examine the impacts of Medicaid expansion on access to diabetes medications, researchers analyzed data on over ninety-six million prescription fills using Medicaid insurance in the period January 2008-December 2015. The researchers found that the increase in prescription fills grew significantly over time. Overall, fills for insulin and for newer medications increased by 40 percent and 39 percent, respectively.
AHRQ-funded; HS023964.
Citation: Myerson R, Lu T, Tonnu-Mihara I .
Medicaid eligibility expansions may address gaps in access to diabetes medications.
Health Aff 2018 Aug;37(8):1200-07. doi: 10.1377/hlthaff.2018.0154..
Keywords: Access to Care, Diabetes, Policy, Medicaid, Medication
Ndumele CD, Schpero WL, Trivedi AN
Medicaid expansion and health plan quality in Medicaid managed care.
The purpose of the study was to assess the effect of the 2014 Medicaid expansion on Medicaid managed care plan quality. The study concluded that Medicaid expansion increased enrollment in managed care plans, but it did not result in erosion of quality.
AHRQ-funded; HS017589.
Citation: Ndumele CD, Schpero WL, Trivedi AN .
Medicaid expansion and health plan quality in Medicaid managed care.
Health Serv Res 2018 Aug;53 Suppl 1:2821-38. doi: 10.1111/1475-6773.12814..
Keywords: Policy, Health Services Research (HSR), Health Insurance, Medicaid
Desai NR, Bourdillon PM, Parzynski CS
Association of the US Department of Justice Investigation of Implantable Cardioverter-Defibrillators and
The US Department of Justice (DOJ) conducted an investigation into implantable cardioverter-defibrillators (ICDs) not meeting the Centers for Medicare & Medicaid Services National Coverage Determination (NCD) criteria. To examine changes in the proportion of initial primary prevention ICDs that did not meet NCD criteria following the announcement of the DOJ investigation at hospitals that reached settlements (settlement hospitals) and those that did not (nonsettlement hospitals).
AHRQ-funded; HS023000.
Citation: Desai NR, Bourdillon PM, Parzynski CS .
Association of the US Department of Justice Investigation of Implantable Cardioverter-Defibrillators and
JAMA 2018 Jul 3;320(1):63-71. doi: 10.1001/jama.2018.8151..
Keywords: Cardiovascular Conditions, Medical Devices, Medical Devices, Medicare, Policy
Henderson ML, DiBrito SR, Thomas AG
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
This registry-based cohort study examined the patient characteristics and outcomes associated with living multiorgan donation in the United States. The authors assert that careful documentation of outcomes is needed to ensure ethical practices in selection, informed consent, and postdonation care of this unique donor community.
AHRQ-funded; HS024600.
Citation: Henderson ML, DiBrito SR, Thomas AG .
Landscape of living multiorgan donation in the United States: a registry-based cohort study.
Transplantation 2018 Jul;102(7):1148-55. doi: 10.1097/tp.0000000000002082..
Keywords: Health Services Research (HSR), Patient-Centered Outcomes Research, Policy, Registries, Transplantation
Decker SL
AHRQ Author: Decker SL
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
The Affordable Care Act required states in 2013 and 2014 to raise Medicaid payment rates to primary care physicians for certain services to the level of Medicare rates. The result was an average 73 percent increase in primary care Medicaid payments for qualifying physicians. This study used nationally representative data to examine the association between this Medicaid "fee bump" and physician-reported measures of participation in Medicaid. No such association was found. The lack of a sizable change in measures of physician participation in Medicaid may have been due to the temporary nature of the fee bump.
AHRQ-authored.
Citation: Decker SL .
No association found between the Medicaid primary care fee bump and physician-reported participation in Medicaid.
Health Aff 2018 Jul;37(7):1092-98. doi: 10.1377/hlthaff.2018.0078..
Keywords: Healthcare Costs, Payment, Medicaid, Policy, Primary Care
Pickens G, Karaca Z, Cutler E
AHRQ Author: Karaca Z, Wong HS
Changes in hospital inpatient utilization following health care reform.
