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 75 of 167 Research Studies DisplayedLyles CR, Gupta R, Tieu L
After-visit summaries in primary care: mixed methods results from a literature review and stakeholder interviews.
This literature review examined the perception of the value of after visit summaries (AVS) in primary care practices to both patients and providers. Seventeen studies were identified, and overall patients reported a higher perceived value of AVS than providers. Even so, key informants found that AVS included incorrect information and that they weren’t being used to their potential to help educate patients.
AHRQ-funded; HS022408.
Citation: Lyles CR, Gupta R, Tieu L .
After-visit summaries in primary care: mixed methods results from a literature review and stakeholder interviews.
Fam Pract 2019 Mar 20;36(2):206-13. doi: 10.1093/fampra/cmy045..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care
Blecker S, Herrin J, Li L
Trends in hospital readmission of Medicare-covered patients with heart failure.
This study sought to compare trends in Medicare risk-adjusted, 30-day readmissions following principal heart failure (HF) hospitalizations and other hospitalizations with HF. The investigators found that patients with HF are often hospitalized for other causes, and these hospitalizations have high readmission rates. Policy changes led to decreases in readmission rates for both principal and secondary HF hospitalizations. Readmission rates in both groups remained high, suggesting that initiatives targeting all hospitalized patients with HF continue to be warranted.
AHRQ-funded; HS022882; HS023683.
Citation: Blecker S, Herrin J, Li L .
Trends in hospital readmission of Medicare-covered patients with heart failure.
J Am Coll Cardiol 2019 Mar 12;73(9):1004-12. doi: 10.1016/j.jacc.2018.12.040..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Hospital Readmissions, Hospitalization, Medicare, Policy
Huckfeldt P, Escarce J, Sood N
Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
The goal of this cohort study was to determine whether short-term mortality rates increased among black and white adults 65 years and older after initiation of the Medicare Hospital Readmissions Reduction Program (HRRP) and whether trends differed by race. Using an interrupted time-series analysis, the researchers found that short-term post-discharge mortality did not appear to increase for black patients under the HRRP, suggesting that certain value-based payment policies can be implemented without harming black populations. However, mortality seemed to increase for white patients with heart failure; this situation warrants investigation.
AHRQ-funded; HS025394.
Citation: Huckfeldt P, Escarce J, Sood N .
Thirty-day postdischarge mortality among black and white patients 65 years and older in the Medicare Hospital Readmissions Reduction Program.
JAMA Netw Open 2019 Mar;2(3):e190634. doi: 10.1001/jamanetworkopen.2019.0634..
Keywords: Medicare, Elderly, Mortality, Heart Disease and Health, Cardiovascular Conditions, Hospital Discharge
Cliff BQ, Hirth RA, Mark Fendrick A
Spillover effects from a consumer-based intervention to increase high-value preventive care.
Increasing the use of high-value medical services and reducing the use of services with little or no clinical value are key goals for efficient health systems. Yet encouraging the use of high-value services may unintentionally affect the use of low-value services. In this study, the investigators examined the likelihood of high- and low-value service use in the first two years after an insurance benefit change in 2011 for one state's employees that promoted use of high-value preventive services.
AHRQ-funded; HS025614.
Citation: Cliff BQ, Hirth RA, Mark Fendrick A .
Spillover effects from a consumer-based intervention to increase high-value preventive care.
Health Aff 2019 Mar;38(3):448-55. doi: 10.1377/hlthaff.2018.05015..
Keywords: Health Insurance, Prevention
Hsu HE, Wang R, Jentzsch MS
Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting.
This letter discussed a study which was done on value-based incentive programs to reduce the number of catheter-associated urinary tract infections (CAUTI) in intensive care units (ICUs). The study used data from 592 hospitals in the District of Columbia and 49 states. Researchers found these incentive programs did not significantly reduce CAUTI.
AHRQ-funded; HS000063; HS025008; HS018414.
Citation: Hsu HE, Wang R, Jentzsch MS .
Association between value-based incentive programs and catheter-associated urinary tract infection rates in the critical care setting.
