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 9 of 9 Research Studies DisplayedAbdus S, Selden TM
AHRQ Author: Abdus S, Selden TM
Well-child visit adherence.
This article presents updated evidence on well-child visit adherence, using MEPS data to conduct a cross-sectional study. The results indicate that average adherence increased between 2006-07 and 2016-17, but the authors note that large gaps remain in such areas as race and ethnicity, poverty level, insurance coverage, and geographic region.
AHRQ-authored.
Citation: Abdus S, Selden TM .
Well-child visit adherence.
JAMA Pediatr 2022 Nov;176(11):1143-45. doi: 10.1001/jamapediatrics.2022.2954..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Healthcare Utilization, Access to Care
Fleming MD, Evans JL, Graham-Squire D
Association of shelter-in-place hotels with health services use among people experiencing homelessness during the COVID-19 pandemic.
During the COVID-19 pandemic, some jurisdictions utilized shelter-in-place (SIP) hotels to provide emergency shelter and support services to people experiencing homelessness (PEH) to reduce the risk of COVID-19 infection. The purpose of this study was to evaluate the association of SIP hotel placements with prior high acute health service use and compare health services use between PEH with prior high service use who did and did not receive a SIP hotel placement. The researchers assessed 25 SIP hotels in San Francisco, California from April 2020 to April 2021 and analyzed data from February 2021 to May 2022. Study participants included PEH who were among the top 10% high users of acute medical, mental health, and substance use services and who had 3 or more emergency department (ED) visits in the 9 months before the implementation of the SIP hotel program. The study reported that the mean number of ED visits decreased significantly in the high-user SIP group compared with high-user controls. The mean number of hospitalizations decreased significantly from 0.41 to 0.14 for SIP guests vs 0.27 to 0.22 for controls. Inpatient hospital days decreased significantly from a mean of 4.00 to 0.81 for SIP guests vs 2.27 to 1.85 for controls as did psychiatric emergency visits, from a mean of 0.03 to 0.01 visits for SIP guests vs no change in the control group. The researchers concluded that placement of PEH in SIP hotels was correlated with significantly reduced acute care use when compared with high acute care users with no SIP placement.
AHRQ-funded; HS027648.
Citation: Fleming MD, Evans JL, Graham-Squire D .
Association of shelter-in-place hotels with health services use among people experiencing homelessness during the COVID-19 pandemic.
JAMA Netw Open 2022 Jul;5(7):e2223891. doi: 10.1001/jamanetworkopen.2022.23891..
Keywords: COVID-19, Access to Care, Healthcare Utilization, Public Health
Levine DM, Chalasani R, Linder JA
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
The national impact of the Patient Protection and Affordable Care Act (ACA) continues to be debated. The purpose of this cross-sectional study was to determine the relationship between the ACA and ambulatory quality, patient experience, utilization, and cost by comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation. The study focused on United States adults between 18 and 64 years of age with income less than and greater than or equal to 400% of the federal poverty level (FPL), who had responded to the annual Medical Expenditure Panel Survey. Researchers conducted analysis of data from a sample of 123,171 individuals between January 2021 and March 2022. The study found that after the implementation of ACA, adults with income levels less than 400% of the FPL received increased high value care such as diagnostic and preventive testing when compared with adults with income 400% or higher of the FPL, and there were no differences in the other quality measures. Individuals with income less than 400% of the FPL had greater improvements in access, experience, and communication measures compared with those who had income greater than or equal to 400% of the FPL. Receipt of primary care services increased for individuals with lower income compared to individuals with higher income and for those with lower income compared to those with higher income, total out-of-pocket expenditures decreased. There were no other differences in utilization or cost between those groups. The researchers concluded that in this study, the ACA was not associated with changes in utilization, quality, or cost, but was related to decreased out-of-pocket expenditures and improved patient access, communication, and experience.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Levine DM, Chalasani R, Linder JA .
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
JAMA Netw Open 2022 Jun 1;5(6):e2218167. doi: 10.1001/jamanetworkopen.2022.18167..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Healthcare Utilization, Ambulatory Care and Surgery, Health Insurance, Access to Care
Allen L, Cummings JR, Hockenberry JM
The impact of urgent care centers on nonemergent emergency department visits.
This study looked at the impact of urgent care centers on nonemergency emergency department (ED) use. Secondary data from a novel urgent care center database, linked to the HCUP State Emergency Department Databases (SEDD) from six states was used. Data from ZIP codes with no urgent care centers served as a control group compared to areas with local urgent care centers. Having an open urgent care center in a ZIP code reduced the total number of ED visits by residents by 17.2% largely due to visits for less urgent conditions. The effect was concentrated in areas with hospitals with the longest ED wait times. The total number of uninsured visits to the ED were reduced by 21% and for Medicaid visits by 29.1%.
AHRQ-funded; HS2484501.
Citation: Allen L, Cummings JR, Hockenberry JM .
The impact of urgent care centers on nonemergent emergency department visits.
Health Serv Res 2021 Aug;56(4):721-30. doi: 10.1111/1475-6773.13631..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Access to Care
Smith JM, Jarrín OF, Lin H
Racial disparities in post-acute home health care referral and utilization among older adults with diabetes.