The purpose of this retrospective study was to estimate the effects of 2014 Medicaid expansions on inpatient outcomes using population and unemployment data from HCUP’s State Inpatient Databases. Outcomes included total admissions, referral-sensitive surgical and preventable admissions, length of stay, cost, and severity of patient illness. The authors conclude that Medicaid expansions did not change all-payer admission volumes, but expansions were associated with increased Medicaid and decreased uninsured volumes. The results of the study suggest that previously uninsured persons with a greater need for inpatient services were the most likely to gain coverage.
AHRQ-authored; AHRQ-funded.
Citation: Pickens G, Karaca Z, Cutler E .
Changes in hospital inpatient utilization following health care reform.
Health Serv Res 2018 Jun 30;53(4):2446-69. doi: 10.1111/1475-6773.12734..
Keywords: Healthcare Cost and Utilization Project (HCUP), Hospitalization, Inpatient Care, Medicaid, Policy
Kung SA, Darney BG, Saavedra-Avendano B
Access to abortion under the health exception: a comparative analysis in three countries.
Access to abortion under the health exception varies widely. This study examines factors that result in heterogeneous application of health exception laws and consequences for access to legal abortion. The study concluded that the health exception is a valuable tool for expanding access to legal abortion. Differences in the use of the health exception as an indication for legal abortion resulted in wide access for women in Britain to nearly no access in Mexican states. The findings highlight the difference between theoretical and real access to legal abortion.
AHRQ-funded; HS022981.
Citation: Kung SA, Darney BG, Saavedra-Avendano B .
Access to abortion under the health exception: a comparative analysis in three countries.
Reprod Health 2018 Jun 13;15(1):107. doi: 10.1186/s12978-018-0548-x..
Keywords: Access to Care, Policy, Women
Navathe AS, Bain AM, Werner RM
Do changes in post-acute care use at hospitals participating in an accountable care organization spillover to all Medicare beneficiaries?
The objective of this study was to evaluate whether changes in post-acute care (PAC) use and Medicare spending spill over to all beneficiaries admitted to hospitals participating in the Medicare Shared Savings Program (MSSP). The investigators found that hospital participation in an accountable care organization (ACO) did not result in spillovers in PAC utilization or payments to all beneficiaries, even when considering high PAC-use conditions and ACO hospitals that also have an ACO-participating PAC.
AHRQ-funded; HS024266.
Citation: Navathe AS, Bain AM, Werner RM .
Do changes in post-acute care use at hospitals participating in an accountable care organization spillover to all Medicare beneficiaries?
J Gen Intern Med 2018 Jun;33(6):831-38. doi: 10.1007/s11606-018-4368-z..
Keywords: Hospitals, Medicare, Policy
Vistnes JP, Cohen JW
AHRQ Author: Vistnes JP, Cohen JW
Duration of uninsured spells for nonelderly adults declined after 2014.
Using MEPS data, the authors found that nonelderly respondents in 2014-15, following implementation of ACA coverage provisions, experienced shorter periods of being uninsured than did respondents in 2012-13 and 2013-14, especially for people with preexisting health conditions.
AHRQ-authored.
Citation: Vistnes JP, Cohen JW .
Duration of uninsured spells for nonelderly adults declined after 2014.
Health Aff 2018 Jun;37(6):951-55. doi: 10.1377/hlthaff.2017.1638.
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Keywords: Health Insurance, Policy, Medical Expenditure Panel Survey (MEPS), Uninsured
Ahluwalia SC, Harris BJ, Lewis VA
End-of-life care planning in accountable care organizations: associations with organizational characteristics and capabilities.
The authors measured the extent to which accountable care organizations (ACOs) have adopted end-of-life (EOL) care planning processes and characterize those ACOs that have established processes related to EOL. Using National Survey of ACOs data, they found that 21 percent of ACOs had few or no EOL care planning processes, 60 percent had some processes, and 19.6 percent had advanced processes.
AHRQ-funded; HS024075.
Citation: Ahluwalia SC, Harris BJ, Lewis VA .
End-of-life care planning in accountable care organizations: associations with organizational characteristics and capabilities.
Health Serv Res 2018 Jun;53(3):1662-81. doi: 10.1111/1475-6773.12720.