JAMA 2019 Feb 5;321(5):509-11. doi: 10.1001/jama.2018.18997.
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Keywords: Adverse Events, Catheter-Associated Urinary Tract Infection (CAUTI), Critical Care, Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety, Urinary Tract Infection (UTI)
Shaker MS, Greenhawt MJ
Analysis of value-based costs of undesignated school stock epinephrine policies for peanut anaphylaxis.
Children experiencing anaphylaxis at school may lack access to a personal epinephrine device, prompting recent legislation permitting undesignated (eg, non-student specific) stock epinephrine autoinjector units at school. However, epinephrine device costs vary, and the cost-effectiveness of undesignated school stock epinephrine is uncharacterized to date. The objective of this study was to define value-based strategies for undesignated school stock epinephrine programs.
AHRQ-funded; HS024599.
Citation: Shaker MS, Greenhawt MJ .
Analysis of value-based costs of undesignated school stock epinephrine policies for peanut anaphylaxis.
JAMA Pediatr 2019 Feb;173(2):169-75. doi: 10.1001/jamapediatrics.2018.4275..
Keywords: Healthcare Costs, Education, Policy, Medication
Damberg CL, Silverman M, Burgette L
Are value-based incentives driving behavior change to improve value?
The purpose of this study, which used semi-structured interviews and surveys, was to understand physician organization (PO) responses to financial incentives for quality and total cost of care among POs that were exposed to a statewide multipayer value-based payment (VBP) program, and to identify challenges that POs face in advancing the goals of VBP.
AHRQ-funded; HS024067.
Citation: Damberg CL, Silverman M, Burgette L .
Are value-based incentives driving behavior change to improve value?
Am J Manag Care 2019 Feb;25(2):e26-e32..
Keywords: Healthcare Costs, Payment
Chan CW, Green LV, Lekwijit S
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
In this study, the authors focused on estimating costs and benefits in a complex healthcare setting where the major differentiation among server types is the intensity of the service provided. They used data from ten hospitals and found that a step-down unit may be a cost-effective way to treat patients when used for those who are post-intensive care unit. However, they also found that the impact of step-down-unit care is more nuanced for patients admitted from the emergency department and may result in increased mortality risk and hospital length of stay for patients who should be treated in the intensive care unit. The authors recommended more study in this area.
AHRQ-funded; HS018480.
Citation: Chan CW, Green LV, Lekwijit S .
Assessing the impact of service level when customer needs are uncertain: an empirical investigation of hospital step-down units.
Management Science 2019 Feb;65(2):751-75. doi: 10.1287/mnsc.2017.2974..
Keywords: Care Management, Healthcare Costs, Healthcare Delivery, Hospitals, Inpatient Care
Sheridan SL, Donahue KE, Brenner AT
Beginning with high value care in mind: a scoping review and toolkit to support the content, delivery, measurement, and sustainment of high value care.
The purpose of this review was to create a shared vision for the content, delivery, measurement, and sustainment of patient-centered, high-value care by creating a toolkit for system leaders. The toolkit was developed by translating included evidence into simple, actionable briefs on key topics and added resources. Although potential users have reported that the toolkit is likely to be globally useful, the authors note that it needs comparison to other approaches.
AHRQ-funded; 233201500024I.
Citation: Sheridan SL, Donahue KE, Brenner AT .
Beginning with high value care in mind: a scoping review and toolkit to support the content, delivery, measurement, and sustainment of high value care.
Patient Educ Couns 2019 Feb;102(2):238-52. doi: 10.1016/j.pec.2018.05.014..
Keywords: Healthcare Delivery, Patient-Centered Healthcare, Tools & Toolkits
Brown TT, Atal JP
How robust are reference pricing studies on outpatient medical procedures? Three different preprocessing techniques applied to difference-in differences.
This study assessed the robustness of using preprocessing techniques for difference-in differences in reference pricing studies for outpatient medical procedures. Three different approaches were tested: propensity score reweighting, exact matching, and genetic matching. The three approaches did not yield statistically different results from those previously published.
AHRQ-funded; HS022098.
Citation: Brown TT, Atal JP .