The purpose of this study was to examine the association between race/ethnicity and hospital discharge to home health care and subsequent utilization of home health care among a cohort of adults (age 50 and older) who experienced a diabetes-related hospitalization. The investigators found that among those discharged to home health care, all non-white racial/ethnic minority patients were less likely to receive services within 14-days.
AHRQ-funded; HS022406.
Citation: Smith JM, Jarrín OF, Lin H .
Racial disparities in post-acute home health care referral and utilization among older adults with diabetes.
Int J Environ Res Public Health 2021 Mar 19;18(6):3196. doi: 10.3390/ijerph18063196..
Keywords: Elderly, Home Healthcare, Diabetes, Chronic Conditions, Racial and Ethnic Minorities, Disparities, Access to Care, Healthcare Utilization
Dy CJ, Salter A, Barker A
Increased utilization of total joint arthroplasty after Medicaid expansion.
This study examined prior analyses that greater utilization of total hip arthroplasty (THA) and total knee arthroplasty (TKA) was to be expected after Medicaid expansion in 2014. Using 2012-2015 data from the HCUP Database, 9 expansion states (Arkansas, Arizona, Colorado, Iowa, Massachusetts, Maryland, Nevada, New York, and Vermont) were compared to 2 states that did not expand Medicaid (Florida and Missouri). After adjusting for community characteristics, THA and TKA increased 15% in 2014 and 23% in 2015 within expansion states compared to 2013. In non-expansion states, compared to 2013, there were significant decreases of 18% in 2014 and 11% in 2015.
AHRQ-funded; HS019455.
Citation: Dy CJ, Salter A, Barker A .
Increased utilization of total joint arthroplasty after Medicaid expansion.
J Bone Joint Surg Am 2021 Mar 17;103(6):524-31. doi: 10.2106/jbjs.20.00303..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Orthopedics, Surgery, Healthcare Utilization, Access to Care
Dean JM, Hreha K, Hong I
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
This study examined post-stroke acute care patterns across Hospital Service Areas among a national stroke cohort of Medicare beneficiaries to determine drivers of variation in post-acute care service utilization. Data was extracted from 2013 to 2014 (174,498 total records across 3232 Hospital Service Areas). Patients’ residence ZIP codes were linked to the facility ZIP code where care was received. Patients were considered a “traveler” if they did not live in the Hospital Service Area where they received care. Only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas although 73.4% of all Hospital Service Areas were skilled nursing-only. Thirty-five percent of all patients traveled to a different Hospital Service Area from their residence. Patients living in skilled nursing-only Hospital Service Areas had more than 5 times the odds of traveling compared to those living in Hospital Service Areas with skilled nursing, inpatient rehabilitation, and long-term care hospital services.
AHRQ-funded; HS026133; HS024711.
Citation: Dean JM, Hreha K, Hong I .
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
BMC Health Serv Res 2021 Feb 25;21(1):176. doi: 10.1186/s12913-021-06159-z..
Keywords: Elderly, Hospitals, Access to Care, Stroke, Cardiovascular Conditions, Healthcare Utilization, Rehabilitation, Nursing Homes
Anderson KE, McGinty EE, Presskreischer R
Reports of forgone medical care among US adults during the initial phase of the COVID-19 pandemic.
This survey measured the frequency of foregone medical care due to COVID-19 from March to mid-July 2020. Johns Hopkins created the COVID-19 Civic Life and Public Health Survey wave 1, with 1468 individuals completing the survey. The sample of respondents were 52% women, 63% non-Hispanic White, 12% Black, and 17% Hispanic. The mean age of respondents was 48 years. A total of 41% of respondents forwent medical care during the March to mid-July time period. Among the 1055 individuals who reported needing care, 52% reported forgoing care for any reason, 29% forwent care owing to fear of COVID-19 transmission, and 7% forwent care owing to financial concerns associated with the pandemic. Respondents lacking any health insurance were more likely to forgo care than respondents with Medicare or commercial insurance.
AHRQ-funded; HS000029.
Citation: Anderson KE, McGinty EE, Presskreischer R .
Reports of forgone medical care among US adults during the initial phase of the COVID-19 pandemic.
JAMA Netw Open 2021 Jan 4;4(1):e2034882. doi: 10.1001/jamanetworkopen.2020.34882..
Keywords: COVID-19, Access to Care, Healthcare Utilization, Public Health, Infectious Diseases
Hatch B, Hoopes M, Darney BG
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Researchers assessed whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. Data was collected from electronic health records in 14 states. The researchers found that among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and non-expansion states, although the overall rates remained low. They recommended continued support to overcome barriers to preventive care in this population.
AHRQ-funded; HS025155.
Citation: Hatch B, Hoopes M, Darney BG .
Impacts of the Affordable Care Act on receipt of women's preventive services in Community Health Centers in Medicaid expansion and nonexpansion states.
Womens Health Issues 2021 Jan-Feb;31(1):9-16. doi: 10.1016/j.whi.2020.08.011..
Keywords: Cancer, Medicaid, Health Insurance, Uninsured, Access to Care, Policy, Cancer: Cervical Cancer, Prevention, Women, Healthcare Utilization