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Keywords: Palliative Care, Policy
Wisk LE, Finkelstein JA, Toomey SL
Impact of an individual mandate and other health reforms on dependent coverage for adolescents and young adults
The purpose of this study is to determine the effect of state-level dependent coverage expansion (DCE), with and without other state health reforms, on exit from dependent coverage for adolescents and young adults (AYA). The study found that an individual mandate and other reforms may enhance the effect of DCE in preventing loss of coverage among AYA.
AHRQ-funded; HS000063; HS025299.
Citation: Wisk LE, Finkelstein JA, Toomey SL .
Impact of an individual mandate and other health reforms on dependent coverage for adolescents and young adults
Health Serv Res 2018 Jun;53(3):1581-99. doi: 10.1111/1475-6773.12723..
Keywords: Children/Adolescents, Health Insurance, Policy, Policy, Young Adults
Klara K, Kim J, Ross JS
Direct-to-consumer broadcast advertisements for pharmaceuticals: off-label promotion and adherence to FDA guidelines.
Direct-to-consumer (DTC) advertisements for prescription drugs in the United States are regulated by the Food and Drug Administration (FDA). Off-label promotion, or the advertisement of a drug for an indication not approved by the FDA, is prohibited. The objective of this study was to examine the presence of off-label promotion in broadcast DTC ads and to assess their adherence to FDA guidelines mandating fair balance in presentation of risks and benefits and prohibiting misleading advertisement claims.
AHRQ-funded; HS022882.
Citation: Klara K, Kim J, Ross JS .
Direct-to-consumer broadcast advertisements for pharmaceuticals: off-label promotion and adherence to FDA guidelines.
J Gen Intern Med 2018 May;33(5):651-58. doi: 10.1007/s11606-017-4274-9..
Keywords: Medication, Guidelines, Policy, Communication
Ashlagi I, Bingaman A, Burq M
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Many U.S. kidney paired donation (KPD) registries have gradually shifted to high-frequency match-runs, raising the question of whether this harms the number of transplants. The authors conducted simulations and found that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting these patients. Further, increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.
AHRQ-funded; HS020610.
Citation: Ashlagi I, Bingaman A, Burq M .
Effect of match-run frequencies on the number of transplants and waiting times in kidney exchange.
Am J Transplant 2018 May;18(5):1177-86. doi: 10.1111/ajt.14566..
Keywords: Transplantation, Kidney Disease and Health, Health Services Research (HSR), Policy, Registries
Raji MA, Kuo YF, Adhikari D
Decline in opioid prescribing after federal rescheduling of hydrocodone products.
This study examined differences in opioid prescribing by patient characteristics and variation in hydrocodone combination product (HCP) prescribing attributed to states, before and after the 2014 Drug Enforcement Administration's reclassification of HCP from schedule III to the more restrictive schedule II. It found that HCP prescribing decreased by 26 percent from June 2013 to June 2015; the rate of prescriptions for any opioid decreased by 11 percent.
AHRQ-funded; HS022134.
Citation: Raji MA, Kuo YF, Adhikari D .
Decline in opioid prescribing after federal rescheduling of hydrocodone products.
Pharmacoepidemiol Drug Saf 2018 May;27(5):513-19. doi: 10.1002/pds.4376.
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Keywords: Policy, Opioids, Practice Patterns, Policy
Roberts MC, Dotson WD, DeVore CS
AHRQ Author: Ganiats TG
Delivery of cascade screening for hereditary conditions: a scoping review of the literature.
The authors conducted a scoping review to obtain a broad overview of cascade screening interventions, facilitators and barriers to their use, relevant policy considerations, and future research needs. They sought standardized best practices for optimizing cascade screening across various geographic and policy contexts, but found none. Studies in which trained providers contacted relatives directly, rather than through probands (index patients), showed greater cascade screening uptake; however, policies in some states might limit this approach.
AHRQ-authored.
Citation: Roberts MC, Dotson WD, DeVore CS .
Delivery of cascade screening for hereditary conditions: a scoping review of the literature.
Health Aff 2018 May;37(5):801-08. doi: 10.1377/hlthaff.2017.1630.