How robust are reference pricing studies on outpatient medical procedures? Three different preprocessing techniques applied to difference-in differences.
Health Econ 2019 Feb;28(2):280-98. doi: 10.1002/hec.3841..
Keywords: Ambulatory Care and Surgery, Healthcare Costs
Adamson B, El-Sadr W, Dimitrov D
The cost-effectiveness of financial incentives for viral suppression: HPTN 065 study.
This study estimated the cost-effectiveness of financial incentives to encourage HIV patients to take their antiretroviral medications. Researchers found incentives increased quality of life and lowered discounted lifetime costs by $4210 per patient.
AHRQ-funded; HS013853.
Citation: Adamson B, El-Sadr W, Dimitrov D .
The cost-effectiveness of financial incentives for viral suppression: HPTN 065 study.
Value Health 2019 Feb;22(2):194-202. doi: 10.1016/j.jval.2018.09.001..
Keywords: Healthcare Costs, Human Immunodeficiency Virus (HIV)
Padula WV, Pronovost PJ, Makic MBF
Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis.
The objective of this study was to analyze the cost-utility of repeated risk-assessments for pressure-injury prevention in all hospital patients or in high-risk groups. Hospitalized adults were classified by Braden Scale scores into five risk levels: very high risk, high risk, moderate risk, at-risk, and minimal risk. The costs of pressure-injury treatment and prevention, and quality-adjusted life years (QALYs) related to pressure injuries were weighted by transition probabilities to calculate the incremental cost-effectiveness ratio. The results of the study indicate that simulating prevention for all patients yielded greater QALYs at higher cost from societal and healthcare sector perspectives. Prevention for all patients was cost-effective in more than 99% of probabilistic simulations. The authors conclude that hospitals should invest in nursing compliance with international prevention guidelines.
AHRQ-funded; HS023710.
Citation: Padula WV, Pronovost PJ, Makic MBF .
Value of hospital resources for effective pressure injury prevention: a cost-effectiveness analysis.
BMJ Qual Saf 2019 Feb;28(2):132-41. doi: 10.1136/bmjqs-2017-007505..
Keywords: Healthcare Costs, Hospitals, Pressure Ulcers, Prevention
Bartsch SM, Avelis CM, Asti L
The economic value of identifying and treating Chagas disease patients earlier and the impact on Trypanosoma cruzi transmission.
Researchers evaluated the economic value of identifying and treatment Chagas disease patients as early as possible. Chagas disease is a parasitic disease which effects many people around the world. Investigators went to a village in Yucatan, Mexico with a population of 2,000 and evaluated impact and economic outcomes of identifying and treating patients in acute and indeterminate states of the disease. They estimated the number of acute cases averted, the number of chronic cases, disability-adjusted life years (DALYs), and savings from the cost of treating more advanced stages of the disease.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Avelis CM, Asti L .
The economic value of identifying and treating Chagas disease patients earlier and the impact on Trypanosoma cruzi transmission.
PLoS Negl Trop Dis 2018 Nov 5;12(11):e0006809. doi: 10.1371/journal.pntd.0006809..
Keywords: Healthcare Costs, Infectious Diseases, Prevention
Tabano DC, Anderson ML, Ritzwoller DP
Estimating the impact of diabetes mellitus on worker productivity using self-report, electronic health record and human resource data.
In this study, the investigators assessed the relationship between diabetes mellitus (DM) and measures of worker productivity, direct health care costs, and costs associated with lost productivity (LP) among health care industry workers across two integrated health care systems. They concluded that the impact of DM was reflected in higher rates of LP and higher indirect costs for employers related to LP and higher health care resource use.
AHRQ-funded; HS018913.
Citation: Tabano DC, Anderson ML, Ritzwoller DP .
Estimating the impact of diabetes mellitus on worker productivity using self-report, electronic health record and human resource data.
J Occup Environ Med 2018 Nov;60(11):e569-e74. doi: 10.1097/jom.0000000000001441..
Keywords: Diabetes, Healthcare Costs, Workforce
Shaker M, Verma K, Greenhawt M
The health and economic outcomes of early egg introduction strategies.
This study compared the costs and benefits of early egg introduction (EEI) using simulation and Markov modeling over a 20-year horizon with data from the United States, Europe, and Canada. Per child it was more expensive to provide early screening for all children with early-onset eczema than to have a “wait and see” approach. While there would be more egg allergy diagnosis with early screening, the increased costs were too great compared to the no-screening approach.
Citation: Shaker M, Verma K, Greenhawt M .
The health and economic outcomes of early egg introduction strategies.
Allergy 2018 Nov;73(11):2214-23. doi: 10.1111/all.13565..
Keywords: Children/Adolescents, Screening, Healthcare Costs, Diagnostic Safety and Quality, Medication
Shaker M, Greenhawt M
The health and economic outcomes of peanut allergy management practices.
Peanut allergy is managed with strict avoidance, epinephrine carriage, and promptly treating reactions. The objective of this study was to assess the health and economic benefits of pre-emptively injecting epinephrine for peanut ingestion in the absence of any symptoms, and to avoid products with peanut precautionary allergen labeling (PAL). The investigators concluded that pre-emptive epinephrine injection in the absence of symptoms, or universal avoidance of PAL, were not cost-effective when compared with administering epinephrine on symptom development or allowing PAL consumption.
AHRQ-funded; HS024599.
Citation: Shaker M, Greenhawt M .
The health and economic outcomes of peanut allergy management practices.
J Allergy Clin Immunol Pract 2018 Nov - Dec;6(6):2073-80. doi: 10.1016/j.jaip.2018.04.036..
Keywords: Healthcare Costs, Prevention
Bradley CJ, Neumark D, Walker LS
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
Investigators recruited low-income uninsured adults in Virginia to determine whether cash incentives would encourage primary care provider (PCP) visits as opposed to going to the hospital emergency room. This randomized, controlled trial determined that PCP visits did increase but no reductions in overall costs occurred there was an offset from increased outpatient utilization.
AHRQ-funded; HS022534.
Citation: Bradley CJ, Neumark D, Walker LS .
The effect of primary care visits on other health care utilization: a randomized controlled trial of cash incentives offered to low income, uninsured adults in Virginia.
J Health Econ 2018 Nov;62:121-33. doi: 10.1016/j.jhealeco.2018.07.006..
Keywords: Healthcare Utilization, Health Insurance, Low-Income, Primary Care, Uninsured, Vulnerable Populations
Lifland B, Wright DR, Mangione-Smith R
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
The purpose of this study was to examine the association between level of adherence to an adolescent depressive disorders inpatient clinical pathway with psychiatric patients’ length of stay (LOS), cost, and readmissions. Patients in the high-adherence category were found to have significantly longer LOS and higher costs when compared to those in the low-adherence category. The authors conclude that understanding which of the care processes within the pathway are most cost-effective for improving patient-centered outcomes requires further investigation.
AHRQ-funded; HS024299.
Citation: Lifland B, Wright DR, Mangione-Smith R .
The impact of an adolescent depressive disorders clinical pathway on healthcare utilization.
Adm Policy Ment Health 2018 Nov;45(6):979-87. doi: 10.1007/s10488-018-0878-6..
Keywords: Care Management, Children/Adolescents, Depression, Healthcare Costs, Healthcare Utilization, Hospital Readmissions, Hospitalization, Inpatient Care, Behavioral Health, Outcomes, Patient-Centered Outcomes Research
Desai NR, Ott LS, George EJ
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
The objectives of this study were to investigate the association between hospital-level 30-day risk-standardized mortality rates (RSMRs) and 30-day risk-standardized payments (RSPs) for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PNA); to characterize patterns of value in care; and to identify hospital characteristics associated with high-value care (defined by having lower than median RSMRs and RSPs).
AHRQ-funded; HS023000.
Citation: Desai NR, Ott LS, George EJ .
Variation in and hospital characteristics associated with the value of care for Medicare beneficiaries with acute myocardial infarction, heart failure, and pneumonia.
JAMA Netw Open 2018 Oct 5;1(6):e183519. doi: 10.1001/jamanetworkopen.2018.3519..