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Keywords: Family Health and History, Genetics, Policy, Screening
Heisel E, Kolenic GE, Moniz MM
Intrauterine device insertion before and after mandated health care coverage: the importance of baseline costs.
This study evaluated changes in out-of-pocket cost for intrauterine device (IUD) placement before and after mandated coverage of contraceptive services and examined how changes in out-of-pocket cost influenced IUD insertion as a function of baseline cost. It concluded that women in plans with the greatest reduction in out-of-pocket cost after mandated coverage of contraception had the greatest gains in IUD insertion.
AHRQ-funded; HS023784.
Citation: Heisel E, Kolenic GE, Moniz MM .
Intrauterine device insertion before and after mandated health care coverage: the importance of baseline costs.
Obstet Gynecol 2018 May;131(5):843-49. doi: 10.1097/aog.0000000000002567.
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Keywords: Sexual Health, Women, Policy, Healthcare Costs
Halle AD, Mroz TM, Fogelberg DJ
Occupational therapy and primary care: updates and trends.
This paper identifies new initiatives and opportunities in primary care, explores common challenges to integrating occupational therapy in primary care environments, and highlights international works that can support the authors’ efforts.
AHRQ-funded; HS022907.
Citation: Halle AD, Mroz TM, Fogelberg DJ .
Occupational therapy and primary care: updates and trends.
Am J Occup Ther 2018 May/Jun;72(3):7203090010p1-10p6. doi: 10.5014/ajot.2018.723001..
Keywords: Healthcare Delivery, Primary Care, Policy, Patient-Centered Healthcare
Kuo YF, Raji MA, Liaw V
Opioid prescriptions in older Medicare beneficiaries after the 2014 federal rescheduling of hydrocodone products.
The authors sought to examine how an October 2014 Drug Enforcement Administration policy reclassified hydrocodone product from schedule III to II has affected older adults. They found that the 2014 change in hydrocodone from schedule III to schedule II was associated with modest decreases in rates of opioid use in the elderly. They also found an unexpected increase in opioid-related hospitalizations without documented opioid prescriptions, which may represent an increase in illegal use.
AHRQ-funded; HS022134.
Citation: Kuo YF, Raji MA, Liaw V .
Opioid prescriptions in older Medicare beneficiaries after the 2014 federal rescheduling of hydrocodone products.
J Am Geriatr Soc 2018 May;66(5):945-53. doi: 10.1111/jgs.15332.
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Keywords: Elderly, Medicare, Opioids, Policy, Practice Patterns
Springer R, Marino M, O'Malley JP
Oregon Medicaid Expenditures after the 2014 Affordable Care Act Medicaid expansion: over-time differences among new, returning, and continuously insured enrollees.
This study assessed health care expenditures among Medicaid enrollees in the 24 months after Oregon's 2014 Medicaid expansions and examine whether expenditure patterns were different among the newly, returning, and continuously insured (CI). After initial increases, newly and returning insured (RI) outpatient expenditures dropped below CI. Expenditures for emergency department and dental services among the RI remained higher than among the newly insured.
AHRQ-funded; HS024270.
Citation: Springer R, Marino M, O'Malley JP .
Oregon Medicaid Expenditures after the 2014 Affordable Care Act Medicaid expansion: over-time differences among new, returning, and continuously insured enrollees.
Med Care 2018 May;56(5):394-402. doi: 10.1097/mlr.0000000000000907.
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Keywords: Healthcare Costs, Policy, Health Services Research (HSR), Medicaid
Briggs ADM, Alderwick H, Fisher ES
Overcoming challenges to US payment reform: could a place-based approach help?
Place-based approaches are defined as giving health care organizations or systems some degree of responsibility for the health or care of all individuals living in a specific place, a geographically defined area such as a county, hospital referral region, or state. As the United States moves away from mandatory participation in payment reform, the current place-based reforms in England offer some useful insights for US policy makers.
AHRQ-funded; HS024075.
Citation: Briggs ADM, Alderwick H, Fisher ES .
Overcoming challenges to US payment reform: could a place-based approach help?
JAMA 2018 Apr 17;319(15):1545-46. doi: 10.1001/jama.2018.1542.
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Keywords: Payment, Policy, Quality Indicators (QIs)
Mullen 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