Keywords: Cardiovascular Conditions, Elderly, Hospitalization, Hospitals, Heart Disease and Health, Inpatient Care, Medicare, Mortality, Pneumonia
Ciotoli C, Smith AJ, Keeling RP
Call to action: better care, better health, and greater value in college health.
This report aims to inspire, motivate, and challenge college health professionals and their colleagues, campus leaders, and national entities to take both immediate and sustainable steps to bring quality improvement (QI) to the forefront of college health practice - and, by doing so, to elevate care, health, and value of college health as a key pathway to advancing student success.
AHRQ-funded; HS022520.
Citation: Ciotoli C, Smith AJ, Keeling RP .
Call to action: better care, better health, and greater value in college health.
J Am Coll Health 2018 Oct;66(7):625-39. doi: 10.1080/07448481.2018.1431908..
Keywords: Education, Quality of Care, Quality Improvement
Shen NT, Schneider Y, Congly SE
Cost effectiveness of early insertion of transjugular intrahepatic portosystemic shunts for recurrent ascites.
Treatment options for recurrent ascites resulting from decompensated cirrhosis include serial large-volume paracentesis and albumin infusion (LVP+A) or insertion of a transjugular intrahepatic portosystemic shunt (TIPS). In this study, the investigators examined whether TIPS insertion was cost effective. The investigators concluded that based on Markov model analysis, early placement of TIPSs appeared to be a cost-effective strategy for management of specific patients with cirrhosis and recurrent ascites.
AHRQ-funded; HS000066.
Citation: Shen NT, Schneider Y, Congly SE .
Cost effectiveness of early insertion of transjugular intrahepatic portosystemic shunts for recurrent ascites.
Clin Gastroenterol Hepatol 2018 Sep;16(9):1503-10.e3. doi: 10.1016/j.cgh.2018.03.027..
Keywords: Healthcare Costs, Surgery, Patient-Centered Outcomes Research, Treatments
Whaley CM, Brown TT
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
This study examined how health care providers respond to a reference pricing insurance program that increases consumer cost sharing when they chose high-priced surgical providers. Geographic variation was used to estimate supply-side responses. Limited evidence of market segmentation and price reductions for providers with baseline prices above the reference price was found. However, 75% of the reduction in provider prices benefited a population that was not subject to the program.
AHRQ-funded; HS022098.
Citation: Whaley CM, Brown TT .
Firm responses to targeted consumer incentives: evidence from reference pricing for surgical services.
J Health Econ 2018 Sep;61:111-33. doi: 10.1016/j.jhealeco.2018.06.012..
Keywords: Health Insurance, Surgery, Payment, Healthcare Costs
Calderwood MS, Kawai AT, Jin R
Centers for Medicare and Medicaid services hospital-acquired conditions policy for central line-associated bloodstream infection (CLABSI) and cather-associated urinary tract infection (CAUTI) shows minimal impact on hospital reimbursement.
In 2008, the Centers for Medicare and Medicaid Services (CMS) stopped reimbursing for hospital-acquired conditions (HACs) not present on admission (POA). This study sought to understand why this policy did not impact central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) trends.
AHRQ-funded; HS018414.
Citation: Calderwood MS, Kawai AT, Jin R .
Centers for Medicare and Medicaid services hospital-acquired conditions policy for central line-associated bloodstream infection (CLABSI) and cather-associated urinary tract infection (CAUTI) shows minimal impact on hospital reimbursement.
Infect Control Hosp Epidemiol 2018 Aug;39(8):897-901. doi: 10.1017/ice.2018.137..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Patient Safety
Markovitz AA, Ramsay PP, Shortell SM
Financial incentives and physician practice participation in Medicare's value-based reforms.
The purpose of this study was to evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. The authors concluded that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale.
AHRQ-funded; HS018546.
Citation: Markovitz AA, Ramsay PP, Shortell SM .
Financial incentives and physician practice participation in Medicare's value-based reforms.
Health Serv Res 2018 Aug;53 Suppl 1:3052-69. doi: 10.1111/1475-6773.12743..
Keywords: Payment, Medicare, Provider Performance
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